Edmonton's First Injectable Opioid Agonist Treatment Clinic To Open at FACS Site on 106 Street

The word 'crisis' is often overused in a world where hyperbolic news headlines scream at us 24/7.

01 April 2019

The word 'crisis' is often overused in a world where hyperbolic news headlines scream at us 24/7. But it's hard to overstate the magnitude of the fentanyl crisis.

Hundreds of Albertans die from fentanyl overdoses every year. In 2018, the province's fentanyl death count averaged almost two a day.

Alberta's Opioid Dependency Program (ODP), operated by Alberta Health Services (AHS), gives users a fighting chance to beat their addictions to opioids like fentanyl, heroin, oxycodone and Percocet.

By providing methadone and suboxone (both synthetic opioids) as well as Kadian (morphine) maintenance treatments - a process formally known as Opioid Agonist Therapy (OAT) - the ODP's nurses, psychiatrists, social workers and others do their best to keep some 700 opioid users who live in the Edmonton Zone alone alive.

"People can come here on a short-term or a long-term basis, but our recommendation is to come for at least six months," says Ali Thompson, a Registered Nurse at the ODP's main downtown Clinic, near Edmonton City Hall.

"While these medications help to keep them from being sick or in withdrawal, we can also work on their psychosocial, physical or psychiatric issues as well. It's very rewarding when you see people go from rock bottom to progressing in treatment to getting some quality of life back."

Unfortunately, such treatments don't work for everyone. For the most severe opioid addicts, an even more aggressive and intense approach is needed.

That's why Alberta's second Injectable Opioid Agonist Treatment (iOAT) Clinic will be opening its doors at AHS's Forensic Assessment & Community Services (FACS) office on 106 Street in May. The first opened in Calgary earlier this year.

Before now, Edmonton's iOAT Clinic operated on a temporary, small-scale basis at the ODP's downtown site.

"If all these other mainstay treatments have failed then the Injectable Opioid Agonist Treatment is the alternative," says Psychiatrist Dr. Avininder (Avi) Aulakh, Clinical Lead for AHS's Opioid Dependency Program in Edmonton, and AHS Edmonton Zone Clinical Site Chief, Addiction Medicine.

"The iOAT Clinic is targeting individuals who have been using opioids intravenously for years, so they typically have multiple other medical co-morbidities like HIV or Hepatitis C. These are very high-risk individuals for whom the mainstay treatments have not been successful," says Dr. Aulakh, who is also a Clinical Lecturer in the Department of Psychiatry at the University of Alberta.

"So these individuals will come to the iOAT Clinic three times a day, where they're given high doses of hydromorphone (Dilaudid). They inject themselves, and the nurses are there to supervise so there are no adverse events or overdoses," he explains.

"After the third dose each day they are also given a dose of Kadian or methadone, so that dose lasts overnight, and they still have some opiate in their system until the next day."

The goal is to keep severely addicted people alive and off the street, so they're not constantly looking for illicit drugs to feed their habit, and are also relieved of the unending pressure to find cash - legally or illegally - to pay for those drugs.

In total, somewhere between 50 and 100 users are expected to seek treatment at Edmonton's new iOAT Clinic once it's fully up and running.

"It a fairly small number but we anticipate that the numbers will go up once we have fully transitioned to the new space at FACS. At the ODP Clinic downtown we just haven't had the capacity to treat more than maybe 10 people because of space and staffing limitations," says Dr. Aulakh, one of several psychiatrists who will staff both the iOAT Clinic and the long-established ODP Clinic.

Others include Dr. Krishna Balachandra - an Assistant Clinical Professor in the Department of Psychiatry - as well as Dr. Neil Parker, Dr. Lovneet Hayer, Dr. Roshan Hegde, and Dr. Mohit Singh, a Clinical Lecturer in the Department of Psychiatry.

The Providence Crosstown Clinic in Vancouver's Downtown Eastside, where many heavy drug users reside, has offered Injectable Opioid Agonist therapy for about five years now.

Studies have found that patients in the program have cut back their use of illicit street drugs significantly.

"Canada's western provinces have been affected the most by the fentanyl crisis, and B.C. has historically been home to about half of the heroin users in Canada, so they are leaders in some of these treatments," says Dr. Aulakh.

About 150 chronic drug users were receiving iOAT Treatments at the Vancouver clinic as of a year ago, according to one news report, with a retention rate of more than 80 per cent. About one in five patients had graduated to less-intensive treatments such as methadone.

"Alberta is just the second province after B.C. to offer Injectable Opioid Agonist Treatments. This is a government-funded program and the Opioid Emergency Response Commission has set aside $5 million a year for the next three years to support it," he says.

The iOAT Clinic in Edmonton is likely to treat more males than females, and the average age is expected to be fairly young.

"Based on the experience of the OAT Clinic in Edmonton, I would say the male-to-female ratio is likely going to be about 60:40. This might change over time but we're dealing with more males right now in this area. And since the iOAT Clinic is only for severe users, we anticipate the users will be mainly in their 30s or above," he notes.

"This is not the program for people who have just started to use or have never tried any other treatment. This is only for severe or chronic users for whom nothing else has worked."

Since the iOAT Clinic will treat the most severely addicted opioid users, its metrics for measuring success will differ from those used by the ODP Clinic.

"At the ODP Clinic, I've seen people who have been treated successfully going from situations where they are literally homeless and living on the streets to going back to school, completing their education, having productive jobs and having a family. In cases like that we might see a turnaround within a few months," he says.

"But for the injectable patients, they are severe users and they've been affected by their use for years. So how we measure our success will be different. Success will be that they are not using anything else, they are not visiting the hospital so frequently, they are not involved with the law, or they are getting the treatment they need for infectious diseases."

Tara O'Mara, a Family Nurse Practitioner who has worked closely with Dr. Aulakh at the iOAT Clinic, shares his high hopes for its success.

"We have one patient who has been travelling (to the existing downtown ODP Clinic) 45 mins each way, three times a day, just to get treatment. That's a big commitment. But on the flip side, heavy users are probably spending lot of time obtaining substances or committing crimes to get those substances. So the new iOAT Clinic takes the need for all that away. If you were spending say, $400 a day on illicit substances just to feel well, imagine what you'd have to do to fund that."