Naloxone kits, which are used to help interrupt opioid overdoses, are available free of charge in many places in Kingston. Photo by Dr. James Heilman.
Public Health Nurse Rhonda Lovell said COVID-19 is “absolutely” a contributing factor to the rise of overdoses in the Kingston, Frontenac, Lennox & Addington (KFL&A) public health region this year.
For the past three years, Lovell has worked on the opioid overdose portfolio at KFL&A.
“We are at an intersection right now between an [opioid] epidemic and a pandemic,” she said, “and it’s really just a challenging time.”
Jurisdictions across Canada, including Vancouver, Toronto and Ottawa have all made headlines in recent weeks, connecting the dots between the COVID-19 lock-down and a nationwide spike in overdoses.
Preliminary results from the Ontario coroners office indicate a 25 per cent increase in overdose deaths between March and May of this year, compared to 2019.
“It’s not just people in Canada that are overdosing,” Lovell said, “not just people in Ontario, but people right here in the KFL&A area at risk from a highly toxic, unregulated drug supply.”
Supply chain disruption
On Monday, May 25, 2020, KFL&A Public Health warned that local emergency room departments, harm reduction centres and first responders were fielding an increased number of drug-related overdoses, attributed to a “bad batch” of street drugs circulating in the area.
Street drugs are often contaminated with other very harmful substances, Lovell said. Now, disruptions in international travel due to COVID-19 have made an unregulated drug supply even more unpredictable, and potentially more toxic.
“We’re hearing about disruptions in the drug supply chain itself,” she said. “There are lots of restrictions on movement right now, moving the drugs themselves, or the precursors, or ingredients.”
Substances that might have been coming from overseas may not be crossing borders as easily as they once were, she said, pushing dealers and users to work with whatever is available.
Those changes in drug supplies can also force users to make “challenging decisions” she said, about what they can do — or take — to avoid a period of withdrawal.
“I don’t even know how to accurately describe it. Its just a situation that you don’t want to find yourself in, going through an opioid withdrawal without adequate support,” she said.
“When someone is using drugs from an unregulated market, they might believe that they’re using one thing, but can’t say with certainty what’s in there. It’s not just drugs. Other contaminants that might be in there as well.”
Crystal methamphetamine and cocaine for example, she said, can both be contaminated with fentanyl, an opioid responsible for many overdose fatalities.
Other factors: stress, isolation
Public health advocates and social workers in Ottawa and Toronto have suggested that easy access to cash through the Canadian Emergency Response Benefit (CERB) could also be a factor in rising overdoses.
“I see that it could be,” Lovell said. “It makes logical sense… The theory applies quite widely and we’re hearing this speculation across the country.”
She said that general feelings of stress and uncertainty, social isolation, and loss of access to services also contribute .
“Job loss or just the general sense of fear and uncertainty from this can be very triggering on a lot of levels,” she said.
People actively using drugs at the start of the pandemic might increase their consumption, she said, while people in recovery risk using again, “particularly if they’ve experienced some of the losses related to the pandemic, or they’ve lost access to supports that they’ve had.”
With many social spaces shuttered during the COVID-19 pandemic, the public has been encouraged to practice social distancing for safety reasons. This presents risks of its own for people with drug addiction, Lovell said.
“Its a loaded statement right now to tell people: ‘Don’t use alone,’” she explained of a harm-reduction strategy often advised by social service workers. “But certainly if people are going to use alone, they need to make sure that someone is available to at least check in on them, make sure they’re okay, or call 911.”
She said that the local social service network has responded well to the crisis.
“One of the things that I’m so proud of in our community… is that we’ve seen just a great modification of services to try to keep as much access as we possibly can, so people are not going without those supports,” Lovell said.
She said KFL&A public health has taken on the issue of overdose risk and awareness more actively in the past few years, and has had a “much more active role in letting the community know that this risk is out there.”
Lovell said she will be watching the outcomes of harm-reduction strategies in British Columbia, where the provincial health authority has recently enabled access to a “safe supplies” of regulated opioids on the street.
“They’re certainly ahead of us in that regard,” Lovell said. “Hopefully we’ll get some attention on that here in Ontario, to see if it might be a solution to help mitigate some of these impacts.”
KFL&A Public Health advice
KFL&A Public Health is urging all those who use drugs not to mix them, to do test amounts, and to never use alone. Public Health is also reminding residents that the Public Consumption and Treatment Service at Kingston’s Street Health Centre is open seven days a week from 9 a.m. to 4 p.m., providing a safe place for anyone who wants to use drugs to do so under the supervision of people who are trained in how to respond to an overdose. Additionally, the Rapid Access Addictions Medicine Clinic at the Street Health Centre is open Monday through Friday from 9 a.m. to 12 p.m. and 1 p.m. to 4 p.m. by appointment. That clinic can provide individuals with support in getting help for a substance use disorder.
KFL&A Public Health is encouraging all residents to be aware of the signs of an opioid overdose and pick up a free naloxone kit. Free kits are available at the following locations:
KFL&A Public Health (Kingston office): Monday to Friday from 8:30 a.m. to 4:30 p.m.
Street Health Centre: Monday to Sunday 9 a.m. to 12 p.m. and 1 to 4 p.m.
HIV/AIDS Regional Services: Contactless drop off available Monday to Friday (call 613-329-6932). Mobile outreach unit is located at Street Health Centre from 4 to 8 p.m. on Mondays, Tuesdays, Thursdays, and Saturdays.
St. Vincent de Paul Society of Kingston: Monday to Friday from 9 a.m. to 1 p.m.
Martha’s Table: Monday to Sunday 11 a.m. to 1 p.m.
Home Base Housing Street Outreach Team: Monday to Friday at Lunch By George from 11 a.m. to 11:30 a.m. and Street Health Centre from 12 to 1 p.m.
Change Health Care: Monday to Friday 6:30 a.m. to 4 p.m.; Saturday to Sunday 8 a.m. to 12 p.m.
Napanee and Area Community Health Centre: Monday to Friday 9:30 to 11:30 a.m. and 1 to 3 p.m.
It is also important for residents to remember that an overdose is a medical emergency. Anyone who suspects or witnesses an overdose should call 911, and the Good Samaritan Drug Overdose Act provides some legal protection against simple drug possession charges for anyone who experiences, witnesses or responds to an overdose and calls authorities.
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
