In 2020, more Albertans died of overdose than of COVID-19. Yet while immense and increasing resources are (quite rightly) poured into the COVID-19 response, resources to stem the tide of our worsening overdose epidemic continue to be cut in this province. There is something fundamentally wrong with this picture.
There is a large body of evidence showing that harm-reduction strategies such as clean-needle distribution, community access to naloxone, and supervised consumption sites (SCS) save lives, prevent disease, connect people to care, and help with social stability. They can also reduce the high costs of health care for infectious and other complications of drug use.
For the past 20 years prior to the pandemic, Alberta has been a leader in adopting harm-reduction strategies to improve health-care outcomes such as HIV. Yet in 2019, the province launched a methodologically flawed and widely discredited inquiry into the local impact of SCS, bizarrely limiting the terms of reference to perceived negative effects and excluding consideration of benefits of the service.
The resulting report was weaponized to shut down North America’s busiest SCS in Lethbridge, replacing it with a program of dramatically reduced capacity. Now this month in Edmonton, the number of SCS booths serving central Edmonton has been reduced from 15 to nine, after the closure of one of three facilities whose location had been chosen after careful research and consultation to align with existing client needs. The province has also quietly reduced community capacity to distribute harm-reduction supplies, and has placed a moratorium on expanding access to injectable opioid agonist therapy (a safer alternative to the current toxic drug supply).
Now is a time to be investing more, not less in the overdose epidemic response. A spectrum of responses is needed to mitigate a broad range of health and social harms which have been dramatically exacerbated by the pandemic. Along with addressing the many upstream influences on substance use — poverty, homelessness, mental illness, colonialism, et cetera — practical, evidence-informed measures to reduce the risk of overdose and transmission of infection are required. Opioid agonist therapy and other treatment options for substance use are part of the response, but you can’t benefit from treatment if you are dead. And in fact, you are unlikely to benefit from treatment if you have no direct contact with helping services such as a trusted relationship with community harm-reduction providers.
As the province pursues its agenda of defunding harm reduction, we expect to see a delay in overdose response times, as well as an increase in reused supplies and unsafe drug-use environments. This means even more premature and preventable loss of life; overdose is already the leading cause of death for younger Albertans by a large margin. It also means more brain injury for overdose survivors, and more infections such as HIV, hepatitis C, and bacterial infections of the heart and other vital organs.
For the fiscally minded, the implications of insufficient community capacity for harm reduction include hundreds of dollars for every added emergency visit, several thousand dollars for every inpatient admission, approximately $50,000 for every acute bacterial infection, and roughly $380,000 for every lifelong course of treatment for HIV. These amount to costs that far exceed the cost of operating community-based harm-reduction services. The cost of unnecessary human suffering, of course, is immeasurable, yet disproportionately shouldered by affected communities.
We can invest in harm reduction now, or pay more later. COVID-19 is no excuse for defunding harm reduction; if anything, consistent harm-reduction funding will prevent additional health system strain. As Alberta struggles to deal with the impact of the COVID-19 pandemic, we ignore the human lives hurt by the overdose epidemic at our peril.
Co-author Dr. Ginetta Salvalaggio is a family physician with addiction medicine expertise and associate professor in the University of Alberta’s Faculty of Medicine and Dentistry.