'Alberta model' proponents learned nothing from BC's early drug policy 'success'
'Alberta model' proponents learned nothing from BC's early drug policy 'success'
Lesson: It's always too soon to declare victory.
Proponents of the “Alberta model” seem to have learned next to nothing from BC’s experience.
The BC government wasn’t exactly declaring victory in February 2020—and rightfully so. But that doesn’t mean they didn’t take some credit for what looked at a glance like rapidly decreasing overdose deaths the year prior.
“While I am very encouraged to see the number of overdose deaths going down for the first time since this crisis began, and that fewer families will receive the terrible news of a loved one lost, our government is committed now more than ever to keep our foot firmly on the gas, to keep going and keep acting on what the evidence shows us is working.”
That’s part of the statement from then-mental health and addictions minister Judy Darcy that was issued on Feb. 24, when the official year-end numbers for 2019 were published by the BC Coroners Service.
The statement makes references to naloxone, overdose prevention sites and medication-assisted treatment and states: “Thanks to our partners at the BC Centre for Disease Control, we know these strategies have prevented thousands of deaths and are helping people become healthy again.” This part of the statement might look like it’s taking credit for the decrease in 2019, and the BC NDP was probably happy to let people make that inference.
But it’s more likely that the lives saved from those aforementioned services are more simply a continuation of what we’d seen in 2017 and 2018. As the provincial government ramped up harm reduction services, a BC CDC study found the rapid increase in annual overdose deaths—from the 300s in 2013 and 2014 to 529 in 2015 to nearly 1,000 in 2016 to about 1,500 in 2017 and 2018—was likely less than half of what it would have been without those services. (The study looked specifically at data from April 2016 to December 2017.)
Drug policy advisor Karen Ward has generally been adamant the drop in 2019 had nothing to do with the policies implemented by the BC government—it’s about the supply—and I’ve typically been skeptical. Surely the policies had something to do with decreasing overdose deaths?
But after tracking monthly unregulated drug death rates in BC against those in Alberta and Ontario, it seems clear the supply had shifted—it seems she was right and I was wrong.
Data from the three provinces don’t track precisely, but they follow similar patterns. Particularly, all three saw notable decreases in deaths in 2019, even if the drops in the other two provinces weren’t as pronounced as in BC. In Ontario, the decrease was much shorter lived, only hitting a brief low in September 2019 before rising again to its previous rates by November. And like BC, Alberta and Ontario saw significant increases come March 2020.
The BC government has generally characterized this increase in two ways: a change in the drug supply due to global supply chains and trade routes being disrupted and people being less likely to save others from overdose due to social distancing. It’s the latter case that would lend credit to BC’s approach to the crisis, where mass distribution of naloxone and opening overdose prevention sites has been the primary response.
But when the rising rates of death at the onset of the pandemic in the other two provinces—particularly Alberta, where overdose prevention sites have always struggled to gain acceptance from their provincial government—closely mirrored that of BC, the former cause seems likely to have played a greater role.
This is only amplified when you consider that we’ve continued to see increasing deaths even as pandemic restrictions have long since been dropped.
If the government is happy to take some credit for the drop in overdose deaths in 2019, surely it should similarly accept the same for the massive increases since?
And this brings me back to the first line of this post.
The BC government seemed careful not to declare outright victory over 2019. The same can’t necessarily be said for proponents of the “Alberta model.” That government’s approach to the toxic drug crisis—one that doesn’t actually address drug deaths but rather addiction—was credited for exaggerated claims of success early on in 2022.
When I say exaggerated, I really mean it.
“In Alberta today, they’ve managed to cut overdose deaths by almost half by getting people into recovery,” said federal Conservative leader Pierre Poilievre in his “Everything feels broken” video posted to Twitter in November last year.
He made a similar claim in Parliament at around the same time.
And that’s true…
…if you compare the absolute height of pre-2021 statistics (December 2021, at an annualized rate of 47.3 deaths per 100,000 people) with the absolute bottom in 2022 (August 2022 at 25.9/100k).
Similarly, in the Aaron Gunn “documentary” Canada is Dying, Alberta premier Danielle Smith’s chief of staff, Marshall Smith, makes the claim:
“After the pandemic, with our new system coming on board, fatalities in British Columbia have continued to increase and fatalities in Alberta are sitting at about 50% of what British Columbia is at.”
The celebrations were swift and often without condition. The government itself was somewhat more cautious—in a news release last fall, the government said the “steady decline in opioid deaths in Alberta is a positive sign, and we are optimistic it will continue.” Earlier in the year and earlier this year, the government’s message was mitigated somewhat with a “cautiously” appended to the optimism. (Hat tip to CBC’s Jason Markusoff for compiling those examples.)
The problem for them today is that none of this remains true. The most recent update to Alberta’s numbers—which included figures from February to April that, for one reason or another, didn’t come in before the election—show their narrative is crumbling.
Euan Thomson has been consistently putting out great analysis on all of this in his Substack, Drug Data Decoded, and Jeremy Appell similarly had a great piece on it in his Substack, The Orchard.
But even as the statistics had come out for Alberta’s decline in deaths last year, a counterpoint to the argument that BC was rising while Alberta was declining was sitting there for the taking—at the same time that Alberta’s deaths dropped, BC’s had dropped somewhat as well. It was less dramatic, but if you took the lowest point of 2022 (June 2022, annualized at 34.4 deaths per 100,000 people), it’s roughly two-thirds of the high point of 2021 (December 2021, at 50.2 deaths/100k).
But that claim would be just as dishonest as the claim for Alberta’s decline. In both cases, the number of people dying quickly grew again. In fact, we’re now at a point where Alberta’s rate of death is about on par with BC’s.
Contrasting the two provinces has always been problematic. Just as Alberta’s drop in deaths last year wasn’t unique to Alberta (Ontario data similarly shows some decline in the middle of the year, but we don’t have a clear picture, as the data only goes up to June 2022), BC’s drop in 2019 also wasn’t unique, as mentioned earlier. And really, while BC’s rate of death has generally been above Alberta’s, the two have also been pretty close to lockstep for month-to-month fluctuations.
The biggest difference for the two provinces is what they do with their supposed successes.
In BC, the province didn’t exactly put the brakes on its policy—it’s hardly necessary to put the brakes on a policy you barely applied the gas on. But it certainly was delegated to the periphery. It became just another crisis rather than the crisis.
This is reflected in its budget documents. The 2019 budget, put forward in March, before the year’s decline in deaths was entirely clear, carves out an entire section for “Improving Mental Health Services and Responding to the Opioid Overdose Emergency.” The funding allotted to this was still paltry—just $10 million a year—but it nevertheless garnered significant lip service.
In March 2020, the following year’s budget was put forward with only two passing references to “overdose” in a section on the money laundering inquiry and in another about healthcare spending.
Come 2021, when the temporary nature of the dip in deaths the year prior was made clear, the word “overdose” appears 11 times again.
This was reflected also in the monthly unregulated drug death stats releases. I don’t have data to back this claim up, but I remember clearly wondering, sometimes aloud in interviews, whether we’d forgotten about this crisis and if we were letting it slip out of our consciousness.
In short, it felt like the government had an excuse to stop talking about policies they had to be dragged kicking and screaming into implementing or even just acknowledge.
In Alberta, the vibe is very different. Rather than turning down the volume, they’re turning it up. They’re doubling down on policies they have an ideological attachment to, and they’re using the fluke of 2022 unregulated drug death data to do it.
Now that the deaths have come roaring back, as Alberta saw a record month for opioid-related deaths in April, their commentary has been more on the defensive. Sure, we’re seeing more deaths this year, but and also BC!
Just a last thing here. I wanted to note I wrote my first piece for the Georgia Straight, and it was published last week. It’s about the recent backlash to the toxic drug crisis, particularly how advocates for safe supply are now fighting a two-front war against a reluctant (to be generous) government and a surge of outright hostility from the right wing. And it touches on a lot of the things we’re talking about here, so if you haven’t already, go check it out here!