Ophelia Black is suing the Alberta government for newly imposed regulations that would prevent her from taking hydromorphone, a potent opioid that she takes uses times a day to treat a severe opioid use disorder.Jeff McIntosh/The Canadian Press
A lawsuit that is challenging Alberta’s opioid prescribing strategy wouldn’t have gone forward if the government had implemented changes proposed by the province’s medical association last fall, according to the plaintiff’s lawyer.
Ophelia Black, a 21-year-old from Calgary, alleges the Alberta government is breaching her Charter-protected rights by making her medication inaccessible. Ms. Black, who lives with severe opioid use disorder, said the prescribed medication has saved her life, and that new rules in the province increase her likelihood of returning to street drugs and related harms.
The United Conservative government updated its standards for opioid dispensing on Oct. 5. The regulations eliminated the ability for pharmacists and other dispensers to prescribe high-potency narcotics, such as hydromorphone and fentanyl, to treat opioid use disorder. It also did away with take-home doses.
Starting March 4, all patients must access treatment under supervision at licensed Alberta Health Services (AHS) clinics with the expectation they will transition to what are considered lower-risk opioid agonist (OAT) medications, such as methadone.
Days after the government’s announcement last fall, the Alberta Medical Association, which advocates on behalf of almost 14,000 physicians, sent a memo to the associate ministry of mental health and addictions (now a full ministry under Premier Danielle Smith) outlining its concerns. A copy of the memo has been obtained by The Globe and Mail.
In the memo, the AMA said it had engaged expert physicians whose opinion is that the legislative changes pose limitations to patient-centred care and physician-prescribing practices. While the association applauded the government’s move to expand access to OAT, it highlighted issues with capacity, insufficient timelines for transition, the risk of destabilizing patients, and the lack of providers and staffing.
“By providing well-thought-out and regulated flexibility in regard to service delivery, transition periods, provider expansion and exemption options, the new regulations can be improved upon and have greater success with its proposed objectives thereby continuing to support all Albertans with opioid use disorder,” the AMA memo said.
The province has billed the changes as necessary to prevent prescribed opioids from being traded or sold on the illicit market, a decision that has come under ardent scrutiny from addiction-treatment patients, doctors and advocates. The government has not publicly disclosed any changes to the regulation since the announcement made four months ago.
In the memo, the AMA outlined several ways to refine the province’s opioid-dispensing services, including an increase to transition periods up to one year for all clients accessing treatment and expanding provider capacity to nurse practitioners with experience in addiction medicine. Additionally, they said a case-by-case exemption system for clients who are stable and accessing take-home doses would support their continued recovery.
Edmonton-based lawyer Avnish Nanda, who is representing Ms. Black, filed her lawsuit against the Alberta government on Feb. 1 to maintain access to her hydromorphone prescription. He said it’s unlikely the lawsuit would have gone forward if the government would have accepted the AMA recommendations.
“This is another example of this government’s callous disregard to substance users in the context of developing drug treatment policies. You have experts in the field of medicine in this province calling on this government to put the brakes on what they’re developing, to put the lives and the interests of substance users front and centre in these sort of policy rollouts,” Mr. Nanda said. “They have clearly disregarded that.”
Ms. Black’s experience is a prime case of how the government’s “hard-handed” approaches to drug policy can have life-threatening consequences, he added.
The statement of claim alleges Alberta’s opioid prescribing program breaches rights secured under the Canadian Charter or Rights and Freedoms, including her right to life, liberty and security of the person, in addition to her right not to be subjected to any cruel and unusual treatment or punishment. She is seeking an exemption to the new regulations.
In the memo, the AMA also recommended the continuation of Calgary’s mobile opioid agonist treatment program, where professionals deliver medication under supervision to complex patients who have trouble accessing specialized clinics owing to cognitive, transportation and financial constraints.
The program, which launched during the COVID-19 pandemic, has proved successful in providing stability to patients and helping with their recovery. Personal connections with the mobile outreach team have also helped connect patients to wraparound supports, such as mental health and housing, primary health care, and communicable disease treatment.
But AHS spokesperson Kerry Williamson said in a statement last week that the specialized program is ending. He said clients have been transitioning from the service since November to the designated clinics.
In a statement Friday, the AMA said it has met with the government since October and has been asked to collect “additional data on patient experience.”
“This is still ongoing. While we do have concerns with the NTS, as outlined in the memo, we appreciate the government’s willingness to listen and discuss,” said Dr. Rahul Mehta, president of AMA’s section of addiction medicine. “They have indicated that they are open to monitoring and considering changes in the future.”
Colin Aitchison, press secretary to Nicholas Milliken, Minister of Mental Health Addiction, said in a statement Friday that the government has had “ongoing engagement” with the AMA, including a joint meeting between the association, ministry and AHS in November.
“At this meeting, the AMA indicated that they would continue to work with our ministry by bringing forward any additional concerns,” he said. “We welcome the opportunity to work with them to address any future concerns.”
Mr. Aitchison declined to comment on Ms. Black’s lawsuit because it is before the court.