The country is wealthy, has a culture of drinking, has easy access to alcohol and most people have to work less than 20 minutes to be able to afford a beer, said Jürgen Rehm, senior scientist in the Institute for Mental Health Policy Research at the Centre for Addiction and Mental Health.
On Monday a new national guideline was published to help family doctors talk with their patients about alcohol use disorder and problematic drinking. The website Help with Drinking was also launched to help people, their loved ones and doctors better understand problematic drinking and how to reduce or quit alcohol.
Health Canada got the Canadian Research Initiative in Substance Misuse and the BC Centre on Substance Use to develop the guideline, which brought together 36 people with expertise and lived experience to develop 15 recommendations to help doctors address alcohol use.
This is the first national guideline to be published on alcohol use disorder, said Rehm, who co-chaired the guideline writing committee.
Currently less than two per cent of Canadians with alcohol use disorder get prescribed effective medication, which Rehm said is due to stigma.
Stigma means patients don’t want to ask their doctors for help and the doctor doesn’t want to ask a patient about their drinking, he said.
He hopes the guideline will change that by training doctors to ask about a patient’s alcohol use at least once a year, in a similar way that they would ask about diet, exercise or smoking.
Rehm said alcohol and alcohol-related harms are the number 1 cause of death in the world for people aged 15 to 49, and are known to cause 200 health consequences, including everything from liver failure to car crashes.
In Canada, 18 per cent of adults will have alcohol use disorder in their lifetime, which is a disease clinically defined as an inability to control your drinking, Rehm said. This can include feeling the need to drink more, repeatedly drinking more than planned or sweating and trembling while sober.
Stigma against people who can’t control their drinking is “really sad” because it “leads to a perception amongst the public that there’s nothing that can be done, and that’s totally inconsistent with the evidence,” said Evan Wood, Canada Research Chair in addiction medicine at the University of British Columbia, who co-chaired the guideline writing committee with Rehm.
“When people get effective treatment they can do really well,” he added.
Medications, effective and not
Rehm and Wood told The Tyee they hope the new guidelines will help clinicians better understand, identify and diagnose alcohol use disorder and better understand what medications to prescribe.
There are two highly effective generic medications approved by Health Canada that can help people reduce their drinking or quit alcohol, Wood said. The medications are proven, cheap and readily available in Canada — but many doctors don’t know about them.
At the same time, for some patients, some antidepressant medication such as selective serotonin reuptake inhibitors, or SSRIs, can impact their relationship with alcohol, making them more likely to drink more, drink more often and spend less time sober, Wood said.
He added alcohol use can impact your physical health, for example causing dementia, liver disease and high blood pressure, and your mental health, affecting people’s sleep and causing depression and anxiety.
And when a patient tells their doctor they’re feeling depressed and not sleeping, a doctor’s go-to move may be to prescribe an SSRI. Wood said he hopes the new guidelines will help retrain doctors to ask more questions and avoid certain antidepressants if they think alcohol could be part of what is making a patient unwell.
As well as combating the social stigma that prevents people from talking about problematic drinking, Wood said he hopes the new guide will help combat some of the structural and academic stigma around alcohol.
If you have a heart attack, you will be taken to the hospital, be seen by several specialists, be given excellent care in a health-care setting and have plenty of followup care, Wood said. But if you show up at the ER begging for help because of your alcohol use, you will likely be turned away, he added.
Wood works at the Vancouver Coastal Health Detox Centre and said “there has been a decades-long failure of institutions to address the needs of people that struggle with alcohol.”
An example of that is how, despite the high number of people who struggle with alcohol, Vancouver Detox is the only public facility available for them. Wood said people will wait for weeks to get in and be “desperate for treatment for their alcohol addiction.” He’ll then have to break the news to them that the facility doesn’t offer treatment, just withdrawal management, which helps people safely get off alcohol in four to five days.
The only other option is private treatment, which Wood said is extremely expensive, comparing it to a mortgage.
Moral judgments don’t help
Canadian drinking culture means alcohol is at the centre of sporting events, celebrations and status. But if a person doesn’t want to drink and says it is because they cannot control themselves, people will make a moral judgment about their character, Rehm said. Women are judged especially harshly, he added.
Many Canadians cannot imagine a life without alcohol, he said. But many places in the world can. More than half the people in the world didn’t drink at all last year, and many European countries, like Italy and Sweden, have lower per-person drinking rates than Canada.
Canada’s drinking guideline says drinking fewer than two standard drinks per week means you’re likely to avoid negative health outcomes related to alcohol.
One standard drink is: 341 millilitres or a 12-ounce sleeve of five per cent beer or cider; 142 millilitres or a five-ounce glass of 12 per cent wine; or 43 millilitres or 1.5 ounces of a 40 per cent spirit.
That means two 20-ounce pints or half a bottle of wine per week is considered to be “moderate risk,” which increases a person’s chances of developing certain types of cancer like breast or colon cancer.
High-risk drinking is seven standard drinks per week or more, which increases a person’s risk of stroke or heart disease. That translates to just over four 20-ounce pints or about 1 1/3 bottles of wine per week.
Every drink more “radically” increases the risks associated with alcohol, the guideline notes.
Around half the country drinks more than two drinks per week, Rehm said.
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.
