The Alberta government announced Wednesday it will fully cover the cost of the injectable opioid treatment drug Sublocade.
As opposed to tablet versions, the injectable treatment lasts in a person’s system for 30 days and provides stabilization, reduces cravings and provides enhanced protection against overdose, the province said.
“There is hope for people with addiction,” said Mike Ellis, associate minister of mental health and addictions. “Recovery is possible.”
“This option will save lives,” Ellis said.
“The addition of Sublocade to the publicly funded formulary and removal from special access will significantly reduce barriers to this medication. Recovery-oriented care is about providing options to Albertans with addiction and this option will save lives and support recovery,” Ellis added.
In order to access the treatment, a person must be diagnosed as having opioid abuse disorder, get a prescription for Sublocade and then receive the medication at a clinic or pharmacy, said Dr. Nathaniel Day, the medical director of AHS’ Virtual Opioid Dependency Program.
Having the costs of Sublocade covered “will be a game-changer for addiction treatment in Alberta,” said Dr. Monty Ghosh, president of the Alberta Medical Association.
“This will increase treatment options for individuals with opioid addiction. Addiction medicine physicians across Alberta will be grateful to have another tool to treat opioid addiction, especially for our various vulnerable clients who previously could not afford this life-saving medication.”
A public health expert said support for recovery is always appreciated but it must be accompanied by a full spectrum of supports, including harm reduction and treatments like Sublocade or the oral version Suboxone.
“That option is important to have on the table for some people who have an opioid addiction disorder,” said Elaine Hyshka, assistant professor at the University of Alberta’s school of public health. “Cost should not be an impediment to access care.
“I think there are very effective treatment options that are not currently supported by the province and I’d like to see the gap coverage program extended further to support slow-release oral morphine, which is increasingly being used as an effective treatment for opioid abuse disorder by many clinicians in Alberta and across Canada.
“I’d also like to see the province reopen access to the injectable opioid agonist treatment (iOAT) program that they closed last year,” Hyshka said.
“Those programs are highly effective and have some of the best statistics in terms of retention and the province has taken that off the table as an option for people. I think that’s really unfortunate because those are life-saving services that could be running full tilt right now and for some reason, the province has decided not to fund them.”
Hyshak believes 2021 will be the worst year on record for drug poisoning deaths in Alberta.
“What was announced today is not going to be enough to get on top of this crisis. I would expect, within the coming weeks, we’re going to see some very grim numbers when it comes to the number of Albertans who died in 2021 from opioid poisoning.”
She thinks the province needs to take an “all-hands-on-deck approach,” including a huge expansion of resources, expert-led committees and direction, coordination across health zones and innovative approaches.
“I’m not seeing that kind of urgency from the province,” Hyshak said. “To feel like you’re not seeing a concerted effort to get on top of the crisis is really frustrating.”
The Opposition agrees this is not enough.
Lori Sigurdson, NDP critic for mental health and addictions, said she called on the UCP in June to “expand supervised consumption services, provide safe, legal and regulated pharmaceutical alternatives to toxic street drugs, and to implement drug testing.
“We haven’t seen any action on these crucial services,” she said.
“I hope that making Sublocade more available saves lives, but this announcement does not take away the need for the UCP to immediately implement more harm-reduction services.”
“Alberta Health Services issued an alert today regarding an increase in opioid-related EMS calls which demonstrates the severity of the drug poisoning crisis. Mike Ellis admitted that the current supply is toxic and dangerous, yet he still rejects and stigmatizes the need to increase harm-reduction services,” Sigurdson said.
In the news conference on Wednesday, both Ellis and Day acknowledged the contamination issue, saying anyone using illicit drugs should assume there’s fentanyl or carfentanyl in it.
When asked if Alberta would consider drug-testing sites where people could screen drugs for lethal contaminants, Ellis said his ministry is “exploring all options” but “no decision has been made.”
The government also announced Wednesday an additional $1.4 million to expand Alberta’s Virtual Opioid Dependency Program (VODP) and create a low-barrier division. The division will do rapid assessment, begin treatment and offer enhanced case management for those struggling with addiction and opioid use.
“Today is a great day for addiction treatment in Alberta,” Day said.
“If we’re really going to tackle opioid addiction, treatment has to be as accessible as possible to as many people as possible.”
By calling the toll-free number, 1-844-383-7688, Albertans can access same-day treatment (including Sublocade) no matter where they live with no waitlist.
For additional support, information and referral to services, people can call Alberta 211 or the Addiction Helpline at 1-866-332-2322.
Individuals in Edmonton, Calgary and surrounding communities also have access to the Digital Overdose Response System (DORS), a free mobile app designed to help prevent fatal overdoses.
Ellis said 70 per cent of overdoses in 2020 happened in private residences.
“We’ve been working with the Edmonton Police Service… Alberta Health Services, paramedics. We’re trying to figure out ways to help people.
“Seventy per cent of overdoses are actually not occurring in the downtown area, but are actually outside the downtown area, in the suburbs.”
Day said anyone using alone should download the DORS app.
“That new app allows people who are using, maybe in an isolated context, to connect to emergency services and if they pass out it sends a signal to bring an ambulance to their home,” Premier Jason Kenney said on Wednesday. “That could help to reduce the deaths of isolated people in their homes across the province.”
The announcements came on the same day that Alberta Health Services issued a public service announcement warning of a spike in opioid-related EMS calls in Edmonton and Calgary.
Over seven days, from Nov. 29 to Dec. 5, emergency medical services responded to 140 opioid-related calls in Edmonton and 85 in Calgary.
Alberta Health Services says that is “higher-than-average” and notes it is working with local agencies to understand the circumstances and what immediate supports are needed.
Over the last month, AHS says EMS responded to between 57 and 112 calls a week in Edmonton and between 44 and 58 in Calgary.
They are urging anyone who is using drugs to not use alone, have naloxone on hand and to access available supports, such as supervised drug-use sites, in their area.
Alberta is on track to record its deadliest year on record for drug poisoning deaths with more than 1,000 fatalities between January and August this year.
Kenney also said he announced Saturday that the UCP government has doubled the number of addiction treatment spaces from 4,000 to 8,000. These spaces are typically used to facilitate short-term treatment, Hyshka noted.
“We’re building five new long-term drug addiction therapeutic treatment communities across the province, including partnerships with First Nations communities that have been hard hit by the opioid crisis.”
The province has put more than $200 million into initiatives to address the opioid crisis, the premier said.
“We also call on law enforcement to redouble their efforts to interdict the importation of the chemical products that are producing fentanyl — most of it generated from black market factories in China — and of course to do what they can to keep the poison off our streets.”
When asked about safe supply options for those who aren’t ready to seek treatment, Kenney said the Alberta legislature appointed a special committee to review that issue.
“I personally think that it’s an extremely dangerous approach to further deepen and facilitate deadly addictions.
“If that approach worked, you wouldn’t see the human carnage that is evident on the streets of the downtown east side of Vancouver, where governments and agencies have pursued a single-minded focus on so-called harm reduction, including so-called safe supply. But the deaths continue to go up and we believe that it’s critical that folks struggling with addiction know that there is a way out.”
Hyshka said she was co-chair of a commission struck by the health minister that looked at the same issue between 2017 and 2019. In 2019, that commission recommended the province pilot and evaluate safe supply initiatives.
“It’s quite disappointing to me to see that three years later and over 2,000 deaths later, we’re still debating the merits of that proposal.”
She said Health Canada has already funded several different programs in other provinces.
“I would like Alberta to accept the federal funds that are on the table and carefully implement it.”
— with files from The Canadian Press