The number of Albertans dying from fentanyl overdoses fell sharply in the first nine months of 2019 from previous years, a turnaround the provincial government credits to a decreasing number of opioid prescriptions written by doctors.
Deaths from illicit opioid use began to decline or plateau across much of Western Canada and parts of the U.S. in 2019, mirroring the trend in Alberta. While the provincial government credits a decline in prescriptions, doctors have cited the spread of supervised drug-consumption sites, overdose-reversal kits and better education for a possible slowdown in the opioid crisis.
With nearly two Albertans dying daily from opioid overdoses, the rate remains much higher than it was only a few years ago.
While the data on opioid deaths can be erratic, with a decline one quarter followed by a surge the next, Alberta’s minister responsible for opioids says his office has identified a decline in the severity of the crisis. “It looks like we have a down trend in opioid deaths, and I hope to see the total lower this year compared to 2018. But these numbers are still too high,” said Jason Luan, Alberta’s associate Minister of Mental Health and Addiction.
“There are many factors that contribute to the trends in overdose deaths, starting with the supply of illicit fentanyl and the behaviour of addicts, which are outside our control,” he added.
The latest data from the Alberta Health Service show 458 deaths from opioid poisoning in the first three quarters of 2019, compared with 576 deaths during the same period in 2018. The opioid crisis began in 2015 and the most deaths from the powerful painkiller fentanyl were recorded in the third quarter of 2018. The number of Albertans who have died from non-fentanyl opioids has also declined significantly in 2019, partly because of a decrease in prescriptions for the drug.
“Prescribing is a critical factor in the opioid crisis. Overprescribing helped drive the increase in overdose deaths, and the move to more appropriate prescribing in recent years is helping to bring the trend down,” Mr. Luan said.
Alberta’s College of Physicians and Surgeons has revised its rules for prescribing opioids since 2016 and has been sending doctors quarterly updates on how their level of prescribing compared to their colleagues.
The amount of opioids prescribed by Alberta’s doctors has fallen by 27 per cent between mid-2016 and mid-2019.
“Alberta was the highest prescriber of opioids in the country, and we also knew from international data that Canada ranked very high in world,” said Dr. Karen Mazurek, the college’s deputy registrar about data from 2016. “We recognized that we had a problem.”
The college soon began monitoring the number of prescriptions handed out by doctors, as well as the strength of the opioids being sent home with patients. There was a surge in fentanyl prescriptions over the past decade to relieve pain. The drug was developed to deal with the severe pain faced by cancer patients in the last few weeks of their lives and proved addictive.
Based on the new data showing a significant decline in opioids being prescribed, she said that the college believes physicians are now being more responsible. “I think we can say quite fairly that the non-fentanyl deaths are related to doctor’s prescribing,” she said.
Hakique Virani, an Edmonton-based physician and public-health specialist at the University of Alberta, warned that the government’s assertion that fewer prescriptions could be linked to fewer deaths might be misplaced. As doctors have decreased opioid prescriptions, there’s been a rise in illicit fentanyl on the streets, he said. “We have seen in Canada that jurisdictions with large decreases in prescribing can see a corresponding increase in overdose death, speaking to the relevance of the opioid supply,” Dr. Virani said.
Fentanyl purchased on the street, rather than redirected from prescriptions, can be sourced from pill presses operated by criminal groups that supply toxic pills because of poor quality control.
Dr. Mazurek also acknowledged that fewer prescriptions could be leading to more toxic street drugs. She stressed that the Alberta government should continue to focus on harm reduction, such as supervised drug-consumption sites, as well as more treatment beds for people addicted to opioids.
Premier Jason Kenney’s government has put a freeze on the opening of new supervised drug-consumption sites since early June, halting the opening of new facilities in Red Deer, Medicine Hat and Calgary. The government commissioned a report on the sites and what type of funding and services should be offered in the future. That report is finished and is currently with the Health Ministry.
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