The Alberta government's primary response to a surge in deaths from the drug fentanyl last year has been to make free antidote kits available across the province, however doctors warn that many aboriginal communities are still struggling to access the potentially life-saving kits.
With 272 overdose deaths from fentanyl in Alberta last year, double the previous year's total, the size of the province's program for the distribution of an antidote known as naloxone has expanded rapidly over the past three months. Alberta Health has more than doubled its purchase of the kits to 7,000 and has made them freely available in pharmacies since Feb. 17.
While the antidote is now available in more than 300 pharmacies and walk-in clinics across Alberta, only four kits are located on reserves, according to data from the provincial government. Health Canada, which helps provide care on reserves, confirmed with The Globe and Mail that no nurses employed by the federal government are currently certified to prescribe or administer naloxone.
"Health Canada nursing services have been focused on education and awareness and harm-reduction activities as needed. There are no Health Canada nurses currently certified but the department is working closely with communities to assess needs," wrote Sylwia Krzyszton, a spokeswoman for Health Canada.
By comparison, 1,600 emergency medical technicians working for the province of Alberta were trained to administer naloxone by early January.
The Blood Tribe declared a state of emergency in March, 2015, as deaths from fentanyl soared in the community. Health Canada responded by sending naloxone kits to the First Nation and provided $200,000 in emergency funding.
"They were really slow initially to help," Dr. Esther Tailfeathers, a physician based out of the Blood Tribe, said of Health Canada's response to the emerging fentanyl crisis in 2015. "And we haven't had much since they first responded. It's mostly been Alberta Health with the naloxone kits."
According to Dr. Tailfeathers, while Health Canada could do more in her community, the sense of urgency with which the federal government first responded to the Blood Tribe should be replicated across the province. Health Canada, which serves 75,000 on-reserve First Nations members in Alberta, is currently working with 17 of the province's 45 First Nations to develop a plan to combat fentanyl.
"It might be time-consuming and costly, but Health Canada should take Blood Tribe as an example for what they should do," she said.
Alberta Health Minister Sarah Hoffman says she sent letters to all of Alberta's chiefs this summer, seeking their input and giving them information on how to access kits for their reserves if needed. According to her, the fentanyl crisis is still growing in her province and Health Canada has been a good partner.
"Their heart is in the right place," she said of Health Canada's approach so far. "I know that there is a history of jurisdictional challenges; I'm not interested in talking about who has what responsibilities.
"We need to help people now."
Fentanyl was developed to treat extreme pain, and is 100 times more potent than morphine in its legal form. However, a dose as small as two grains of sand can be lethal. Many of the pills seized on the streets of Alberta's largest cities over the past year were manufactured by organized crime and were found to contain far more than the lethal dose.
Fentanyl is fast-acting and can create a sense of euphoria, but can also cause users to experience breathing problems and die within 15 minutes of consuming the drug. Naloxone is an antidote that can reverse the symptoms of a fentanyl overdose within minutes, but it must be administered quickly. A naloxone kit costs $27 and contains two syringes of naloxone, alcohol swabs and latex gloves, as well as a one-way breathing mask.
While a user still needs to seek medical attention, the antidote can buy them time to reach a health centre. Naloxone is currently available only by prescription; however, Health Canada has been asked to change that designation, a rule change that could come soon.