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Interior Health's slow progress on safe supply frustrates doctor, advocates – CBC.ca

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A doctor in Nelson, B.C., says after four years of trying to establish a safe supply program through conversations with the local health authority, he is making his frustrations public with hopes it will pressure officials into action. 

Michael Vance, a family physician who focuses on addictions, says he’s had multiple meetings about safe supply with Interior Health over the span of four years.

However, the health authority has never committed to providing him with the funding for a nurse, which would allow Vance to adhere to professional recommendations around prescribing safe supply in a team-based setting. 

Vance would like to be able to prescribe drugs such as fentanyl, sufentanil, and morphine, which are allowed under B.C.’s safe supply program. He says the prescribed drugs would help people get off an increasingly toxic street supply, which has already resulted in a number of fatal overdoses in Nelson and the West Kootenay region this year.

“How many more deaths need to happen before we actually put our money where our mouths are and get this treatment going?” he said.

“Every time I go to these meetings, I get more and more frustrated that there’s people dying and we’re not doing anything. I just can’t understand how we can continue.”

Vance said he’s already able to prescribe drugs like hydromorphone without the aid of support staff, as part of programs that are in place across the province. These are also used for opioid agonist therapy (OAT), which provides opioid users with longer-acting drugs to reduce dependency.

However, the B.C. College of Physicians and Surgeons says doctors looking to prescribe safe supply drugs should do so “preferably in a team-based setting,” and there should be safeguards in place. Vance says prescribed safe supply programs are set up with multidisciplinary teams to ensure smoother administration.

CBC News has requested comment from Interior Health on the specifics of Vance’s request.

However, the health authority confirmed in an email that there are no safe supply programs they are aware of in Nelson. Health authorities are responsible for dispensing funding for safe supply programs. 

“Interior Health has implemented, or is in the process of implementing, services that offer prescribed safer supply in Kelowna, Vernon, Kamloops and Penticton,” a spokesperson said. “Planning for other communities is underway.”

Vance says he’s able to prescribe drugs like hydromorphone already. However, to prescribe stronger substances like fentanyl (pictured here), he needs the help of a nurse. (CBC)

Safe supply not reaching rural communities

Vance said dozens of his clients would benefit from a prescribed safe supply, and that they aren’t able to travel to Vancouver or the province’s bigger urban centres to do so.

He says the lack of funding for safe supply in rural areas of B.C. is negatively impacting drug users there, with some communities seeing extremely high rates of death.

Holly Trider, a peer worker with Kootenay-based harm reduction organization ANKORS, says it is “hard not to feel abandoned” by Interior Health’s slow progress on the issue.

“Living rurally adds an extra barrier to how safe supply rolls out here. Many folks live an hour or more from their OAT clinic, relying on a public transit system that, well, isn’t reliable,” she said. “If they cannot get at least weekly [prescriptions], then safe supply just isn’t feasible for them.”

In addition, Trider criticized hydromorphone and other drugs used for OAT as not being close enough to the drugs people are using daily.

“Safe supply does not work if it’s done halfway like this. So yes, this means fentanyl and proper stimulants’ availability,” she said. “It is my understanding that we do not have these options for our folks because there is no one to run the program.

“It is devastating and infuriating to see all this loss, pain and struggle — when we know the answer, and our health authority holds the power to make it happen.”

Compassion clubs another option

Dylan Griffith, the founder of the Kootenay Insurrection for Safe Supply, says prescribed safe supply programs are beneficial for drug users because they get connected to health care as a result, and it offers stability.

However, he says that in the context of a primary health-care crisis and stigma against drug users on the part of some doctors, the prescriber model alone would not be enough to solve the toxic drug emergency.

Griffith is advocating for a compassion club model in the Kootenays, which sees drug user groups hand out tested drugs at cost to participants in a program.

“We’re sick of watching our friends and neighbours die,” he told CBC News. “If [the government] is not going to implement those solutions then we will.”

A man wears an upturned baseball hat and a blue T-shirt as he poses in front of mountains.
Dylan Griffith, the founder of the Kootenay Insurrection for Safe Supply, says the prescribed model for safer supply is useful, but its current implementation doesn’t come close to meeting the needs of drug users across B.C. (Submitted by Dylan Griffith)

Griffith said he is aware of four people who died of a fatal overdose in Nelson over the past three weeks, and he would be working with drug user groups to get his program off the ground.

“For some people, those substances are necessary for them to function in daily life,” he said. “We believe that denying them access to a clean supply of those drugs is a violation of their rights.”

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Artificial sweeteners tied to increased heart risk, new study finds – The Globe and Mail

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Participants in the study who had a higher intake of total artificial sweeteners had an increased risk of developing cardiovascular disease compared to non-consumers.NYSE/PEPSICO Handout via Reuters

Artificial sweeteners are added to thousands of foods and beverages – soft drinks, yogurts, pancake syrups, jams, baked goods, frozen desserts, chewing gum, candy – to help us satisfy our sweet tooth with fewer (or zero) calories and no added sugar.

But the effect of artificial sweeteners on body weight and health has long been debated.

Short-term randomized controlled trials have mostly shown that, when substituted for sugar-sweetened beverages, artificially-sweetened drinks help prevent weight gain.

Findings from numerous observational studies, however, suggest that over the long-term, a regular intake of these substances can have harmful effects on cardiometabolic health including increased waist circumference, elevated blood sugar, insulin resistance and inflammation.

Now, new research published in The British Medical Journal adds to growing evidence that a high intake of artificial sweeteners may harm cardiovascular health.

The latest findings

For the study, researchers examined the link between artificial sweetener intake and risk of cardiovascular disease in 103,388 participants enrolled in the NutriNet-Santé study, an ongoing nutrition and health study conducted among adults living in France.

Participants, who were followed for close to a decade, provided three days’ worth of 24-hour diet records, which included brand names of products, at the start of the study and every six months thereafter. The researchers calculated participants’ intakes of total artificial sweeteners (from foods, beverages and tabletop sweeteners), as well as intakes of different types of artificial sweeteners.

Diet soft drinks accounted for half (53 per cent) of artificial sweeteners consumed. Other important contributors were tabletop sweeteners (30 per cent) and flavoured dairy products, such as yogurt and cottage cheese (8 per cent). Aspartame, acesulfame potassium and sucralose represented most of the total artificial sweetener intake.

Participants who had a higher intake of total artificial sweeteners had an increased risk of developing cardiovascular disease compared to non-consumers. The average daily artificial sweetener intake among people classified as “higher consumers” was 77 mg, equivalent to roughly two packets of tabletop sweetener or 200 mL of diet pop.

Aspartame intake was linked to a greater risk of stroke; sucralose and acesulfame potassium were associated with an increased risk of coronary heart disease.

The researchers accounted for several factors tied to cardiovascular risk including age, family history, smoking, physical activity and diet components.

Strengths, caveats

The study’s strengths include its large sample size and high quality dietary data. The researchers collected repeated 24-hour diet records, which are known to be more precise than food frequency questionnaires typically used in nutrition studies.

One limitation of this study is that the findings show correlations only; they don’t establish a cause-and-effect relationship.

As well, it’s possible that some participants assessed as higher consumers at the start of the study had increased artificial sweetener intake in response to having risk factors for cardiovascular disease and may have already been in poorer cardiovascular health.

Artificial sweeteners may activate sweet taste receptors in the gut, which can alter the body’s regulation of blood glucose.Justin Sullivan/Getty Images

How artificial sweeteners may harm

These new findings are consistent with those from several other large observational studies that investigated the association between artificially sweetened soft drinks and cardiovascular disease risk.

There are plausible ways in which artificial sweeteners may increase heart risk. Previous studies have linked artificially sweetened beverages to metabolic syndrome, a collection of risk factors for cardiovascular disease that can include abdominal obesity, elevated blood pressure, high blood triglycerides, increased blood sugar and low HDL (good) cholesterol.

Ultraprocessed foods tied to colorectal cancer risk, study finds

Artificial sweeteners may also activate sweet taste receptors in the gut, which can alter the body’s regulation of blood glucose.

And experimental studies have shown that some artificial sweeteners alter the composition of the gut microbiome in a direction that can lead to inflammation and glucose intolerance.

What to do?

Due to a lack of consensus on whether the habitual use of non-sugar sweeteners is effective for long-term weight loss, or tied to other long-term health effects, in July the World Health Organization proposed a draft guideline recommending that “non-sugar sweeteners not be used as a means of achieving weight control or reducing the risk of non-communicable diseases.”

If you’re a daily consumer of artificial sweeteners, I do advise cutting back. That doesn’t mean it’s necessary to completely avoid them; there is no evidence that occasional use is harmful.

Replace soft drinks with sparkling water, unsweetened flavoured carbonated water or plain water with a wedge of citrus fruit.

If you add a packet of sweetener to coffee, tea or hot cereal, cut back gradually and incrementally. Ditto for real sugar.

Replace artificially sweetened yogurt with plain yogurt; sweeten it with fruit.

The good news: your taste buds will come to prefer a less sweet taste.

Leslie Beck, a Toronto-based private practice dietitian, is director of food and nutrition at Medcan. Follow her on Twitter @LeslieBeckRD

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Health unit hosting pop-up COVID vaccine clinics – BradfordToday

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NEWS RELEASE
SIMCOE MUSKOKA DISTRICT HEALTH UNIT
***********************
The Simcoe Muskoka District Health Unit is continuing to offer one-day pop-up COVID-19 vaccination clinics at locations throughout Simcoe Muskoka, with upcoming clinics taking place from Sept. 26 to Oct. 2. Walk-ins for individuals aged 5 years and older will be available, including the bivalent booster dose for people 18 years of age and older, as capacity allows as follows:

Monday, Sept. 26

  • Clinic location:  POP-UP Clinic – Stayner Arena and Community Centre, 269 Regina St. Stayner
    Time: 1 – 6 p.m.
  • Clinic location:  POP-UP Clinic – Chappell Farms, 617 Penetanguishene Rd., Barrie
    Time: 10 a.m. – 4 p.m.

Tuesday, Sept 27

  • Clinic location:  POP-UP Clinic – South Innisfil Community Centre, 1354 Killarney Beach Rd, Innisfil
    Time: 10 a.m. – 3:30 p.m.

Wednesday, Sept 28

  • Clinic location:  POP-UP Clinic – Huntsville Trinity United Church, 33 Main St. E., Huntsville
    Time: 10 a.m. – 2 p.m.

Thursday, Sept. 29

  • Clinic location:  POP-UP Clinic – Orillia Common Roof – Boardroom, 169 Front St. S., Orillia
    Time: 9:30 a.m. – 3:30 p.m.

GO-VAXX bus and mobile clinics continue to operate on an appointment only basis. Appointments for the GO-VAXX clinics may also be booked up to four days prior to the clinic through the COVID-19 vaccination portal or by calling the Provincial Vaccine Contact Centre at 1-833-943-3900. 

The health unit continues to offer COVID-19 vaccinations on an appointment only basis to individuals aged six months and older at the Georgian Mall, 509 Bayfield St. (upper level) in Barrie: 

  • Wednesday: 1 p.m. – 7 p.m.
  • Friday: 10 a.m. – 4 p.m.
  • Saturday: 10 a.m. – 4 p.m.

Appointments are also available at the health unit office immunization clinic locations in Midland, Orillia, Cookstown, Collingwood, Huntsville and Gravenhurst and can be booked through the COVID-19 vaccination portal or by calling the Provincial Vaccine Contact Centre at 1-833-943-3900.

In addition, the RVH COVID-19 Immunization Clinic at 29 Sperling Dr. in Barrie continues to offer booked appointments and walk-ins from 10 a.m. to 6 p.m. on Tuesdays and Thursdays. Appointments may also be booked with the Couchiching Ontario Health Team Clinic  located in the Orillia Soldier’s Memorial Hospital Kiwanis Building – West Entrance 170 Colborne St., W.

Individuals six months of age and older may also receive the vaccine at some local pharmacies or booked appointments through some primary care providers, and Family Health Teams who are offering the vaccine as part of their regular clinical practice. Pop-up and GO-VAXX mobile clinics will continue to be scheduled throughout Simcoe and Muskoka.

Staying up to date with all COVID-19 vaccine doses you are currently eligible for remains the best defense against infection, severe illness, long term COVID-19 symptoms, hospitalization and death.

For more information about COVID-19 vaccination, dose eligibility and booking an appointment, please visit www.smdhu.org/GetVaccinated.

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Advancing care for burn patients | Queen's Gazette – Queen's University

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New research finds that glutamine, previously thought to help with burn injuries, does not improve patients’ time to discharge from hospital.

Dr. Daren Heyland, Director of the Clinical Evaluation Research Unit at Queen’s University and principal investigator and sponsor of the glutamine trial.

Queen’s researcher Daren Heyland (Medicine) has spent his career studying what nutrients are best for intensive care patients who cannot eat for themselves, trying to understand if certain nutrients assist with their recovery. Patients in intensive care who cannot eat for themselves are fed artificial nutrition through a feeding tube or an intravenous catheter. For over 20 years, Dr. Heyland has been evaluating the role of glutamine, which is an amino acid that is made in the body and is found in foods like fish, eggs, and nuts.  

Worldwide, burn injuries are among the most expensive traumatic injuries to treat and 50 per cent of burn patients are treated using glutamine. Before adopting this practice more broadly, however, the medical community wanted more evidence of the efficacy of glutamine.

Seeking to understand the role of the amino acid in burn recovery, Heyland has been involved in a decade-long scientific trial involving 1,200 patients around the world with severe burns. The study was recently published in the high-impact New England Journal of Medicine (NEJM), and marked the first time a clinical trial on burn patients was featured in the prestigious publication. It yielded some unexpected results – the glutamine did not appear to harm or help burn patients.

“In the past, small, single-centre trials had suggested that glutamine was beneficial in the recovery of patients with severe burns. However, our previous work with glutamine in stressed, sick patients suggested that glutamine might actually be harmful in critically ill patients with organ failure. The only way to resolve these conflicting data was to conduct a large trial evaluating glutamine in severe burns,” said Dr. Heyland.

Dr. Heyland is the Director of the Clinical Evaluation Research Unit at Queen’s University, which functioned as the coordinating centre for the trial. He also serves as the principal investigator and sponsor of the trial, partnering with over 60 hospital burn units in nearly 20 countries.

“It took us 10 years to complete the trial, including recruiting patients and securing funding,” said Dr. Heyland. “The results of this trial will hopefully cause burn units that were using glutamine to put a stop this unnecessary practice.”

The trial was funded by the Canadian Institutes of Health Research and the Department of Defense (DOD) in the U.S. through their competitive granting programs. About 20-30 per cent of wounded soldiers have burns, and the DOD is looking for new ways to manage burns.

Dr. Heyland’s research evaluating the use of nutrition or specific nutrients and their role in improving the recovery of critically ill patients is not over. With $1.5 million in new funding from the DOD, he is now looking at high-dose intravenous vitamin C in burn-injured patients, which may help reduce the amount of fluid burn patients require to stay alive.

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