Lethbridge Harm Reduction
History of the Epidemic
To gain an understanding of how the community of Lethbridge is facing both an opioid and methamphetamine crisis, the past should be taken into consideration. By the 1950s both synthetic opioids (particularly oxycodone) and amphetamines were being prescribed for a range of medical conditions [1][2], and through fraudulent and aggressive pharmaceutical promotion, the market grew exponentially [1][2]. But, as more surveillance on drug prescribing occurred, those who obtained their substances from doctors sought to find their drugs elsewhere; and through the Narcotic Act in 1961, punishment for the use of street drugs became harsher than ever before [3].
As substance use disorder became increasingly pervasive, in 1976 the South Country Treatment Centre opened in Lethbridge, followed by ARCHES in 1986 [4][5]. By the 2000’s the dangers of pharmaceutical promotion of opioids became recognized and led to several Alberta communities creating drug coalitions to deal with their local problems [1], including the Alberta Law Enforcement Response Teams (ALERT) in 2005 [6], and the more current Coalition on Opioid Use in 2016 [7]. In 2004, a survey on addiction was released and found 6.1% of Albertans aged 15 or older had used amphetamines [1] placing the province in third as “highest rate of lifetime users” [8]. As the need for these substances grew, so did drug seizures from law enforcement. Compared to 1999, in 2005 methamphetamine seizures in Alberta increased sevenfold [8], and between 2014 and 2015 increased 35% with quantities rising 42% [9]. In this same period, opioid seizures increased 60% and their quantities by 728% [9].
Non-medicinal opioid use continued to rise, becoming the fourth most common misused substance [10], and at this point, since the 1980s, medicinal prescriptions had increased by over 3000% [11]. After a longitudinal study was completed in 2012, the Government of Canada formally announced that oxycodone, which was being prescribed at astronomical rates for pain-alleviation, was an addictive substance despite what pharmaceutical companies were suggesting, and pulled it from the market [12]. As opioid users who were obtaining their substances through the medical system had lost their supply; they were forced to turn to street drugs. As such, heroin use was expected to upsurge, but by around 2014, its rising cost and limited supply created a gap, one that was filled by fentanyl, a substance much easier and cheaper to produce [12]. Consequently, the opioid epidemic ensued.
In 2017, Canada reported 4000 opioid-related deaths, an increase of 33% compared to the previous year [13]. 733 of these deaths originated in Alberta [14], 15 of which were from Lethbridge [15]. In February of 2018, the opening of the Supervised Consumption Site (SCS) program, operated by ARCHES, marked an important effort in addressing the needs of drug users in Lethbridge. 2018 also marked the opening of the Lethbridge Treatment Center (Detox) [16], and the community group SAGE Clan [17]. Simultaneously there was a national increase in drug offenses, with Lethbridge ranking second for the highest rate related to opioids [18]. Also, the city's crime severity index increased, which included a 14% increase in violent crimes [18], and the cities ranking went from 26th place in 2016 [19] to 3rd place in 2019 [20] for the “most dangerous place to live in Canada”. These statistics in the media encouraged public fear and further hostility towards those with addictions, primarily persons making use of SCS; even though no reports link the crime to its arrival. In contrary to the statistics above, the ARCHES 2019 report stated that when the SCS opened in 2018, crime had increased by 13.05%, yet this was lower than the predicted levels for that period [21]. Subsequently came the implementation of The Watch, a volunteer-based patrol program for Lethbridge’s downtown [16] as well as an increased community effort to band together in reporting crimes [22].
City Demographics
Lethbridge has a population of 101,482 residents [23] and has a trading area that serves nearly 342,000 people in the region [24]. Lethbridge is growing in diversity with over 15% of the population with English as a second language; immigrants account for 11.6% of the population [25]. The population growth is steady at an average of 1.41 % each year over the past three years [23]. The unemployment rate for Lethbridge is 4% which is below the average for Canada at 5.2 % [25]. In 2018, 223 people in Lethbridge were experiencing homelessness, and 73 % of that population self-identified as Indigenous [26]. The average income for residents in Lethbridge is $48, 771 with the median income being $54,496 [25].
According to the 2016 census data, Lethbridge is home to 6132 people of Aboriginal identity [25]. The Lethbridge south zone region is within Treaty 7 and includes the Kainai, Piikani, Siksika, Tsuu T’ina Nations, and the Nakoda Nations. These Nations have been impacted by the opioid crisis disproportionately as reported by Health Canada [11]. For example, in Alberta, “First Nations individuals were five times more likely than non-First Nations people to be hospitalized and six times more likely to present at an Emergency Department [sic] for opioid poisoning” [11]. According to the First Nations Health Authority (2017), “oppressive and assimilationist colonial policies and practices… including the residential school system as a key contributor to historical trauma... threaten cultural identities and have contributed to high rates of suicide, depression, anxiety, substance abuse and despair” [27].
The information within this website may seem exasperating to those who are feeling personally victimized through increased theft, fear, and concerns of safety, and although these feelings are valid, it is important to better understand the innate societal structures that are providing our perception of reality. Yes, drug use in the community is prevalent, and abstinence and criminalization may seem logical, yet this “War on Drugs” is not effective; and seeing those with substance use disorder as criminals instead of individuals in need of help only squanders resources and creates a divided mentality of “us versus them”. This divide is disadvantageous to both community cohesion and individual growth.
It has been recognized how a crisis can contribute to one of two outcomes, community action or retreat [28], and Portugal is a prime example of a country implementing community action with a crisis similar to Lethbridge. By focusing on public health instead of incarceration, Portugal stopped their opioid epidemic [29]. Their community shifted their efforts to harm reduction and treatment through the decriminalization of all illicit substances, thereby dramatically reducing problematic drug use, HIV and hepatitis infection rates, overdose deaths, drug-related crime, and incarceration rates [30]. Although Lethbridge may not yet be able to comprehend decriminalization of the possession and consumption of drugs, treating people with dignity is basic human decency, and right now a dramatic cultural shift in how our society views drugs and those who use them is essential.
Social change is uncomfortable, as it involves an awareness of the current power imbalances within our cultural norms, and forces individuals to recognize the role they play both in the oppression of others and the current limitations they believe the community has; this makes resistance understandable as it is incredibly difficult to question what one has always known. However, change may also create feelings of uncertainty, and these internal and external doubts surrounding one’s own environmental (resources in the area), economic (financial wealth), human (skills and health), political (policy setting), informational (knowledge), and social (norms and interrelationships) capital may jeopardize community interrelationships and reinforce intolerance, oppression, and authoritarian rigidity [28]; As such, change is crucial.
It is important to recognize that substance use will always exist, and although the focus is placed on marginalized groups most vulnerable to substance use disorder, it is an issue spread across all classes. Knowing this, it is imperative to shift our approach to what is best for all of those within the community, which begins with understanding, empathy, and compassionate language. Barriers, obstacles, and setbacks are common with change; yet through creative solutions, it is possible to develop an inclusive and healthy community [28].
[1] Alberta Alcohol and Drug Abuse Commission [AADAC]. (2006). Methamphetamine: What we know about it, what we’re going about it. Edmonton, AB: AADAC. (p.21)
[2] Ubelacker, S. (2017). The inside history of Canada’s opioid crisis. https://www.macleans.ca/society/inside-the-history-of-canadas-opioid-crisis/
[3] Canadian Centre for Addictions. (2016). The history of drug abuse in Canada. https://canadiancentreforaddictions.org/history-of-drug-abuse-in-canada/
[4] South Country Treatment Centre. (2010). Our history. http://www.southcountrytreatment.com/history.asp
[5] ARCHES Lethbridge. (n.d.). About us. https://lethbridgearches.com/new-about-us-page/
[6] Alberta Law Enforcement Response Teams (ALERT). (2020). About alert. https://alert-ab.ca/about-alert/
[7] City of Lethbridge. (n.d.). Coalition on Opioid Use. https://www.lethbridge.ca/living-here/Our-Community/Pages/Coalition-on-Opioid-Use.aspx
[8] Canada Department of Justice. (2019). Methamphetamine report for federal-provincial-territorial ministers responsible for justice. https://www.justice.gc.ca/eng/rp-pr/other-autre/meth/p3.html
[9] Russell, A. (2017). These 9 maps show where Canada’s illegal drugs are coming from. Global News. https://globalnews.ca/news/3636788/these-9-maps-show-where-canadas-illegal-drugs-are-coming-from/ (para. 10, para. 9)
[10] Fischer, B., & Rehm, J. (2009). Deaths related to the use of prescription opioids. Canadian Medical Association Journal (CMAJ), 181(12), 881-882. https://doi.org/10.1503/cmaj.091791
[11] Belzak, L., & Halverson, J. (2018). Evidence synthesis-The opioid crisis in Canada: A national perspective. Health Promotion and Chronic Disease Prevention in Canada: Research, Policy and Practice, 38(6), 224. (p. 4, p. 228)
[12] Kingston, A. (2018, May 11). A criminal investigation into opioid marketing would expose larger systemic rot. Macleans.ca. https://www.macleans.ca/society/health/a-criminal-investigation-into-opioid-marketing-would-expose-larger-systemic-rot/.
[13] International Narcotics Control Board. (2018). Report of the International Narcotics Control Board for 2018: Chapter III. analysis of the world situation. https://www.incb.org/documents/Publications/AnnualReports/AR2018/Annual_Report_Chapters/05_Chapter_III_Annual_Report_2018_E_.pdf(p.60)
[14] Gillespie, C. (2019). Unravelling drug addiction: Addiction knows no boundaries. https://lethbridgecollege.ca/wider-horizons/winter-2019/unravelling-drug-addiction-addiction-knows-no-boundaries (p.1)
[15] Government of Alberta. (2019). Alberta opioid response surveillance report: Q3 2019. https://www.alberta.ca/assets/documents/opioid-substances-misuse-report-2019-q3.pdf (p.10)
[16] Mahoney, A. (2018). Eight bed detox centre now open at Chinook Regional Hospital. https://lethbridgenewsnow.com/2018/11/27/eight-bed-detox-centre-now-open-at-chinook-regional-hospital/
[17] Bobinec, G. (2019, July 3). SAGE Clan offers help to homeless. Lethbridge Herald.https://lethbridgeherald.com/news/lethbridge-news/2019/07/03/sage-clan-offers-help-to-homeless/
[18] Moreau, G. (2019). Police-reported crime statistics in Canada, 2018. https://www150.statcan.gc.ca/n1/pub/85-002-x/2019001/article/00013-eng.htm (para. 16)
[19] Campbell, Q. (2017, November 30). Lethbridge ranked 26th in list of 229 most dangerous centres in Canada: Report.Global News. https://globalnews.ca/news/3888677/lethbridge-ranked-26th-in-list-of-229-most-dangerous-centres-in-canada-report/
[20] Macleans. (2020). Canada’s most dangerous places 2019. https://www.macleans.ca/canadas-most-dangerous-places-2019/
[21] ARCHES. (2019). Report to mayor and city council. https://lethbridgearches.com/wp-content/uploads/2019/08/Report-to-Mayor-and-City-Council-Final.pdf (p. 6)
[22] Ferris, D. (2019). Lethbridge neighbors band together against community crime. Global News.https://globalnews.ca/news/5670499/north-lethbridge-crime-community-concerns/
[23] City of Lethbridge. (2019). Lethbridge census online: 2019 census results.https://www.lethbridge.ca/CityGovernment/Census/Documents/2019%20Final%20Census%20Report.pdf
[24] World Population Review. (2020). Lethbridge population 2020. http://worldpopulationreview.com/world-cities/lethbridge-population/
[25] Statistics Canada. (2019, August 9). Census profile, 2016 report: Lethbridge [Population centre], Alberta and Alberta [Province]. https://www12.statcan.gc.ca/census-recensement/2016/dp-pd/prof/details/page.cfmLang=E&Geo1=POPC&Code1=0467&Geo2=PR&Code2=48&SearchText=Lethbridge&SearchType=Begins&SearchPR=01&B1=All&GeoLevel=PR&GeoCode=0467&TABID=1&type=0
[26] Homeless Hub. (2019). Lethbridge. https://www.homelesshub.ca/community-profile/lethbridge
[27] First Nations Health Authority. (2017). Overdose data and First Nations in BC: Preliminary findings. https://FNHA_OverdoseDataAndFirstNationsInBC_PreliminaryFindings_FinalWeb_July2017.pdf (p. 2)
[28] Parada, H., Barnoff, L., Moffatt, K. & Homan, M.S. (2011). Promoting community change: Making it happen in the real world (1st Canadian Ed.). Toronto, ON: Nelson Education. (p. 65, p. 50)
[29] Clay, R. A. (2018). How Portugal is solving its opioid problem. https://www.apa.org/monitor/2018/10/portugal-opioid
[30] Bajekal, N. (2018, August 1). Want to win the war on drugs? Portugal might have the answer. https://time.com/longform/portugal-drug-use-decriminalization/