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Commissioned by Alberta’s health minister, a report makes more recommendations that are needed immediately, including more public awareness, more partnership with the federal government and increased training for first responders who could be faced with fentanyl users.

The Canadian Press

Alberta is facing calls to immediately remove rules that forbid many first responders from administering an antidote to a potentially deadly opiate that has created a public-health crisis in the province.

In a Nov. 23 report obtained by The Globe and Mail, the co-chairs of the province's Mental Health Review urge Rachel Notley's government to take immediate steps to respond to fentanyl abuse, which has resulted in 213 deaths in Alberta over the first nine months of this year.

The report also makes five more recommendations to Health Minister Sarah Hoffman that the co-chairs say are desperately needed, including more public awareness, more partnership with the federal government and increased training for first responders who could be faced with fentanyl users, especially in First Nations communities. While the authors say these issues must be addressed now, the government said it was not planning on making the report public until late December.

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The report coincides with the disclosure by Alberta's specialized law enforcement agency, known as ALERT, that lowered funding could see it lose a quarter of its 268 officers. ALERT seized 18,000 fentanyl pills in 2014 while investigating gangs, domestic violence and human trafficking.

Ms. Hoffman's staff said on Sunday that she was unavailable to comment on the report's findings.

Deaths from fentanyl began to increase rapidly in Alberta in the second half of 2014, leading to 120 fatalities that year. The illicit version of the drug, which is up to 100 times more potent than morphine, is manufactured by organized crime and is readily available, cheap and lethal in small doses. Many public-health experts in the province warn that deaths from the opioid could surpass fatalities from automobile accidents this year.

The NDP government's handling of this crisis has come under scrutiny. In a three-page letter, the co-chairs wrote to Ms. Hoffman that "clear leadership and partnership is needed."

The body responsible for the report, Alberta's Mental Health Review, was struck by Ms. Notley in June and is chaired by Municipal Affairs Minister Danielle Larivee and Liberal Leader David Swann. The four-member committee will file a full report on the state of Alberta's mental-health system around Christmas. On Nov. 18, Ms. Hoffman asked the co-chairs to send her their interim recommendations on fentanyl.

"This is a life or death issue," the Health Minister wrote in a letter to the committee. Calling fentanyl a "growing health crisis," Ms. Hoffman added that a response to the drug is a priority issue for Alberta Health. "Our government is committed to taking action now to prevent further tragedies."

Reached by The Globe on Sunday, Dr. Swann said the Health Minister's first step should be to declare a public-health emergency. In an emergency, the province's medical officers have the ability to mobilize more resources.

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"It's a much-heightened commitment to getting a particular issue under control," he said. "The minister has dedicated more resources, she has more meetings, more people communicating, but I would argue that we aren't at the level where we are getting this under control, it continues to increase."

The state of emergency would also make it easier for Ms. Hoffman to issue a directive allowing more first responders to deliver naloxone, an antidote to fentanyl. The government has committed to making naloxone more available and any Albertan can order and use a take-home kit from the province's health agency. However, of first responders, only paramedics are allowed to inject the antidote.

"If you saw someone on the street collapse, you could give them that shot without any repercussion. [But] unless they are paramedics and have that extra year of training, emergency medical technicians and basic life support people can't provide naloxone," said Dr. Swann.

Paramedics are largely limited to Alberta's largest cities. Few are found in the First Nations communities where fentanyl has left a deadly mark.

Along with the report from the co-chairs, Tyler White sent Ms. Hoffman a letter urging action. The head of health services for the Siksika Nation southeast of Calgary and the only member of the Mental Health Review who isn't an elected official, Mr. White said the minister's current approach to fentanyl is "concerning" and called for a dramatic increase in access to treatment.

"A failure to deal with the prescription opioid crisis of the past two decades has resulted in our present situation where, in some demographics, opioids are more pervasive than marijuana and alcohol," he wrote.

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