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Canada gets new guidelines to recognize and treat high-risk drinking

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At half a bottle of wine a day, Lynn thought of herself as a “casual drinker.” The 53-year-old Vancouver resident owns a small business where socializing with alcohol is common.

When she began experiencing symptoms of depression, she chalked it up to social isolation during the COVID-19 pandemic. She got a prescription for antidepressants, but after a few months she saw no sign of improvement.

She did, however, find herself craving alcohol more often.

“I was drinking faster, I was drinking more,” she recalled. “I was getting up to go to the liquor store to start my day.” (CBC News agreed not to use Lynn’s last name because she feared the stigma associated with alcohol use disorder would hurt her business.)

Two papers published in CMAJ Monday underscore the dangers that high-risk alcohol use can pose to people like Lynn. The first explains that high-risk drinking often goes unrecognized and offers guidelines for treating it. And the second shows that certain kinds of antidepressants can drive some alcohol users to drink more.

High-risk drinking often goes unnoticed

Lynn’s initial daily intake of half a bottle of wine would make her a high-risk drinker, according to Canada’s guidelines on alcohol and health, updated in January. The fact that she considered it “casual” could be a sign of how prevalent this level of drinking has become: more than 50 per cent of people aged 15 and up in Canada drink more than recommended, according to the new guidance released Monday.

(No amount of alcohol is currently considered safe in Canada. To avoid serious health consequences, we’re advised to have no more than two drinks a week.)

New alcohol guidance warns more than 2 drinks per week risky

 

Featured VideoCanada’s new alcohol guidance warns that consuming more than two alcoholic drinks per week raises the risk of developing certain cancers, including breast and colorectal, and more than seven drinks a week also increases your risk of heart disease and stroke.

The new findings also show that high-risk drinking often goes unrecognized and untreated, as does alcohol use disorder (AUD) — defined as ongoing use and difficulty controlling drinking, even in the face of consequences.

“On the order of 95 to 99 per cent do not get effective medications for the treatment of craving of alcohol, or medications that can help prevent a relapse to alcohol,” said Dr. Evan Wood, co-author of the guidelines released Monday and Canada Research Chair in Addiction Medicine at the University of British Columbia.

The guidelines were developed by a committee of experts and those with lived experience. They’re the first national guidelines for high-risk drinking ever published in Canada.

They make 15 recommendations for family physicians, nurse practitioners and other health-care providers, ranging from how to ask about a patient’s alcohol use, to how to manage withdrawal symptoms and treat AUD over the long term.

Dr. Tim Naimi, director of the Canadian Institute for Substance Use Research at the University of Victoria and a primary care physician, said we’re all on different trajectories when it comes to drinking, but few are asked about it by their family doctors, if they have one.

“There are lots of people who sort of drink to the point of impairment on a pretty regular basis who may not qualify for an alcohol use disorder,” said Naimi, who was not involved with the guidelines. “But they’re contributing to domestic violence, to injuries, [experiencing] stomach problems.”

In 2017 alone, alcohol was linked to 18,000 deaths and cost Canadian health systems $5.4 billion.

A woman sits on a couch holding a mug, seen in profile with her dark hair covering her face
Lynn drinks tea at her home in Vancouver. She has gone nearly a year without alcohol. (Dillon Hodgin/CBC)

Alcohol and SSRIs can be dangerous mix

When Lynn went to her family physician about her depression, she was prescribed a common antidepressant that’s in a group of drugs called selective serotonin reuptake inhibitors, or SSRIs. Over six months, her mood didn’t improve. But her drinking rapidly escalated.

The feeling of suddenly craving hard liquor scared Lynn. She entered a detox program with Wood, who recommended she taper off her antidepressants and take an alcohol anticraving medication. As she did, her AUD symptoms improved.

While Lynn knew alcohol could interfere with medications, she said, she didn’t know SSRIs could make alcohol dependency worse.

“I was relating it to stress, anxiety, the pandemic,” Lynn said of her increased drinking. “Everything but the SSRIs.”

Four young adults with beer cans sit on a log at a public beach
People drink alcohol at a public beach in Vancouver, B.C. Drinking is normalized in Canadian society, public health physicians say. (Ben Nelms/CBC)

The second paper published in CMAJ on Monday uses a case study to illustrate how “SSRIs may not be effective for depressive symptoms in people with concurrent AUD, and may worsen alcohol use in some.”

Psychiatrist David Menkes of Hamilton, New Zealand, has treated and studied interactions between alcohol and medications for 20 years. He says SSRIs prescribed for low mood, anxiety or insomnia can aggravate AUD in some people like Lynn, leading to more cravings and an overwhelming compulsion to drink.

“A lot of these people who don’t have their substance use problems assessed or treated often get antidepressants,” Menkes said. “The horrible irony … is that it usually doesn’t help and it sometimes makes things worse.”

The new paper says it is reasonable for doctors to continue SSRIs in people with AUD whose depressive symptoms improve without their drinking increasing. It also recommends documenting a patient’s starting point for using substances, including alcohol.

Doctors stress that no one should stop use of SSRIs suddenly.

Lynn took a hard look at her alcohol use once people around her pointed out that she was no longer herself.

After entering detox treatment, she says, she turned her life around, drawing closer to her husband and improving her career.

Lynn no longer takes any medications. She’s been abstinent from alcohol for nearly a year.

Her advice to those watching a loved one struggle with alcohol, or struggling themselves: “Don’t be scared to take that first step.”

 

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Time limits were meant to speed up justice. They also halt hundreds of criminal cases

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When police turned up at Melanie Hatton’s home in Kelowna, B.C., in November 2021, she says they found her in the bathroom covered in blood, her then-husband Jeffrey Maclean was standing over her “in an aggressive manner.”

She describes a gruesome scene in a court filing, with blood from her head wound allegedly smeared on Maclean’s mouth from his whispering in her ear. The filing in a civil lawsuit against Maclean says he tolda 911 operator his wife was “bleeding like a pig.”

Hatton said police and prosecutors told her that the criminal case against Maclean in B.C. Supreme Court would be a “slam dunk,” and he was charged with assault causing bodily harm and resisting arrest.

But the case was thrown out in August 2023 — not for a lack of evidence, but because the Crown took too long to bring it to trial under a set of strict timelines that have reshaped the way criminal cases are handled since a landmark 2016 ruling by the Supreme Court of Canada.

Supporters say the so-called Jordan ruling has sped up proceedings and strengthened Charter rights for prompt justice.

But the legacy of Jordan is mixed, and some victims say the time limits work in criminals’ favour. Eight years into the rules, cases continue to collapse because the time limits are breached, although these represent a small fraction of all cases.

A review of statistics provided by provinces and territories shows that since the beginning of last year, more than 400 criminal cases countrywide have been dismissed, stayed or withdrawn as a result of Jordan challenges.

Among the defendants were some accused of sexual assault, child exploitation, fraud and drug trafficking; murder cases have also been thrown out in previous years.

The case against Maclean was among those dropped.

Hatton said she was thrown into “an absolute pit of despair and shame” after the case was thrown out.

Prosecutors blamed factors including COVID-19 and the availability of Maclean’s lawyer for the delays and the failure of the case.

Hatton thought otherwise, and sent a one-line email to the Crown prosecutor.

“I said ‘this is on you,'” said Hatton, who now lives in Ontario with the couple’s two children.

None of the allegations in Hatton’s civil suit against Maclean have been proven or tested in court, and in his response, Maclean “denies each and every allegation.”

A ‘REVOLUTIONARY’ RULING

The Jordan ruling imposed “a presumptive ceiling” of 18 months between charge and the actual or anticipated end of a trial in provincial court, and 30 months in superior courts.

Barring “exceptional circumstances,” exceeding those limits was deemed by the country’s top court to breach the Canadian Charter, which requires that criminal defendants “be tried within a reasonable time.”

Exactly how long “reasonable” meant was unclear until the high court’s ruling in R. V. Jordan.

The case would upend criminal law practice countrywide, but B.C. lawyer Tony Paisana, who was involved in the trial, didn’t know just how significant it would be at the time.

“Looking back, it’s certainly difficult to say that we, any of us, really expected this to come out the way that it did and how revolutionary it was going to be,” he said in an interview.

The case started modestly enough in December 2008 with the arrest of an alleged drug dealer named Barrett Jordan in Langley, B.C., along with a number of others who police accused of running a “dial-a-dope” operation.

It took more than four years from Jordan being charged to the end of his original trial.

He unsuccessfully argued that his Charter rights to a timely trial had been breached in both the B.C. Supreme Court and Court of Appeal before it ended up in the Supreme Court of Canada.

Paisana and colleagues Eric Gottardi and Richard Peck argued that the right to a timely trial went back hundreds of years, quoting the 1215 Magna Carta in their submissions.

Paisana said the high court’s decision in Jordan “completely achieved its intended objective, which was to speed up criminal trials.”

“And to have various judicial participants, that being the judge, the Crown, the defence, the accused, everyone start paying attention to the timeliness of trials,” he said.

“It was a chronic problem that existed in our system and Jordan was what we call in the law a ‘clarion call’ to change the culture that surrounded criminal trials.”

He said cases were stayed for unreasonable delays before this case, but Jordan established new thresholds.

“There’s just a greater confidence in the justice system when things are resolved more quickly,” he said. “I think it’s a net positive effect that the judgments had. It’s not without its controversy, but nothing that we do is without its controversy, frankly.”

The debate over Jordan was reignited in B.C. this summer, after a case was dismissed against a man accused of molesting a six-year-old.

Premier David Eby said at the time it was due to a “perfect storm” of delays, and that “not one case should be dismissed this way.”

The Jordan deadlines, he said, had been “very restrictive” and “devastating in other provinces.”

Among at least 409 Jordan challenges that ended cases across Canada since the start of last year were 26 in B.C., involving allegations ranging from fraud, to theft, drug and weapons offences, and sexual assault.

“Every case that is judicially stayed due to delay is a concern. Victims and the public expect to see cases determined on their merits and not dismissed because of unreasonable delay,” the B.C. Ministry of Attorney General said in a statement.

“We have taken this issue seriously and invested in transforming processes and increasing resources to prevent judicial stays,” the statement said.

In Maclean’s case, the B.C. Supreme Court found in August 2023 that his trial had been set “well beyond the Jordan limits,” through no fault of the defence, nor any delay caused by COVID-19 interruptions of court operations.

“If the Crown had not failed in its disclosure obligations,” the judge wrote, “the matter would have likely concluded within the Jordan limits.”

‘A HUGE NEGATIVE IMPACT’

Stacey Purser, a criminal defence lawyer in Edmonton, said Jordan had not resulted in the “culture of urgency that I think the Supreme Court was trying to create.”

“Unfortunately, I don’t think that much really has changed since Jordan other than to say that, you know, once you get past those presumptive deadlines, people seem to be in quite a panic to get things done,” she said.

Vancouver defence lawyer Kyla Lee, who specializes in impaired driving cases, said Jordan has had a “huge negative impact on not just my practice, but the practice of law generally for criminal lawyers.”

“The problem is that now every time you go to court, no matter what the purpose of the appearance is, there is always a discussion about Jordan,” she said. “It comes up at every single appearance and it’s gotten to the point where the ceilings in Jordan are effectively being weaponized against accused individuals.”

With a busy schedule, finding court dates that work for both her and prosecutors is challenging, and the inability to agree results in arguments over who’s to blame. Judges have to conduct “microscopic analysis” to determine the length and cause of trial delays, Lee said.

“It has made everything far more complex, far more contentious, and it’s really done a disservice to the timely administration of justice because more court time is being taken up simply to address these issues,” she said.

Former Toronto resident Cait Alexander, a Canadian model and actress now living in Los Angeles, founded the group End Violence Everywhere after an abusive relationship nearly ended her life, alleging her ex-partner brutally beat her with a wooden rolling pin in July 2021.

Multiple charges were stayed due to delays, and Alexander said she felt “disgusting” after having received assurances from prosecutors that the case would go ahead.

She said the only consequence against her ex-boyfriend — who was originally charged with assault causing bodily harm, uttering threats, obstruction and other offences — was a peace bond, and she left the country in fear of her safety.

“That’s all they could offer me because they didn’t have time to prosecute my case,” she said.

Alexander testified before the House of Commons Standing Committee on the Status of Women this past July, recounting stories of survivors including Hatton, whose experience she called “harrowingly similar” to her own.

In her testimony, Alexander told members of the committee that the “government doesn’t care” about survivors and victims of intimate partner violence.

“We, as Canadians, have Charter rights that are essentially a ‘get out of jail free’ card for criminals, but what about survivors’ rights? Why are our Charter rights never accounted for?,” she testified.

Like Hatton, she’s suing her ex-boyfriend because it’s “the only form of legal justice I have left,” she told the committee.

Alexander testified to the committee again last week, telling members that Jordan timelines shouldn’t apply in cases of sexual assault or intimate partner violence.

“There should be no time limit or stay permitted with human-on-human crimes,” she testified, later tearfully describing the Jordan rules as “sickening” and “terrifying.”

Paisana said it was important to keep in mind the “bigger picture” of Jordan, the importance of timely trials and the rights of accused persons who are presumed innocent until proven guilty.

“It benefits society as a whole in a very dramatic way, as opposed to one or two individual cases in a given a year, in a given jurisdiction, that might be stayed as a result of it,” he said.

For Hatton, the collapse of the case against her ex-husband was devastating, and continues to influence her life. She now has multiple security systems in her new home after fleeing her old life in B.C.

In October 2023, Hatton filed her civil lawsuit against Maclean in B.C. Supreme Court, alleging a “history of abuse” throughout their relationship, seeking damages for assault, intentional infliction of emotional distress and defamation.

She said getting a relocation order allowing her to move out of B.C. with her children is a “slight bit of justice.”

But she now lives in a state of hyper vigilance.

“I sleep with a golf club beside my bed,” she said.

This report by The Canadian Press was first published Nov. 8, 2024.



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Donald Trump election sparks U.S. interest in move to Canada, say immigration lawyers

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Vancouver immigration lawyer Ryan Rosenberg says he’s been getting so many inquiries from disaffected U.S. voters that he set up a website to address their concerns.

It’s called “Trumpugees.ca” and asks visitors on the home page: “Tired of Trump? Thinking about Canada? We can help.”

Rosenberg – a managing partner at Larlee Rosenberg, Barristers & Solicitors – says he and his colleagues are sensing a spike in immigration interest from a broad swath of U.S. residents disappointed by Donald Trump’s election win Tuesday.

Immigration lawyer Meghan Felt says she’s hearing the same thing from her office in Newfoundland. In Toronto, Royal LePage president Phil Soper says online searches of Canadian properties spiked in the months leading up to the vote.

Maryland geologist Jackson Speary says he’s felt disillusioned with politics for “a very long time,” and is considering job or educational opportunities in Canada.

The 22-year-old says he’s worried Trump’s environmental and economic policies will hinder his work, much of which involves ensuring compliance to federal environmental rules. He wonders if his career would be more stable in Canada.

“It’s a very scary time to be my age and try to continue my career. Especially when you know political turmoil is so topsy-turvy,” Speary says from Stevensville, Md., where he works.

“I feel as though there’s a lot more job security for me in Canada, and potentially a lot more job security for me anywhere else,” he says, noting he’s also considering a move to New Zealand, where he has professional contacts.

Grand proclamations to move to Canada are nothing new, says Rosenberg, who recalls similar promises after George W. Bush’s second election from “mostly blue state Americans who wanted out.” Rosenberg dubbed those would-be Canadians “Bushugees.”

But this time, he says the demographics of the disaffected seem broader in scope, encompassing wealthy Americans, ethnic minorities and Democrats disappointed by the loss of Kamala Harris.

Felt doesn’t have a targeted website like Rosenberg nor is she doing focused promotion, but she says word-of-mouth chatter led five Americans to reach out in the past few days. That’s a jump from maybe one a week.

One client who had mused on moving to Canada two months ago emailed after the vote.

“They’re moving forward, like, immediately,” Felt says from St. John’s, N.L.

More often than not, Americans are curious about Canada’s urban centres and don’t ask about political differences between provinces or countries, she says.

“Canada is Canada. I’ve heard of Americans refer to Canada as like a really large Massachusetts.”

Speary says he’s heard Canada has capped the number of foreign students permitted but that likely won’t dissuade him from pursuing grad school north of the border.

“It is going to be harder, but I think I would be willing to try.”

This report by The Canadian Press was first published Nov. 8, 2024.

The Canadian Press. All rights reserved.



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In the news today: N.S. votes: Tories to release platform today

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Here is a roundup of stories from The Canadian Press designed to bring you up to speed…

N.S. votes: Tories to release platform today

The Progressive Conservatives are set to release their party platform today ahead of Nova Scotia’s Nov. 26 provincial election.

They will be the second of the three major parties to release a platform this week after the Liberals presented a plan containing $2.3 billion in election promises over four years.

Liberal Leader Zach Churchill, meanwhile, has an announcement planned in Halifax where he is expected to discuss improving health care for women.

NDP Leader Claudia Chender is in Cape Breton where she is scheduled to spend much of the day campaigning.

Tory Leader Tim Houston pledged to remove parking fees at all provincial hospitals, while Churchill promised to reduce immigration levels to align them with provincial Labour Department targets he says have been exceeded by the government.

Here’s what else we’re watching…

StatCan to release October jobs report today

Statistics Canada is set to release its October labour force survey this morning, shedding light on employment trends and wage growth last month.

RBC is forecasting the economy added a modest 15,000 jobs and the unemployment rate to have ticked back up to 6.6 per cent.

The jobless rate declined slightly to 6.5 per cent in September.

The Canadian job market has loosened significantly as high interest rates have restrained economic growth.

The Bank of Canada, which lowered its policy interest rate by 1.25 percentage points since June, now says it wants to see the economy rebound.

RBC says it expects the unemployment rate to reach seven per cent next year, before trending lower again.

What Trump’s election could mean for rates

Experts say Donald Trump’s election victory could shift interest rate policy in the U.S. as his promised policies risk higher inflation, which could ultimately have implications for Canadian rates and the loonie.

Markets rallied Wednesday and into Thursday in the wake of his victory as investors prepared for what his proposals might bring.

Among those promises are large tariffs on imported goods, especially from China, as well as lower tax rates and lighter regulation.

Economist Sheila Block says the large tariffs proposed by Trump would likely put upward pressure on inflation in the U.S.

Higher inflation would mean the U.S. Federal Reserve could be slower to cut interest rates, and markets are already shifting their bets on how low the central bank is likely to go on rates.

B.C. election judicial recounts expected to finish

Judicial recounts in British Columbia’s provincial election should wrap up today, confirming whether Premier David Eby’s New Democrats hang onto their one-seat majority almost three weeks after the vote.

Most attention will be on the closest race of Surrey-Guildford, where the NDP were ahead by a mere 27 votes, a margin narrow enough to trigger a hand recount of more than 19,000 ballots that’s being overseen by a B.C. Supreme Court judge.

Elections BC spokesman Andrew Watson says the recounts are expected to conclude today, but certification won’t happen until next week following an appeal period.

The Election Act says the deadline to appeal the results must be filed with the court within two days after they are declared, but Watson says that due to Remembrance Day on Monday, that period would end at 4 p.m. Tuesday.

When an appeal is filed, it must be heard no later than 10 days after the registrar receives the notice of appeal.

Another full recount is also taking place in Kelowna Centre, narrowly won by the B.C. Conservatives, while a partial recount will take place in Prince George-Mackenzie to tally votes from an uncounted ballot box that contained about 861 votes.

The Prince George-Mackenzie recount won’t change the outcome because the B.C. Conservative candidate there won by more than 5,000 votes.

If neither Surrey-Guildford nor Kelowna Centre change hands, the NDP will have 47 seats and the Conservatives 44, while the Greens have two seats in the 93-riding legislature.

Another beluga whale dies at Marineland

Three weeks after the death of another beluga whale at Marineland, the Ontario government is speaking publicly about its ongoing investigation of the park, saying water troubles are under control after a recent investment.

The province’s chief animal welfare inspector told The Canadian Press that to her understanding, marine mammal deaths at the tourist destination in Niagara Falls, Ont., have not been related to water quality.

Five belugas have died at the park in the last year and 17 have died since late 2019, government records show. Three other belugas sold to a Connecticut aquarium in 2021 have since died.

Kiska, the country’s last remaining killer whale in captivity, died in April 2023. One dolphin, one harbour seal, one grey seal, two sea lions and two Magellanic penguins have also died at the park in the past five years.

Marineland did not answer questions about the animal deaths, and instead twice responded to recent queries with accusations that journalism published by The Canadian Press was driven by its reporter’s “personal animal rights beliefs and activism.”

This report by The Canadian Press was first published Nov. 8, 2024



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