Dozens of doctors and researchers are calling a paper being used by the Alberta government for drug policy direction “flawed,” saying it is “unhelpful and potentially dangerous.”
At issue is a report commissioned by the Ministry of Health for the province’s select special committee to examine safe supply.
More than 50 doctors and researchers from across the country, including one director of harm-reduction research at Yale University, penned an open letter pointing out what they call a number of flaws in the rapid review titled “Public Supply of Addictive Drugs,” done by four people from Simon Fraser University’s Centre for Applied Research in Mental Health and Addiction.
The letter published by the B.C. Centre on Substance Use started by pointing out the paper commissioned by the Alberta government was graded “critically low-quality” when the centre used AMSTAR, a tool used to evaluate quality of publications like the one Alberta received.
The paper provided to Alberta was found to exclude key studies and included “a number of irrelevant” ones.
But the “critically low-quality” report had a number of other errors not covered in the AMSTAR evaluation.
The criticisms included:
- the report’s conclusion not being based on existing evidence,
- inaccuracy in its description of safe supply,
- not covering the range of clinical opinions on safe supply,
- not including the perspectives of people who would benefit from safe supply,
- misrepresenting the full range of recommendations of researchers currently evaluating safe supply,
- the recommendations from the report go beyond safe supply and are not scientifically-based,
- and the report’s analysis of cost and cost-effectiveness is flawed.
The group of clinicians and researchers who receive funding from organizations like the Canadian Institutes of Health Research, Natural Sciences and Engineering Research Council, Social Sciences and Humanities Research Council and the U.S. National Institutes of Health said they are “deeply concerned about the aforementioned report, its methods, content and conclusions, and the recommendations (the provincial) committee may make as a result of this report.”
They also recognized the science behind safe supply is “in its infancy and there remains much to be learned.”
“It is too early to make firm conclusions such as those offered by authors of this report,” the letter said. “Given the ever-escalating opioid overdose crisis, decisions must be based on rigorous empirical studies and reviews.”
Eric Engler, press secretary to associate minister for mental health and addictions Mike Ellis, took to Twitter to rebuke the letter, trying to point to an apparent hypocrisy “the left” uses when evidence doesn’t match an argument, “in this case, a pro-drug agenda.”
Despite the use of the term “safer supply” 32 times in the letter from researchers and clinicians, Engler tweeted it was “not a medical term, it’s a marketing term just like ‘clean coal’… used to sell opioids to the public as a response to an issue that was started by opioids.”
But there has been a large body of evidence showing that using opioids to wean someone off harsher opioids works.
A retrospective cohort study of heroin-assisted treatment (HAT) of 1,885 Swiss inmates over 15 years showed no serious heroin-related medical complications between 2000 and 2015.
“This study shows that heroin-assisted treatment can be a valuable treatment option for severely dependent (opioid-using individuals or OUI) during imprisonment, can be delivered safely by prison health staff over extended periods of time and allows OUI in treatment to achieve work performance rates comparable to that of the general prison population,” the study published in the Harm Reduction Journal concluded.
HAT programs issue pharmaceutical-grade heroin alongside other interventions to support long-term heroin users to help them move to better health outcomes, according to the Canadian Drug Policy Coalition.
“It certainly sounds counterintuitive, doesn’t it, to use heroin to treat what you see as a heroin addiction problem,” said Euan Thomson, executive director at Each + Every and board member of AAWEAR.
“But in a lot of cases, the drug itself isn’t the biggest problem. In a lot of cases, it’s the poverty, it’s the marginalization. In some cases, it’s racism or bad treatment by police or the medical system.”
The paper commissioned by the Alberta government overlooked the HAT evidence and the letter said the group “(failed) to cite empirical work to support (the) claim” a safe supply of drugs is associated with an increase in adverse effects.
Thomson said countries like Germany and the Netherlands, following trailblazing by the U.K., have found success in getting people out of criminal lifestyles with HAT – just one type of harm reduction.
“It’s all about gaining stability in your life. So even if somebody is going to continue using heroin, at least they’re using a predictable, known substance and not needing to chase it around all day just to access it,” he said.
Testing purity of drugs
AAWEAR will be launching a provincial mobile drug testing pilot program in Calgary later this year. It will be an Alberta first.
Anyone will be able to approach a testing van to have their drugs tested for both purity and concentration. Data from the test results will be made public.
While some young adults might want to check the quality of their MDMA ahead of a party, others who are frequent opioid users might want to make sure their drugs aren’t going to immediately threaten an overdose by being laced with a more intense opioid like carfentanyl.
But people using the mobile drug test service will also have access to other wrap-around services via a “peer navigator” to help people gain access to social services like housing.
“This is going to be a great opportunity for one service to dovetail into the next and for people to really access a whole host of services all at once, rather than having to go all over town for everything that they need,” Thomson said.
Thomson said connecting people with those harm-reduction measures is a measure of success for the pilot.
The van-based program has received funding for 18 months of operation from the Public Health Agency of Canada and if successful will be expanded to other Alberta cities.
Thomson said there is a throughline in successful recovery from addiction.
“Recovery should be defined by the individual,” he said.
“I don’t think it’s fair for us as this society to enforce this idea that everybody must be abstinent from all substances.”
Thomson added the addiction situation in the province is becoming more and more complicated by the nature of the illegal supply.
“Right now, we’re in a situation where a lot of people have not consented to some of the drugs that they are now addicted to,” Thomson said.
“So, for example, a lot of people are now addicted to benzodiazepine-contaminated opioids, which means that they’ve got two different substances now to try and remove themselves from.”
The open letter from the 50 researchers and clinicians is the latest challenge to the alleged direction of the committee examining safe supply.
Of the legislative committee of 12, eight are UCP MLAs while four seats are vacant after the Opposition members resigned in protest, calling the committee a “political stunt.”
The following week, two national advocacy organizations announced their departure from the committee, saying an announcement from Ellis made it clear “the outcome of the committee had been predetermined.”
According to provincial data, 1,758 people died of drug overdoses in 2021. That trend appears to be continuing this year, with January marking the third-highest month of drug-poisoning deaths in the past five years.