Protecting Albertans from high-risk opioids

Alberta is the first province in Canada to protect communities from the diversion of high-risk opioids while increasing access to specialized care for people with severe opioid addiction.

High-risk opioid narcotics such as hydromorphone and diacetylmorphine are highly addictive and carry significant health and safety risks. Evidence shows that when high-potency narcotics are widely available many are traded or sold on the illicit market, increasing addiction and overdose rates.

An amendment to the Mental Health Services Protection Regulation establishes new Community Protection and Opioid Stewardship Standards. These standards govern new narcotic transition services, ensuring patients prescribed high-potency narcotics for opioid addiction receive high-quality medical care with the goal of transitioning to lower-risk opioid agonist treatment (OAT) medications. They also introduce additional opioid stewardship requirements, such as witnessed dosing, to reduce the risk of drug diversion in our communities.

“We continue to urgently respond to the addiction crisis in our province.  We are taking steps to protect patients – and communities – from high-risk opioid narcotics, while still providing evidence-based care to those who need it. In consulting with experts in addiction medicine, and reviewing best practices from across the world, including the Swiss model, I am confident this is the best path forward for Alberta.”

“Evidence-based treatment is key to helping people with addiction. For those with extremely severe opioid addiction, high-potency opioids may be necessary to help them stabilize, but without medical oversight, those same medications carry substantial risk to public health and safety. My expectation is that narcotic transition services will help our most vulnerable patients and serve as a stepping stone towards recovery, while still protecting the public from unintended harm.”

“As an addiction medicine physician, I’m focused on medications and behavioural treatments that are proven to be effective when treating people with opioid use disorder. These new standards around prescribing and dispensing high-potency narcotics will assist patients while helping them transition to evidence-based interventions. In addition, the standards are a reasonable balance between allowing access while protecting the community.”

Establishing narcotic transition services in Alberta

The vast majority of Albertans with opioid addiction are able to successfully stabilize and enter recovery with evidence-based OAT medications like Suboxone, Sublocade and methadone. Any Albertan can access opioid agonist treatment on demand through Alberta’s Virtual Opioid Dependency Program. This program provides same-day access to opioid addiction treatment anywhere in the province with no fees and no waitlists.

Narcotic transition services are designed to help people with severe opioid addiction who have not been able to initiate or stabilize on conventional OAT medications. Narcotic transition services focus on stabilizing and transitioning patients under expert medical supervision from high-potency opioids to evidence-based OAT medications and recovery-oriented care.

Since the use of these narcotics presents a significant risk to the community if diverted, and since patients with severe opioid addiction receiving these medications are extremely vulnerable, Alberta Health Services (AHS) is now the only service provider authorized to offer narcotic transition services. AHS health professionals are best equipped to prescribe and monitor this specialized treatment and transition patients to evidence-based OAT medications, while preventing diversion to the community. Service providers who are currently prescribing high-potency opioids, for opioid addiction will have a transition period of up to five months to transition patients onto conventional OAT medications or transfer patients to a licensed AHS clinic.

Narcotic transition services are available at AHS Opioid Dependency Program (ODP) clinics in Calgary and Edmonton, and in the coming months, services will be added in Grande Prairie, Red Deer, Lethbridge, and Medicine Hat.

The Community Protection and Opioid Stewardship Standards are based on learnings from the ongoing opioid addiction crisis and the best available evidence from around the world, including the Swiss model. In developing the regulatory framework for Alberta’s narcotic transition services, the province consulted with experts in addiction medicine, regulatory colleges and professional associations, as well as Alberta Health Services.

Earlier this year, Purdue Pharma (Canada) agreed to a historic settlement with federal, provincial and territorial governments in a class action lawsuit to recover health-care costs resulting from the actions of companies involved in the widespread manufacturing and distribution of opioids. A portion of Alberta’s settlement will fund narcotic transition services in the province to ensure the lessons learned during the early years of the opioid crisis – including the risks of prescription opioids and the harms caused by drug diversion – are never forgotten.

This approach will ensure the principles of community protection and opioid stewardship are followed by dramatically reducing the risk for diversion of high-risk opioids, while increasing access to narcotic transition services for people with severe opioid addiction.

Albertans living with chronic pain

These changes do not impact Albertans prescribed high-potency opioid narcotics for chronic pain or other illnesses. Many people living with chronic plain across the province lack access to effective treatment. To address this gap, Alberta’s government is investing $500,000 towards developing a Provincial Pain Program, based on the Alberta Pain Strategy, which will build capacity, provide more supports for physicians, and ensure safe and consistent access to pain management supports while preventing addiction. The program will support the responsible use of opioids in treating chronic pain, improving appropriate deprescribing practices for pain while increasing access to non-opioid therapies to help prevent opioid addiction.

“The Alberta Pain Strategy is the country’s most comprehensive pain strategy. With Canada’s first provincial pain program, we are putting people living with pain first. This is really about ensuring access for all Albertans and removing the health inequality that we often see in our rural populations. With the creation of narcotics transition services, we will be protecting Albertans so that we don’t repeat some of the mistakes made in the past, while at the same time providing incredible access to appropriate medications under a regulated body for all Albertans.”

“The College of Registered Nurses of Alberta (CRNA) supports the announcement of the new Mental Health Services Protection Regulation. Patients have a right to autonomy, respect and dignity from their health-care professionals. Registered nurses and nurse practitioners work on collaborative teams in harm reduction services. They are expected to provide evidence-informed care for patients living with substance use to assist them in achieving optimum well-being, while building effective, trusting relationships with their families and communities.”

“We recognize that opioid addiction is a critical issue that we all care about. While this approach for narcotic transition services will create challenges for some patients, we also acknowledge that wrap-around services provided may start most efficiently from a specified number of sites. We appreciate efforts made to avoid creating barriers for patients to obtaining or maintaining services. There is a harm reduction perspective on narcotic transition services as well as a treatment/recovery approach. Although harm reduction isn’t reflected in the new regulations, we are pleased that there is openness to considering such aspects going forward. The AMA supports government’s intention to work with physicians to provide the expertise for communication and implementation of the regulations.”

These changes are another important step in building Alberta’s recovery-oriented systems of care. Alberta spends more than $1 billion annually on addiction and mental health care and supports, including prevention, intervention, treatment and recovery. This includes adding more than 8,000 new publicly funded treatment spaces; eliminating daily user fees for residential addiction treatment; launching the Digital Overdose Response System (DORS) app; expanding opioid agonist treatment with same day access; and fully covering the cost of the injectable opioid treatment drug Sublocade.

Quick facts

• High-potency narcotics include hydromorphone, diacetylmorphine and fentanyl. They do not include opioid agonist treatment (OAT) medications, such as Suboxone, Sublocade or methadone, or slow-release oral morphine.

• The amendment does not impact Albertans prescribed high-potency narcotics for chronic pain and other illnesses, such as cancer.

• Under the amendment to the Mental Health Services Protection Regulation:

  • AHS is the only service provider licensed to provide narcotic transition services, with certain exemptions for hospitals, hospital emergency departments and designated facilities under the Mental Health Act.

  • Only patients with severe opioid addiction who have been unable to initiate or stabilize on OAT medications are eligible for narcotic transition services.

  • Before beginning treatment, patients will receive an individual assessment and specialized treatment plan, including access to wraparound supports.

  • Best efforts must be made to transition patients to evidence-based OAT medications.

• Narcotic transition services are available at AHS Opioid Dependency Program (ODP) clinics in Calgary and Edmonton. By the end of January 2023, services will be available in Grande Prairie, Red Deer, Lethbridge, and Medicine Hat.

• Current health providers will have a period of five months to transition patients to OAT medications or to transfer to a licensed AHS clinic.

• In its June 2022 final report, the Committee to Examine Safe Supply recommended taking steps to protect the public from drug diversion and the widespread prescription of full agonist opioids.

• Albertans struggling with opioid addiction can call the Virtual Opioid Dependency Program at 1-844-383-7688, seven days a week, from 8 a.m. to 8 p.m. daily, for same-day access to addiction medicine specialists. There is no waitlist.

• For additional support, information and referral to services, call 211 Alberta.