Alberta government report on supervised consumption 'pseudoscience,' says medical journal

An Alberta government report that influenced safe drug consumption policy is so badly flawed it's harming people and should be withdrawn, says a new study in a prominent medical journal.

The paper, published Monday in the Canadian Journal of Public Health, calls the government's 2019 report into seven supervised consumption sites "pseudo-science." It says the United Conservative-commissioned study is irredeemably flawed by bias against safe consumption sites, in which drug addicts can use illegal substances in a safe and supervised environment.

"It is critical that the report be retracted by the Alberta government and that any of its scientifically trained authors distance themselves immediately from its contents," the new study says. "It is fundamentally methodologically flawed, with a high risk of biases that critically undermine its authors’ assessment of the scientific evidence."

A spokesman for Alberta Health downplayed the report's influence on policy, saying funding was pulled from a Lethbridge site over financial irregularities. Hunter Baril said the government remains willing to fund safe consumption sites.

However, Ginatta Salvalaggio, professor of family medicine at the University of Alberta, said after the report was released in 2020, all plans for new sites in the province were cancelled.

"There's decisions being made on the basis of the data that they present that aren't put up to sufficient scrutiny," she said.

Salvalaggio and her 13 co-authors find three major sources of bias in the government report.

It finds the report presupposed conclusions that consumption sites were harmful and selected evidence to reinforce that.

"The review … explicitly excluded any positive health and social impacts of (consumption sites)," it said. "The report also does not present a balanced account of the information collected throughout the review, emphasizing anecdotes that support the government’s ideological position."

As well, the government study relied on "systematically imprecise measurement," the authors say.

It also failed to examine evidence or studies that contradicted its findings.

"Failure to situate results within existing literature that contradicts a study’s claims increases the risk of confirmation bias when drawing conclusions and undermines the development of evidence-based recommendations," it says.

Scientists rely on peer review to safeguard against bias. Unlike Salvalaggio's paper, the government study was not peer-reviewed.

Salvalaggio said the study wouldn't pass such a test — "not in its current form."

Despite its flaws, Salvalaggio said the study has been influential. It has been cited as far away as a Philadelphia civil case, which resulted in a consumption site not being allowed to open.

"The public needs to understand that this is a dangerous path," she said. "We're already seeing it with other similar reviews out there, for example, safer supply."

The government has also commissioned reports or inquiries into non-health-related fields, including a proposed Alberta pension plan and the impacts of renewable energy development.

Monday's article is not the first to criticize the safe consumption study. A 2021 paper in Harm Reduction Journal by a criminologist said the government study distorted police data and relied heavily on public perception to suggest the sites help increase in crime, despite findings in other peer-reviewed studies.

Baril didn't defend the study, but said the government doesn't oppose safe consumption sites.

"We continue to provide services such as drug consumption sites while also balancing the safety and well-being of communities," he said in an email.

He said the government has funded more than 10,000 new addiction treatment spaces while removing the $40-a-day user fee.

Baril said the government is working with an Edmonton agency to find a new location for a safe consumption site that was closed.

"We remain willing to fund the program."

Meanwhile, Salvalaggio points out 2023 is on track to be the deadliest year for opioid deaths in the province. Newly released numbers put the toll to the end of August at 1,350.

"We're just trucking along at record levels," Salvalaggio said.

This report by The Canadian Press was first published Nov. 7, 2023.