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Opioid crisis not going away amid pandemic, and will 'kill more Canadians,' says Dr. Daniel Kalla – CBC.ca

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As the country and the rest of the world grapple with the coronavirus pandemic, the opioid crisis threatens to deepen and “kill more Canadians,” says a Vancouver ER doctor.

“[COVID-19] knocked … opioids right off the front page,” Dr. Daniel Kalla told White Coat, Black Art.

“But this is a crisis that we both know isn’t going away.”

In British Columbia, a total of 113 people died of suspected illicit drug overdoses in March — the highest death toll in a year, according to the B.C. Coroners Service. Experts have warned fentanyl and other contaminants are still present in many illicit drugs.

Kalla says people were afraid to use safe injection sites or join other people because they feared contracting COVID-19.

“So there was an increase in users using alone which … can be suicidal for opiate users.”

In his latest novel The Last High, Kalla chronicles the search for a deadly form of fentanyl in Vancouver. He spoke to White Coat, Black Art host Dr. Brian Goldman about his experience working in the ER for more than 20 years, how it has shaped his books and the pandemic’s impact on the opioid crisis.

Here is part of their conversation.

Your latest book The Last High begins with seven teenagers partying. All of them [overdose]. Only two make it to the ICU alive. Eventually we learn that an ultra-powerful form of fentanyl and carfentanil are behind the deaths. It sounds ripped from the headlines. Has anything like that ever happened on your watch?

Not in that scale. I’ve seen a couple of kids come in — and overdose — who didn’t know they were taking fentanyl or opioids. I saw one tragic 21-year-old girl — who ended up brain dead — who is not a regular opioid user.

As much as anything, I meant this book to be a cautionary tale. I have a 19 and 22 -year-old [daughters], and it’s the message I wanted to get out there that this stuff is the ultimate Russian roulette that some people are playing with.

Daniel Kalla, shown here with his daughters, says The Last High is a cautionary tale about opioid use. (Submitted by Daniel Kalla)

I want to take you back to that to that 21-year-old. What was that experience like for you?

Most opioid overdoses either die in the field or they get Narcan [brand name], naloxone, an antidote.

And by the time we usually see them in the emergency, they’re generally wide awake.

And then there’s that slim proportion that’s in the middle — whose [hearts] stay alive long enough to get to hospital — but they’re effectively brain dead. And I described that in the novel a little bit.

With no sign Canada’s opioid crisis will improve in the near future, the federal government has announced dramatic steps to try and stop its spread 3:18

I had the sense immediately when I saw her that she probably was brain dead.

She was deeply comatose … but, you know, she had a blood pressure. Her parents were rushing in. 

It was very devastating because even though we were trying to resuscitate her, I [had] this sinking feeling at the pit of my stomach that she’s never going to wake up, and sure enough, the CT scan confirmed that the brain damage was already irreversible. 

And she died a couple days later.

Clearly as a fiction author you want to entertain, but I’m getting the sense just listening to you that there’s a serious message behind this book. What would you say that is? 

Opioids touch everyone whether you’re a direct user or you’re a friend or a loved one of a victim and … when you look at our hardest core street users, homeless addicts … no one would choose that lifestyle.

They have a genetic predisposition towards addiction.

They make some wrong choices, and they end up where they do. 

I have friends … non-medical friends [who say], “Well, you know, it’s sad about fentanyl, but that’s a ‘them’ kind of thing.”

And it’s not. It’s pervasive, it’s everywhere, it can touch you personally. 

Solving Canada’s opioid crisis is complex, and those on the frontlines of the epidemic say over-prescribing, tainted drugs and housing issues are creating the perfect storm. 11:30

Based on your experience as an emergency physician, but also having conversations with your undercover police officer [Kalla’s source of background for his novels], any ideas on how to solve this crisis?

I’m one of those people who … first and foremost, believes in harm reduction at the top of the list and treating substance usage as a disease and getting them help and therapy. 

Second of all, stop treating users as criminals and treat them … as patients. 

The war … against drugs has never worked in the history [of] any country that’s tried it.– Dr. Daniel Kalla

Third of all, I think you need to decriminalize the drug. If we had control over the source, and you weren’t bringing in this dynamite that they’re using, we could control the death rate for sure.

The war … against drugs has never worked in the history [of] any country that’s tried it, and I think we really need to change the attitude. 

We have to stop the criminal supply of fentanyl that’s being shipped into the country,

But as long as people don’t have an alternative, they’re going to turn to the illegal dangerous stuff.

What are the lessons from the COVID-19 pandemic that you think might inform us on how to meet the needs of the patients you see?

Kalla says the opioid crisis is going to kill more Canadians and be with us long after the pandemic. (Submitted by Daniel Kalla)

I’ve been so generally impressed in the level of our response … the effort that we’ve put in, the innovativeness. 

We basically rejigged our entire emergency department  … we had, not just money, but thought and effort and dedication, and, you know, we saw a result right away.

I think the same thing can be applied to [not] just the opioid crisis, but the mental health crisis and the homelessness crisis. 

Obviously the pandemic gave us a pretty strong stimulus, but at the end of the day … I think the opioid crisis is going to kill more Canadians, certainly more young Canadians for sure, and be with us long after the pandemic.

You write fiction and sometimes real life is stranger than fiction. So let’s end our conversation on this. How do you think COVID-19 ends?

I keep hearing mixed things about how long the vaccine will take and … if ever they will get one. 

I think until we have that vaccine, or at least a very good treatment, which personally I think will come first — I think it’ll be like a cocktail HIV drug kind of treatment that will manage the sickest, and we reduce the death rate. 

Until then, I think we’ll see a rolling series of small little waves … that will lead to all kinds of, you know, social distancing.

We’ll move forward in these phases that Canada’s proposing now, and then we’ll have an outbreak, and we’ll all be stuck indoors for a couple of weeks again.

I don’t see any way around that because I don’t imagine natural herd immunity developing [with] this virus unless it has a horrific death toll across the world.


Q&A edited for length and clarity. 

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What’s the greatest holiday gift: lips, hair, skin? Give the gift of great skin this holiday season

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Give the gift of great skin this holiday season

Skinstitut Holiday Gift Kits take the stress out of gifting

Toronto, October 31, 2024 – Beauty gifts are at the top of holiday wish lists this year, and Laser Clinics Canada, a leader in advanced beauty treatments and skincare, is taking the pressure out of seasonal shopping. Today, Laser Clincs Canada announces the arrival of its 2024 Holiday Gift Kits, courtesy of Skinstitut, the exclusive skincare line of Laser Clinics Group.

In time for the busy shopping season, the limited-edition Holiday Gifts Kits are available in Laser Clinics locations in the GTA and Ottawa. Clinics are conveniently located in popular shopping centers, including Hillcrest Mall, Square One, CF Sherway Gardens, Scarborough Town Centre, Rideau Centre, Union Station and CF Markville. These limited-edition Kits are available on a first come, first served basis.

“These kits combine our best-selling products, bundled to address the most relevant skin concerns we’re seeing among our clients,” says Christina Ho, Senior Brand & LAM Manager at Laser Clinics Canada. “With several price points available, the kits offer excellent value and suit a variety of gift-giving needs, from those new to cosmeceuticals to those looking to level up their skincare routine. What’s more, these kits are priced with a savings of up to 33 per cent so gift givers can save during the holiday season.

There are two kits to select from, each designed to address key skin concerns and each with a unique theme — Brightening Basics and Hydration Heroes.

Brightening Basics is a mix of everyday essentials for glowing skin for all skin types. The bundle comes in a sleek pink, reusable case and includes three full-sized products: 200ml gentle cleanser, 50ml Moisture Defence (normal skin) and 30ml1% Hyaluronic Complex Serum. The Brightening Basics kit is available at $129, a saving of 33 per cent.

Hydration Heroes is a mix of hydration essentials and active heroes that cater to a wide variety of clients. A perfect stocking stuffer, this bundle includes four deluxe products: Moisture 15 15 ml Defence for normal skin, 10 ml 1% Hyaluronic Complex Serum, 10 ml Retinol Serum and 50 ml Expert Squalane Cleansing Oil. The kit retails at $59.

In addition to the 2024 Holiday Gifts Kits, gift givers can easily add a Laser Clinic Canada gift card to the mix. Offering flexibility, recipients can choose from a wide range of treatments offered by Laser Clinics Canada, or they can expand their collection of exclusive Skinstitut products.

 

Brightening Basics 2024 Holiday Gift Kit by Skinstitut, available exclusively at Laser Clincs Canada clinics and online at skinstitut.ca.

Hydration Heroes 2024 Holiday Gift Kit by Skinstitut – available exclusively at Laser Clincs Canada clinics and online at skinstitut.ca.

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Here is how to prepare your online accounts for when you die

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LONDON (AP) — Most people have accumulated a pile of data — selfies, emails, videos and more — on their social media and digital accounts over their lifetimes. What happens to it when we die?

It’s wise to draft a will spelling out who inherits your physical assets after you’re gone, but don’t forget to take care of your digital estate too. Friends and family might treasure files and posts you’ve left behind, but they could get lost in digital purgatory after you pass away unless you take some simple steps.

Here’s how you can prepare your digital life for your survivors:

Apple

The iPhone maker lets you nominate a “ legacy contact ” who can access your Apple account’s data after you die. The company says it’s a secure way to give trusted people access to photos, files and messages. To set it up you’ll need an Apple device with a fairly recent operating system — iPhones and iPads need iOS or iPadOS 15.2 and MacBooks needs macOS Monterey 12.1.

For iPhones, go to settings, tap Sign-in & Security and then Legacy Contact. You can name one or more people, and they don’t need an Apple ID or device.

You’ll have to share an access key with your contact. It can be a digital version sent electronically, or you can print a copy or save it as a screenshot or PDF.

Take note that there are some types of files you won’t be able to pass on — including digital rights-protected music, movies and passwords stored in Apple’s password manager. Legacy contacts can only access a deceased user’s account for three years before Apple deletes the account.

Google

Google takes a different approach with its Inactive Account Manager, which allows you to share your data with someone if it notices that you’ve stopped using your account.

When setting it up, you need to decide how long Google should wait — from three to 18 months — before considering your account inactive. Once that time is up, Google can notify up to 10 people.

You can write a message informing them you’ve stopped using the account, and, optionally, include a link to download your data. You can choose what types of data they can access — including emails, photos, calendar entries and YouTube videos.

There’s also an option to automatically delete your account after three months of inactivity, so your contacts will have to download any data before that deadline.

Facebook and Instagram

Some social media platforms can preserve accounts for people who have died so that friends and family can honor their memories.

When users of Facebook or Instagram die, parent company Meta says it can memorialize the account if it gets a “valid request” from a friend or family member. Requests can be submitted through an online form.

The social media company strongly recommends Facebook users add a legacy contact to look after their memorial accounts. Legacy contacts can do things like respond to new friend requests and update pinned posts, but they can’t read private messages or remove or alter previous posts. You can only choose one person, who also has to have a Facebook account.

You can also ask Facebook or Instagram to delete a deceased user’s account if you’re a close family member or an executor. You’ll need to send in documents like a death certificate.

TikTok

The video-sharing platform says that if a user has died, people can submit a request to memorialize the account through the settings menu. Go to the Report a Problem section, then Account and profile, then Manage account, where you can report a deceased user.

Once an account has been memorialized, it will be labeled “Remembering.” No one will be able to log into the account, which prevents anyone from editing the profile or using the account to post new content or send messages.

X

It’s not possible to nominate a legacy contact on Elon Musk’s social media site. But family members or an authorized person can submit a request to deactivate a deceased user’s account.

Passwords

Besides the major online services, you’ll probably have dozens if not hundreds of other digital accounts that your survivors might need to access. You could just write all your login credentials down in a notebook and put it somewhere safe. But making a physical copy presents its own vulnerabilities. What if you lose track of it? What if someone finds it?

Instead, consider a password manager that has an emergency access feature. Password managers are digital vaults that you can use to store all your credentials. Some, like Keeper,Bitwarden and NordPass, allow users to nominate one or more trusted contacts who can access their keys in case of an emergency such as a death.

But there are a few catches: Those contacts also need to use the same password manager and you might have to pay for the service.

___

Is there a tech challenge you need help figuring out? Write to us at onetechtip@ap.org with your questions.

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Pediatric group says doctors should regularly screen kids for reading difficulties

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The Canadian Paediatric Society says doctors should regularly screen children for reading difficulties and dyslexia, calling low literacy a “serious public health concern” that can increase the risk of other problems including anxiety, low self-esteem and behavioural issues, with lifelong consequences.

New guidance issued Wednesday says family doctors, nurses, pediatricians and other medical professionals who care for school-aged kids are in a unique position to help struggling readers access educational and specialty supports, noting that identifying problems early couldhelp kids sooner — when it’s more effective — as well as reveal other possible learning or developmental issues.

The 10 recommendations include regular screening for kids aged four to seven, especially if they belong to groups at higher risk of low literacy, including newcomers to Canada, racialized Canadians and Indigenous Peoples. The society says this can be done in a two-to-three-minute office-based assessment.

Other tips encourage doctors to look for conditions often seen among poor readers such as attention-deficit hyperactivity disorder; to advocate for early literacy training for pediatric and family medicine residents; to liaise with schools on behalf of families seeking help; and to push provincial and territorial education ministries to integrate evidence-based phonics instruction into curriculums, starting in kindergarten.

Dr. Scott McLeod, one of the authors and chair of the society’s mental health and developmental disabilities committee, said a key goal is to catch kids who may be falling through the cracks and to better connect families to resources, including quicker targeted help from schools.

“Collaboration in this area is so key because we need to move away from the silos of: everything educational must exist within the educational portfolio,” McLeod said in an interview from Calgary, where he is a developmental pediatrician at Alberta Children’s Hospital.

“Reading, yes, it’s education, but it’s also health because we know that literacy impacts health. So I think that a statement like this opens the window to say: Yes, parents can come to their health-care provider to get advice, get recommendations, hopefully start a collaboration with school teachers.”

McLeod noted that pediatricians already look for signs of low literacy in young children by way of a commonly used tool known as the Rourke Baby Record, which offers a checklist of key topics, such as nutrition and developmental benchmarks, to cover in a well-child appointment.

But he said questions about reading could be “a standing item” in checkups and he hoped the society’s statement to medical professionals who care for children “enhances their confidence in being a strong advocate for the child” while spurring partnerships with others involved in a child’s life such as teachers and psychologists.

The guidance said pediatricians also play a key role in detecting and monitoring conditions that often coexist with difficulty reading such as attention-deficit hyperactivity disorder, but McLeod noted that getting such specific diagnoses typically involves a referral to a specialist, during which time a child continues to struggle.

He also acknowledged that some schools can be slow to act without a specific diagnosis from a specialist, and even then a child may end up on a wait list for school interventions.

“Evidence-based reading instruction shouldn’t have to wait for some of that access to specialized assessments to occur,” he said.

“My hope is that (by) having an existing statement or document written by the Canadian Paediatric Society … we’re able to skip a few steps or have some of the early interventions present,” he said.

McLeod added that obtaining specific assessments from medical specialists is “definitely beneficial and advantageous” to know where a child is at, “but having that sort of clear, thorough assessment shouldn’t be a barrier to intervention starting.”

McLeod said the society was partly spurred to act by 2022’s “Right to Read Inquiry Report” from the Ontario Human Rights Commission, which made 157 recommendations to address inequities related to reading instruction in that province.

He called the new guidelines “a big reminder” to pediatric providers, family doctors, school teachers and psychologists of the importance of literacy.

“Early identification of reading difficulty can truly change the trajectory of a child’s life.”

This report by The Canadian Press was first published Oct. 23, 2024.

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