Concerns about Alberta plan to administer addiction treatments in jail

On Thursday, the Alberta government announced a new plan that will hopefully help people struggling with addiction while they sit in a municipal jail.

It would involve administering sublocade, if the prisoner agrees, in order to help manage withdrawal symptoms. It’s the latest announcement in the government’s push to use sublocade more widely, as it is touted as an effective path to get people towards long-term treatment.

The drug is also special because it can reduce withdrawal symptoms for up to a month on just a single dose.

“Albertans have yet another opportunity to choose treatment and recovery over a life in addiction,” said Associate Minister of Mental Health and Addictions Mike Ellis. “The recovery-oriented system of care we’re building is about ensuring Albertans across multiple systems have access to evidence-based treatment options when and where they need them.”

Ellis, who is a former police officer, was backed by the police chiefs from Calgary and Edmonton as well as the deputy commissioner of the Alberta RCMP, during the announcement. The press release sent out for the announcement was titled “police to play key role in offering addiction treatment”. The medical director of the province’s Virtual Opioid Dependency Program (VOPD) also spoke.

The focus on centring the police in this narrative immediately raised alarm bells for lawyer Avnish Nanda, who has been battling the government in court over addiction policies.

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“Police officers aren’t health care professionals. There’s no details to really ensure that what the government is promising will really happen, and if it will lead to positive impacts,” Nanda said.

When asked more about the process of administering sublocade behind bars, Dr. Nathaniel Day said it would still include health care workers.

“Alberta Health Services is the organization that runs the Virtual Opioid Dependency Program. Our staff come from a variety of backgrounds: addiction counselling, social work and nursing. And of course, our medical staff are physicians trained in addictions,” he said.

Day said this strategy fits with a “recovery-oriented system of care”, and this can help provide immediate relief for people in jails.

This leads to the concerns coming from Dr. Bonnie Larson, a clinical assistant professor in the Department of Family Medicine at the University of Calgary.

On Dec. 8, Ellis spoke about sublocade and how they will be offering it on-demand around the province thanks to over a million dollars in funding. In these cases, people are encouraged to engage with their health care team to determine if the medication is right for them.

WATCH: Paramedics responded to dozens of overdose calls and Alberta is on track for the most overdose deaths on record, as the province doubles down on treatment strategies.

Larson said sublocade is an extremely specialized treatment and it is not automatically available for everyone, and the point about people engaging with their health care team before taking sublocade does not fit with this strategy.

“It requires a very high standard for informed consent, a very skilled health care provider with experience in prescribing and administering and monitoring the medication,” she said. “It’s difficult to do that when somebody is in distress, and not seeking that care themselves in that moment. It can also be complicated in the moment by severe withdrawal symptoms, which happens all the time when folks are brought in.”

Larson said sublocade can cause severe side effects in some people, depending on prior conditions, and people also need to be closely watched for several days after the injection to make sure there are not any significant problems.

If a prisoner is experiencing severe pains due to withdrawal, and they are presented with an option to take a drug that will help, they may feel there are few other options and may elect to take it without knowing about possible negative effects.

Larson said there are so many questions on this point because it is unclear if there will be proper monitoring and if the staff in jails are ready for this sort of work.

“Far out of the scope of law enforcement officers or social workers that are working with them to make that determination about whether or not someone is a good candidate.”

She said sublocade can certainly be a very effective treatment for people, but then this plan could end up backfiring if it causes side effects that drive people further into addiction after leaving jail.

“If people have horrible experiences with medications that are actually very effective under the right circumstances, they will not be willing to try that medication again,” Larson said.

Nanda said this plan fails to address the wider issues at play when it comes to addressing the overdose crisis, which is on track this year to kill more Albertans than ever before, and it can further breed mistrust in the criminal justice system.

“Fears of criminalization and stigma, particularly from police agencies, is a big factor why people use unsafely,” he said. “Pairing the two raises real questions if this government really understands the real challenges that are out there.

“To me, this is just optics, and doesn’t really get to the heart of what needs to be done to help folks who are using substances and to ensure that they don’t die of an overdose.”

Larson said this plan should only play a minor role in a much wider strategy to help people dealing with substance abuse, and there needs to be more thought given to decriminalization of drugs and providing a safe supply in order to cut back on the poisoned drug supply that is out on the streets.

“Why are they making such a big deal about the sublocade? It has a very narrow application,” she said. “Safe supply and overdose prevention services within the correction system, those things need to be maximized before we look at a very specialized intervention.”