As deaths from opioid abuse began soaring across Alberta in 2014, the province's public drug program was spending less to treat addictions to the substances than any other province: only 5.7 cents for every dollar that went toward prescription painkillers.
Alberta spent $1.1-million on medication for opioid dependence in 2014, according to figures the Canadian Institute for Health Information compiled for The Globe and Mail. That same year, Alberta's public drug program spent $18.1-million on opioids.
Once reserved for terminal cancer patients or those in extreme pain, the most popular type of opioid had become Alberta's seventh-most-prescribed drug by 2014. That was not unusual compared with other Canadian provinces at the time and public health experts warned the province was becoming addicted to powerful painkillers. However, its low spending on medication to treat opioid dependence made it "an outlier," said Hakique Virani, a public-health specialist based in Edmonton.
"It does not make a lot of sense that we continue to spend so many times more on opioid prescriptions than treatment, and the cost of drugs is just the tip of the iceberg when it comes to the opioid burden," Dr. Virani said.
Spending less on treatment, he warned, could increase the province's costs for emergency room visits, hospital care, emergency response, law enforcement and incarceration.
With the increase in legal painkillers came an explosion in illicit opioids, and patients who had overdosed on legal and illegal versions of the drug fentanyl became common in the province's emergency rooms in late 2014. In Alberta, 120 people died from overdosing on the drug in 2014 and 274 died the next year.
A recent Globe investigation found that Ottawa and the provinces failed to take adequate steps to stop doctors from indiscriminately prescribing highly addictive opioids for chronic pain. In 2015, doctors wrote 53 opioid prescriptions for every 100 people in Canada, according to figures compiled for The Globe by IMS Brogan, which tracks pharmaceutical sales.
Three provinces – PEI, Newfoundland and Labrador, and New Brunswick – spent more on addiction treatment than opioids in 2014. British Columbia spent 94 cents on treatment for every dollar spent on opioids. In Saskatchewan, the figure was 11.4 cents.
The Globe contacted Health Minister Sarah Hoffman's office and Alberta's department of health for this story. After being given a week to examine the data from CIHI, the Alberta government said the numbers do not represent the province's spending, but would not provide official figures for 2014.
"It is not appropriate to compare opioid and opioid dependency treatment spending using this CIHI data," Gaïtane Villeneuve, a spokeswoman for Alberta Health, wrote to The Globe.
The government released partial figures for 2015-2016 in response to The Globe's inquiries. Alberta's public drug plan spent about $51-million on opioids last year and $6-million on dependency treatment. That is about 11 cents for treatment on every dollar spent on painkillers.
Alberta's College of Physicians and Surgeons is monitoring doctors' prescriptions in the province and warning physicians who have multiple patients on very high daily doses of opioids about the potential for abuse. It is also putting the final touches on a system that will provide every physician in the province with a report showing how many opioids they prescribe and how that compares to the average.
"We're certainly one of the jurisdictions with the highest opioid use in the country. It's a big problem to tackle and it won't be tackled just by having physicians turn off the tap," the college's registrar, Trevor Theman, said.
The college is also preparing a new standard of practice that seeks to limit the use of opioids, making it clear to physicians they should not prescribe them for chronic, non-cancer pain.
Ms. Hoffman told The Globe health spending has "budgetary challenges," but the government is looking at ways to increase options for addiction treatment.
"The gap is something we've inherited," she said of the deep difference between spending on opioids and treatment.
"Our intent is to move forward in providing more treatment, and that's one of the reasons why we've put a $3-million grant to [the Alberta Health Service] around … treatment clinics," Ms. Hoffman said.
The one-time grant has helped finance a clinic in southern Alberta that provides treatment spaces for opioid addictions, the minister said. Two more clinics are planned. However, the Health Minister could not say whether the province was prepared to spend an additional $40-million annually to bring its spending on treatments to a level closer to that of B.C.
The Alberta Adolescent Recovery Centre in Calgary, which has treated teenagers for addiction during the province's fentanyl crisis, currently has 21 patients. The 26-year-old centre gets no government funding, despite repeated requests.
"It's a huge frustration for us," said Jackie Smith, the centre's director of community education and research. "We've been talking about a public health crisis and we spend so little, it's very counter-intuitive. The solution is not aligning with the problem."
Instead of increasing funding for treatment, she said, Ms. Hoffman's office has concentrated on making a drug known as naloxone more readily available. Naloxone can reverse the symptoms of an overdose, but is not a form of treatment – it is to be used in a crisis.
"Optic-wise, naloxone looks incredible for the government, they are dealing with the crisis, but are they really treating addiction," Dr. Smith asked.
With a report from Karen Howlett in Toronto