Health-care professionals are questioning the efficacy of private mental health and addictions care in Alberta due to the lack of public data.
In June, the Alberta government published data on how many people accessed the Opioid Dependency Program (ODP), a program managed by the Alberta Health Service that provides treatment to people suffering from opioid addictions.
Around 5,392 people accessed ODP treatments from January to March this year, according to the substance use surveillance system. This is around 28 per cent lower compared with the same period in 2023, about 24 per cent compared with the same period in 2022 and almost eight per cent lower compared with the same period in 2021.
In total, 8,690 people accessed ODP treatment in 2023 while 7,883 people accessed treatment in 2022. AHS recorded 6,131 patients in 2021, 5,070 in 2020 and 4,030 in 2019.
The government did not release data about long-term outcomes of patients who access treatment through ODPs, a key metric to measure whether or not these treatments are working.
But a study published in the National Library of Medicine suggested that 90 per cent of clients who access Alberta’s virtual ODPs remain in treatment over six months. Around 58 per cent showed retention over 12 months.
The study also suggests around 90 per cent of clients reported high levels of satisfaction and reductions in drug use, as well as improved social functioning.
“It has always been the goal to improve this system to include outcome metrics for health-care services related to substance use. We do plan on expanding the scope of data posted to ASSUS (Alberta substance use surveillance system) in the future to include these outcomes,” said Hunter Baril, press secretary for the Minister of Mental Health and Addictions.
The substance use surveillance system is missing information about how many people accessed private clinics, something the government says it will address through the Centre of Research Excellence.
In April, the United Conservative government announced it would be establishing a new Crown corporation called the Canadian Centre of Recovery Excellence (CORE) to build “recovery-oriented systems of care” by researching best practices, analyzing data and making “evidence-based recommendations.”
“Despite all provinces across Canada facing an addictions crisis, there is no clear centre of recovery excellence that can advise on what works and does not work when it comes to mental health and addictions,” said Minister of Mental Health and Addiction Dan Williams at the time.
“It is important to have jurisdictions working together, growing in the same direction when it comes to creating healthy societies.”
Dr. Monty Ghosh, an addictions specialist with Alberta Health Services, says there are significant concerns regarding private treatment due to the lack of data. He said a lot of work and oversight has been put into ODP data tracking, something that is not being done at private clinics
“The amount of rigour that’s done with ODP data tracking should be applied to these other (private and not-for-profit) facilities. There’s a lot of oversight in the (ODP) system, but why isn’t there that oversight in the others?” he told Global News.
“We need to know which programs are working and which programs are not working.”
Jennifer Jackson, a registered nurse and assistant professor at the University of Calgary’s nursing faculty, said the lack of public data on private facilities is concerning for her as a researcher.
“I want everything that I do and the care that my family receives to be based on the best available information on how to provide health care. (Public facilities) in general have tons of it. I’m not seeing that evidence applied in these (private) spaces,” she said in an interview with Global News.
“There also aren’t good studies like randomized control trials to assess whether these programs work. What specific elements of the program are effective? Without a lot of understanding of the science behind it or really thoughtful oversight, there are huge risks with these programs.”
Lack of standardization concerning
Ghosh and Jackson also raised concerns about practices in private clinics because it is unclear if they follow the “gold standards” of addiction treatment. This includes, but is not limited to, providing medications on-site, providing naloxone kits and providing effective counselling or psychosocial treatment.
“The quality of the psychosocial piece could potentially vary because it’s hard to standardize those pieces … It’s based on the skill set of the counsellor,” Ghosh said.
“But there still needs to be some gold standards that are followed, and not all of them are true to that. I know there’s a huge breadth of variety in terms of how these addiction treatment facilities are managing patients, and some of them accept medication management, some of them don’t. It varies from place to place.”
The doctor said he’s also heard stories about private clinics forcing patients to come to a specific pharmacy to get a prescribed opioid, instead of a pharmacy that is convenient for the client.
“There’s no standardization for these private clinics. The College of Physicians and Surgeons does not standardize them either. That becomes an issue. Some of them are good and some of them are not so good, and you just have to be very wary,” Ghosh said.
Jackson adds that it’s unclear how long patients stay at private facilities and if they’re provided social support after leaving these programs.
“We know that (the time) after leaving treatment programs is one of the highest-risk times for people who use drugs. There may have been a period of detoxification, but if they go back to using street drugs after they leave a treatment program, there is a very high risk for overdose because their drug tolerance has changed,” she said.
“So many people have died in that window of leaving treatment and reintegrating into the community.”
The nurse also raises privacy concerns. Currently, patient data is stored in AHS’ Connect Care program, which gives health-care providers a central access point for up-to-date patient information.
The government did not say what will happen to that information when services are transferred to Recovery Alberta.
“The benefits of the data sharing mean that I can go to my pharmacist and my family doctor and a nurse practitioner, and they can all access the same information about me, meaning I don’t have to give my prescription list time and time again,” Jackson said.
“There’s no discussion of what is going to happen to those data as a part of Alberta Health Services. Is it something new? What are the privacy rights for people around that information? Who may have access to it? Would it be used in criminal proceedings potentially?
“So by building something new, they are not only spending money creating this infrastructure that we don’t need and giving money to people who presumably are going to manage these funds. And again, we don’t need that.”
In a statement to Global News, Baril said the United Conservative government was the first to fully fund and license addiction treatment across the province, adding there had not been reporting requirements or any outcome metrics defined beforehand.
Private addiction treatment centres in Alberta are not required to report back to the government but are required to be licensed but publicly-funded facilities are required to report to the government as part of funding agreements, he said.
“As we build the Alberta Recovery Model, a big focus is building the outcome framework that will show more clearly the long-term outcomes of those receiving addiction treatment. Alberta’s government recently established the Canadian Centre of Recovery Excellence in part to conduct program evaluations and develop these outcome frameworks,” the statement read.
What are some solutions?
Ghosh says he is hopeful that CORE will help shed light on private addiction treatment facilities in Alberta.
However, he said he wants the organization to have academic oversight instead of being monitored by the government.
“I think overall CORE is a great thing to have. It can be a very powerful organization to demonstrate the impact of recovery as long as they adhere to the principles of transparency and being objective in nature, being academically rigorous and going through ethical processes in evaluation and being peer-reviewed,” Ghosh said.
“I think that’d be very helpful instead of government oversight, because whenever something becomes (part of the government) or whenever our government has oversight of an agency, a lot of people get weary because they think we just provide government propaganda.”
Ghosh added that the province needs to build trust in the process.
“If we’re going to move forward, you need to have some trust with (the government) and trust that they do it in a transparent process,” he said. “If they don’t, then what we need to do is call it out. That’s where we need to take action and say we can’t trust the data because it’s biased.”
Jackson, however, says she doesn’t think CORE will make data and information more transparent. She told Global News there have not been credible results from Alberta Health or the UCP government about the outcomes.
The money can be better spent by expanding accessible options for treatment and harm reduction, as well as funding mental health and addiction research already occurring at post-secondary institutions across Alberta.
“I think any government in Canada that pursues a policy of privatization of health-care services is severely misguided,” Jackson told Global News.
“We know that health care is among the top three issues for Canadian voters in every election, and access to health-care services that are free, universal, portable, all of those factors is foundational to who we are as Canadians.
“If we get rid of community-based harm reduction services, and we make it increasingly difficult to access community options for drug treatment, the need is not going to go away.
“People are going to go to the emergency department instead because that is our catch-all mechanism for places where people with social and medical problems can go when they don’t have anything else.”
Jackson says she encourages Albertans to contact their MLA or municipal councillors to support harm reduction as an official policy but it is also important to disprove misinformation surrounding harm reduction facilities from politicians.
“The notion that harm reduction is passing out drugs on street corners or giving drugs to children is absolute nonsense. What harm reduction services aim to do is to build relationships with people so that they then can access other options,” Jackson said.
“If parents are having the local hockey team over in the basement and they’re having a few beers, but they’re doing it there so that parents can kind of keep an eye on things and make sure that they drive kids home at the end of the night, that is an example of harm reduction.”
Jackson adds it’s important to expand mental health resources so youth feel supported in their households and community. Many people who regularly use supervised consumption sites have complex trauma, such as residential school survivors and survivors of childhood sexual abuse.
“In general, the people who are using the supervised consumption site are not people who use drugs recreationally. They are people who have experienced complex trauma and have found a way to deal with it,” she said.
“They’ve been greatly harmed by institutions in the past … So instead, if they can go to a supervised consumption site, they start to build a relationship with staff there.
“Over time, those staff members can say, ‘We know that you had really bad experiences in the past, and we acknowledge that those are valid and we can maybe help you find alternatives or like a middle ground that isn’t, you know, a residential treatment program but still can help you move towards your goals.'”