On track for a record number of deaths from overdoses this year, Alberta is planning to test an injectable drug to treat opioid dependency – a therapy health officials say is now available to Canadians only in British Columbia.
The drug hydromorphone would be given to people who have not responded well to Suboxone or methadone, drugs that are given orally. The government did not say when the pilot project will start, but it will involve 50 people each in Edmonton and Calgary at Alberta Health Services' Opioid Dependency Program clinics. The criteria for eligibility are still being determined.
Illicit fentanyl and chemically similar drugs have caused fatal overdoses to skyrocket in recent years, particularly in Western provinces such as British Columbia and Alberta. Officials in Alberta said the province had 315 fentanyl-related overdose deaths between January and August of 2017. That compares with 368 deaths for all of 2016.
The hydromorphone pilot and other new programs were recommended by the province's Opioid Emergency Response Commission, which was asked in May to guide government programs and determine how to spend $30-million in new public funding this year for dealing with the overdose crisis.
In a brief statement, Alberta associate health minister Brandy Payne said the government has accepted the commission's work in full. Her department says all of the recommendations will be implemented by the end of March.
"We have accepted all 12 recommendations and will be supporting efforts to implement them as quickly as possible in the months ahead," Ms. Payne said in an e-mailed statement.
Commission members told reporters on Wednesday that Alberta will boost supports to Indigenous communities, which a government report to be released soon says are being disproportionately affected by the opioid crisis.
The members are also calling for the expansion of a program that distributes naloxone, a drug that can reverse the effects of an opioid overdose. They said about 31,000 free naloxone kits had been distributed as of Sept. 30 to people in Alberta, including those who work at bars or nightclubs and might witness an overdose. The province is also set to open this month the first of what will be six supervised consumption sites for drug users this year and early in 2018.
"This work has been sobering, because far too many Albertans are continuing to die from overdoes, every day," said Elaine Hyshka, co-chair of the emergency-response commission.
Hydromorphone is a semi-synthetic opioid commonly used in palliative and acute care. A Vancouver-based study that concluded last year found that heroin users could not differentiate between it and pharmaceutical-grade heroin, meaning it could become an effective treatment.
Heroin-assisted treatment – giving heroin users a legal supply of the drug to inject in a medical setting – has been proven to be a safe and effective option for those who do not respond to traditional therapies such as methadone and Suboxone. However, pharmaceutical-grade heroin is manufactured only in Europe, and regulatory hurdles make it difficult to import. Hydromorphone is readily available in Canada.
B.C.'s fledgling Ministry of Mental Health and Addictions last month approved guidelines for treating opioid addiction with injectable drugs, and is encouraging the province's health authorities to scale up the service. Currently, fewer than 100 people are receiving hydromorphone for opioid addictions in B.C.
In Alberta, the Opioid Emergency Response Commission was originally asked to recommend ways to expand public coverage of opioid-replacement therapy drugs, including Suboxone and methadone. Currently, those drugs are covered only for people who are on income support or have benefit plans at work.
However, the commission recommended that Alberta not fund universal coverage – saying the money could be better used on other fronts in the opioid crisis.
Hakique Virani, a public-health and addiction medicine specialist at the University of Alberta, said with limited resources, the commission has zeroed in on priorities "that actually would improve morbidity and mortality better than if they were to just offer universal coverage."
Dr. Virani said the commission has made bold recommendations based on solid evidence. But the government needs to act quickly.
"At the least in Canada we are losing one person every eight hours, and Alberta is one of the hotspots in the country," he said.
"The illicit market is more dangerous than it was even weeks ago."
With a report from Andrea Woo in Vancouver