Thank you for the opportunity to appear today. My name is Elaine Hyshka, and I am a Canada research chair in health systems innovation, and an associate professor at the University of Alberta's school of public health. I am joining today from Edmonton, on Treaty No. 6 territory, the traditional lands of first nations and Métis people.
My opening remarks outline the current situation in Alberta, how we got here and where we need to go provincially and nationally to achieve sustained reductions in drug-related morbidity and mortality.
In Alberta, 2023 will be the worst year on record for opioid poisoning deaths. Between January and November, we lost five people per day—a total of 1,706 people—to fatal opioid poisoning. This annual death count, though still incomplete, is nearly 19 times higher than that observed at the height of the prescription opioid crisis in 2011, when 91 Albertans died from opioid overdose. The situation is so severe that it is contributing to declines in population life expectancy.
What accounts for this substantial increase in mortality? The preponderance of evidence indicates that the exponential increase in deaths in Alberta is the result of fundamental and, presumably, permanent shifts in the illegal drug supply, which have made using drugs much more dangerous than ever before. It is not the result of a significant increase in the prevalence of addiction or opioid use disorder. We currently have no data showing that there has been a huge increase in the number of people who have developed opioid use disorder or addiction in Alberta since 2011. Instead, well-intended efforts to reduce prescription opioid use beginning in 2012 led to a rapid reduction in prescribing and a 50% reduction in the total population flow of prescription opioids by 2018. Unfortunately, the death rate did not decline. It surged as the illegal drug market moved to fill this gap with highly toxic, clandestinely produced novel synthetic opioids. Complicating the situation further are increasing rates of stimulant co-use, and contamination of opioid products with benzodiazepines and other sedatives.
We have now lost 10,060 Albertans to toxic drugs. To put this number in perspective, 3,861 more people have died in this crisis than have died from COVID-19 in Alberta. Most people dying are young and middle-aged. Many are first nations people, who as a result of colonization, racism and discrimination, die at seven times the rate than non-first nations people in Alberta, contributing to a seven-year decline in their life expectancy between 2015 and 2021 alone. The potential years of life lost and the impacts on surviving children, parents, families, friends and communities are enormous, and they are devastating.
Reversing this trend will require an evidence-informed public health response that we have yet to see anywhere in Canada. COVID-19 demonstrated how coordinated and well-resourced public health efforts can achieve rapid advances in science and avert substantial morbidity and mortality over time. We need a similar societal response to toxic drugs to save lives, promote health equity, reduce pressure on health systems, and avert billions of dollars in lost economic productivity attributable to toxic drug deaths.
Critical components of this response include estimating the number of Canadians at risk for drug poisoning, and then using this data to optimize and expand proven interventions, like opioid agonist treatment and supervised consumption, to ensure we meet needs across the population. It also includes acknowledging the reality that the majority of people at risk for drug poisoning in Canada do not meet criteria for opioid use disorder and will not routinely seek health care for drug use. This means continuing to trial novel models of prescribed and non-prescribed safer supply with the aim of reducing exposure to toxic drugs. Equally important, we must address the underlying factors that increase vulnerability to drug-related harm. This requires concerted efforts to improve management of chronic pain and mental health conditions, improve health and social status of indigenous peoples, and reduce rates of housing insecurity and poverty nationally.
Finally, we need to invest in implementing and evaluating community-wide, universal prevention programs for children, youth and families, which have strong potential to reduce rates of early adolescent drug use, and would pay dividends in many realms of social life.
Thank you again for the invitation to appear today and for your thoughtful study of this issue.