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Ottawa comes out in favour of injectable opioid therapy, urging Alberta not to shutter program

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Canada’s health minister is calling on the Alberta government to reconsider the closure of its injectable opioid agonist treatment program, which Premier Jason Kenney says will end in the spring when the province stops funding it.

The service provides patients with severe opioid use disorder, a recognized condition, with injections of pharmaceutical-grade heroin, known as diacetylmorphine, or hydromorphone.

“We are disappointed by this decision from the Alberta government, and we urge them to reconsider,” a spokesperson for Patty Hajdu said.

The health minister’s call comes one week after a group of patients benefiting from Alberta’s injectable opioid agonist treatment (iOAT) pilot program filed a lawsuit seeking an injunction to stop Alberta’s provincial government from ending it.

If the three Alberta clinics that offer the treatment close, few people east of British Columbia would have access to the program, which is a cornerstone of the federal government’s latest strategy to combat the opioid crisis.

“Many people are struggling with substance use, and in too many communities, the COVID-19 pandemic is compounding this ongoing public health crisis,” the minister’s statement said.

From January 2016 to March of this year 16,364 Canadians died from opioid overdoses according to figures from the federal government. The numbers have shown an increasing trajectory, with 3,799 deaths last year, and over 1,000 in the first three months of 2020.

The federal government began opening the door to community-based iOAT treatments in 2018 and has provided funding for pilot projects.

The move followed decades of research — first in Europe, then in British Columbia. Multiple studies suggested that providing daily access to pharmaceutical grade injectable opioids allowed long-term chronic users to stabilize their lives, find homes and stop engaging in criminal activity many relied on to support their addictions. Most stuck with the program long term, and some were able to stop using injection drugs altogether.

Alberta’s previous NDP government launched the pilot program in late 2017. Premier Jason Kenney is giving the 60 patients currently enrolled one year to transition to other programs that do not involve injecting opioids. He has called the federal government’s approach “facilitating addiction.”

“Handing out free narcotics to addicts is not compassion,” the premier said in response to questions from CBC News in September.

Patients file lawsuit to keep Alberta program operating

Patients enrolled in the program have have filed 11 affidavits in a lawsuit that is attempting to put a human face on the treatment. People who had focused their entire lives on the pursuit of drugs described awakening to a new world free of the stress and danger on the streets.

 

Taylor Maxey receives injectable opioid agonist treatments at a clinic in Calgary. He fears a return to the streets when the program is ended. (Taylor Maxey)

 

Among them a once nationally ranked swimmer. Taylor Maxey began taking opioids following an injury in his late teens. He was soon homeless, panhandling on the streets and committing petty crimes.

Maxey’s drug habit was costing $900 a day. He watched friends die around him. He attempted suicide. He tried and failed multiple treatment programs.

Today, at the age of 32, he says in an affidavit that he has stable housing, a new network of supportive friends, and hopes of becoming an outreach worker. Instead of hustling for street drugs, he is injected with opioids at the Calgary clinic slated to close in the spring.

Maxey is terrified of what will happen.

“My life would be shorter and much harsher if I returned to the streets and were denied access to iOAT,” he says in an affidavit. “I would be subject to the violence of the streets and the unsafe and precarious world of opioid use. I would be exposed to unsafe supplies of opioids.”

 

Patients of Edmonton’s injectable opioid agonist treatment program meet outside the office of lawyer Avnish Nanda on October 8, as they announce legal action to block the program’s closure. (Sam Martin CBC News)

 

The Alberta government has not filed a statement of defence in the case. The injunction application will be heard in November.

What the research shows

Beyond personal testimonials, iOAT is supported by a range of clinical research that began in Switzerland in the 1990s. on what was then known as heroin assisted treatment, or HAT. A  two-year study of 1,000 people across several centres in Switzerland found “substantial improvements for illicit heroin use, health status and crime among HAT patients,” according to a published review of the evidence. It also found a positive cost-benefit ratio because those provided with drugs had fewer medical issues and committed less crime.

A groundbreaking study published in 2009 in the New England Journal of Medicine concluded heroin-assisted treatment was safe and effective. Researchers followed 251 people in Vancouver and Montreal over 12 to 15 months. They found 88 per cent of patients receiving heroin stayed with the program, and among them, there was a 67 per cent decrease in criminal behaviour.

Overdoses and seizures were the most common adverse events recorded, though the study noted that since the patients were under close medical supervision, the overdoses were treated and the patients recovered.

As fentanyl and carfentanil have increasingly tainted the illicit drug supply, creating an overdose crisis, the provision of pharmaceutical heroin has increasingly been seen as a potential solution.

In 2019, the federal government formalized regulations, and the Canadian Research Initiative on Substance Misuse added clinical practice guidelines. At the time, Theresa Tam, Canada’s chief public health officer, said expanding the availability of pharmaceutical-grade heroin “will save lives.”

Availability limited as overdose deaths increase

But in spite of expectations the therapy would expand across Canada, it remains limited to a handful of sites in B.C., mostly in Vancouver. If the Alberta program shuts down, the only other places in Canada offering it will be Ottawa’s Managed Opioid Program, which treats a maximum of 25 people in a residential setting, and a newly opened program in Fredericton, which currently serves seven patients.

Rob Boyd, the program director of another Ottawa treatment centre, would like to offer iOAT but says he can’t, because the drugs are not adequately covered by Ontario’s health plan.

“Lots of places want to do it,” he said. “We would fill up right away.”

As overdose deaths increase — there have been more than 1,000 in British Columbia alone this year — Canada’s health minister is urging provinces and regulatory bodies to adopt the treatment.

“Do all you can to help provide people who use drugs a full spectrum of options for accessing medication,” she wrote in a letter to her provincial counterparts and regulatory bodies on Aug. 24.

“We need immediate action from all levels of government and health care practitioners to prevent further deaths from the contaminated illegal drug supply and COVID-19.”

Source: – CBC.ca

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Ontario records 1746 new COVID-19 cases today amid drop in testing – CP24 Toronto's Breaking News

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The number of new COVID-19 cases in Ontario surpassed 1,700 once again today amid a significant drop in testing over the past 24 hours.

Ontario health officials reported 1,746 new infections today, up slightly from the 1,708 confirmed one day prior but down from the record 1,855 recorded on Friday.

The new cases come as the province reports a notable drop in testing today.

After surpassing 50,000 tests per day for three consecutive days, only 39,406 tests were completed yesterday.

According to provincial health officials, the test positivity rate provincewide is now 4.6 per cent, up substantially from 3.7 per cent on Sunday but on par with the positivity rate at this point last week.

The rolling seven-day average of new cases is now 1,570, up from 1,429 one week ago.

“These trends of course remain concerning. The fact that we have had record high numbers on Friday and continued high numbers over the weekend and today is troubling,” Dr. David Williams, Ontario’s chief medical officer of health, said at a news conference on Monday afternoon. 

“The question is will we be able to keep it there and come down or will we plateau and start going up again?”

COVID-related hospitalizations also climbed to 618 today, up from 601 on Sunday, with 168 of those patients now in intensive care.

A count of local public health units and individual hospitals puts the number of hospitalizations at 631.

Eight more virus-related deaths were recorded today, down from 24 on Sunday and the lowest single-day death toll since Nov. 20.

Two of the fatalities confirmed over the past 24 hours involve residents of long-term care facilities, the latest data from the province reveals.

Of the new infections today, 622 are in Toronto, 390 are in Peel, and 217 are in York Region.

Toronto’s total today is the highest single-day tally recorded in the city since the start of the pandemic.

Another 108 new cases were reported in Durham Region today, up from 73 one day prior.

GTA public health units account for nearly 80 per cent of all new COVID-19 cases in the province and today marks one week since Toronto and Peel Region entered a 28-day lockdown.

During the lockdown, restaurants can only remain open for takeout and delivery and non-essential retailers are only permitted to offer curbside pickup and delivery.

Gyms, casinos, and movie theatres have also been closed.

Residents are being advised to only gather with members of their household and only go out for essential purposes.

Tougher public health measures were introduced in five more Ontario regions today, including Windsor-Essex, which was placed in the province’s “red” zone.

Task force working on plan for vaccine rollout

Last week, the province released details of its COVID-19 vaccine task force, which will be responsible for the distribution of vaccines when they are approved and arrive in Canada.

Ontario Health Minister Christine Elliott previously said she expects Ontario to receive a total of 2.4 million doses of the Pfizer and Moderna vaccines in the first three months of 2021.

Recipients of the vaccine will require two doses 28 days apart, which means the first shipment Ontario receives will likely only be enough to inoculate 1.2 million residents.

Prime Minister Justin Trudeau said last week that he expects most Canadians who want to be vaccinated will be able to do so by September 2021.

“I really think that if we have these vaccines landing on Canadian soil some time in very early 2021, like if it is the month of January, even in early February, I think this would be considered a huge success,” Dr. Isaac Bogoch, an infectious diseases specialist, told CP24 on Monday morning.

“We are not making these vaccines here. We are really relying on companies in other countries to produce this and send it to us.”

He said early rollout of the vaccine in Canada will go a long way to protecting the most vulnerable.

“Even with that very first early batch of vaccines that are coming… you can do so much good with that. If we just vaccinate target populations, like people in long-term care facilities… right off the bat, you are going to just decrease the probability of so many people getting very, very sick, coming to hospital, and sadly dying,” he said.

“We can alleviate that, we can alleviate tremendous suffering at an individual level but we can also take off tremendous pressure from our health-care system… Even well before September we can do some tremendous good.”

New cases in the GTHA today:

Toronto: 622

Peel Region: 390

York Region: 217

Durham Region: 108

Halton Region: 35

Hamilton: 54

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Ontario parents can now apply for second COVID-19 payout. Here's how – CTV Toronto

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TORONTO —
Just in time for the holidays, Ontario parents can now apply for their second COVID-19 payment from the provincial government.

Ontario Premier Doug Ford made the announcement during a news conference on Monday, saying the funds aim to help parents struggling due to additional learning and child-care costs amid the pandemic.

“There are thousands of families out there who have made sacrifices, who’ve taken seriously the public health advice, and who have gone that extra mile to make sure their child can learn safely,” Ford told reporters.

“We will always be there to support each and every single person in this province. That’s why I’m proud to announce that starting today the portal is open for applications for the ‘Support for Learners’ program.”

Parents of children aged 12 or younger will be able to receive a one-time payment of $200 per child, and $250 for children 21 years of age or younger with special education needs.

The portal is open to all eligible parents in Ontario, whether their children attend school in-person, online, or both.

“This financial support will help families cover the unexpected costs of school supplies, and other learning resources, especially for our youngest learners,” Education Minister Stephen Lecce told reporters.

“The money will be deposited directly into your accounts within roughly two weeks following your verification.”

The province said the application for the “direct one-time payments” can be submitted online and parents have until Jan. 15 of next year to apply.

This is the second payout from the province to Ontario families during the COVID-19 pandemic. The first payout came in the spring. The government said it will spend $380 million on the second payout to parents, on top of the $378 million from the first round. 

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Winnipeggers in 30s, 40s among new COVID-19 deaths in Manitoba – CBC.ca

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A Winnipeg man in his 30s and a Winnipeg woman in her 40s are among 11 new COVID-19 deaths in Manitoba, health officials say.

Manitoba hit a new record high for COVID-19 hospitalizations with 342 people in hospital on Monday, as the province added 343 new cases to its total. There are 43 positive patients in intensive care units, down one from Sunday.

Seven of the deaths are connected to outbreaks at long-term care homes, including a man and a woman in their 80s at Fairview Personal Care Home.

The deaths also include a woman in her 70s linked to the outbreak in the GA3 unit at Health Sciences Centre, a man in his 80s linked to the Villa Youville personal care home, a man in his 80s linked to the Charleswood Care Centre, a man in his 80s linked to Golden Links Lodge, a woman in her 90s linked to St. Norbert Personal Care Home, a man in his 90s linked to the Bridgepark Manor assisted living facility, and a Winnipeg woman in her 90s.

Manitoba’s test-positivity rate is 13.4 per cent, a slight increase of 0.1 percentage points from Sunday but still lower than at any other point last week.

Outbreaks at the Women’s Correctional Centre in Headingley and the Keeyask Generating Station near Thompson have been declared over. 

New outbreaks have been declared at the Lakeshore General Hospital in Ashern and West Park Manor Personal Care Home in Winnipeg.

The Winnipeg health region produced the majority of new cases, with 207 confirmed infections, while the Southern Health region had the second most, with 53. The rest of the cases were in the Northern Health region (46), Interlake-Eastern health region (23) and Prairie Mountain Health region (14).

Manitoba has now had 16,825 confirmed coronavirus cases since the start of the pandemic, with 9,260 reported as still active, although that number is likely inflated due to a backlog in clearing recovered cases.

A boy under 10 is the youngest person to die of COVID-19 in Manitoba, health officials announced on Saturday.

Two Manitoba churches, Church of God and Springs Church, held drive-in services on the weekend, in violation of public health orders capping gatherings at five people and ordering religious services to move online.

Winnipeg School Division teachers will walk thousands of students through an in-class exercise on Tuesday that’s meant to simulate what it could be like if the entire school system is suddenly forced to learn remotely.

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