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Liberal government seeking delay to expanding medically assisted dying program

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The Liberal government announced Thursday it will seek to delay the expansion of Canada’s assisted-dying regime to include people whose sole underlying conditions are mental disorders.

Justice Minister David Lametti said during a news conference that the government has heard concerns the health-care system might not be prepared to handle those complicated cases.

“Some provinces, territories and those working in the health-care system say that more time is needed,” he said.

“That includes having the time to implement those practice standards, and to complete and disseminate key resources that are being developed for clinicians and other health-care system partners to address these more complex MAID requests.”

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An update to Canada’s medical assistance in dying legislation that passed in the spring of 2021 included a provision to temporarily exclude those whose sole underlying condition is a mental disorder from eligibility.

The provision is set to expire on March 17, 2023.

Dying with Dignity Canada, a non-profit that advocates for assisted dying, called the delay disappointing.

The group’s CEO, Helen Long, said she acknowledged the government’s concerns and its desire to “get things right” but said that since 2021, there has been rigorous study of how the expansion will work.

“It’s stigmatizing, discriminatory, unconstitutional,” she said. “And we’re really concerned about those who suffer intolerably and who have been waiting for that opportunity to be assessed for MAID.”

An expert panel studying the issue has heard concerns from clinicians, researchers and academics who questioned whether the proper safeguards are in place to expand the eligibility criteria without putting people with mental disorders or those living in poverty at risk.

Mental Health Minister Carolyn Bennett said the expert panel determined that the safeguards in place under the current regime are “excellent.”

“I think that there is very clear consensus this would be very rare, that the assessment may be pending over a long period of time, a number of different assessments,” she said.

Lametti added that the expert panel’s chair, Dr. Mona Gupta, is among those who feel that clinicians in Canada are ready to handle the expansion.

However, he acknowledged that not everyone is ready, and he has heard from those who “would like a short delay.”

In order to make that happen, the minority government will need to amend the existing legislation. Lametti said he expects there is widespread support for the move from other parties in the House of Commons and among senators.

Conservative MP Michael Cooper, who sits on a joint parliamentary committee that is studying medically assisted dying, said the decision to now seek a delay in the expansion underscores the “reckless approach” the Liberals have taken on the issue.

He argued it is “not safe to expand MAID in cases of mental illness.”

The NDP said it has heard “serious concerns” about the expansion of MAID and has called for better supports and treatments for people with mental disorders.

“Even though the Liberals called for this expansion, they haven’t acted to improve other options or programs to help people suffering from mental or physical disorders,” NDP MP Alistair MacGregor said in a written statement.

Lametti said any cases of medically assisted deaths as a result of mental disorders will follow a long period of treatment and insisted the federal government has spent millions of dollars on improving mental health care.

“I want to assure Canadians that it isn’t just the case that you can walk off the street and seek MAID if you’re feeling depressed,” he said.

Cooper criticized the government for failing to provide details Thursday about when the legislation will be introduced or how long the extension will be.

But Lametti said he did not want to speculate about the length of the proposed extension before negotiations with other parties begin.

Despite the criticism, the Conservatives said Thursday that pausing the expansion is the “only responsible course of action,” and the NDP promised to closely review any legislation.

The House of Commons and Senate have adjourned for the holidays. They are expected to resume sitting at the end of January.

This report by The Canadian Press was first published Dec. 15, 2022.

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Canada province experiments with decriminalising hard drugs – BBC

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Needles of drugs being preparedGetty Images

Canada’s province of British Columbia is starting a first-in-the-nation trial decriminalising small amounts of hard drugs such as cocaine and heroin.

From Tuesday, adults can possess up to 2.5g of such drugs, as well as methamphetamine, fentanyl and morphine.

Canada’s federal government granted the request by the west coast province to try out the three-year experiment.

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It follows a similar policy in the nearby US state of Oregon, which decriminalised hard drugs in 2020.

Ahead of the pilot’s launch, British Columbia and federal officials outlined the rules under the federally approved exemption from the Controlled Drugs and Substances Act.

While those substances will remain illegal, adults found in possession of a combined total of less than 2.5g of the drugs will not be arrested, charged or have their substances seized. Instead, they will be offered information on available health and social services.

Federal minister of mental health and addictions Carolyn Bennett on Monday called the move “a monumental shift in drug policy that favours fostering trusting and supportive relationships in health and social services over further criminalisation”.

Some 10,000 residents have died from drug overdoses since British Columbia declared drugs to be a public health emergency in 2016, officials said.

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“Decriminalising people who use drugs breaks down the fear and shame associated with substance use and ensures they feel safer reaching out for life-saving supports,” said Jennifer Whiteside, the British Columbia minister for mental health and addictions.

Thousands of police officers in the province have been offered training on the rule change, including those in Vancouver, the largest city in the province.

The programme will run from 31 January 2023 until 31 January 2026, unless it is revoked by the federal government.

Some experts have questioned the 2.5g limit, saying that it is not enough to account for the habits of many addicts.

There are some exemptions to the scheme.

The sale of drugs remains illegal. It is also illegal to possess drugs on the grounds of schools, childcare facilities and airports.

Canada legalised the use of recreational cannabis for adults nationwide in 2018.

But the four drugs now allowed in small quantities remain prohibited, meaning there are no plans to sell them in stores, unlike marijuana. Trafficking them across borders also remains illegal.

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Health Canada reviewing safety of controversial breastfeeding drug – CBC.ca

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Health Canada has launched a safety review of the psychological withdrawal symptoms associated with stopping or reducing use of a drug commonly prescribed to help women breastfeed.

The agency confirmed the review in an email to CBC News.

“A safety review is currently under way for domperidone and drug withdrawal symptoms after stopping or reducing the dose of domperidone used to stimulate lactation,” the statement said. 

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Domperidone is approved in Canada to treat gastrointestinal disorders. Health Canada has never authorized its use as a lactation aid, but it is widely prescribed off-label for this purpose. 

The Health Canada review follows a CBC News investigation into severe psychological effects that can occur when some women stop taking the drug. Women who spoke to CBC described anxiety, lack of sleep and thoughts of self-harm severe enough that in some cases they became incapable of caring for their children or returning to work. One woman described multiple attempts to take her own life. 

CBC’s investigation also found domperidone is prescribed by some doctors to stimulate lactation at doses three to five times higher than what is recommended by both Health Canada and the drug manufacturer. Because this is not an approved use or dosage anywhere in the world, there are no large-scale clinical trials that shed any light on how often these side effects occur. 

This makes it challenging for regulators like Health Canada to evaluate the safety of a drug for an off-label purpose, said Mina Tadrous, an assistant professor at the Leslie Dan Faculty of Pharmacy at the University of Toronto who specializes in drug safety.

Toronto pharmacist Mina Tadrous says it is challenging for regulators to evaluate the safety of a drug used for off-label purpose. (CBC)

“The company may not have intended it for that, so the original clinical trials were not designed for that. And so it means that they have to look at different mechanisms to be able to evaluate the safety of these drugs,” he said.

That can include looking at data from other countries with larger populations, according to Tadrous.

Case studies document concerns

There are, however, case studies documenting the withdrawal effects, including three published in November 2022 in the peer-reviewed journal Breastfeeding Medicine. Domperidone blocks dopamine receptors in the brain, which stimulates the release of prolactin. This causes lactation, the authors note, but can also cause domperidone to act as an antipsychotic. The authors also noted withdrawal symptoms are typically less severe when women taper off the drug slowly.

The most recent case studies are from the United States, where domperidone is not approved by the Food and Drug Administration for any purpose. CBC’s investigation found some American women get the drug from doctors in Canada.

Health Canada will review “all relevant domestic and foreign case reports,” the statement said.

Reviews can result in Health Canada requesting more information, studies or monitoring by the manufacturer. They can also result in warnings to patients and health care providers, changes to how a drug is labelled or, if necessary, the withdrawal of a drug from the market “if the benefits no longer outweigh the risks of the product,” according to the statement released by the department.

“The decision to take action, including issuing a warning, is not based solely on the number of case reports, but on a comprehensive assessment of the information contained in these case reports,” Health Canada’s statement said. 

“Should new safety risks be confirmed, Health Canada will take appropriate action and continue to keep Canadians informed.”

WATCH | Women report alarming withrawal effects after taking domperidone as a lactation aid:

Women report alarming withdrawal effects from drug prescribed for breastfeeding

2 months ago

Duration 7:08

WARNING: This story contains distressing details about suicidal thoughts and attempts. Correction: A previous version of this video included inaccurate Health Canada data about the number of domperidone prescriptions that were filled in 2020. That publicly available data has since been updated to show that 1.7 million prescriptions were filled that year.

The distinction between quantity and quality of reports is important, Tadrous said, because large numbers of reports, especially from non-clinicians, may only indicate people believe there’s a connection between a drug and a reaction. 

“That’s the lesson we’ve learned with vaccines, for example, where these adverse event systems are flooded,” he said.

“And so if you base something just on the number of reports without doing a thorough investigation and a different type of study design that reduces bias … you might reach a false conclusion.”

Health Canada has conducted multiple safety reviews of domperidone, most recently in 2021. Previous reviews confirmed the risk of serious abnormal heart rhythms and sudden cardiac death related to domperidone use. These reviews resulted in Health Canada introducing a maximum daily dose recommendation of 30 mg and restricting its use in patients with certain cardiac conditions or taking other drugs.

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The Holocaust strikes our very being

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Holocaust

To be a Jew is not something special,
being a human being is normal.
Dealing with prejudice, hatred, and oppressive action,
now that’s something special for the Jewish Nation.

Oppression, hatred, and genocide besides,
is not just a Jewish person’s situation.
Armenian, Cambodian and Jewish Peoples deal,
with a national eradication event.

People of the world unit,
genocide is an international delight.
Oppress your people, crush opposition too.
The elites of the world are making exceptions for you.

Don’t be weak, allowing excuses to be made,
but lift your hands in justice’s cruel wave.
Hatred knows no reasonability, it knows no mercy.
Hatred, oppression, and prejudice need no exception.

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Long ago Jews were murdered by the millions,
Cambodians died at the hands of their neighbors.
Palestine still walks within the borders of other nations,
and peace is nowhere to be found, my friend.

If your arms are in righteous ways demand justice for all,
for the people who hate will not see our peaceful ways.
A gun, a bayonet, and a saber be brought,
for the right to justice begins today,
and ends with blood if the opposition has any say.

Gandhi spoke of peaceful ways,
while Martin Luther Jr surrendered his life. to the cause.
Young blacks die each and every day,
while the power of prejudice wins the day.

My first lifts in anger that is for sure,
while the average person just shrugs this day.
But the goose-stepping troops may one day march on,
and the ignorance that prevails will let them carry on.

Open our eyes to the wrongs before us,
clear our minds and accept what bothers us.
Injustice is a prevailing horrid thing,
and ONLY YOU CAN BRING IT TO AN END.

Steven Kaszab
Bradford, Ontario
skaszab@yahoo.ca

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