More and more toxic drug deaths in Alberta are happening in public. Why? | Globalnews.ca

For the first time since 2018, the majority of toxic drug deaths in Alberta are happening in public spaces rather than private residences.

According to data from Alberta’s substance use surveillance system, 43 per cent of toxic drug deaths in Alberta happened in public settings in Q3 2023, the highest it has ever been since the data was made available in 2018. This is 20 percentage points higher than Q3 2022, 16 percentage points higher than Q3 2021 and 22 percentage points higher than Q3 2020.

In Q2 2023, 37 per cent of toxic drug deaths in the province happened in public settings. That is 25 percentage points higher compared with Q2 2022, 18 percentage points higher compared with Q2 2021 and 33 percentage points higher compared with Q2 2020.

In Calgary, 53 per cent of toxic drug deaths happened in public in Q3 2023, a 28-percentage-point increase compared with Q3 2022 and a 25-percentage-point increase compared with Q3 2021.

In Edmonton, 42 per cent of toxic drug deaths happened in public in Q3 2023. That is a 15-percentage-point jump compared with Q3 2022 and a 13 percentage-point-jump compared with Q3 2021.

In the South Zone (which includes Lethbridge), 37 per cent of toxic drug deaths happened in public in Q3 2023. That is a 22-percentage-point jump compared with Q3 2022 and a 24-percentage-point increase compared with Q3 2021.

All three zones also saw high numbers of public toxic drug deaths in Q2 2023.

“What you’re seeing is that it’s actually shifting towards, a different set of populations. We’re not seeing people overdosing who are being housed necessarily. We’re now seeing more of the people who are rough sleeping, experiencing homelessness that is experiencing a spike in these drug poisoning events,” said Monty Ghosh, an internist, addictions specialist and assistant professor at the University of Calgary and the University of Alberta.

Ghosh said it’s hard to say why this shift is happening but highlighted a change in the drug supply. Recent data suggests a spike in substances such as carfentanil, xylene and benzodiazepines in Q3 2023 which are a “deadly cocktail” when used together, he said.

“During that time period, we did see a spike in carfentanil and benzodiazepines, but I think it’s a mix of different factors,” he said.

“It is the summertime. More people are outside. I do see some of the public messages that we do provide to individuals saying they shouldn’t be using alone, that they need to use in groups or with someone else, or be, you know, in a safe place to use, such as a physical supervised consumption site. Lacking all of that, it’s better for them to use outside in public spaces than using indoors home alone.”

Socioeconomic factors have also been shown to increase substance use among vulnerable populations. According to the Calgary Point-In-Time Count Report 2022, 2,782 individuals experienced some form of homelessness in Calgary that year. This represents a 4-per cent decrease from 2018 and a 16 per cent increase from 2016.

Of those, 71 per cent were sheltered and 29 per cent were unsheltered.

Ghosh said a lot of drug users who experience homelessness do not have the proper supports they need. He told Global News a lot of homeless people use drugs to stay awake to protect their belongings or to prevent physical and sexual assault.

“What we did notice was that the the change in drug toxicity with the drug supply very much coincided with, areas that (they) congregate,” the assistant professor said. “Certain sites in the city had these spikes in certain drugs, and those spots often are associated with those experiencing homelessness. And so there could be a correlation between that as well as the deaths that we’re seeing in public spaces because of people experiencing homelessness losing out in the open.”

Drug users need to feel a part of their community: Ghosh

For many drug users, feeling part of a community is a crucial part of getting out of the cycle of addiction. Getting rid of supervised consumption sites will have disastrous effects on communities, Ghosh said.

“These people are often living alone on the streets. They don’t have most of the right supports around them. They’re also a difficult population to reach, and they’re facing an ever increasingly worse drug supply,” he said.

“In order to deal with the situation, we need to get them the right support such as housing, income support and mental health supports. It has to be a multi-faceted, wraparound approach to making sure they can be in the best health they can be in.”

One way to make drug users feel part of the community is to increase access to supervised consumption sites in communities, he said. Currently, no supervised consumption site in Alberta is open 24 hours. Many cities and rural communities also only have one supervised consumption site, which means drug users often have to wait before they can get care.

Ghosh suggested outdoor tents with heaters, social workers and health-care professionals where drug users can access care in warmer temperatures. Temporary structures such as trailers or mobile homes set up near parks or LRT stations can also help drug users access care.

“The evidence is fairly clear around safe consumption sites that they reduce mortality rates, they reduce public consumption of substances. The data shows, contrary to what’s been seen in the past or suggested in the past, it does reduce crime,” Ghosh said.

“We need to be supportive of these facilities now … You really need to concentrate these services where the population is. Then we also have to provide them with reasonable access to these services that are conducive to their needs.”

Addiction services also need to provide comprehensive care, Ghosh said. Alberta’s supervised consumption sites currently don’t have the resources to provide care for those who choose to inhale their drugs.

“Often (drug users) don’t just use opioids. They use crystal meth. They drink alcohol on top of using benzos, whether they know it or not. Stopping at just opioids isn’t ideal, so we need to expand our addiction services,” Ghosh said.

Peer-led supports, such as AAWEAR’s mobile drug-checking program, can also help drug users feel welcomed and accepted in their communities. However, many grassroots initiatives face financial challenges.

“We can have peers working these sites, people who have lived experience being and taking part in some of the operations of these facilities,” Ghosh said.

Recovery and harm reduction programs both needed

In an emailed statement to Global News on Tuesday afternoon, Alberta’s Ministry of Mental Health and Addictions said the data shows a decline of overall overdose fatalities in Calgary throughout the last year, which is why fewer people are dying in private residences.

“Our condolences are with the families and loved ones of those who have lost their lives to the deadly disease of addiction. We are committed to giving every person suffering from the deadly disease of addiction an opportunity to pursue recovery, and connect to supports like the Virtual Opioid Dependency Program (VODP) or the Digital Overdose Response System (DORS),” said Hunter Baril, press secretary for Mental Health and Addictions Minister Dan Williams, said.

But Ghosh said recovery and harm reduction programs are both needed to help drug users.

“I think whatever we do, (deaths are) still going to climb … The solution is having a menu of options that’s available on demand, but that’s hard to do. That requires more funding, requires more supports, and it’s incredibly tough,” he said.

“When people say it’s expensive and don’t want to spend money on it … This drug poison crisis is the number one public health crisis right now facing our population, and it’s cost us more lives than the COVID pandemic.

“We put so much money into COVID, but we haven’t been doing the same for this population.”

Ghosh added the Alberta government needs to work with drug users, health-care professionals and community groups to deal with the toxic drug crisis.

“We still need to do more because it is a crisis. We can’t just stop here. We need to coordinate ourselves and work together as a community to deal with this, and working together as a community means having these sites available in the community to support everyone,” he said.

“How are we ever going to help them get recovery if we’re not allowing them to be part of the community?”