A new study published in a Canadian medical journal paints a bleak picture around opioid-related deaths in Canada.

It shows the number of those deaths has more than doubled over a three-year period when the pandemic hit high gear.

The study, published recently in the Canadian Medical Association Journal, covers a period from January of 2019 to December 2021.

“There was this immediate and significant increase in opioid related deaths,” said Tara Gomes, an epidemiologist at Unity Health.

Over that three-year stretch, opioid deaths jumped from 3,007 in 2019 to more than 6,222 in 2022, which according to study authors equates to a quarter million years of life lost due to opioid-related deaths.

The group most affected is men between the ages of 30 and 39.

It hits close to home for Christy Soulliere of Windsor, Ont. who lost her son Austin Tremblay to an accidental overdose in November, 2022.

“He’s gone. You know, and there’s nothing worse in the world than losing a child,” said Soulliere.

She said Tremblay battled addiction since he was 15 and was in and out of treatment facilities more than a dozen times.

On his last day, after 30 days of sobriety, he took a substance which was laced with four times the lethal dose of fentanyl.

“I crumbled,” she recalled. “My world, everything I had fought 12 years to stop, it happened.”

Tremblay was just 27 years old.

In Ontario, one in three deaths of people in their 20s and 30s are opioid related and according to the study, they’re primarily caused by fentanyl.

“These are kids, it’s a whole generation. And if those numbers are right, it’s 25 per cent of that generation is no longer going to be here,” said Soulliere. “I don’t know how people aren’t taking that serious.”

The report suggests the increase among younger age groups points to a critical need for targeted prevention efforts.

And that’s exactly what Soulliere is doing in her son’s memory.

She launched Austin’s Red Shoe Project with the goal of opening a transitional house for people who have gotten sober, left detox and need support before treatment beds open up.

“Nobody’s staying sober for those four months. So there needs to be an area that fills that gap,” she said. “And there needs to be more support for families that are dealing with this themselves.”

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There are no sirens or flashing lights in the kitchen at Vancouver General Hospital, but their staff — and several key people — are addressing an emergency: the food. 

Not the food that visitors and staff buy, but rather the food that is delivered to VGH’s hundreds of patients daily, each of whom is healing from any number of conditions covering a wide spectrum of nutritional needs. 

Hospital food, with its rep for being boring, basic and bland, has been a long-overlooked component of patient care.

“We cannot afford to not talk about it,” says Ned Bell. 

The Vancouver-based chef, known for his commitment to fresh, seasonal ingredients, including sustainable seafood, has been working with VGH for the past few years by way of a pilot program to modernize the hospital’s food program. 

Patients said they wanted more diverse and meatless options

While VGH has always served healthy food that meets nutritional requirements, over the years, patients have expressed a wish for the hospital’s roster of largely Western-based meals to better reflect the diversity of its diners. That means more plant-based options and more global flavours, all in the name of health.

Bell didn’t have the state of hospital food on his plate for most of his culinary career until his wife began spending more time at VGH as she underwent cancer treatment. The timing was crucial, as conversations were in the beginning stages of implementing a pilot program to study how food could be improved and factor in cultural and dietary diversity, as well as more eco-friendly choices.

And, of course, being a chef, Bell was keen to find out if hospital food could actually taste great.

Joining a team led by Dr. Annie Lalande, surgical resident and PhD student in the Institute for Resources, Environment and Sustainability at the University of British Columbia (UBC), and Tiffany Chiang, director of food service transformation and strategic projects at Vancouver Coastal Health (VCH), Bell, along with key VGH staff like registered dietitian in acute care Elaine Eppler, got to work on developing new recipes.

Though the pandemic put a hold on the fieldwork, in 2022 the team regrouped to get the Planetary Health menu pilot up and running. 

Revamping hospital food menu not the same as in a restaurant

Given the scope of the hospital’s food program, and its limitations, as well as the highly specified nutritional requirements each meal has to meet, tackling the menu at VGH wasn’t anything like revamping a restaurant menu.

“I had to learn a ton,” shares Bell during an in-person menu tasting and info session. “My learning curve was steep.”

Starting with an initial batch of 53 recipes, Bell explored all the ways by which he could dial up the flavour, sustainability, and overall deliciousness of existing dishes in the VGH food program. 

The working list was narrowed down to about 20 or so lunch and dinner dishes (the team soon realized breakfast items needed the least attention for the time being) and Bell sought ways to make minor adjustments, asking question after question along the way. 

Where could ground beef be subbed for ground turkey or lentils? Which ingredients could be sourced from within B.C. at a lower price point, to boot? What could be made in-house rather than brought in packaged? Could a sauce or dressing import offer more flavour in a meal? 

Adding garnish a game-changer

But it was the simple addition of garnish to the pilot program’s dishes, a practice often reserved for restaurants, that emerged as a game-changer.

What might seem like a minor detail to some has proven to be a significant catalyst in transforming not only the visual appeal of hospital meals but also the overall satisfaction and well-being of patients.

“Sauce and a bit of garnish made a good dish better,” explains Lalande. 

Lalande explains that the pilot program began by gauging patient feedback through multiple means to discover what people most wanted to see improved. “More flavour,” was the dominant response, recalls Lalande, adding that patients spoke up about wanting the ingredients to be fresher and the recipes “more culturally diverse,” with more seasoning and texture.

Recognizing that crafting scratch-made meals for six to 700 patients a day is no small feat, Lalande says it was essential for the pilot program to look at meaningful solutions with significant impact. 

“Unless we take this time to stop and embrace the complexity, it’s hard to come up with something that isn’t a band-aid solution,” she adds, noting that change in hospital systems is so often reactive and not proactive. 

Looking at hospital food programs in North America and even as far away as Lebanon for inspiration on how to be more plant-forward and eco-conscious, the changes in the works at VGH are likely “the most progressive in Canada,” attests Lalande.

Subbing in plant-based proteins for meat – without shouting about it

While cost is, of course, a factor, the pilot program made certain to keep ingredient choices within the budget, even finding ways to save by using a plant-based protein source over an animal one. Chickpeas, generally, are cheaper than chicken.

“Plant-based proteins do tend to be less expensive,” says Lalande.

Oftentimes, offering a meatless version of a familiar dish didn’t yield objections. 

“We don’t scream from the rooftop that the Sloppy Joe is vegetarian,” says Bell. 

It simply is vegetarian, which makes it an option for more patients than a beef version. 

Popular new meals include a chickpea curry and trout with tomato miso dressing

A not-so-coincidental side effect of embracing more plants, whether it be fresh vegetables alongside a moist piece of fish or lentils in a Sloppy Joe, is that the impact on the environment is lessened. Even shifting to leaner animal proteins, like turkey or trout, are lower-impact options. 

It’s not exactly an off-label use of the food program, but it’s a way VGH has of “giving the planet a seat at the table,” explains Lalande.

Bell, who has long championed a “globally inspired, locally sourced” approach to his cooking, says he’s never worked so hard on perfecting so many recipes in his career. 

Some of Bell’s dishes that have emerged as popular favourites have been the Steelhead Trout with Tomato Miso Dressing; Creamy Coconut Chickpea Curry with Cauliflower and Cashews with Mango Chutney; and the Korean Gochujang Bowl.

During the study, patients answered surveys about the meal, and the team kept an eye on how empty the plates were when they came back to the kitchen. 

Eppler calls the Planetary Health pilot program “probably the most exciting thing I’ve ever worked on in my 36-year career.”

Food is more than nutrients: ‘there’s also the emotional feeling’

The longtime dietitian describes the constant and nuanced challenges of working with patients who not only have specific dietary needs but also various struggles to eat. Many hospital patients are unmotivated to eat or do not have the strength for rigorous chewing. 

However, having food that looks appetizing and hints at the taste and care of home, can go a long way in getting a patient excited about meal time. 

What Bell calls those “little touches of home-made,” can wind up “encouraging people to eat,” describes Lalande.

“Nutrients help with the physical — but there’s also the emotional feeling,” elaborates Eppler. Food encompasses so much, she continues: “It’s comfort, memory, healing, companionship, building relationships, respecting culture.”

With the pilot program concluded, VGH is preparing to implement a variety of improvements to its food system in the facility, starting with adjustments to its meal ordering and distribution system to work on a hub or satellite model to shorten the distance between patients and their food. 

The plan is to continue “with a few of the recipes right away and introducing [some of the] recipes to other VGH hospitals,” explains Chiang.

“This work matters,” says Bell, who adds he is extremely proud of the recipes he and the team have produced. “There is an opportunity for us to make changes and that is so incredibly powerful.”

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A group of doctors say Canadian cancer screening guidelines set by a national task force are out-of-date and putting people at risk because their cancers aren’t detected early enough.

“I’m faced with treating too many patients dying of prostate cancer on a daily basis due to delayed diagnosis,” Dr. Fred Saad, a urological oncologist and director of prostate cancer research at the Montreal Cancer Institute, said at a news conference in Ottawa on Monday.

The Canadian Task Force on Preventive Health Care, established by the Public Health Agency of Canada, sets clinical guidelines to help family doctors and nurse practitioners decide whether and when to recommend screening and other prevention and early detection health-care measures to their patients.

Its members include primary-care physicians and nurse practitioners, as well as specialists, a spokesperson for the task force said in an email Monday.

But Saad and other doctors associated with the Coalition for Responsible Healthcare Guidelines, which organized the news conference, said the task force’s screening guidelines for breast, prostate, lung and cervical cancer are largely based on older research and conflict with the opinions of specialists in those areas.

For example, the task force recommends against wide use of the prostate specific antigen test, commonly known as a PSA test, for men who haven’t already had prostate cancer. Saad called that advice, which dates back to 2014, “outdated” and “overly simplistic.”

The task force’s recommendation is based on the harms of getting false positive results that lead to unnecessary biopsies and treatment, he said.

But that reasoning falsely assumes that everyone who gets a positive PSA test will automatically get a biopsy, Saad said.

“We are way beyond the era of every abnormal screening test leading to a biopsy and every biopsy leading to treatment,” he said, noting that MRIs can be used to avoid some biopsies.

“Canadian men deserve (to) have the right to decide what is important to them, and family physicians need to stop being confused by recommendations that go against logic and evidence.”

Dr. Martin Yaffe, co-director of the Imaging Research Program at the Ontario Institute for Cancer Research, raised similar concerns about the task force’s breast cancer screening guideline, which doesn’t endorse mammograms for women younger than 50.

That’s despite the fact that the U.S. task force says women 40 and older may decide to get one after discussing the risks and benefits with their primary-care provider.

The Canadian task force is due to update its guidance on breast cancer screening in the coming months, but Yaffe said he’s still concerned.

“The task force leadership demonstrates a strong bias against earlier detection of disease,” he said.

Like Saad, Yaffe believes it puts too much emphasis on the potential harm of false positive results.

“It’s very hard for us and for patients to balance this idea of being called back and being anxious transiently for a few days while things are sorted out, compared to the chance of having cancer go undetected and you end up either dying from it or being treated for very advanced disease.”

But Dr. Eddy Lang, a member of the task force, said the harms of false positives should not be underestimated.

“We’ve certainly recommended in favour of screening when the benefits clearly outweigh the harms,” said Lang, who is an emergency physician and a professor at the University of Calgary’s medical school.

“But we’re cautious and balanced and want to make sure that we consider all perspectives.”

For example, some men get prostate cancer that doesn’t progress, Lang said, but if they undergo treatments they face risks including possible urinary incontinence and erectile dysfunction.

Lang also said the task force monitors research “all the time for important studies that will change our recommendations.”

“And if one of them comes along, we prioritize the updating of that particular guideline,” he said.

The Canadian Cancer Society pulled its endorsement from the task force’s website in December 2022, saying it hadn’t acted quickly enough to review and update its breast cancer screening guidelines to consider including women between 40 and 50.

“(The Canadian Cancer Society) believes there is an obligation to ensure guidelines are keeping pace with the changing environment and new research findings to ensure people in Canada are supported with preventative health care,” it said in an emailed statement Monday evening.

Some provinces have implemented more proactive early detection programs, including screening for breast cancer at younger ages, using human papillomavirus (HPV) testing to screen for cervical cancer and implementing CT scanning to screen for lung cancer, doctors with the Coalition for Responsible Healthcare Guidelines said.

But that leads to “piecemeal” screening systems and unequal access across the country, said Dr. Shushiela Appavoo, a radiologist with the University of Alberta.

Plus, many primary-care providers rely on the national task force guidelines in their discussions with patients, she said.

“The strongest association … with a woman actually going for her breast cancer screen is whether or not her doctor recommends it to her. So if her doctor is not recommending it to her, it doesn’t matter what the provincial guideline allows,” Appavoo said.

In addition to updating its guideline for breast cancer screening this spring, the task force is due to review its guidelines for cervical cancer screening in 2025 and for lung cancer and prostate cancer screening in 2026, according to its website.

This report by The Canadian Press was first published April 16, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

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