Harm reduction; we can't afford to wait

September 22, 2021

In this letter:

• Opioid crisis – we must act now
• Fourth wave continues
• Cabinet shuffle
• AMA Annual General meeting

Dear Members,

In the midst of the chaos of the fourth wave of COVID-19, we must not forget the vulnerable and disadvantaged. There are many individuals in need, but I refer today to those trapped in the opioid crisis. Care and support for this population was already under-resourced prior to the disruptions created by the pandemic. The crisis has of course worsened due to an exponentially more dangerous street drug supply.

I wrote to you in February about this aspect of the care deficit and motions passed by the Representative Forum calling for further action. Heading into the Fall RF meeting on September 24-25, I wanted you to know that the AMA continues to advocate on this front.

I recognize the challenge of raising this subject at a time when COVID-19 is eclipsing so many issues, but I would argue that it is, in fact, timely. In previous waves, public health restrictions, while necessary, have had impacts on mental health and have been linked to increased deaths from overdoses. We must keep thinking of the Albertans who have died unnecessarily from preventable overdoses – 624 people in the first five months of 2021, an increase of 41 per cent over the same time last year. At times, the rate of overdoses was double that of 2020 with three-to-four individuals dying per day, accounting for more deaths than motor vehicle accidents.

There is a foundation for our advocacy. The AMA previously submitted our position on Alberta Supervised Consumption Services to the Supervised Consumption Services Review Committee in 2019. In that submission, the AMA joined with the Canadian Medical Association, Canadian Nurses Association and the World Health Organization in endorsing harm reduction strategies and tools. It was also stated that “offering Albertans evidence-based harm reduction interventions including take-home naloxone programs, needle distribution programs, and supervised consumption services constitutes part of standard care for opioid use disorders.” The Section of Addiction Medicine wrote to the Minister and the Associate Minister of Mental Health and Addictions in July on this topic as well. I also want to commend the Edmonton Zone Medical Staff Association for striking an Opioid Poisoning Steering Committee.

Working with our Health Issues Council (member login required), the AMA is reaching out to allied health organizations to explore opportunities for collaboration. Dr. Monty Ghosh, Section of Addiction Medicine President and I will be writing to the Minister to reinforce the evidence and dire need for harm reduction strategies as part of the overall continuum of care. The benefits are not only clinical, but humanitarian in nature. Harm reduction has also been shown to reduce costs at the system level.

The AMA is ready to work with government and all those who need to be involved to find solutions to challenges arising from new regulations, closures and shifting of some safe consumption sites – all of which have led to reduced supports in key jurisdictions. We acknowledge and appreciate that government has invested in addiction recovery, but there is much more opportunity if we combine this approach with one that supports Albertans who, without harm reduction, will never make it to the recovery stage.

November 21 to 27 is National Addictions Awareness Week. It would be wonderful to be able to report some progress by then.

Fourth wave continues

I have given many media interviews about the fourth wave and what we are all facing in terms of our health care system in the next few overwhelming weeks. I know many of you in both acute care and the community are tired and feeling overwhelmed. After all we have been through in the last year and a half, it is truly discouraging to be faced with such a high case load. The prospect of having the system overcome with patients and needing to enact triage protocols is horrifying.

Thankfully, vaccination numbers have risen in the last few days since the vaccine passport system was announced. We can only hope that this is the beginning of a trend. I implore Albertans to get vaccinated.

The coming weeks may be like nothing we have seen before. I know you are all doing your best for your patients, but please care for yourself as much as you can. I hope you can find something to ground you every day, something that reminds you of why you do what you do. Also, check in on those around you, sometimes it is these small acts of kindness that turn you into someone’s anchor. Remember, the Physician and Family Support Program is only a call away.

New Minister of Health

Following yesterday’s cabinet shuffle and the change in the Minister of Health, I provided the following statement to media:

The AMA has always had a relationship with the government of the day, and the AMA President with the Minister of Health. There have certainly been challenging times in the past few years between the parties. I have appreciated Minister Shandro’s efforts to improve the relationship with physicians in recent months. I wish him well. We look forward to continuing our current efforts with Minister Copping, working to solidify the relationship between government and the medical profession. Reaching an agreement is important for physicians and government, but also for Albertans and our fragile healthcare system.

AMA AGM September 28 - Register today!

A reminder that registration is open (member login required) for the 116th Annual General Meeting of the Alberta Medical Association.

The meeting will take place virtually (via Zoom) on September 28 from 7 – 9:30 p.m.

Dr. Michelle Warren (President-Elect) and Mr. Mike Gormley (AMA Executive Director) and I will share information about the past year and the year ahead of us. There will be time for questions and answers, and other Board members, senior AMA staff, legal counsel, etc. will also be in attendance to answer questions and offer insight.

Visit the 2021 AGM Registration page (member login required) to register and to access the 2020-21 Reports to the Annual General Meeting. We hope to see you there!

Your comments are welcome in the following ways:

• Communicate with me privately and directly by email if you would like a reply: president@albertadoctors.org
• Comment publicly on this President’s Letter (please be aware that comments are public, i.e., not members-only, even if you are logged in as a member)

Sincerely,

Paul E. Boucher, MD, FRCPC
President, Alberta Medical Association