More than 40,000 people have died from opioid poisoning in Canada since 2016. That’s 22 deaths a day. The drugs are more toxic and more accessible than ever. And it’s not getting better, especially in the West. At the epicentre of the crisis are Alberta and British Columbia. Since 2020, more deaths have been attributed to overdoses than to COVID-19. While the Rocky Mountains separate the two provinces, they are also divided by an ideological divide over how to fight this epidemic.
Outside Hope Mission, an organization that helps people experiencing homelessness in Edmonton, paramedics attempt to resuscitate a man lying on the ground. “You literally just watched a man die of an overdose,” Lucy says.
The petite, dark-haired, sunken-eyed woman lives in the neighborhood known as The Hood. Here, between downtown and Chinatown, a stone’s throw from the arena where the Oilers played in the last Stanley Cup final, hundreds of homeless people like Lucy have taken up residence right on the sidewalk.
“It’s become our daily life,” she adds. “In winter, it’s worse, because people take drugs and fall asleep outside.”
Behind her, a man who has lost all his fingers to frostbite struggles to count a small wad of bank notes. A little further away, a couple passes around a glass crack pipe that they light with a butane torch.
In 2023, 1,867 people died from an opioid overdose in Alberta. A sad record for the province, which ranks second in Canada for this cause of death, behind neighbouring British Columbia.
Trade fair
Some 300 kilometres away, in downtown Calgary, the Recovery Capital Conference took place last April, an event that brought together more than 2,000 people to discuss Alberta’s conservative model for combating addictions.
At the entrance to the Telus Convention Centre, dozens of exhibitors, mainly representatives of private addiction therapy homes, offer all sorts of promotional items: pens, stickers, mandalas to colour, stress balls… The event has all the attributes of a trade show.
Alberta Premier Danielle Smith opened the show with a speech. Elected in May 2023, she considers herself a libertarian and has championed the truckers’ movement that opposed health measures during the COVID-19 pandemic. To thunderous applause, the United Conservative Party leader touted her successes in combating drug addiction.
“We just finished building 2 of 11 treatment centres that will provide free treatment to Albertans struggling with addictions. Since 2021, alcohol-related deaths are down 60 per cent. Methamphetamine-related deaths are down 41 per cent. And cocaine-related deaths are down 61 per cent.”
But at no point does the politician mention the record mortality associated with opioid overdoses in the province.
A problem of dependency
Since coming to power, Danielle Smith has championed the “Alberta recovery model.” Here, therapy centres are being used to overcome the overdose crisis. Federal Conservative leader Pierre Poilievre has indicated that he wants to emulate this approach if he is elected to lead the country. Ontario and Saskatchewan also want to embrace the model.
Alberta plans to create more than 2,000 new therapy centre spaces within three years, adding to the 10,000 that already exist in the province.
“The problem we have with this addiction crisis is not that some drugs are more toxic than others,” Alberta Minister of Mental Health and Addictions Dan Williams said in an interview with The duty. “It’s an addiction problem. And it always ends one of two ways: either with pain, misery and death, or with treatment.”
Tall and slender, in an impeccable suit and tie, with a perfectly trimmed beard, the minister attended the conference accompanied by his wife and toddler. He receives us in a glass room overlooking Stephen Avenue, the very place where the overdose crisis is raging in the Alberta metropolis.
The former construction contractor is now tasked with solving his province’s biggest public health problem. The Smith government is funding the distribution of injection equipment and naloxone, the antidote to opioid overdoses. These measures are part of harm reduction, an approach that focuses on reducing the negative consequences of drug use.
But Williams is fiercely opposed to the decriminalization of drugs as implemented in British Columbia, which he considers the “most radical policy in the world.” “Over the last 20 or 30 years, that approach has morphed into harm-producing. And that’s why Alberta needs to come up with another option, the Alberta model,” he says.
The United Conservative Party has also promised to use a specialized tribunal that could order someone with a serious addiction to undergo treatment. That controversial measure has yet to be implemented. “This disease is so severe that it impairs decision-making,” Williams said. “If someone is a danger to themselves or others, treatment could become mandatory.”
There are seven supervised consumption sites in the province. While they have been proven to save lives, Williams has no plans to open more or provide more funding. “As a minister, I have limited resources. And I don’t believe these services can help someone overcome their addiction.”
Across the street from the Telus Convention Centre, in a smokehouse downtown, an event organized by community actors in response to the Recovery Capital Conference is taking place. The atmosphere is completely different. Gay and trans pride flags fly at the entrance to the establishment. And in the basement, they sell T-shirts with graphics reminiscent of punk bands.
Elaine Hyshka, an associate professor at the University of Alberta’s School of Public Health, is speaking at the event. She believes that her province’s policies to address the overdose crisis aren’t working. “We can’t be leaders when the situation is at an all-time high,” she says. “The data shows that the majority of people who use substances are not addicted and therefore don’t need treatment. We can build all the therapy centres in the world, but if people die before they get in, it doesn’t matter.”
The researcher questions the Alberta model, which, according to her, relies on abstinence among drug users. “We have more and more evidence from American authorities that this approach can even contribute to an increase in deaths. The risk of relapse is high when people leave these programs. After a long period of abstinence, users see their tolerance to drugs decrease and are exposed to overdoses.”
An exception named Ophelia
In 2020, Justin Trudeau’s federal government launched a safer drug supply pilot project to combat the overdose crisis. Since then, doctors have been able to prescribe opioids to their patients struggling with addictions.
Once in power, however, the United Conservative Party made the measure illegal. The Alberta government’s medical director of addictions, Dr.r Nathaniel Day says this approach only increases the supply of drugs on the province’s streets. “When doctors provide opioids to their patients, it sends a message to young people that it’s safe, when in fact these are drugs that are as powerful as heroin.”
Only one woman currently has access to safe supply in Alberta, thanks to a temporary court injunction. Ophelia Black sued her government to continue receiving hydromorphone, an opioid she takes three times a day. “I have proven that I use my medication responsibly and don’t resell it on the black market,” she says.
She welcomes us into her apartment on the outskirts of downtown Calgary, where she lives with her two cats and her dog. With her blond hair neatly arranged and her voice soft and calm, she is a world away from the cliché of the homeless drug user.
“I tried suboxone and naloxone,” agonists that counter withdrawal symptoms, she said. “But it just didn’t work for me. So I ended up on the street getting fentanyl.”
So three years ago, his doctor decided to prescribe him hydromorphone. “I want to have a job. I want to have a career. I want to go to college. I want to get married. There are so many things I couldn’t do without my medication. Without the safe supply, I probably wouldn’t have celebrated my 23rd birthday.”e birthday. “
An addiction medicine physician and assistant professor at the University of Alberta and the University of Calgary, Dr.r Monty Ghosh considers Ophelia Black to be a model patient. “She’s doing incredibly well,” he admits. “I would probably prescribe hydromorphone for her, too. But in medicine, if there’s one thing that’s certain, it’s that not all patients are perfect.”
Alberta’s medical and community communities are divided on how to combat the overdose crisis. Dr.r Ghosh is calling for more unity to combat this scourge. “There is no model that is working across the country right now. In Alberta, we are seeing more deaths from opioid overdoses than from heart attacks, car crashes and homicides combined. We need to put as many resources into this as we did for COVID-19. And we’re not.”
This report was made possible thanks to the excellence grants from the Association of Independent Journalists of Quebec.