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.”
More reading
What a forgotten 1970s experiment can teach us about today’s drug crisis
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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Thousands of Sydney residents flocked to a prominent horse race on Saturday, as Australia’s biggest city emerges from a strict COVID-19 lockdown and the nation begins to live with the coronavirus through extensive vaccination.
Up to 10,000 fully vaccinated spectators can now attend races such as The Everest https://www.reuters.com/lifestyle/sports/horse-racing-third-time-lucky-nature-strip-everest-2021-10-16 in Sydney, Australia’s richest turf horse race, and the country’s most famous, Melbourne Cup Day, on Nov. 2.
New South Wales State, of which Sydney is the capital, reached its target of 80% of people fully vaccinated on Saturday, well ahead of the rest of Australia.
“80% in NSW! Been a long wait but we’ve done it,” New South Wales Premier Dominic Perrottet said on Twitter.
The state reported 319 new coronavirus cases, all of the Delta variant, and two deaths on Saturday. Many restrictions were eased in New South Wales on Monday, when it reached 70% double vaccinations.
Neighbouring Victoria, where the capital Melbourne has been in lockdown for weeks, reported 1,993 new cases and seven deaths, including the state’s youngest victim, a 15-year-old girl.
Victoria is expected to reach 70% double vaccination before Oct. 26 and ease its restrictions more slowly than New South Wales has, drawing criticism from the federal government on Saturday.
“It is really sad that Victorians are being held back,” said Treasurer Josh Frydenberg.
Australia is set to gradually lift its 18-month ban on international travel https://www.reuters.com/world/asia-pacific/covid-19-infections-linger-near-record-levels-australias-victoria-2021-10-14 from next month for some states when 80% of people aged 16 and over are fully vaccinated. As of Friday, 67.2% of Australians were fully inoculated, and 84.4% had received at least one shot.
The country closed its international borders in March 2020, since then allowing only a limited number of people to leave or citizens and permanent residents abroad to return, requiring them to quarantine for two weeks.
Australia’s overall coronavirus numbers are low compared to many other developed countries, with just over 140,000 cases and 1,513 deaths.
(Reporting in Melbourne by Lidia Kelly; Editing by William Mallard)
Health
Canada heading for flu season in the middle of fourth wave of COVID-19 – CP24 Toronto's Breaking News
Laura Osman, The Canadian Press
Published Friday, October 15, 2021 1:09PM EDT
Last Updated Friday, October 15, 2021 4:34PM EDT
OTTAWA – The country could be heading for its first typical flu season since the pandemic began, even as health systems are still battling the fourth wave of COVID-19, Canada’s top doctor warns.
Last year the flu was “virtually non-existent,” in Canada, thanks to strict public health measures to protect against COVID-19, chief public health officer Dr. Theresa Tam said Friday.
What served as a blessing last fall, sparing already overwhelmed health systems, could now mean Canadians have less immunity against common strains of the flu.
Surveillance data from the Public Health Agency of Canada shows higher rates of infection than expected for some of Canada’s most common seasonal viruses: respiratory syncytial virus, or RSV. and human parainfluenza.
“This year we are anticipating a possible flu resurgence, due to lower levels of immunity in the population as a result of less circulation last flu season, and the easing of some restrictive, community-based public health measures,” Tam said.
Even during non-pandemic times, flu season has been known to bring hospitals to their knees, overcrowding emergency rooms and intensive care units.
Now, with some hospitals already at capacity and staff across the country burnt out by a year and a half of providing pandemic care, an intense flu season could be especially dire.
“This is definitely not the year to have influenza wreak havoc,” Tam said.
That’s why public health officials say it will be more important than ever that people get flu shots to avoid complications like pneumonia and protect hospitals from becoming overloaded.
On Oct. 7, The National Advisory Committee on Immunization suggested the flu vaccine can be given any time before or after – or even at the same time as – the COVID-19 vaccine, so there’s no reason to postpone either shot.
It’s too early to say how severe the flu season is likely to be, but pediatric hospitals are already feeling the ill effects.
The emergency room at the Children’s Hospital of Eastern Ontario is packed to the level the hospital would normally see at the peak of flu season.
The surge has been driven partly by routine injuries, but also from a “potpourri” of viruses, including RSV, said Tammy DeGiovanni, the hospital’s senior vice-president of clinical services and chief nurse executive.
Because of COVID-19, she said, CHEO has had to cancel surgeries and add to already length backlogs. Flu cases would only compound that problem further and create lengthy waits for non-urgent care.
“What we worry about is our capacity and our ability to staff,” DeGiovanni said in an interview Friday. “What we try not to do, but we’ve been forced to, are some cancellations.”
A similar situation is playing out at other children’s hospitals as well, she said.
Tam said the federal government has been bolstering health-care systems throughout the pandemic by ensuring emergency aid from the Canadian Armed Forces and the Canadian Red Cross, but the solution is not sustainable.
“Health-care capacity cannot be generated overnight, and particularly things like ICU capacity,” Tam said.
“People need to do everything they can to reduce both COVID and other respiratory viruses in order to keep our system going.”
Tam’s deputy, Dr. Howard Njoo, said one of the silver linings of the pandemic may be the prevalence of flu prevention measures, like hand-sanitation stations and mask wearing.
“Hopefully these types of behaviors will carry on long past … COVID-19 and become part of normal healthy behaviors to protect yourselves in the future against other respiratory infections, including annual flu.”
This report by The Canadian Press was first published Oct. 15, 2021
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New Zealand vaccinated at least 2.5% of its people on Saturday as the government tries to accelerate inoculations and live with COVID-19, preliminary health ministry data showed.
Through an array of strategies, gimmicks and Prime Minister Jacinda Ardern’s encouragement through the day, 124,669 shots were administered by late in the day in a country of 4.9 million.
“We set a target for ourselves, Aotearoa, you’ve done it, but let’s keep going,” Ardern said, using a Maori name for New Zealand at a vaccination site, according to the Newshub news service. “Let’s go for 150 [thousand]. Let’s go big or go home.”
New Zealand had stayed largely virus-free for most of the pandemic until an outbreak of the Delta Variant in mid-August. The government now aims to have the country live with COVID-19 through higher inoculations.
Forty-one new cases were reported on Saturday, 40 of them in Auckland, New Zealand’s largest city. It has been in lockdown since mid-August to stamp out the Delta outbreak. Officials plan to end the strict restrictions when full vaccination rates reach 90%.
As of Friday, 62% of New Zealand’s eligible population had been fully vaccinated and 83% had received one shot.
Vaccination spots were set up on Saturday throughout the country, including at fast-food restaurants and parks, with some spots offering sweets afterwards, local media reported.
“I cannot wait to come and play a concert, I want to be sweaty and dancing and maybe not even wearing masks. Hopefully we can get there,” said pop singer Lorde, according to local media.
“Protect your community, get yourself a little tart, perhaps a little cream bun,” she said. “But please, please get that jab.”
Final results of the mass vaccination drive are expected to be released on Sunday.
(Reporting by Lidia Kelly in Melbourne; Rditing by William Mallard)
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