Alberta’s Minister of Mental Health and Addiction, Dan Williams, at the Alberta Legislature in Edmonton on Sept. 11 2024. [Photo credit: Alexandra Keeler]

By Alexandra Keeler

Alberta’s Minister of Mental Health and Addiction explains the shift from overdose prevention to recovery amid community concerns

On Sept. 23, Alberta announced the city of Red Deer would be closing the community’s only overdose prevention site by spring 2025. The closure will mark the first time an Alberta community completely eliminates its supervised consumption services.

The decision to close the site was taken by the city — not the province. But it aligns with Alberta’s decision to prioritize recovery-focused approaches to addiction and mental health over harm-reduction strategies.

“The whole idea of the Alberta Recovery Model is that unless you create off-ramps [from] addiction, you’re barreling ahead towards a brick wall, and that’s going to be devastating,” Alberta Minister of Mental Health and Addiction Dan Williams told Canadian Affairs in an interview in September.

However, the closure — which parallels similar moves by other provinces — has sparked debate over whether recovery-oriented models adequately meet the needs of at-risk populations.

The Alberta Recovery Model

The Alberta Recovery Model, which was first introduced by Alberta’s UCP government in November 2023, emphasizes prevention, early intervention, treatment and recovery.

It is informed by recommendations from Alberta’s Mental Health and Addiction Advisory Council and research from the Stanford Lancet Commission on the North American Opioid Crisis.

“Alberta, in our continuum of care, has everything from low entry, low barriers, and zero cost [for] detox, to treatment, to virtual opioid dependency, to outreach teams working with shelters,” said Williams.

Williams said that Alberta intends to continue funding safe consumption sites as short-term harm-reduction measures. But it views them as temporary components in the continuum of care.

This is not without controversy.

At the Feb. 15 Red Deer council meeting where councillors voted 5-2 to close the city’s safe consumption site, some councillors noted that safe consumption sites play an essential role in the continuum of care.

“Each individual is at a different stage of addiction … the overdose prevention site does play a role in the treatment spectrum,” said Coun. Dianne Wyntjes, who voted against the closure.

While Red Deer is home to Alberta’s first provincially funded addiction treatment facility, Wyntjes noted there had been reports within the community of the facility lacking capacity to meet demand.

She pointed to Lethbridge’s experience in 2020, where overdose deaths spiked after its consumption site was replaced with mobile services.

The Ontario government’s recent decision to close 10 safe consumption sites located near schools and daycares has prompted similar concerns.

In August, Ontario Health Minister Sylvia Jones told reporters that the province plans to “very quickly” replace the closed sites with Homelessness and Addiction Recovery Treatment (HART) hubs that prioritize community safety, treatment and recovery. But critics — including site workers, NDP MPPs and harm-reduction advocates — have warned these shutdowns will lead to an increase in fatal overdoses.

It is possible that Alberta, Ontario and other jurisdictions will make other moves in tandem in the coming months and years.

In April, Alberta announced it was partnering with Ontario and Saskatchewan to build recovery-focused care systems. The partnerships include sharing of best practices and advocating for recovery-focused policies and investments at the federal level.

‘Mandatory treatment’

Another controversial component of Alberta — and other provinces’ —  recovery-oriented strategy is involuntary care.

The UCP government has said it plans to introduce “compassionate intervention” legislation next year that will enable family members, doctors or police officers to seek court orders mandating treatment for individuals with substance use disorders who pose a risk to themselves or others.

“If someone is a danger to themselves or others in the most extreme circumstances because of their addiction, then we as a society have an obligation to intervene, and that might include mandatory treatment,” said Williams.

Critics have raised concerns about increasing reliance on involuntary care options.

“Over the last two decades, there has been a dramatic increase in reliance on involuntary services [such as psychiatric admissions and treatment orders], while voluntary services have not kept up with demand,” the B.C. division of the Canadian Mental Health Association said in a Sept. 18 statement published on their website.

The statement followed an announcement by B.C. Premier David Eby — who was recently reelected — to expand involuntary care in that province.

Research from Yale University’s School of Public Health indicates involuntary interventions for substance use are generally no more effective than voluntary treatment, and can in some cases cause more harm than good. The research notes that “involuntary centers often serve as venues for abuse.”

A 2023 McMaster University study that synthesized the research on involuntary treatment from international jurisdictions similarly found inconclusive outcomes. It recommended expanding voluntary care options to minimize reliance on involuntary measures.

Williams emphasized that the province’s involuntary care legislation would target “a very small group of people for whom all else has failed … those at the far end of the addiction spectrum with very serious and devastating addictions.”

‘Off-ramps from addiction’

Over the past six years, Alberta has incrementally increased its mental health and addiction budget from an initial $50 million to a cumulative total of $1.5 billion.

The funding boost has enabled Alberta to eliminate a $40 daily user fee for some detox and recovery services, add 10,000 publicly funded addiction treatment spaces, and expand access to its Virtual Opioid Dependency Program, which offers same-day access to life-saving medications.

To support addiction prevention, Williams said Alberta is expanding CASA Classrooms in schools. These offer mental health support and therapy to Grade 4-12 students who have ongoing mental health challenges, and equip school staff and caregivers to support these students.

“Mental health and addiction needs to be as connected to the emergency room as it is to the classroom,” Williams said. “We need to be able to understand low-acuity chronic mental health challenges as they begin to manifest [in the community].”

The province is also in the process of establishing 11 residential recovery communities across the province. These centres provide free, extended treatment averaging four months — which is longer than most recovery programs.

Oct. 23 marked the one-year anniversary of one such centre, the Lethbridge Recovery Community. The $19-million, 50-bed facility served more than 110 clients in its first year and expects to serve about 200 individuals in 2025.

“I’m coming to see that entering treatment is only the start,” said Sean P., a client of Lethbridge Recovery Community, in a government press release celebrating the anniversary.

“With the support of the staff and the community here, I’m beginning to face my past and make real changes. Recovery is giving me the tools I need for this journey, and I’m genuinely excited to keep growing and moving forward with their help.”

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By: Alexandra Keeler

In a new documentary, Port Coquitlam teens describe how safer supply drugs are diverted to the streets, contributing to youth drug use

Madison was just 15 when she first encountered “dillies” — hydromorphone pills meant for safer supply, but readily available on the streets.

“Multiple people walking up the street, down the street, saying ‘dillies, dillies,’ and that’s how you get them,” Madison said, referring to dealers in Vancouver’s Downtown Eastside.

Madison says she could get pills for $1.25 each, when purchased directly from someone receiving the drugs through safer supply — a provincial program that provides drug users with prescribed opioids. Madison would typically buy a whole bottle to last a week.

But as her tolerance grew, so did her addiction, leading her to try fentanyl.

“The dillies weren’t hitting me anymore … I tried [fentanyl] and instantly I just melted,” she said.

Kamilah Sword, Madison’s best friend, was just 14 when she died of an overdose on Aug. 20, 2022 after taking a hydromorphone pill dispensed through safer supply.

Madison, along with Kamilah’s father, Gregory Sword, are among the Port Coquitlam, B.C., residents featured in a documentary by journalist Adam Zivo. The film uncovers how safer supply drugs — intended as a harm reduction measure — contribute to harm among youth by being highly accessible, addictive and dangerous.

Through emotional interviews with teens and their families, the film links these drugs to overdose deaths and explores how they can act as a gateway to stronger substances like fentanyl.

Some last names are omitted to respect the victims’ desire for privacy.

‘Not a myth’

Safer supply aims to reduce overdose deaths by providing individuals with substance use disorders access to pharmaceutical-grade alternatives, such as hydromorphone.

But some policy experts, health officials and journalists are concerned these drugs are being diverted onto the streets — particularly hydromorphone, which is often sold under the brand name Dilaudid and nicknamed “dillies.”

Zivo, the film’s director, points out the disinformation surrounding safer supply diversion, highlighting that some drug legalization activists downplay the issue of diversion.

In 2023, B.C.’s then-chief coroner Lisa Lapointe dismissed claims that individuals were collecting their safer supply medications and selling them to youth, thereby creating new opioid dependencies and contributing to overdose deaths. She labeled such claims an “urban myth.”

In the film, Madison describes how teen substance users would occasionally accompany people enrolled in the safer supply program to the pharmacy, where they would fill their prescriptions and then sell the drugs to the teens.

“It’s not a myth, because my best friend died from it,” she says in the film.

Fiona Wilson, deputy chief of the Vancouver Police Department, testified on April 15 to the House of Commons health committee studying Canada’s opioid crisis that about 50 per cent of hydromorphone seizures by police are linked to safer supply.

Deputy Chief of the Vancouver Police Department, Fiona Wilson, testified on April 15 during the House of Commons ‘Opioid Epidemic and Toxic Drug Crisis in Canada’ health committee meeting.

Additionally, Ottawa Police Sergeant Paul Stam previously confirmed to Canadian Affairs that similar reports of diverted safer supply drugs have been observed in Ottawa.

“Hopefully, by giving these victims a platform and bringing their stories to life, the film can impress upon Canadians the urgent need for reform,” Zivo told Canadian Affairs.

‘Creating addicts’

The teens featured in the film share their experiences with the addictive nature of dillies.

“After doing them for like a month, it felt like I needed them everyday,” says Amelie North, one teen featured in the documentary. “I felt like I couldn’t stand being alive without being on dillies.”

Madison explains how tolerance builds quickly. “You just keep doing them until it’s not enough at all.”

Madison started using fentanyl at the age of 12, leading to a near-fatal overdose after just one hit at a SkyTrain station. “It took five Narcan kits to save my life,” she says in the film.

Many of her friends use dillies or have tried fentanyl, she says. She estimates half the students at her school do.

“Government-supplied hydromorphone is a dangerous domino in the cascade of an addict’s downward spiral to ever more risky behaviour,” said Madison’s mother, Beth, to Canadian Affairs.

“The safe drug supply is creating addicts, not helping addicts,” Denise Fenske, North’s mother, told Canadian Affairs.

“I’m not sure when politicians talk about all the beds they have opened up for youth with drug or alcohol problems, where they actually are and how do we access them?”

Sword, Kamilah’s father, expressed his concern in an email to Canadian Affairs. “I want the people [watching the film] to understand how easy this drug is to get for the kids and how many kids it is affecting, the pain it causes the loved ones, [with] no answers or help for them.”

Screenshot: Dr. Matthew Orde reviewing Kamilah Sword’s toxicology report during his interview for the filming of ‘Government Heroin 2: The Invisible Girls’ in March 2024.

Autopsy

Kamilah’s death raises further concerns.

According to Dr. Matthew Orde, a forensic pathologist featured in the film, Kamilah’s toxicology report revealed a mix of depressants and stimulants, including flualprazolam (a benzo), benzoylecgonine (a cocaine byproduct), MDMA and hydromorphone.

Orde criticizes the BC Coroners Service for not following best practices by focusing solely on cardiac arrhythmia caused by cocaine and MDMA, while overlooking the potential role of benzos and hydromorphone.

Orde notes that in complex poly-drug deaths, an autopsy is typically performed to determine the cause more accurately. He says he was shocked that Kamilah’s case did not receive this level of investigation.

B.C. has one of the lowest autopsy rates in Canada.

Zivo told Canadian Affairs he thinks a public inquiry into Kamilah’s case and other youth deaths involving hydromorphone since 2020 is needed to assess if the province is accurately reporting the harms of safer supply.

“That just angers me that our coroners did not do what most of Canada would have done,” Sword told Canadian Affairs.

“It also makes me question why they didn’t do an autopsy, what is our so-called government hiding?”

Government Heroin 2: The Invisible Girls is available for free on YouTube.

This article was produced through the Breaking Needles Fellowship Program, which provided a grant to Canadian Affairs, a digital media outlet, to fund journalism exploring addiction and crime in Canada. Articles produced through the Fellowship are co-published by Break The Needle and Canadian Affairs.