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Canadian federal prisoners waiting for opioid treatment



For the last 18 months, Ricky Leslie’s been cut off from Suboxone, the prescription medication the federal inmate relied on to keep his withdrawal symptoms of opioid addiction at bay, lessening his chances of yet another overdose.

“They’re making me suffer, they’re putting my life in danger every day,” Leslie said of Correctional Services Canada during an interview with CBC News from Port Cartier Institution, a federal penitentiary in Quebec, where he is currently incarcerated.

Leslie said his attempts at staving off cravings have led him to use illicit substances instead.

“Every time I use or whatever, it might be my last time,” he said.

“That’s not fair for me or my family.”

Leslie is on a wait list for what the CSC calls “opioid agonist treatment,” a catch-all term for medical substances, including Suboxone, that replace opioids to help those with addiction issues.

As of June, he was one of 14 people on the wait list in his prison alone, and across the country, the number of inmates waiting for the potentially life-saving treatment has continued to grow throughout the pandemic.

In the 52 penitentiaries run by the federal government, 494 inmates are on a wait list, an increase from 447 in March, the last month Ottawa publicly posted numbers.

“The longer the wait list you get, the more people that are high risk of a fentanyl overdose,” said Dr. Lori Regenstreif, an assistant clinical professor of family medicine at McMaster University in Hamilton, Ont.

The federal body declined an interview for this story, and would only address general numbers in statements, not Leslie’s situation.

“Throughout the COVID-19 pandemic, the provision of health services continued,” the CSC said in an emailed statement, “although there has been a need to prioritize services and resources.”

‘Treated unfairly’

The 50-year-old is from Edmonton, where he was serving his sentence for robbery and assault until the end of July, when CSC transferred him to Quebec.

“I got assaulted by four offenders in Edmonton,” Leslie said. “I wanted to mediate,” but federal authorities decided to move him instead.

The current distance from his loved ones has only exacerbated his addiction problems, he said, which he has been dealing with for decades.


Ricky Leslie, 50, seen here in November 2019, says he is finding it difficult to cope with the lack of medical treatment for his opioid addiction. (Submitted by Ricky Leslie)


“They’re the ones who support me and are behind me,” he said of his two daughters.

Leslie’s court record shows he has been in and out of the correctional system since 2001, mostly on robbery and assault charges.

He began serving his latest sentence in February 2017. At the time, it took more than a year and a complaint to the Canadian Human Rights Commission to temporarily put him on Suboxone.

According to that document, he had been addicted to opioids since approximately 1997, when he was working on oil rigs in northern Alberta. “I was stabbed by a dirty needle and contracted Hepatitis C,” he wrote. “This seriously affected me mentally and physically.”

He also wrote that he has overdosed approximately four times since then.

Leslie was placed on opioid agonist treatment in November 2018. But in March of last year, he said security guards accused him of “diverting” the Suboxone, which means trading it with other inmates instead of using it. They summarily removed him from treatment.

Leslie denied he ever did that.

“You’re standing in front of an officer and in front of a nurse,” he said. “How are you going to take powder out of your mouth? Wouldn’t it be all over your face? Wouldn’t it be all over your lips?”

Leslie, who is Métis, referred to himself as an Aboriginal offender, and said he was being treated unfairly. “How does a person have to wait that long to get back on Suboxone?” he asked.

Dangerous to cut off, experts warn

CBC spoke to two medical experts who warned it is dangerous to suddenly cut off patients from opioid substitutes.

“The symptoms are pretty debilitating,” said Josh Fanaeian, an emergency physician and addiction specialist in Edmonton.


Josh Fanaeian, an emergency physician in Edmonton, warns against cutting off those with addiction issues from medical treatment. (Trevor Wilson/CBC )


“It’s almost like the worst flu you can get. Severe sweats, shakes, fever-like symptoms, muscle and bone aches.”

To fight these symptoms, he said patients who are cut off from treatment might try accessing drugs off the street, which could lead to further health issues, including overdoses. “You put a penny into prevention,” he said, “saves a dollar in treatment down the road.”

Regenstreif, who has worked as a physician an Ontario jail, also said that prevention while behind bars would help once an inmate is released into the general public.

“The sooner you set them up for treatment, the better,” Regenstreif said.

Both physicians likened addiction to a chronic disease.

“You wouldn’t fault someone for going on medication if they had diabetes,” Fanaeian said.


Dr. Lori Regenstreif, an assistant clinical professor of family medicine at McMaster University in Hamilton, Ont., says federal correctional facilities too often examine opioid agonist treatment through a correctional lens rather than a public health lens. (Craig Chivers/CBC )


For Regenstreif, one problem in the federal penitentiary system is that priorities are set though a correctional lens, instead of public health.

“Once a facility has X amount of funding, are they going to spend it on nurses or are they going to spend it on more correctional officers? I don’t know how they budget,” she said.

Treatment increases over four years: CSC

Correctional Services Canada cited Ricky Leslie’s human rights complaint in explaining why it could not comment about him.

In its statement, it said the number of patients on opioid agonist treatment increased from 920 in December 2016 to 2,242 in June 2020, with a 21 per cent increase since December 2019.

“Over the past three years, in the context of the Canadian opioid crisis, the demand for treatment has dramatically increased and continues to increase,” according to the CSC’s website.

The federal body also said all decisions related to a prescription of medication are “made by a health care professional.”

CSC did not provide an explanation for exactly why the wait list grew between March and June, other than mentioning COVID-19.

Regenstreif acknowledged the pandemic has made many things more difficult, but said waiting for prescribed medication is not the same as waiting for a hair cut.

“We’re not talking about … an optional thing, we’re talking about an essential service,” she said.

Regional disparities

The CSC’s statements also could not explain the regional differences between its penitentiaries.

According to the June 2020 figures, of the 494 inmates on wait lists in Canada, 169 — more than one-third — were in Alberta, and wait list numbers grew more in that province from March to June than in the entire country.

Though the CSC did manage to eliminate wait lists completely for two Alberta locations, the Drumheller Institution and Grierson Centre, the number of Alberta inmates waiting for opioid agonist treatment grew from 118 to 169 over that time.

By contrast, Ontario’s wait list shrunk, from 48 inmates in March to just 20 in June.

As for Ricky Leslie, he enlisted the help of the Alberta Prison Justice Society to try and get him back on Suboxone.

“When he’s released, if he’s treated, he’s less likely to reoffend,” said Kate Engel, a lawyer and the secretary for the society. “If he’s languishing in jail without treatment, that’s going to increase his chances of reoffending.”


Kate Engel is a lawyer who works with Alberta Prison Justice Society, which has taken up Ricky Leslie’s case. (Sam Martin/CBC)


The society was urging Correctional Services Canada to put him on Suboxone by Aug. 14. That date has now come and gone, with no sign of when his wait might end.

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Passengers at 11 more Canadian airports face mandatory temperature checks – CTV News



Transport Canada is expanding mandatory temperature screening to all passengers in 11 additional airports across the country.

The department announced on Tuesday that temperature screening has begun at airports in St. John’s, N.L. Halifax, Quebec City, Ottawa, Toronto (Billy Bishop), Winnipeg, Regina, Saskatoon, Edmonton, Kelowna, B.C. and Victoria.

“Since the beginning of the pandemic, Canadians have come together, made sacrifices, and done their part to help limit the spread of the virus,” Transport Minister Marc Garneau said in a news release.

“Our government has expanded temperature screenings to major airports across the country to support these efforts and as another measure in our multi-layered approach to help protect the safety of the travelling public and air industry workers.”

This is an expansion of the temperature screening program that began on June 30 at four of Canada’s busiest airports: Montreal, Calgary, Vancouver and Toronto (Pearson).

Any passenger found to have an elevated temperature without a medical certificate with a reason for this elevation will not be allowed to continue their travel and will be told to book another flight at least 14 days later.

All employees who work within the restricted area of an airport will also be subject to temperature screening.

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Feds announce plan to buy 7.9 million rapid COVID tests –



Public Services and Procurement Minister Anita Anand today announced a plan to buy roughly 7.9 million rapid point-of-care COVID-19 tests from U.S.-based Abbott Laboratories.

The purchase is meant to offer other testing options to Canadians at a time when the country’s testing apparatus is being severely strained, with coronavirus caseloads spiking in some regions.

To date, the vast majority of tests have been done at public health clinics, with samples then sent to laboratories for analysis — a process that can take days.

A point-of-care test could be administered by trained professionals in other settings. The molecular test Canada is looking to buy — the ID NOW — can produce results from a nasal swab in as little as 13 minutes.

While Canada has announced this purchase from a well-regarded U.S. firm, the test itself has not yet been approved by Health Canada for distribution.

Proactive purchasing

“As with many of our agreements for equipment, tests and vaccines, we have pursued an advanced purchase agreement to secure Canada’s access to these tests conditional on Health Canada’s regulatory approval,” Anand said.

“These rapid tests will aid in meeting the urgent demands from provinces and territories to test Canadians and reduce wait time for results, which is key to reducing the spread of the virus.”

The U.S. Food and Drug Administration (FDA) first issued an emergency use authorization (EUA) to Abbott for the ID NOW device in March.

Since then, some researchers have said the device has led to false positives in a small number of cases. The FDA re-issued a revised EUA on Sept. 18, saying that the test should be administered within the first seven days of the onset of symptoms.

Anand said that, beyond the Abbott deal, Canada will proactively purchase other rapid tests in bulk to supply the country.

With tens of thousands of tests being done each day, the demand is high.

The announcement comes as Health Canada bureaucrats in charge of regulating new testing devices are defending the government’s response to this point.

A lab technician dips a sample into the Abbott Laboratories ID Now testing machine at the Detroit Health Center in Detroit. Illinois-based Abbott Laboratories says its test delivers results within minutes. (Carlos Osorio/AP Photo)

Health experts — including Dr. David Naylor, the co-chair of the federal government’s COVID-19 task force — have for weeks been urging regulators to approve rapid testing to take the pressure off testing centres.

While other major Western countries such as the U.S. have authorized a number of point-of-care tests, Health Canada regulators have been slow to give the necessary approvals to deploy these devices.

Regulators approved Cepheid’s Xpert Xpress SARS-CoV-2 device in late March, a test that can be used in both lab and point of care settings.

The next approval for a point-of-care device — one that could be used in a doctor’s office or a walk-in clinic — only came last week.

On Sept. 23, Health Canada approved for use in Canada the Hyris bCube — a portable device that its Guelph, Ont.-based distributor says can be used “wherever people are — anytime, anywhere.”

The regulator hasn’t yet approved any antigen tests — a different form of testing that can be easily deployed to high-risk workplaces and schools to help identify positive COVID-19 cases.

In fact, Health Canada only posted guidance for antigen device manufacturers to its website today, seven months into the pandemic.

The antigen tests — which, depending on the device, use matter collected from a nasal or throat swab — don’t require the use of a lab to generate results.

While much faster, these tests are considered by some to be less accurate than the “gold standard” — the polymerase chain reaction (PCR) testing process currently in use across Canada.

U.S. President Donald Trump opens a box containing the ID NOW testing device during a coronavirus briefing at the White House in March. (Alex Brandon/AP Photo)

Antigen testing devices like Quidel Corporation’s Sofia 2 SARS, which received emergency authorization from the U.S. FDA in May, can produce results in less than 20 minutes. As of Tuesday, Quidel’s device was listed as “under review” by Health Canada.

Antigen tests have been used in thousands of U.S. long-term care homes for months.

Speaking to reporters on teleconference about Health Canada’s progress, Dr. Supriya Sharma, senior medical adviser to the department’s deputy minister, said she doesn’t think the authorization process has been slow to this point.

She said Canada’s regulatory regime is different from what’s in place in the U.S. and the department has been focused on approving lab-based PCR testing devices.

“I don’t think we’re slow. We’ve got staff working flat out,” she said. “There’s no file sitting on anyone’s desk not being looked at.”

Sharma said it’s difficult to state exactly when the Abbott test or an antigen test will be approved for use in Canada.

“Antigen testing is our number one priority and we are doing everything that we can to review these tests to ensure they are available to Canadians,” she said.

“We have increased the efficiency and we’re streamlining those review processes. We’re committed to getting a company a decision within 40 days,” she said, adding that the pre-pandemic process often would take months to complete.

She said regulators will not be rushed, citing the risk of approving a faulty test that tells people they’re clear of COVID-19 when they’re actually infected.

“A test that doesn’t meet this criteria could have devastating consequences for Canadians,” Sharma said.

When asked if the department was reluctant to approve new devices because of past missteps, Sharma conceded Health Canada’s early decision to authorize a device from Ottawa-based Spartan Bioscience — a test that later proved faulty — resulted in some “lessons learned” for regulators. In May, the National Microbiology Lab found problems with the test that made it unreliable.

While Canadian regulators have not yet given the green light, the World Health Organization (WHO) announced on Monday a plan to send 120 million COVID-19 antigen tests to low- and middle-income countries over the next six months to dramatically expand access to testing in places where PCR isn’t viable due to limited laboratory capacity.

The WHO touted these tests as “highly portable, reliable and easy to administer, making testing possible in near-person, decentralized healthcare settings.”

“High-quality rapid tests show us where the virus is hiding, which is key to quickly tracing and isolating contacts and breaking the chains of transmission,” Dr. Tedros Adhanom Ghebreyesus, the director general of the WHO, said in announcing the plan.

“The tests are a critical tool for governments as they look to reopen economies and ultimately save both lives and livelihoods.”

Asked about the WHO plan after a meeting with UN officials, Prime Minister Justin Trudeau told reporters Canada would rely on its own scientists to determine which devices should be used here at home.

WATCH: Trudeau is asked about rapid COVID-19 tests

Prime Minister Justin Trudeau appeared in a United Nations video conference on the COVID-19 crisis 0:47

“As much as we’d love to see those tests as quickly as possible, we’re not going to tell our scientists how to do their job and do that work. We are, however, ensuring that as soon as those approvals happen, we are ready to deliver these tests across the country,” he said.

Raywat Deonandan, an associate professor at the University of Ottawa and an expert in epidemiology, said that while antigen tests can be less sensitive than PCR tests, they can be useful for “reassurance” purposes.

“If someone needs a negative test to go back to work, we’ll use this,” Deonandan said in an interview.

“We need more creative tools on the table and this is one creative tool — again, with the caveat that it matters entirely how you use it, where you use it and by whom,” he said, adding that he believes antigen tests shouldn’t be a primary diagnostic tool.

While antigen tests can be less accurate, they’re also cheap to produce and easy to administer. That means they can be used multiple times to ensure a more accurate reading — not unlike a home pregnancy test.

“The advantage of these types of tests is that you can do them frequently,” said Ashleigh Tuite, an assistant professor at the University of Toronto and an infectious disease researcher.

“You could do it the day that you were going to visit the person who you cared about and it would basically tell you at that point in time, are you infectious? That’s incredibly powerful information.

“It just makes common sense — use every tool you have.”

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COVID-19 in Canada will get worse before it gets better, and here's why –



Cases of COVID-19 will likely continue to climb in Canada’s most populous provinces for a while even if people start to hunker down, experts say, because of the nature of the infection.

Epidemiologists look at the effective reproductive number of COVID-19, which describes how many other people an infected person will pass the coronavirus onto on average.

Public health experts like to see the value significantly below one so cases don’t snowball and spread out of control.

The effective reproductive number of COVID-19 in Canada continues to hover at 1.4, the Public Health Agency of Canada reported on Friday. That means for every 10 people who test positive for COVID-19, they’ll likely infect 14 others who then pass it on to 20 others and so on.

Christopher Labos, a physician in Montreal with an epidemiology degree, said the effective reproductive number also varies depending on the population in which a virus is spreading.

“If nothing changes, certainly it’ll keep rising and may even surpass a number of cases we had before,” Labos said. 

The doubling time depends on how contagious someone is, the likelihood they’ll contact and infect another susceptible person and the frequency of contact.

But Labos said there’s another important factor: individual changes in behaviour.

WATCH | Flattening Canada’s COVID-19 curve again:  

New COVID-19 infections are emerging at double the rate of just two weeks ago. Experts say the curve is getting steeper and the only way to bend it back is to change behaviours — fast. 3:28

“We probably will see rising case numbers in the next few days, maybe in the next few weeks. But if we take action now and control stuff, we might see this virus plateau before the end of the year. And that’s really what we’re trying to hope for.”

To that end, Quebec’s premier announced on Monday partial shutdowns in areas with high case counts, namely Montreal, Quebec City and Chaudière-Appalaches, south of the provincial capital.

“We see that our hospitals are in a fragile situation,” Premier François Legault said.

As of Thursday for 28 days, visiting those in other households won’t be allowed (with exceptions), restaurants will be serving delivery and takeout only and other gathering places such as bars, concert halls, cinemas, museums and libraries in the affected regions will close, he said

To explain why, Legault said protecting people in school communities, hospitals and long-term care homes is a priority.

Sacrifices required to change course

“None of this is a given. We can change the outcome,” Labos said. “It simply requires us to sacrifice a little bit.”

Nicola Lacetera, a behavioural economist at the University of Toronto, first studied compliance with physical distancing during the start of the pandemic in Italy. He found that the more frequently governments extended lockdown dates, the more disappointed the public tended to get, which could lessen co-operation.

“People say, ‘Well, I don’t know anybody who has COVID,'” Lacetera said. “From a statistical point of view, it makes no sense. But people tend to over-weigh what’s closer to them, like having known someone who got COVID.”

When the public can’t see the health consequences of COVID-19 directly in their daily lives then Lacetera said making hygiene, distancing and wearing masks more of a habit, alongside consistent messaging from different levels of government and communicating the science, could help.

A woman wears a face mask as she walks by a sign instructing people to wear masks at a market in Montreal on Sept. 13. The city’s restaurants will face new restrictions this week. (Graham Hughes/The Canadian Press)

‘Targeted’ measures

Ontario’s Chief Medical Officer of Health, Dr. David Williams, suggested “targeted” measures are under consideration. His Toronto counterpart, Dr. Eileen de Villa, called for new limits in restaurants on Monday, such as reducing the number of patrons from 100 to 75 and requiring establishments to collect contact information from those attending.

De Villa also said the extent of spread of the infection in the city means the concept of the bubble or a social circle “no longer reflects the circumstances in which we live.” 

Jacob Wharton-Shukster said his Toronto restaurant would stay open until 2 a.m. before the pandemic. He voluntarily chose to close at 11 p.m. after watching what can happen elsewhere in the world late at night when people have been drinking alcohol.

“The numbers are doubling from last week, and this is all reasonably foreseeable,” he said. ” We would have had to have taken a mitigation strategy a month ago to see any result now.”

Epidemiologists agree, saying the effects of measures only become apparent two weeks down the road because of the lag when someone is newly infected, develops symptoms, gets tested and receives the result.

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