Danielle Smith's comments on opioid crisis draw return fire from Alberta doctors

Premier Danielle Smith is facing pushback from Alberta doctors over statements she made while defending a new piece of legislation.

The proposed bill amends the Health Statutes Amendment Act, 2024. It would ban gender-affirming surgeries for youth and restrict doctors from prescribing some medications.

Smith says it is designed as a guardrail to protect the health and safety of Alberta kids.

"The proposed changes would prevent regulated health providers — including doctors — from providing puberty blockers and hormone therapies to kids under 16," she said at the news conference announcing the bill on Thursday.

During that news conference, Smith was asked if the legislation could be seen as a direct attack on the medical independence of doctors. The premier responded by tying the actions of doctors to the present opioid crisis.

"Look, doctors were given a lot of latitude to prescribe opioids and now we have a fentanyl crisis as a result of inappropriate prescribing. And we've had to put guardrails around who can prescribe opioids, how they can be delivered," she said.

"I would say doctors aren't always right."

In response to Smith's comments, the Alberta Medical Association issued a news release stating physicians are not the reason for the opioid crisis.

Multi-system failure

The statement, written by Dr. Monty Ghosh and Dr. Sam Wong, called the opioid crisis a "multi-system failure of regulation." 

"Oxycontin was falsely marketed by Purdue and approved by the regulator, triggering the first wave of deaths," the statement said.

"Industry completely failed to fulfil its role to educate and advise prescribers on how to evaluate and mitigate risk while opioid manufacturers continue to influence government regulatory agencies."

The AMA statement did acknowledge that doctors' prescriptions for chronic pain may have led to an increase in opioid use, but "it was done with the best evidence at the time, in a manner which was best supporting patients who had severe pain concerns."

According to Lorian Hardcastle, who teaches in the faculties of law and medicine at the University of Calgary, the premier's reference to the opioid crisis was "a poor analogy."

"Most of the problematic behaviour in that case was driven by the pharmaceutical companies, and not the doctors," Hardcastle said.

But while she didn't like the premier's answer, she did like the question that prompted it. 

Hardcastle says she believes the proposed bill does intrude on the independence of health professionals working in the area of gender-affirming care, saying, "they may have their hands tied by the government in terms of the kind of care they can provide."

"In all the other areas of medicine, we allow professional bodies to develop those kinds of guidelines for treating patients," Hardcastle told CBC News.

She says governments don't have the level of expertise you'll find within regulating bodies, such as the College of Physicians and Surgeons. That's why it's important, Hardcastle says, that decisions like these be left to the trained professionals.

The changes introduced by Smith include:

• Minors under 15 would not be allowed to receive hormone therapy and puberty blockers. Patients who started the treatment before proclamation of the bill would be exempt. Minors who are 16 and 17 would be able to receive the medication with the approval of parents, a physician and psychologist.

• Physicians would be prohibited from performing top and bottom gender surgeries on minors. Bottom surgery is already restricted to patients over the age of 18. All surgeries are currently performed in Quebec.

According to the AMA statement, hormone blockers are not addictive and are usually stopped after a few years without any significant side-effects. 

"In fact, hormone blockers have no effect on fertility," Ghosh and Wong write.

"Let us be clear that adolescents are not making these decisions in isolation and parents are involved in the decision-making. These changes actually impinge on the rights of parents to make medical decisions for their children, whom they know the best."

They echo Hardcastle's concerns about decisions being taken out of the hands of trained professionals. 

"Alberta's health-care system is strained and the focus must be on comprehensive, lifelong care. We need to stick to evidence-based approaches when dealing with medical matters," the statement said.

Hardcastle says she's worried this legislation could open the door for the province to introduce limits in other aspects of health care, for example, in the area of reproductive rights.

"I think there is reason to be concerned when the government starts to deviate from professional self-regulation and to directly dictate to health professionals when certain treatments can and can't be performed," she said.