The Politics of Substance Use and Addiction in Alberta

Heather Morris|University of Alberta|hmmorris@ualberta.ca

Hauwa Bwala| University of Alberta |bwala@ualberta.ca

Pam Downe | University of Saskatchewan| pamela.downe@usask.ca

Elaine Hyshka |University of Alberta | ehyshka@ualberta.ca

December 10, 2020

Introduction

The following report breaks down results from an August 2020 Viewpoint Alberta Study surrounding Albertans’ perceptions of substance use (including drug and alcohol consumption) and policy options for addressing overdose, addiction, and other related harms. Alberta is currently experiencing an unprecedented drug overdose epidemic. The COVID-19 pandemic has only exacerbated the situation as a result of disrupted illegal drug supply chains leading to more toxic drugs circulating, increased isolation and stress, and reduced community supports. This research brief reports on the attitudes of over 800 Viewpoint Survey respondents towards substance use and related policy responses.

Attitudes Towards Substance Use

A significant proportion of respondents had personal experience with substance use. Respondents were asked if they or someone close to them had ever struggled with drugs or alcohol (Fig.1). A large minority indicated “Yes” (41%), while 55% stated, “No.” The remaining 4% of respondents answered, “Rather not say.”

Overall, there is wide recognition that the COVID-19 pandemic is contributing to further provincial challenges with regards to mental health and substance use. Respondents were asked if they agree with the statement, “The COVID-19 pandemic and its economic fallout will lead to worsening addiction and mental health problems in Alberta” (Fig.2). A majority (78%) indicated that they either “Strongly agree” (38%) or “Somewhat agree” (40%) with this statement. Albertans were also asked to comment on whether the COVID-19 pandemic and its economic fallout will lead to more fatal overdoses in Alberta (Fig.3). Again, most respondents (61%) were in agreement with 28% stating “Strongly agree” and 33% stating “Somewhat agree.” Nearly one-third of respondents indicated “Neither agree nor disagree” (31%) to this question.

Viewpoint Alberta survey respondents were asked to provide feedback on a wide variety of policy options for addressing substance use and addictions in Alberta (Figure 4). To begin with, respondents were asked if they agreed with the statement, “To address substance use and addiction issues, the Alberta government should increase awareness of substance use and addictions issues.” A majority of all respondents (76%) expressed either “Strongly agree” (36%) or “Somewhat agree”(40%) with this statement. Albertans were also asked to comment on whether the Alberta government should support doctors to treat more people with substance use disorders (i.e. the medical diagnostic term for addiction to alcohol or drugs). Most respondents (73%) were in favor of this proposal with 35% stating “Strongly agree” and 38% stating “Somewhat agree.”

Expanding Access to Treatment for Substance Use Disorder 

The majority of Albertans would like to see an expansion of treatment for people living with substance use disorder. Survey respondents were asked to comment on whether they supported an expansion of access to abstinence-only residential treatment programs (sometimes referred to as ‘rehab’ programs). Since 2019, Alberta’s government has announced significant investments in abstinence-only treatment programs and recently committed to making spaces in these programs universally accessible and publicly-funded. A total of 63% of respondents supported investing in abstinence-based treatment programs with 23% stating “Strongly agree”; 40% “Somewhat agree”; 16% indicating “Somewhat disagree”; 6% “Strongly disagree” and 14% “Not sure/Don’t know” (Fig.4).

There was even broader support for medical treatment of substance use disorders, however. When asked whether the Alberta government should increase access to medications that treat addiction by preventing cravings and withdrawal (e.g. Suboxone, Methadone), 70% of respondents were in agreement. Specific proportions included 30% “Strongly agree”; 40% “Somewhat agree”; 13% “Somewhat disagree”; 5% “Strongly disagree”; and 12% “Not sure/Don’t know” (Fig.4). 

Attitudes Towards Expanding Harm Reduction

Harm reduction is an approach that seeks to minimize the harms of ongoing substance use. Some examples of harm reduction interventions include community distribution of naloxone kits, supervised consumption services and injectable opioid agonist treatment. While harm reduction is one of four key pillars of the federal Canadian Drug and Substances Strategy , the approach has been criticized by the current provincial government as ‘enabling’ drug use, and remains somewhat controversial in Alberta. Below we explore Albertans support for harm reduction as an approach to substance use.

Overall, respondents were generally supportive of harm reduction efforts. When presented with the statement, “To address substance use and addiction issues, the Alberta government should expand harm reduction programs that train people to reduce risks from substance use, and help them to connect to treatment and healthcare”, the majority of all respondents (76%) were in agreement with 33% stating “Strongly agree” and 43% stating “Somewhat agree” (Fig.4).

We wanted to know what support there was in Alberta for increasing the distribution of naloxone kits (which are a harm reduction measure to enable bystanders to provide first aid and reverse an opioid overdose). Over 270,000 naloxone kits distributed across the province by Alberta Health Services since January 2016, with over 18,000 self-reported overdose reversals being made during this time. A total of 25% of Alberta Viewpoint respondents “Strongly agreed” to increasing the distribution of naloxone kits while 36% “Somewhat agreed” (Fig.4).

One demographic factor that influenced support for expanding harm reduction was gender, as 40% of women strongly agreed with expanding harm reduction compared to just over a quarter (27%) of men (Fig.5). Personal experience also influenced support for expanding harm reduction. Respondents who have struggled with drugs or alcohol themselves or have someone close to them with this life experience were more likely to strongly agree with the expansion of harm reduction (44%) compared to those that had not (25%) (Fig.6). One area where there appeared to be little difference between attitudes however, was in religiosity. Respondents were asked how important religion was in their life. Few differences (Fig. 7) were seen in strong support for the expansion of harm reduction amongst those who believe religion is “Very important” (33%), “Somewhat important” (34%), “Not very important” (32%) and “Not important at all “(32%).

Attitudes Towards Expanding Supervised Consumption Services (SCS)

Albertans were asked if they supported the expansion of “supervised consumption services” (SCS; where people consume drugs, get emergency care if they overdose, and have access treatment and other supports). Earlier this year the provincial government released a polarizing report on Alberta’s seven supervised consumption services. In the Viewpoint Alberta survey, almost half of all respondents (49%) indicated “Strongly agree” (19%) or “Somewhat agree” (30% ) with expanding supervised consumption services. The remainder expressed “Somewhat disagree” (18%), “Strongly disagree” (23%) and “Not sure/Don’t know” (10%) (Fig.4).

Respondents who identified themselves as living in suburban (23%) and urban (19%) settings were more likely to “Strongly agree” with the expansion of supervised consumption services versus those who lived in rural (15%) settings (Fig. 8). Political affiliation was also a factor in supporting the expansion of supervised consumption services. Respondents were asked, “In Alberta provincial politics, do you usually think of yourself as a: New Democrat, United Conservative, Alberta Party, Liberal, Green, Wildrose Independence Party, or none of these?” From the 3 primary parties, those who identified as NDP were most likely to strongly agree with the expansion of supervised consumption services (41%) followed by Liberals (26%) and UCP (9% ) (Fig. 9). Over half of rural respondents and half of UCP supporters strongly or somewhat disagreed with SCS expansion.

Attitudes Towards Safer Supply Programs

Safer supply programs have been proposed as a potential solution for the increase in overdose fatalities currently being seen in Alberta and across Canada. Research suggests that providing access to pharmaceutical grade opioids could potentially help to curb deaths associated with consuming highly toxic illegal drugs. The federal government has funded several ‘safer supply’ pilot programs, however the Alberta government has indicated it does not support this approach.

Viewpoint Alberta respondents were asked whether they agree with the following: “To address substance use and addiction issues, the Alberta government should: Support safer supply programs that replace illegal street drugs with pharmaceutical alternatives for those unable to stop using” (Fig. 4). Over half (58%) were in agreement with this statement, with 22% of respondents indicating “Strongly agree” and 36% stating “Somewhat agree.” A total of 17% stated “Somewhat disagree” while 12% indicated “Strongly disagree” and 13% stated “Not sure/don’t know.”

Once again we see that community setting and political affiliation are factors which affect support for safer supply programs. A quarter of suburban (24%) and 21% of urban respondents strongly agreed with expanding safer supply programs in comparison to 17% of rural residents (Fig.10). Differences in support also emerged by political affiliation. Those who think of themselves as NDP in provincial politics were most supportive (40%=Strongly agree), followed by those who saw themselves as Liberal (31% Strongly agree), and finally those who think of themselves as UCP (13% Strongly agree) (Fig. 11).

We also observed that those who had personal experience with substance use were more likely to strongly agree with expanding safer supply programs (Fig.12). When respondents were asked, “Have you or someone close to you ever struggled with drugs or alcohol?”, 27% of those who stated ‘Yes’ were in strong agreement of expanding safer supply vs. 17% of those who responded ‘No’ to this question.

Attitudes Towards Decriminalizing Illegal Drug Possession

Decriminalizing illegal drug possession for personal use has been suggested as a means of reducing stigma against people who use drugs and subsequently decrease barriers to seeking care within the health care system. This policy option has been endorsed by the Canadian Public Health Association, Canadian Association of Chiefs of Police, public health officials, researchers, and advocates working in the drug policy field. While the criminalization of illegal drugs is a federal matter, Canadian laws allow for the federal Health Minister to grant legal exemptions to federal drug laws. In line with this, Vancouver’s City Council recently passed a motion to formally request a federal legal exemption to allow for the decriminalization of personal use of illegal drugs within city limits.

To gauge their attitudes, Viewpoint Alberta respondents were presented with the statement, “To address substance use and addiction issues, the Alberta government should support efforts to decriminalize drug possession for personal use.” Respondents were split on this question with 45% of all respondents in agreement, 44% in disagreement and 12% indicating they were undecided or don’t know [specific proportions were: 17% “Strongly agree,” 28% “Somewhat agree,” 21% “Somewhat disagree,” 23% “Strongly disagree,” and 12% indicated “Not sure/Don’t know” (Fig.4)].

Once again, attitudes towards decriminalizing illegal drug possession for personal use were divided along party lines (Fig.13). Those who saw themselves as NDP in Alberta provincial politics were most likely to support the idea of decriminalization (28% Strongly agree); followed by Liberals (26 % Strongly agree) and theUCP (10% Strongly agree).

Feelings towards decriminalization of illegal drugs also varied by education (Fig.14). Respondents with a graduate or professional degree were most likely to Strongly agree (22% ) or Somewhat agree (31%) with decriminalization followed in succession by those with a post-secondary certificate/degree (17% Strongly agree & 28% Somewhat agree); some college or university (14% Strongly agree & 29% Somewhat agree); high school/GED (14% Strongly agree & 23% Somewhat agree); and less than high school (10% Strongly agree & 28% Somewhat agree).

Summary

In conclusion, most Albertans support further investments in substance use and addiction programs such as increasing awareness of substance use, supporting doctors who treat addictions and expanding access to treatment for substance use disorders. Opinions vary regarding decriminalization of illegal drugs for personal use, and just over half of Albertans support expanded access to a safer supply. While most Albertans expressed general support for an expansion of harm reduction services in the province, such support varies according to individual initiatives being proposed. Political party affiliation and a variety of demographic factors such as community size (urban/suburban/rural), gender, personal experience with substance use disorder, and, in some cases, level of education appear to impact people’s opinions of the various policy options put forth.

Methodology of the Viewpoint Alberta Survey

The 2020 Viewpoint Alberta Survey was conducted between August 17 and 30, 2020. The survey was deployed online by the Social Sciences Research Laboratories (SSRL). A copy of the survey questions can be found here: https://bit.ly/35rtU9F. SSRL co-ordinates the survey with an online panel system that targets registered panelists that meet the demographic criteria for the survey. Survey data is based on 825 responses with a 17-minute average completion time. 

The Viewpoint Alberta Survey was led by co-principal investigators Loleen Berdahl, Elaine Hyshka, and Jared Wesley. It was funded in part by an Alberta-Saskatchewan Research Collaboration Grant from the Kule Institute for Advanced Study at the University of Alberta and the College of Arts and Science at the University of Saskatchewan.