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 Adam Zivo

“As soon as [my son] was put on safe supply, he started diverting his safe supply” Mom tells Parliament safer supply isn’t working

“The whole purpose of the safer supply program was to divert addicts from using harmful street drugs, but that’s not happening,” testified Masha Krupp, an Ottawa-based mother, at the House of Commons Health Committee last week. Exhausted and blunt, she described how her son has, in the past, diverted his “safer supply” drugs to the black market and how she has personally witnessed widespread diversion, by other patients, outside the clinic her son attends.

Safer supply programs distribute free addictive drugs – typically hydromorphone, a heroin-strength opioid – under the belief that this stabilizes addicts and dissuades them from consuming riskier street substances. Addiction experts and police leaders across Canada, however, say that recipients regularly divert these taxpayer-funded drugs to the black market, fueling new addictions and gang profits.

The Liberals and NDP have denied that widespread safer supply diversion is occurring, despite ample evidence to the contrary – but Krupp’s lived experiences underline the folly of their willful blindness.

“As soon as he was put on safe supply, he started diverting his safe supply,” she testified. “You’ve got drug dealers – I know this for a fact through my son; I’ve seen it – they will come to your home, 24/7, you can call two in the morning. They take your hydromorphone pills.”

According to Krupp, her son’s addiction issues have not improved despite him being enrolled in a safer supply program for more than two years. He still uses fentanyl and crack cocaine, which led to yet another overdose just last month, she said, adding that diversion and a lack of recovery-oriented services contribute to his instability.

“The Dilaudid (brand name hydromorphone) is a means of currency for my son to continue using crack cocaine – so it’s not safe, because he’s still using unsafe street drugs,” she said in parliament.

Krupp further explained that, on multiple occasions, she witnessed and photographed patients selling their safer supply in front of the clinic where her son has been a patient since June 2021. The transactions were not subtle: she could see them counting and exchanging white pills.

Over time, Krupp corroborated these observations by acquainting herself with some of these patients, who would admit to selling their safer supply: “I get to know all these people that are diverting and using right in front of the clinic, in front of all the tourists, parents walking by with kids.”

She believes that safer supply could have a role in addiction care if it were better regulated, but feels that the current model, where supervised consumption of these drugs is rarely required, is only “flooding the market, using taxpayers’ dollars, with lethal opiates…”

“It’s unsafe supply, in my view, as a mother with lived experience,” said Krupp. “Our Liberal government, right now, is acting like a drug lord.”

Her testimony was consistent with what was described in a CBC investigative report published last February, wherein Ottawa’s police officers confirmed that safer supply diversion is rampant.

One constable quoted in the story, Paul Stam, said that virtually anytime police would pull up to Rideau and Nelson street, where the clinic Krupp’s son attends is located, “they would observe people openly trafficking in diverted hydromorphone.” The officer further told the CBC that the “street is flooded with this pharmaceutical grade hydromorphone” and that there has been a dramatic, province-wide reduction in the drug’s blackmarket price – from $8-9 per 8-mg pill to just $1-2 today.

Although Krupp gave her parliamentary testimony last week, I interviewed her in July and kept her story private at her request – at the time, she worried that going public could interfere with her son’s attempts at recovery.

In the July interview, Krupp explained that, not only had her son told her that safer supply diversion is ubiquitous, she had also heard this from two acquaintances of his, who were also on the program: “The information that I’ve received is that the drug dealers have operations set up 24/7 across the city, buying legal dillies (the slang term for hydromorphone).”

She explained that she had been able to witness and document safer supply diversion because, on most Friday mornings, she would take her son to his clinic appointments and wait for him outside in her car. As she was often parked just two or three metres away from where many drug deals occurred, she had a line of sight into what was going on: clearly-identifiable dillies being handed over for other drugs.

She estimated that, by that point, she had cumulatively witnessed at least 25 safer supply patients engage in diversion.

“[Safer supply patients] would trade their dillies for fentanyl and/or crack cocaine and smoke or inject it right in front of me. They would just huddle in a corner. It’s all done very openly,” she said. “What I witness, to me, is a human tragedy on the sidewalks of the nation’s capital, with Parliament Hill eight or nine blocks away, and all the politicians sitting there singing praises to safer supply.”

She pushed back on the narrative, popular among Liberal and NDP politicians, that criticism of safer supply is conservative fear mongering and said that she had voted NDP in the past, and had even voted for Trudeau in 2015. Her disgust with safer supply was simply her “speaking from the heart as a mother.”

While harm reduction activists claim that safer supply is a form of compassionate care, Krupp vehemently disagreed: “How is it compassionate to fuel somebody’s addiction? How is it humane to keep a perpetual cycle of drug abuse and dependence?”