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.

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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.”

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.

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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.

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.

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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Health

Toronto's top doctor orders closure of four businesses over concerns about transmission of COVID-19 – CP24 Toronto's Breaking News

Published

26 mins ago

September 25, 2020

Chris Fox, CP24.com

Published Friday, September 25, 2020 4:43PM EDT

Last Updated Friday, September 25, 2020 6:17PM EDT

Toronto’s top public health official has ordered the closure of four hospitality businesses that she says failed to take the necessary precautions to limit the spread of COVID-19.

Medical Officer of Health Dr. Eileen de Villa says that the reasons behind the closure orders are specific to each business but generally point to an abdication of responsibility to help control the spread of COVID-19.

As an example, she said that investigators with Toronto Public Health found that one of the businesses served food buffet-style in direct contravention of provincial regulations.

Others, she said, pressured employees to work when they were ill and were “frequently uncooperative” with Toronto Public Health investigators as they attempted to trace cases of COVID-19.

De Villa also said that investigators found a “concerning link” among the businesses with many people who contracted COVID-19 having visited more than one of them. There were also instances in which staff members who tested positive for COVID-19 worked at more than one of the locations.

“These factors combined to create a significant risk to efforts to limit the spread of COVID-19 so I am acting under my authority to close down these businesses,” de Villa said during a briefing at city hall on Friday afternoon. “These are not actions I take lightly but I act first in the interest s of public health and in these circumstances the action taken is the right action to protect your health.”

De Villa said that orders requiring the closure of all four businesses are currently being issued, at which point their names and locations will be released to the public.

She said that in order to reopen each business will have to satisfy the specific conditions spelled out in the closure orders.

Speaking with reporters alongside de Villa, Mayor John Tory said that her decision to use her powers under the Health Protection and Promotion Act to order the closure of the business is the sort of “tactical responses” that the city will have to take when it finds “specific hot spots contributing to the spread of COVID-19” going forward.

“The action that Dr. de Villa is taking today will close some businesses but they must close so the vast majority of businesses can stay open,” he said.

Health

Chinese company says coronavirus vaccine ready by early 2021 – WellandTribune.ca

Published

1 hour ago

September 25, 2020

BEIJING – A Chinese pharmaceutical company said Thursday the coronavirus vaccine it is developing should be ready by early 2021 for distribution worldwide, including the United States.

Yin Weidong, the CEO of SinoVac, vowed to apply to the U.S. Food and Drug Administration to sell CoronaVac in the United States if it passes its third and final round of testing in humans. Yin said he personally has been given the experimental vaccine.

“At the very beginning, our strategy was designed for China and for Wuhan. Soon after that in June and July we adjusted our strategy, that is to face the world,” Yin said, referring to the Chinese city were the virus first emerged.

“Our goal is to provide the vaccine to the world including the U.S., EU and others,” Yin said.

Stringent regulations in the U.S., European Union, Japan and Australia have historically blocked the sale of Chinese vaccines. But Yin said that could change.

SinoVac is developing one of China’s top four vaccine candidates along with state-owned SinoPharm, which has two in development, and military-affiliated private firm CanSino.

More than 24,000 people are participating in clinical trials of CoronaVac in Brazil, Turkey, and Indonesia, with additional trials scheduled for Bangladesh and possibly Chile, Yin said. SinoVac chose those countries because they all had serious outbreaks, large populations and limited research and development capacity, he said.

He spoke to reporters during a tour of a SinoVac plant south of Beijing. Built in a few months from scratch, the plant is designed to enable SinoVac to produce half a million vaccine doses a year. The bio-secure facility was already busy on Thursday filling tiny bottles with the vaccine and boxing them. The company projects it will be able to produce a few hundred million doses of the vaccine by February or March of next year.

SinoVac is also starting to test small doses of CoronaVac on children and the elderly in China after noticing rising numbers of cases globally among those two groups.

Yin said the company would prioritize distribution of the vaccine to countries hosting human trials of CoronaVac.

While the vaccine has not yet passed the phase 3 clinical trials, a globally accepted standard, SinoVac has already injected thousands of people in China under an emergency use provision.

Yin said he was one of the first to receive the experimental vaccine months ago along with researchers after phase one and two of human trials showed no serious adverse effects. He said that self-injecting showed his support for CoronaVac.

“This is kind of a tradition of our company,” Yin said, adding that he had done the same with a hepatitis vaccine under development.

Earlier this year, China permitted “emergency use” of vaccine candidates for at-risk populations like border personnel and medical workers if companies could show “good safety and good antibodies” from tests of about 1,000 people, Yin said.

SinoVac received that approval in June along with SinoPharm and CanSino, and was able to provide tens of thousands of doses of CoronaVac to Beijing’s municipal government, Yin said.

SinoVac employees qualified for emergency use of the vaccine because an outbreak inside the company would cripple its ability to develop a vaccine, he said. About 90% of the company’s staff have received it.

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“We are confident that our research of the COVI-19 vaccines can meet the standards of the U.S. and EU countries,” Yin said.

___ Associated Press video producer Olivia Zhang contributed to this report.

Health

After long-term care, Quebec private seniors residences a growing COVID-19 concern – Pipeline News

Published

2 hours ago

September 25, 2020

MONTREAL — A slow but steady rise of COVID-19 cases in Quebec’s private seniors residences in recent weeks is causing concern among experts and authorities, who want to avoid the disaster that befell long-term care homes during the first wave of the novel coronavirus.

As of Wednesday evening, there were 39 private residences in Quebec with 180 COVID-19 cases between them listed on the government’s website. Four among them were described as “critical” because more than 25 per cent of their residents were infected.

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In comparison, only 20 long-term care homes were listed as having cases. One facility was listed as critical.

Yves Desjardins, the head of a group representing hundreds of seniors residences, says the number of facilities affected and the total number of COVID-19 cases in the network remains low. He said, however, managers are watching the trend carefully.

Unlike the first wave of the virus, which was concentrated in long-term care, the second has the virus spreading throughout the community, according to health officials. Desjardins says community spread poses a risk for people living in seniors residences because they are generally more active than are residents of long-term care homes.

“We have a clientele that is much more autonomous, that move around, families coming to visit, workers coming to the residence,” Desjardins said in a recent interview. “The virus is circulating in the community, and we’re in the community.”

Health Minister Christian Dube has expressed concern about cases appearing in private seniors homes, known as RPAs. On Sept. 15, he tightened health directives in those facilities, mandating that masks be worn in common areas such as hallways and elevators.

“The RPAs, for me, that’s our next problem if we’re not careful,” he said on Sept. 15.

Seniors residences must record the names of guests, who are required to wear masks. Despite the rules, there have been some outbreaks.

The four seniors residences listed as critical are located in the Quebec City area and in the region to its south, called Chaudiere-Appalaches. The RPA called Villa Ste-Rose in Laval, north of Montreal, has seen cases jump from four to 18 in recent days.

Dube said this week that while some cases in seniors residences are unavoidable, public health is contacting each place to ensure infection-control measures are being followed.

Louis Demers, a professor at Quebec’s public administration school, known as Ecole nationale d’administration publique, says the province should be concerned.

By raising the salaries of orderlies in long-term care homes, he said the government may have lured people away from the public sector. That attempt to reverse critical staff shortages in long-term care has the potential to increase seniors residences’ dependence on employment agencies.

“If your personnel is insufficient, and you have to choose between not giving a woman a bath, or giving one by someone who might have the virus, what do you do?” he said in a recent interview.

A major issue that contributed to hundreds of deaths in long-term care homes in the spring was the fact employees worked in more than one facility, often carrying the virus with them to vulnerable and captive populations.

Desjardins said it’s nearly impossible to “100 per cent” ensure staff only work at one residence, especially when some health professionals come in and out to provide services.

He said, however, that owners of residences generally ask staffing agencies to ensure personnel don’t rotate between facilities. When it comes to professionals providing medical services, they are asked not to visit multiple places in the same day, he explained.

Both Demers and Desjardins said private seniors residences are better prepared to face a second wave than long-term care homes were prepared to face the first wave of the novel coronavirus last spring.

Owners have a set of clear guidelines explaining which measures to impose based on the alert levels in their regions, covering everything from visitors to cafeteria dining. Infection-control measures are now known and understood, and personal protective equipment such as masks are available, Desjardins said.

Demers said the population in seniors residences are healthier than in long-term care homes and generally live in their own small apartments, which makes distancing easier. They’re also less likely to suffer from cognitive problems such as dementia.

He believes the government’s biggest challenge when it comes to private seniors homes is to find the right balance of measures that will protect people from the virus while allowing them the social contact that’s essential to their mental health.

After witnessing the hardships caused by the restrictive measures placed on seniors homes last spring — such as including banning all visitors and limiting movement — there’s little appetite for another lockdown, he said.

This report by The Canadian Press was first published Sept. 25, 2020.