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Benzodiazepines 'a major problem' in illicit drug supply – CBC.ca

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Within a fraction of a second, Speedy says he knew something was wrong. 

In September, the longtime drug user, who didn’t want CBC to use his real name, unwittingly smoked fentanyl spiked with a benzodiazepine. 

He says he seized up and just managed to make it to a safe space before he lost control of his body. 

“For five hours, I just held on,” he said.

Benzodiazepine, which is typically prescribed as a sedative, is dangerous when paired with an opioid like fentanyl, because the sedation increases the risk of an overdose, according to Health Canada. Withdrawal symptoms can include extreme anxiety, sweats and dangerous seizures. 

Worst of all, the lifesaving medication naloxone, which brings someone out of an opioid overdose, does not work on benzos.

WATCH | Downtown Eastside drug user describes frightening experience with benzodiazepine:

Benzodiazepines on the rise in street opioids, drug checking services say

6 days ago

Duration 2:20

Speedy, who uses drugs, says benzodiazepines are a big problem in Vancouver’s Downtown Eastside. He accidentally ingested fentanyl spiked with benzos in 2021 and says he thought he was going to die. 2:20

Speedy, who works at the Overdose Prevention Society in Vancouver’s Downtown Eastside, says he’s seen the combination of the drugs become a “major problem.”

According to a report by the BC Coroners Service, “benzos” or “benzodope,” as it’s called in the street, is the new scourge of B.C.’s contaminated drug supply.

Some people are knocked out for hours or a whole day, and harm reduction sites say people passed out in a public place can be robbed or sexually assaulted while they’re unconscious. 

Speedy had a bad experience with fentanyl spiked with benzodiazepines on the Downtown Eastside. He managed to find a safe space, but he’s heard of people getting robbed or assaulted while on the drug. (Andrew Lee/CBC)

‘It’s everywhere’

Like fentanyl when it was first introduced, benzos started popping up randomly in drug checking and now it’s everywhere, says Sarah Blyth, the executive director of the Overdose Prevention Society. 

“People completely black out, they don’t know who they are sometimes, where they are,” she said. “It’s leaving people with long-term damage, if they don’t die.”

Between July 2020 and October 2021, the detection rate of benzodiazepines in B.C. went from 15 per cent to 53 per cent, according to the BC Coroner Service’s Illicit Drug Toxicity report in December. 

Fentanyl is still detected in an overwhelming majority of illicit drug deaths and drug samples, but the unpredictability and potency of these other substances are making the supply more dangerous, says the report. 

Advocates for safe supply can only speculate why benzos are having such a moment in opioids right now, but Blyth puts it down to the unregulated supply, which continues to allow more unpredictability and volatility in the drugs. 

Sarah Blyth from the Overdose Prevention Society says benzodiazepines are ‘a whole other level of terrible’ in the drug supply. She says the benzos in the supply are making it harder to bring people back from overdoses. (Andrew Lee/CBC)

“It’s just a mishmash of whatever’s under your kitchen sink,” she said.

‘We can’t keep up’ 

Benzodiazepines exist in some of the most commonly prescribed medications. They’re often used as sedatives because of their ability to calm the brain, and are used to treat people with sleep, seizure or anxiety disorders. 

Types of benzos can be found in medicines like Valium and Xanax.

But the danger for drug users is the combination of strong benzodiazepines with potent opioids. 

It’s getting harder for harm reduction services to give users enough information to plan their drug use, says Karen McDonald, the lead for Toronto’s drug checking service, which operates out of St. Michael’s Hospital. 

She said they’ve found 13 different types of benzos in Ontario, and some aren’t even prescribed in Canada. 

“It’s consistently changing. We feel like we can’t keep up with how many new drugs are coming in and out.”

A guessing game

It’s been one year since Dean Wilson took opioids spiked with a benzodiazepine. The former drug user and co-founder of the Vancouver Area Network of Drug Users (VANDU) says he didn’t realize he’d inadvertently taken benzos until he was coming down off the drugs. 

He didn’t sleep for six days. 

Bruce Wallace, an associate professor at the University of Victoria’s school of social work, says it’s normal now that most opioids tested in Victoria will include a benzodiazepine. (Mike McArthur/CBC)

Many drug users are unknowingly ingesting benzos, says Dr. Paxton Bach, a medical director at the British Columbia Centre on Substance Use (BCCSU). He describes it as a “nightmare.” 

“We don’t know what people are using. They don’t know what they’re using,” said Bach. 

The mystery is especially concerning when a person is withdrawing from benzos. Detoxing from these substances is dramatic and, unlike fentanyl withdrawal, patients must be monitored in a hospital setting, Bach says. 

The way the body becomes dependent on the substance over time means the brain is unable to function without it, Bach says. Tremors, sweats, nausea, extreme anxiety and even seizures form part of the dangerous withdrawal. 

“Anyone who uses drugs daily now is going to have benzos in their system. The question is, how much, what kind?”

Keeping people alive 

While visiting a drug-checking site in Victoria, B.C., recently, CBC watched an attendant scrape an unknown powder into a small paper cup and pour it into a plastic tube. Methanol was added to dilute the substance and a skinny paper strip was inserted. 

A few minutes later, the opioid sample was confirmed to contain benzos.

It’s the norm that most opioids tested in Victoria will include a benzodiazepine, says Bruce Wallace, who works with the Victoria Drug Checking Program and is an associate professor at the University of Victoria’s school of social work. 

Their job isn’t just to provide test results for illicit substances, but to help drug users make informed decisions, says Wallace.

What drugs are safe to consume and in what amount — these are the questions they try to solve with costly lab equipment. But he says even that can be difficult. 

“To have an opioid with a benzodiazepine, and having a whole range of benzodiazepines … [it’s] challenging to try to figure out what does that really mean to somebody using that substance,” said Wallace. 

Fear of unpredictability

For drug users like Jarret McConnell, knowing what’s in his drugs is a lifesaver. 

He had the drugs in his pocket tested by a facility in Vancouver and told CBC they were found to contain 15 per cent fentanyl and six per cent benzodiazipines, among a range of other ingredients. 

Jarret McConnell says he’s bought fentanyl spiked with benzodiazepines, but he’s not sure if he’s addicted to it yet. (Andrew Lee/CBC)

He says the amount of benzos in the drugs doesn’t concern him, because he buys them from the same dealer every time. Even so, he admits the increasing potency and unpredictability is worrying. 

McConnell says he’s making plans to stop using drugs soon, before the contaminated supply claims his life. 

“That scares me and I don’t want to be sent back to where my mum is … where she has to see me with a toe tag over a benzo overdose,” he said. “I don’t want that.” 

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Over 1.2 million people died from drug-resistant infections in 2019 – study

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More than 1.2 million people died in 2019 from infections caused by bacteria resistant to multiple antibiotics, higher than HIV/AIDS or malaria, according to a new report published on Thursday.

Global health officials have repeatedly warned about the rise of drug-resistant bacteria and other microbes due to the misuse and overuse of antibiotics, which encourages microorganisms to evolve into “superbugs”.

The new Global Research on Antimicrobial Resistance report, published in The Lancet, revealed that antimicrobial resistance (AMR) was directly responsible for an estimated 1.27 million deaths and associated with about 4.95 million deaths. The study analysed data from 204 countries and territories.

“These new data reveal the true scale of antimicrobial resistance worldwide… Previous estimates had predicted 10 million annual deaths from AMR by 2050, but we now know for certain that we are already far closer to that figure than we thought,” said Chris Murray, co-author of the study and a professor at the University of Washington.

Last year, the World Health Organization warned that none of the 43 antibiotics in development or recently approved medicines were enough to combat antimicrobial resistance.

Cornelius Clancy, professor of Medicine at the University of Pittsburgh, said one of the ways to tackle AMR is to look at a new treatment model.

“The traditional antibiotic model that we’ve had for past number of decades since penicillin. I think it is tapped out.”

Most of 2019’s deaths were caused by drug resistance in lower respiratory infections such as pneumonia, followed by bloodstream infections and intra-abdominal infections.

AMR’s impact is now most severe in Sub-Saharan Africa and South Asia, while around one in five deaths is in children aged under five years.

There was limited availability of data for some regions, particularly many low and middle-income countries, which may restrict the accuracy of the study’s estimates.

Clancy said the focus has been on COVID-19 for the past two years, but AMR is a “long-term kind of challenge”.

 

(Reporting by Mrinalika Roy in Bengaluru; Editing by Krishna Chandra Eluri and Devika Syamnath)

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Study casts doubt on reliability of rapid antigen tests in kids; COVID transmission through breastmilk unlikely

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The following is a summary of some recent studies on COVID-19. They include research that warrants further study to corroborate the findings and that has yet to be certified by peer review.

Rapid antigen tests may be unreliable in children

When used in children, rapid antigen tests for detecting the coronavirus do not meet accuracy criteria set by the World Health Organization and U.S. and UK device regulators, according to researchers who reviewed 17 studies of the tests.

The trials evaluated six brands of tests in more than 6,300 children and teenagers through May 2021. In all but one study, the tests were administered by trained workers. Overall, compared to PCR tests, the antigen tests failed to detect the virus in 36% of infected children, the researchers reported on Tuesday in BMJ Evidence-Based Medicine. Among children with symptoms, it missed 28% of infections. Among infected kids without symptoms, the tests missed the virus in 44%. Only about 1% of the time did the tests mistakenly diagnose the virus in a child who was not actually infected.

Given that more than 500 antigen tests are available in Europe alone, the authors said, “the performance of most antigen tests under real-life conditions remains unknown.” But the new findings “cast doubt on the effectiveness” of rapid antigen tests for widespread testing in schools, they concluded.

Breastmilk transmission of COVID-19 unlikely

A new study appears to confirm smaller, earlier studies that suggested nursing mothers are unlikely to transmit the coronavirus in breastmilk.

Between March and September 2020, researchers obtained multiple breastmilk samples from 110 lactating women, including 65 with positive COVID-19 tests, 36 with symptoms who had not been tested, and a control group of 9 women with negative COVID-19 tests. Seven women (6%) – six with positive tests and one who had not been tested – had non-infectious genetic material (RNA) from the virus in their breastmilk, but none of the samples had any evidence of active virus, according to a report published on Wednesday in Pediatric Research. Why breastmilk would contain coronavirus RNA but not infectious virus is unclear, said study leader Dr. Paul Krogstad of the David Geffen School of Medicine at UCLA, “Breastmilk is known to contain protective factors against infection, including antibodies that reflect both the mother’s exposure to viruses and other infectious agents and to vaccines she has received,” he noted.

The U.S. Centers for Disease Control and Prevention (CDC) advises that before breastfeeding, bottle-feeding, or expressing milk, women with COVID-19 should wash their hands or use hand sanitizer with at least 60% alcohol. The CDC also recommends that they wear a mask when within 6 feet (1.8 meters) of the baby.

New technique may speed vaccine, antibody drug development

Researchers are working on a way to speed development of vaccines and monoclonal antibody drugs for COVID-19 and other illnesses, shortening the time from collection of volunteers’ blood samples to identification of potentially useful antibodies from months to weeks.

As described in Science Advances on Wednesday, the new technique employs cryo-electron microscopy, or cryoEM, which involves freezing the biological sample to view it with the least possible distortion. Currently, “generation of monoclonal antibodies involves several steps, is expensive, and typically takes somewhere on the order of two to three months, and at the end of that process you still need to perform structural analysis of the antibodies” to figure out where they attach themselves to their target, and how they actually work, explained Andrew Ward of Scripps Research Institute in La Jolla, California.

In experiments using the new approach to look for antibodies to HIV, “we flipped the process on its head… by starting with structure,” Ward said. Because cryoEM affords such high resolution, instead of having to laboriously sort through antibody-producing immune cells one by one to identify promising antibodies, the process of identifying antibodies, mapping their structure and seeing how they are likely to attack viruses and other targets goes much faster, he added. “The ongoing COVID-19 pandemic has highlighted the need for such robust and rapid technologies,” his team concluded.

Click for a Reuters graphic on vaccines in development.

 

(Reporting by Nancy Lapid; Editing by Bill Berkrot)

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Vaccination plus infection offered most protection during Delta surge, U.S. study shows – CBC News

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Protection against the previously-dominant Delta variant was highest among people who were both vaccinated and had survived a previous COVID-19 infection, according to a report published Wednesday by the U.S. Centers for Disease Control and Prevention (CDC).

The report also found those who had previously been infected with COVID-19 were better protected against the Delta variant than those who were vaccinated alone, suggesting that natural immunity was a more potent shield than vaccines against that variant, California and New York health officials reported on Wednesday.

Protection against Delta was lowest among those who had never been infected or vaccinated, the CDC report continued.

“The evidence in this report does not change our vaccination recommendations,” Dr. Ben Silk of the CDC and one of the study’s authors told a media briefing.

“We know that vaccination is still the safest way to protect yourself against COVID-19,” he said.

The findings do not apply to the Omicron variant of the virus, which now accounts for 99.5 per cent of COVID-19 cases in the United States.

Study includes data from May to November

For the study, health officials in California and New York gathered data from May through November, which included the period when the Delta variant was dominant.

It showed that people who survived a previous infection had lower rates of COVID-19 than people who were vaccinated alone.

That represented a change from the period when the Alpha variant was dominant, Silk told the briefing.

“Before the Delta variant, COVID-19 vaccination resulted in better protection against a subsequent infection than surviving a previous infection,” he said.

In the summer and fall of 2021, however, when Delta became the predominant circulating iteration of the virus in the United States, “surviving a previous infection now provided greater protection against the subsequent infection than vaccination,” he said.

But acquiring immunity through natural infection carries significant risks. According to the study, by Nov. 30, 2021, roughly 130,781 residents of California and New York had died from COVID-19.

The analysis did not include information on the severity of initial infection, nor does it account for the full range of illness caused by prior infection.

One important limitation to the study was that it ended before administration of vaccine booster doses was widespread.

WATCH | Experts agree the science behind booster shots is sound:

The safe science behind COVID-19 booster shots

5 days ago

Duration 1:55

While some Canadians who have received their booster shots have later tested positive for COVID-19, medical experts agree that the science behind booster jabs is sound. 1:55

‘Clearly shows’ vaccines provide safest protection

Dr. Erica Pan, state epidemiologist for the California Department of Public Health, said in an email that the study “clearly shows” that vaccines provide the safest protection against COVID-19 and they offer added protection for those with prior infections.

“Outside of this study, recent data on the highly contagious Omicron variant shows that getting a booster provides significant additional protection against infection, hospitalization and death,” Pan said.

Silk said the CDC is studying the impact of vaccination, boosters and prior infection during the Omicron surge and expects to issue further reports when that data becomes available.

So far, Omicron has proven to evade some level of immunity from both vaccination and previous infection, but vaccines are still largely preventing serious illness and death.

An Israeli hospital on Monday also said preliminary research indicates a fourth dose of leading mRNA-based vaccines provides only limited defence against infection from the variant.

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