Skip to main content
The Globe and Mail
Support Quality Journalism.
The Globe and Mail
First Access to Latest
Investment News
Collection of curated
e-books and guides
Inform your decisions via
Globe Investor Tools
per week
for first 24 weeks

Enjoy unlimited digital access
Cancel Anytime
Enjoy Unlimited Digital Access
Get full access to
Just $1.99per week for the first 24weeks
Just $1.99per week for the first 24weeks
var select={root:".js-sub-pencil",control:".js-sub-pencil-control",open:"o-sub-pencil--open",closed:"o-sub-pencil--closed"},dom={},allowExpand=!0;function pencilInit(o){var e=arguments.length>1&&void 0!==arguments[1]&&arguments[1];select.root=o,dom.root=document.querySelector(select.root),dom.root&&(dom.control=document.querySelector(select.control),dom.control.addEventListener("click",onToggleClicked),setPanelState(e),window.addEventListener("scroll",onWindowScroll),dom.root.removeAttribute("hidden"))}function isPanelOpen(){return dom.root.classList.contains(}function setPanelState(o){dom.root.classList[o?"add":"remove"](,dom.root.classList[o?"remove":"add"](select.closed),dom.control.setAttribute("aria-expanded",o)}function onToggleClicked(){var l=!isPanelOpen();setPanelState(l)}function onWindowScroll(){window.requestAnimationFrame(function() {var l=isPanelOpen(),n=0===(document.body.scrollTop||document.documentElement.scrollTop);n||l||!allowExpand?n&&l&&(allowExpand=!0,setPanelState(!1)):(allowExpand=!1,setPanelState(!0))});}pencilInit(".js-sub-pencil",!1); // via darwin-bg var slideIndex = 0; carousel(); function carousel() { var i; var x = document.getElementsByClassName("subs_valueprop"); for (i = 0; i < x.length; i++) { x[i].style.display = "none"; } slideIndex++; if (slideIndex> x.length) { slideIndex = 1; } x[slideIndex - 1].style.display = "block"; setTimeout(carousel, 2500); } //

Dr. Hakique Virani calls for evidence-based treatment as the best chance to combat the fentanyl crisis in Alberta.

for The Globe and Mail

Dr. Hakique Virani has been on the front lines of Alberta's battle with fentanyl. In the first half of this year, 145 Albertans died of fentanyl overdoses and Dr. Virani's clinic in downtown Edmonton sees dozens of fentanyl cases weekly. A physician who also teaches at the University of Alberta, the 38-year-old specializes in addiction medicine. He spoke with The Globe's Justin Giovannetti about Alberta's leading public-health crisis.

What does the fentanyl crisis currently look like?

To use one word: bad. This is the worst problematic opiate use we have ever seen in Alberta. We are essentially seeing a death a day. The deaths are occurring in every socioeconomic demographic and every age group, you name it, people are using fentanyl and are at risk of overdose death. It's urgent and the No. 1 public-health problem in Alberta.

Story continues below advertisement

On the front line, we see people who were formerly well-functioning and had jobs, such as professional athletes and bankers, as patients. For whatever reason, they were exposed to opiates, either after a prescription from a doctor for an injury or through from recreational use, and that use has escalated very quickly into dysfunctional use that is associated with social dysfunction: job loss, apprehension of children, criminal activity. The changes in the human brain that occur with chronic opiate exposure are such that there is a complete loss of control. I don't think it's banal to say that it really could happen to anybody.

Is there a possibility that this fentanyl crisis flames out over time?

If there was, I wouldn't be so shocked to see the magnitude of the problem now. It's predictable that fentanyl and heroin would arrive in Alberta because we've done a very poor job of addressing this problem with evidence-based intervention. I don't think it's natural that this has flared up or will flame out. It's a function of our failure to address an issue that was simmering, bubbling and is now boiling over.

What do you make of the Notley government's response so far?

I'm not going to say that it's unfortunate that we have a new government, but what is unfortunate is that there is a delay in acting when you take over a file. You try to learn things, you have to trust your bureaucracy to inform you about the situation, but we're at a [crisis] point now. We first saw this, ground zero, with the Blood Tribe, where this problem turned from insidious to overflowing. That was in January, we're almost at the end of the calendar year now and we don't have a great handle on the distribution of the antidote naloxone yet, we certainly don't have access to treatment figured out and we don't have supervised injection sites in Alberta, which might have tempered this problem.

I would characterize the government's response as inadequate but I'm cautiously optimistic that their ideology is consistent with the evidence.

There is an argument for abstinence-based treatment in Alberta. How would you improve the treatment system as it currently exists?

Story continues below advertisement

Treatment must be evidence-based. Period. We must do more of what works. In a system where resources are always necessarily scarce and we are dealing with other medical needs, including needs in mental health and addiction, we should stop doing what doesn't work and we should really stop doing what kills people. The evidence is very clear that an abstinence-only admission to care is the No. 1 factor associated with death. At the level of the President of the United States there has been recognition that offering abstinence-only treatment is not okay.

This is not someone's failure to exercise conscious volition over drug use, but this comes after fundamental changes in their neurobiology. Their only fault is that they had a human brain. This isn't something that they want to do. They have no control over the drug use and if they are exposed [to the drug] one time after an abstinence-based treatment they can die. It's a science versus ideology debate, not a science versus science debate.

The antidote naloxone only works when a user has someone with them when they use fentanyl. You've raised a need for supervised injection sites. Do you think those sites are possible in Alberta?

I think after the federal election on Oct. 19 more things are possible in every province. There has certainly been a more open dialogue around the idea of supervised injection sites. The evidence around Vancouver's Insite is not mixed; it's clear. It works at reducing the dysfunction associated with injection drug use and it works with preventing death from drug toxicity.

This interview has been edited and condensed.

Your Globe

Build your personal news feed

  1. Follow topics and authors relevant to your reading interests.
  2. Check your Following feed daily, and never miss an article. Access your Following feed from your account menu at the top right corner of every page.

Follow the author of this article:

View more suggestions in Following Read more about following topics and authors
Report an error Editorial code of conduct
Due to technical reasons, we have temporarily removed commenting from our articles. We hope to have this fixed soon. Thank you for your patience. If you are looking to give feedback on our new site, please send it along to If you want to write a letter to the editor, please forward to

Welcome to The Globe and Mail’s comment community. This is a space where subscribers can engage with each other and Globe staff. Non-subscribers can read and sort comments but will not be able to engage with them in any way. Click here to subscribe.

If you would like to write a letter to the editor, please forward it to Readers can also interact with The Globe on Facebook and Twitter .

Welcome to The Globe and Mail’s comment community. This is a space where subscribers can engage with each other and Globe staff. Non-subscribers can read and sort comments but will not be able to engage with them in any way. Click here to subscribe.

If you would like to write a letter to the editor, please forward it to Readers can also interact with The Globe on Facebook and Twitter .

Welcome to The Globe and Mail’s comment community. This is a space where subscribers can engage with each other and Globe staff.

We aim to create a safe and valuable space for discussion and debate. That means:

  • Treat others as you wish to be treated
  • Criticize ideas, not people
  • Stay on topic
  • Avoid the use of toxic and offensive language
  • Flag bad behaviour

If you do not see your comment posted immediately, it is being reviewed by the moderation team and may appear shortly, generally within an hour.

We aim to have all comments reviewed in a timely manner.

Comments that violate our community guidelines will not be posted.

UPDATED: Read our community guidelines here

Discussion loading ...

To view this site properly, enable cookies in your browser. Read our privacy policy to learn more.
How to enable cookies