Health
Canada's opioid crisis: The people and communities fighting for change and finding solutions – The Globe and Mail
Photos: Chad Hipolito/The Globe and Mail and Nicole Richard
The families fighting for action
Nicole Richard/Handout
It was a photo that stirred hearts across Canada: A group of 15 women who lost loved ones to drug overdoses posing together with crosses to illustrate the depth of the crisis – and to remind people that those who are dying “are somebody’s someone.”
The picture was circulated online by Moms Stop the Harm, a national organization lobbying for better drug policy. The group is calling on the federal government to declare the opioid crisis a national health emergency, to increase safe supply of drugs and to decriminalize possession of illicit substances.
The government response: The Liberals have repeatedly rejected calls to decriminalize possession of hard drugs. The party has said it will proceed on the issue of “safe supply” – that is, helping provide a regulated, quality-controlled source of drugs. The NDP and the Greens both support decriminalization. And while drug policy is a federal mandate, provinces and municipalities can take steps to de facto decriminalize. That’s what B.C.’s top public health officer is urging, but the NDP government has resisted the proposal.
Why decriminalization? Advocates say decriminalizing personal possession – a measure Portugal took in 2001 – would play a critical role in responding to the crisis. “The societal stigma associated with drug use leads many to use drugs alone and hidden, increasing their risk of dying. B.C. cannot ‘treat’ its way out of this overdose crisis, or ‘arrest’ its way out either,” health officer Bonnie Henry wrote in a report.
The Globe’s view: Our editorial board argues that decriminalization would be a key step in treating addiction as a health-care issue, not a criminal-law problem. “Decriminalization of drugs is not a magic bullet that will end drug addiction. But it can be part of a broader harm-reduction strategy that includes many other steps.”
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Outreach efforts
Combining resources
Vancouver Fire and Rescue Services captain Jonathan Gormick and Vancouver Coastal Health social worker Robyn Kelway visit residences in Vancouver in August, 2019.
Jackie Dives/The Globe and Mail
How do you deliver services to drug users who are often hard to reach? A new outreach initiative in Vancouver pairs firefighters with social workers to follow up on recent overdose calls. At each location, a worker with Vancouver Fire and Rescue Services asks for the patient by name but says only that they’re following up on a recent call. If the patient is there and consents to further help, they wave over a Vancouver Coastal Health (VCH) social worker, who is waiting just out of sight.
The response: During an August trial period, the Combined Overdose Response Team made 107 visits, making contact in 22 of them, with 21 patients consenting to further help. That can include connecting people to housing supports or drug counsellors, and even teaching a user’s partner how to use a naloxone kit. “It doesn’t surprise me that they want help,” said Patricia Daly, chief medical health officer for VCH. “People don’t want to die; they want to get out of the cycle of repeated overdoses.”
The fly-in doctor
Dr. Todd Young, centre, and ‘recovery coach’ Craig Wiseman, right, carry charts and luggage off a small airstrip in the rain after landing in Clarenville, Nfld.
Darren Calabrese
For many patients in far-flung Newfoundland and Labrador towns, Todd Young is the only person who will prescribe opioid-replacement medication – and he flies his own plane to get to them. Dr. Young heads to eight-and-counting towns each month to provide access to methadone or Suboxone, allowing patients to receive help within five days as opposed to waits of one month or more in other rural parts of the province. Dr. Young manages about 600 patients that range in age from 15 to 94.
A long way to go: “This is not a popular form of medicine in Newfoundland,” said Dr. Young, who said many physicians “look at addictions patients as problem patients.” It’s not uncommon for him to show up to work to find a patient who has hitchhiked hundreds of kilometres to beg for treatment, or another waiting in her truck before office hours begin, trembling with the onset of withdrawal and the determination to get help. Dr. Young hopes that his willingness to treat addictions will eventually entice other physicians.
A multilayered response
Yellow boxes to dispose of used needles are now a fixture in Brantford.
Fred Lum/The Globe and Mail
As Brantford’s hospital admissions for overdoses soared in 2016 and 2017, leaders in the Southwestern Ontario city knew they had to act. Police Chief Geoff Nelson huddled with other local officials and put together a plan. Start treating users as sick people rather than criminals; make it easier for them to get addiction treatment; spread the word about the dangers of fentanyl; hand out lots of free naloxone kits.
Promising results: Although officials are quick to say the crisis is far from over, overdose figures were down sharply in 2018 from their peak in 2017. Emergency services responded to 35 per cent fewer overdose incidents in 2018. The hospital emergency department received 44 per cent fewer overdose visits.
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Pilot programs
PHS Community Services Society medical director Christy Sutherland said the idea to dispense hydromorphone in tablet form came from patients themselves, who were not satisfied with the injectable program.
B.C. has been the hardest-hit province in the overdose crisis, but it has also paved the way with innovative responses. Insite, North America’s first supervised consumption site, opened in Vancouver in 2003. Today, there are dozens of supervised sites across the country. There are also newer initiatives under way to stanch overdoses:
Pharmaceutical-grade pills: A pilot project from Vancouver’s largest social-service provider is allowing about 50 patients at a time to access the opioid hydromorphone in tablet form and ingest them on site while staff observe them. Hydromorphone is an opioid medication used to treat moderate to severe pain that is commonly used in palliative and acute care. One Vancouver study found that hydromorphone could be an affordable and effective substitution therapy for heroin.
Fighting fentanyl with fentanyl: A program launched in July, 2019, sees patients get a fentanyl patch – commonly used to treat chronic pain for conditions such as cancer – that is applied to the skin and changed every two days by a nurse. To address misuse, the patches are signed and dated, and a transparent film is applied to prevent tampering. It is believed to be the first formal program of its kind.
A proposal for regulated retail heroin sales: British Columbia’s authority on addictions care is recommending allowing regulated retail heroin sales in the province to reduce overdose deaths caused by fentanyl-tainted illicit drugs and to generate funds for addiction-treatment services. Members would be permitted to purchase personal amounts of the drug from a location connected to health-care services.
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Community challenges
Men in trades
Sam Stahnke in Campbell River, B.C.
CHAD HIPOLITO/The Globe and Mail
Sam Stahnke was making good money working three weeks a month in Alberta’s oil sands. Then a knee injury forced him to go on opioid painkillers, and soon he was buying Oxycontin, hydromorphone and morphine pills by the thousands. Soon, he started crushing the pills into powder, mixing it with saline solution and injecting the liquid with a big syringe. Then, he turned to heroin. But he kept working, never telling anyone as he used drugs in the isolation of his house in Campbell River, B.C. “I’m lucky to be alive,” he says, recalling the years before his recovery.
The ‘working-man’s code’: B.C. statistics show that of those who died by overdose that were employed, 55 per cent worked in transport or the trades. In Ontario, one-third with known employment status were in construction. The vast majority of victims are men, and most die in private residences. But stigma remains pervasive, with working men reluctant to seek help. “This has been a neglected population that nobody is talking about,” says Andrea Furlan, a scientist at the Institute for Work and Health in Toronto.
Addressing the problem: Authorities have been aware of the issue for trades workers for years, but action has been slow. Mr. Stahnke found the courage to tell his family doctor, and was put on Suboxone, a substitute opioid that reduces the craving for drugs without producing a high. He hopes that telling his story will encourage others in his position to get help.
The prison system
One of the letters sent by Spencer Kell to his friend Manie Daniels.
Tijana Martin/The Globe and Mail
When Spencer Kell got out of jail in the spring of 2018, leaving his cellmate Manie Daniels behind, the two friends started exchanging letters. Both had used drugs in the past; they shared their struggles – and hopes – in the notes. The pair hoped to reunite soon after Daniels’s release that July. “I’m waiting for you! Write me soon. Stay safe,” Mr. Kell wrote. But Daniels died less than two days after getting out, overdosing on hydromorphone.
Transitioning to civilian life: Mr. Kell told a Senate forum in February, 2019, that with nowhere else to go, just-released prisoners often head “right back to the dealer’s house.” The numbers bear that out: A study on overdose deaths in Ontario showed that, between 2006 and 2013, one in 10 happened within a year of release from a provincial jail.
The services available: After his release, Mr. Kell ended up at the Salvation Army’s Ottawa Booth Centre, a Christian non-profit that offers help to the capital’s homeless and the addicted. He subsequently found an apartment and finished a college course on becoming an addiction worker. In Ontario, when prisoners are released they get naloxone kits and training about how to use the overdose-reversal drug, as well as a wallet card on how to avoid an opioid overdose. But the families of victims say that’s not nearly enough. They are advocating for more treatment programs and beds.
ontario Drug Toxicity Deaths
after incarceration
Number of deaths by day in the year after release from provincial incarceration, up to day 60, 2006–2013.
Days since release from incarceration
JOHN SOPINSKI/THE GLOBE AND MAIL
SOURCE: pols.org
ontario Drug Toxicity Deaths
after incarceration
Number of deaths by day in the year after release from provincial incarceration, up to day 60, 2006–2013.
Days since release from incarceration
JOHN SOPINSKI/THE GLOBE AND MAIL, SOURCE: pols.org
ontario Drug Toxicity Deaths after incarceration
Number of deaths by day in the year after release from provincial incarceration, up to day 60, 2006–2013.
Days since release from incarceration
JOHN SOPINSKI/THE GLOBE AND MAIL, SOURCE: pols.org
Compiled by Arik Ligeti, based on reports from Marcus Gee, Andrea Woo and Jessica Leeder
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India said on Wednesday it has found around 40 cases of the Delta coronavirus variant carrying a mutation that appears to make it more transmissible, and advised states to increase testing.
Below is what we know about the variant.
WHAT IS DELTA PLUS?
The variant, called “Delta Plus” in India, was first reported in a Public Health England bulletin on June 11.
It is a sub-lineage of the Delta variant first detected in India and has acquired the spike protein mutation called K417N which is also found in the Beta variant first identified in South Africa.
Some scientists worry that the mutation, coupled with other existing features of the Delta variant, could make it more transmissible.
“The mutation K417N has been of interest as it is present in the Beta variant (B.1.351 lineage), which was reported to have immune evasion property,” India’s health ministry said in a statement.
Shahid Jameel, a top Indian virologist, said the K417N was known to reduce the effectiveness of a cocktail of therapeutic monoclonal antibodies.
WHERE ALL IT HAS BEEN FOUND?
As of June 16 https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/994839/Variants_of_Concern_VOC_Technical_Briefing_16.pdf, at least 197 cases has been found from 11 countries – Britain (36), Canada (1), India (8), Japan (15), Nepal (3), Poland (9), Portugal (22), Russia (1), Switzerland (18), Turkey (1), the United States (83).
India said on Wednesday around 40 cases of the variant have been observed in the states of Maharashtra, Kerala and Madhya Pradesh, with “no significant increase in prevalence”. The earliest case in India is from a sample taken on April 5.
Britain said its first 5 cases were sequenced on April 26 and they were contacts of individuals who had travelled from, or transited through, Nepal and Turkey.
No deaths were reported among the UK and Indian cases.
WHAT ARE THE WORRIES?
Studies are ongoing in India and globally to test the effectiveness of vaccines against this mutation.
“WHO is tracking this variant as part of the Delta variant, as we are doing for other Variants of Concern with additional mutations,” the World Health Organization (WHO) said in a statement sent to Reuters.
“For the moment, this variant does not seem to be common, currently accounting for only a small fraction of the Delta sequences … Delta and other circulating Variants of Concern remain a higher public health risk as they have demonstrated increases in transmission,” it said.
But India’s health ministry warned that regions where it has been found “may need to enhance their public health response by focusing on surveillance, enhanced testing, quick contact-tracing and priority vaccination.”
There are worries Delta Plus would inflict another wave of infections on India after it emerged from the world’s worst surge in cases only recently.
“The mutation itself may not lead to a third wave in India – that also depends on COVID-appropriate behaviour, but it could be one of the reasons,” said Tarun Bhatnagar, a scientist with the state-run Indian Council for Medical Research.
(Reporting by Shilpa Jamkhandikar in Pune, Bhargav Acharya and Ankur Banerjee in Bengaluru and Alistair Smout in London; Editing by Miyoung Kim and Giles Elgood)
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The majority of colon cancer cases are more common among older citizens. However, research has found that colorectal cancer rates have been rising in healthy people under 50. The rate has increased over the ten years. Medical professionals recommend screening from age 45. A colorectal screening test is done to ensure that the individual does not have any signs of cancer.
A study found that there has been a surge in colorectal cancer in younger generations and could become the dominant cause of cancer-related deaths by 2030. Since the risk is alarming, everyone needs to take their gut health seriously. Here are some things that people can do to improve their well-being.
Consider Hydrotherapy
Hydrotherapy is a type of colon cleanse that treats digestive issues such as constipation and bloating. Chronic constipation can lead to colon cancer, so it is vital to deal with the issue before it worsens. Colon hydrotherapy is offered at a few places, including a wellness colonic clinic in Toronto where the staff is committed to providing solutions for their clients’ digestive health.
Cleansing your colon can help improve digestion, relieve constipation, reduce gas, rejuvenate skin, and increase energy. The process involves flushing the colon with a large volume of water. It can be beneficial to speak to the professionals at the clinic and discuss your concerns with them. They will educate you about the process and answer any concerns you may have. The treatment can seem overwhelming but can also be helpful for your gut health.
Consume Sensibly
Your food intake plays a significant role in your gut health. If you have gut problems, it may be worthwhile to speak to a doctor and change your diet. You should also consider finding out if you have any food intolerance. There may be trigger foods such as oil or dairy that could be causing discomfort.
Even if you do not have any problems with your food consumption, it is never wrong to watch what you eat. Foods with probiotics or high fibre content can be good for you. Eating the right foods can improve your overall health too.
Stay Hydrated
Water almost seems like a magical drink sometimes. From skin problems to digestive issues, it can improve many situations. Consuming a good amount of water every day can balance good bacteria in the gut and promote your health. Hydration can also help your organs function properly and improve cognitive function.
Say Goodbye to Extreme Stress
It can be challenging to bid farewell to stress forever. However, chronic high levels of stress can impact your abdomen and your overall health. There is a connection between the brain and gut, and stress can cause your stomach to become anxious.
Long-term stress can trigger several gut problems such as indigestion, constipation, or diarrhea. Look for ways to reduce stress levels so that your gut can remain healthy.
Some health problems are inevitable with age, but you can do your best to stay healthy and deal with any issues you face. Prepare yourself to fight any disease beforehand, and your body will thank you.
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The United States on Thursday raised the pressure on other Group of Seven leaders to share their vaccine hoards to bring an end to the pandemic by pledging to donate 500 million doses of the Pfizer coronavirus vaccine to the world’s poorest countries.
The largest ever vaccine donation by a single country will cost the United States $3.5 billion but Washington expects no quid pro quo or favours for the gift, a senior Biden administration official told reporters.
U.S. President Joe Biden‘s move, on the eve of a summit of the world’s richest democracies, is likely to prompt other leaders to stump up more vaccines, though even vast numbers of vaccines would still not be enough to inoculate all of the world’s poor.
G7 leaders want to vaccinate the world by the end of 2022 to try to halt the COVID-19 pandemic that has killed more than 3.9 million people and devastated the global economy.
A senior Biden administration official described the gesture as a “major step forward that will supercharge the global effort” with the aim of “bringing hope to every corner of the world.” “We really want to underscore that this is fundamentally about a singular objective of saving lives,” the official said, adding that Washington was not seeking favours in exchange for the doses.
Vaccination efforts so far are heavily correlated with wealth: the United States, Europe, Israel and Bahrain are far ahead of other countries. A total of 2.2 billion people have been vaccinated so far out of a world population of nearly 8 billion, based on Johns Hopkins University data.
U.S. drugmaker Pfizer and its German partner BioNTech have agreed to supply the U.S. with the vaccines, delivering 200 million doses in 2021 and 300 million doses in the first half of 2022.
The shots, which will be produced at Pfizer’s U.S. sites, will be supplied at a not-for-profit price.
“Our partnership with the U.S. government will help bring hundreds of millions of doses of our vaccine to the poorest countries around the world as quickly as possible,” said Pfizer Chief Executive Albert Bourla.
‘DROP IN THE BUCKET’
Anti-poverty campaign group Oxfam called for more to be done to increase global production of vaccines.
“Surely, these 500 million vaccine doses are welcome as they will help more than 250 million people, but that’s still a drop in the bucket compared to the need across the world,” said Niko Lusiani, Oxfam America’s vaccine lead.
“We need a transformation toward more distributed vaccine manufacturing so that qualified producers worldwide can produce billions more low-cost doses on their own terms, without intellectual property constraints,” he said in a statement.
Another issue, especially in some poor countries, is the infrastructure for transporting the vaccines which often have to be stored at very cold temperatures.
Biden has also backed calls for a waiver of some vaccine intellectual property rights but there is no international consensus yet on how to proceed.
The new vaccine donations come on top of 80 million doses Washington has already pledged to donate by the end of June. There is also $2 billion in funding earmarked for the COVAX programme led by the World Health Organization (WHO) and the Global Alliance for Vaccines and Immunization (GAVI), the White House said.
GAVI and the WHO welcomed the initiative.
Washington is also taking steps to support local production of COVID-19 vaccines in other countries, including through its Quad initiative with Japan, India and Australia.
(Reporting by Steve Holland in St. Ives, England, Andrea Shalal in Washington and Caroline Copley in Berlin; Writing by Guy Faulconbridge and Keith Weir;Editing by Leslie Adler, David Evans, Emelia Sithole-Matarise, Giles Elgood and Jane Merriman)
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