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Christina Chant of Vancouver Coastal Health during a recent naloxone training session in Vancouver.

Christina Chant of Vancouver Coastal Health during a recent naloxone training session in Vancouver.

John Lehmann/The Globe and Mail

Alberta's fentanyl crisis has unfolded as its top medical officials have been replaced – more than once. Justin Giovannetti reports

A flood of grim reports detailing a surge in fentanyl deaths had been pouring into the office of Alberta's chief medical officer for months before Jim Talbot finally got good news. In May, 2015, he learned in a phone call that one of the antidote kits his office bought to fight illicit fentanyl had saved a life for the first time.

It was one of the proudest moments of his career. Days later, he was told he was out of the job.

Sarah Hoffman was sworn in as the province's Health Minister on May 25, 2015, nearly three weeks after Rachel Notley's New Democrats swept to power and ended more than four decades of Conservative rule in Alberta.

A Western crisis

The number of people who have died after ingesting the deadly opioid fentanyl has been on a steep climb in British Columbia and Alberta since 2012. B.C.’s death toll could reach 800 this year, prompting an unprecedented public health emergency declaration. In Alberta, where deaths far outstripped those of its neighbour last year, the office charged with leading a response has had a rotation of leaders.

Read Justine Hunter's report on the situation in B.C..

Within her first week in office, Ms. Hoffman signed a letter telling Dr. Talbot his contract would not be renewed. He got the letter on May 31, six days after she was sworn in. His last day was June 30.

Michael Trew, the province's chief mental health officer, got a similar letter the next week.

"My belief is … well … while the government is ultimately responsible for signing off on those types of decisions, I think that they both had more to do with internal things at the Department of Health, rather than the politicians involved," Dr. Trew told The Globe and Mail.

A Globe investigation found that Health Canada and Alberta's health department ignored red flags as fentanyl use began to soar, and did not take adequate steps to stop doctors from indiscriminately prescribing highly addictive opioids to treat chronic pain.

While fentanyl deaths have increased in other provinces, the drug's impact has been most pronounced in Alberta. The number of Albertans dying from a fentanyl overdose soared to 272 last year from 66 in 2013. As the crisis unfolded, Alberta's incoming Health Minister and senior officials in her department chose to end the contracts of the province's two most senior public health doctors. They did so without plans for an immediate replacement for Dr. Talbot. Dr. Trew's position was eliminated.

Ms. Hoffman said in a statement provided by her office that she would not discuss Dr. Talbot or Dr. Trew, citing privacy rules. Ms. Hoffman also would not confirm whether she understood at the time that she was removing Alberta's two leading public health doctors during a health crisis.

The first month of the NDP government was chaotic. After a crushing defeat, the province's Progressive Conservatives packed up their offices and left, handing off to a new government without any veterans. Fentanyl deaths were quickly increasing – 390 between January, 2014, and December, 2015, would die from illicit forms of the drug. Before being sworn in as Health Minister, Ms. Hoffman was chair of the Edmonton School Board.

"I have no illusions that there is much more work to be done as long as families and communities struggle with the far-reaching consequences of addiction," Ms. Hoffman said in the statement.

Alberta's top doctor since 2012, Dr. Talbot had not had an easy time in office. He had to deal with avian flu, the largest meat recall in Canadian history at XL Foods, and then the 2013 floods across southern Alberta. The challenges of his three-year term were described by a senior health official as "ceaseless disaster" in the province.

While Dr. Trew was hired to help Alberta cope with the fallout of the record floods, he soon turned his attention to the fentanyl crisis. He told The Globe he was looking forward to working with the New Democrats – the previous government had not always supported harm-reduction strategies.

"I thought there was much I could do working within government," he said.

Dr. Trew and Dr. Talbot worked together to start the program that has now distributed 9,000 doses of the antidote naloxone. Today, Ms. Hoffman and the Health Department trumpet the program as a success in the fight against fentanyl, but Dr. Talbot told The Globe it faced opposition from some health administrators in the previous government.

He says when he asked for funding, he was turned down and told the $300,000 cost was too high. As a result, he found the funds in his office's budget. Alberta's annual health budget at the time was nearly $20-billion.

It was soon after the naloxone program was rolled out that he was notified that his contract would not be renewed.

"I was given no reason, and I asked for reasons. I had a significant amount of work in progress that has suffered, and I regret that. It was important work. I don't know why it happened," Dr. Talbot said.

One of Alberta's deputy chief medical officers filled in for Dr. Talbot until November, when she stepped down. She is no longer listed as working for the government. Ms. Hoffman's office would not explain why.

Karen Grimsrud took over as Alberta's chief medical officer on April 18, nearly 10 months after Dr. Talbot's term ended. The job description for Alberta's chief medical officer has changed since Dr. Talbot's days. While Dr. Talbot says he advised and reported to the health minister, the position now reports to the top administrator in the Department of Health.

Dr. Grimsrud said that so far, she has advised Ms. Hoffman about her concerns over the province's growing rates of sexually transmitted infection.

"I'm getting up to speed on a lot of files. It's a busy office. STIs, fentanyl, mental health are at the top," she said. "When I feel there is a public health issue that [the Health Minister] needs to be made aware of, then I can speak with her directly about that and provide my advice."