In 2015, it didn't receive a single mention in the platforms of Alberta's political parties.

Then people kept dying. More than 2,200 over four years — the population of a town like Nanton. Now, the province's opioid epidemic has forced itself into the political consciousness, prompting commitments from all major party leaders in this election.

For addictions specialist Dr. Hakique Virani, none of the proposed plans goes far enough.

"We need to see more boldness across the board," said Virani, who educates fellow physicians on how to treat opioid use disorder.

"And the priority has to be on rapid and urgent response that is proportional to the great magnitude of this emergency."

Here is how Alberta's political parties would respond to what Virani has called the "most urgent public-health problem of my generation":

The NDP would expand access to addiction treatment programs, and launch a lawsuit against opioid manufacturers to recoup the costs of the opioid crisis.

The UCP wants to invest $100 million over four years in a mental health and addiction strategy that includes expanding drug treatment courts and increasing funding for treatment centres, detox beds, and mobile detox programs.



It would ask the federal government to restore mandatory minimum sentences for drug traffickers, and give Alberta more resources to fight drug trafficking. A UCP government would not endorse any new supervised consumption sites, a proven tool at preventing overdoses, without a "robust evidence-based analysis of the socio-economic impact." Along with stakeholders, it would assess the locations of current sites to see if they should be moved.

The Alberta Party promises to increase funding for opioid response from the current $45 million to $68 million. Using that money, it would create more treatment beds and provide more local access to mental-health and addiction services, directing some resources specifically to Indigenous communities and organizations.



The Alberta Party would also maintain and fund supervised consumption sites, and explore ways to treat substance abuse in people who encounter the criminal justice system.

The Liberal Party would fund more treatment beds, expand mental-health and drug courts, and increase the number of supervised consumption sites. Addictions counselling would be free to those who need it, as would suboxone, an opioid replacement therapy.



A Liberal government would decriminalize the possession of small quantities of drugs, and redirect the money saved from the justice system into addictions treatment.

The Freedom Conservative Party wants to concentrate on prosecuting drug traffickers, not drug users, and would provide more funding for treatment programs in correctional facilities.

Virani said the expansion of supervised consumption sites is "critical," and that any plan that halts or delays it is unacceptable. Indigenous people on reserves need sufficient access to treatment programs, he said. And he wants Alberta's next government to properly fund addiction services in the corrections system.

Ultimately, Virani believes stopping the opioid epidemic will require pushing for a federal policy not likely to win over some voters: decriminalize drug possession altogether.

"Politicians, of course, are trying to score points in campaigns and that means that they need to be coming up with solutions that are popular," he said. "But sometimes in public-health emergencies, the solutions are not popular."

Crisis killing two Albertans every day

Many, including Virani, criticized Alberta's NDP government for not taking more urgent action on opioid abuse and failing to declare the crisis a public-health emergency, something both the Liberals and the Alberta Party say they would do if elected.

The government funded the opening of six supervised consumption sites across the province, and has supported applications for the creation of several more.

It expanded access to the opioid antidote naloxone and struck an opioid emergency response commission made up of various experts and stakeholders, including people with current or past addiction issues. Detailed quarterly reports provide vital information on overdoses and opioid use.

The opioid epidemic kills two Albertans every day



More than 2,200 Albertans have died from opioid overdoses since the last provincial election. (CBC)

Dr. Michael Ashburn is working to reverse similar statistics in Pennsylvania, a state whose novel approach to the opioid epidemic could provide direction for Alberta.

An anesthesiologist and researcher at the University of Pennsylvania, Ashburn is a nationally recognized expert in pain medicine and palliative care. He served on the state's House Advisory Committee on Opioid Addiction and is a current member of Pennsylvania's opioid task force.

The U.S. Centers for Disease Control and Prevention (CDC) reports that on average, 130 Americans die every day from an opioid overdose. The crisis has hit Pennsylvania particularly hard.

The CDC estimates between August 2017 and August 2018, nearly 4,600 Pennsylvanians died from drug overdoses, the vast majority caused by opioids. Since death investigations often take several months, the actual death count is probably higher.

Other jurisdictions struggling too

At the University of Pennsylvania, Ashburn and a research team are pioneering innovative approaches to curbing opioid abuse.

They studied how doctors prescribe opioids for patients undergoing common surgical procedures, as well as the dose needed to actually manage pain. They then created treatment guides and, working with the state, integrated them into Pennsylvania's electronic health record system.

"That led to significant decreases in opioid prescribing," he said, "while actually improving patients' pain control and improving their outcomes because we avoided the opioid-related side effects."



Dr. Michael Ashburn is part of a research team creating novel approaches to curbing Pennsylvania’s opioid crisis. (Penn Medicine)

Ashburn is hopeful these measures and others, like state-led targeted medical education, are making an impact.

"We're starting to see a flattening of the curve," he said.

"Around the middle of 2018, we were starting to see what we hope is the peak of the mountain of destruction that we have been seeing in our communities from the deaths from opioids. And we would like to see that curve, of course, go down over the next few months to years."

A long-term problem with no easy fix

Ashburn said Alberta needs to be committed to solving a problem that will take years to fix.

"This is a very complex, multi-factorial, public-health crisis that is going to take a lot of soul searching and a lot of work to try to address," he said. "And it won't be as simple as telling doctors to prescribe opioids less frequently.

"It is going to require development and implementation of opioid stewardship, careful thinking about how opioids are used to treat chronic non-cancer pain, and a strong effort to think carefully about harm-reduction efforts."

Data shows that in this provincial election, the public is largely focused on job creation and the economy. So why does Virani say voters should pay particular attention to the parties' stances on this issue?

The scale of the opioid crisis is so large that "it is one or two degrees of separation from every Albertan to find somebody affected by this epidemic, if you're not [affected] yourself," he said. "That's an easy answer.

"But you know, I think the more important answer is that when there are parts of our population who are suffering, and where the effects of a health hazard may result in their preventable, premature deaths, we should all be concerned, whether or not it is our friend or neighbour."