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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.

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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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Measles case reported locally turns out to be negative: health unit

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NEWS RELEASE
SIMCOE MUSKOKA DISTRICT HEALTH UNIT
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On March 26, the Simcoe Muskoka District Health Unit (SMDHU) was notified by Public Health Ontario’s (PHO) laboratory that due to laboratory error, the case of measles that had been lab-confirmed positive on March 12, based on symptoms and a positive urine measles laboratory result by PHO’s laboratory, is in fact negative for the measles virus.

“With this new information of the negative lab result, we believe that that individual was not infected with measles and that there has not been any public exposure to measles resulting from this individual’s illness,” said Dr. Charles Gardner, medical officer of health. “We recognize that notifying the public of what we believed to be a positive measles case in our area created worry, anxiety and disruption for some, and we regret this.

“We do know that, despite best efforts, on rare occasions laboratory errors can occur. We are working closely with the PHO’s laboratory to do all that we can to ensure that such an incident does not occur again.”

Measles is a highly contagious viral infection that spreads very easily through airborne transmission. The measles virus can live in the air or on surfaces for up to two hours.

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Symptoms of measles begin seven to 21 days after exposure and include fever, runny nose, cough, drowsiness, and red eyes. Small white spots appear on the inside of the mouth and throat but are not always present. Three to seven days after symptoms begin, a red, blotchy rash appears on the face and then progresses down the body.

The risk of transmission to those vaccinated with two doses is low, and when it does occur tends to show a reduction in the severity of these symptoms.

“Although we are relieved for the individual involved, and for all Simcoe-Muskoka residents, that this case has now been confirmed as negative, we know that measles is still active in Ontario at this time and the potential remains for new cases to arise, especially given the increase in Ontarians travelling to areas in the world that have higher numbers of measles cases,” said Dr. Gardner. “This is why we continue to advise individuals to keep up to date with their routine immunizations, including measles, mumps and rubella (MMR) vaccination.”

The risk of measles is low for people who have been fully immunized with two doses of measles vaccine or those born before 1970; however, many children have been delayed in receiving their routine childhood immunizations and people who have not had two doses of measles vaccine are at higher risk of contracting the disease.

People who do get sick usually recover without treatment, but measles can be more severe for infants, pregnant women, and those with compromised immune systems. Possible complications include middle-ear infections, pneumonia, diarrhea, or encephalitis (swelling of the brain) and occasionally death in the very young. Even individuals who are up to date with the measles vaccine should watch for symptoms of measles for 21 days after exposure.

For more information about measles, please visit smdhu.org or call Health Connection at 705-721-7520 or 1-877-721-7520, Monday to Friday between 8:30 a.m. and 4:30 p.m. to speak with a public health professional.

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Kate Middleton Not Alone. Cancer On Rise For People Under 50, Say Experts

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Kate Middleton revealed on Friday that her cancer was discovered after she received abdominal surgery

London:

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When Catherine, Princess of Wales, revealed she was being treated for cancer last week, part of the shock was that an otherwise healthy 42-year-old has a disease that mostly plagues older people.

However, researchers have been increasingly sounding the alarm that more and more people under 50 are getting cancer — and no one knows why.

Across the world, the rate of under-50s diagnosed with 29 common cancers surged by nearly 80 percent between 1990 and 2019, a large study in BMJ Oncology found last year.

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The researchers predicted the number of new cancer cases among younger adults will rise another 30 percent by the end of this decade, with wealthy countries particularly affected.

The increase in cases — and soaring global population — means that the number of deaths among under 50s from cancer has risen by nearly 28 percent over the last 30 years.

This occurred even as the odds of people of all ages surviving cancer have roughly doubled over the last half century.

Shivan Sivakumar, a cancer researcher at the UK’s University of Birmingham, called it an “epidemic” of young adult cancer.

Since Kate Middleton revealed on Friday that her cancer was discovered after she received abdominal surgery earlier this year, Sivakumar and other doctors have spoken out about the uptick in younger cancer patients they have been seeing at their clinics.

While breast cancer remains the most common for people under 50, the researchers expressed particular concern about the rise of gastrointestinal cancers — such as of the colon, pancreas, liver and oesophagus — in younger adults.

Colon cancer is now the leading cause of cancer deaths in men under 50 in the United States, according to the American Cancer Society. For women, it is number two — behind only breast cancer.

One high profile case of colorectal cancer was “Black Panther” actor Chadwick Boseman, who died at the age of 43 in 2020.

Why is this happening?

“We just don’t have the evidence yet” to say exactly what is causing this rise, Sivakumar told AFP, adding it was likely a combination of factors.

Helen Coleman, a cancer epidemiology professor at Queen’s University Belfast who has studied early onset cancer in Northern Ireland, told AFP there were two potential explanations.

One is that people in their 40s were exposed to factors known to cause cancer — such tobacco smoke, alcohol or being obese — at an earlier age than previous generations.

She pointed out that the “obesity epidemic” did not start until the 1980s.

Sivakumar felt that at least part of the puzzle could be explained by obesity.

However, there is “another wave” of under-50 patients who are neither obese nor genetically predisposed still getting cancer, he emphasised, adding that this could not be put down to “statistical chance”.

The other theory, Coleman said, is that “something different” has been going on with her generation.

Fingers have been pointed out a range of possible culprits — including chemicals, new drugs and microplastics — but none have been proven.

Some have suggested that so-called ultra-processed foods could be to blame. “But there’s very little data to back any of that up,” Coleman said.

Another theory is that the food we eat could be changing our gut microbiome.

While there is nothing conclusive yet, Coleman said her own research suggested that cancer causes changes to the microbiome, not the other way around.

Anti-vaxx conspiracy theorists have even tried to blame Covid-19 vaccines.

This is easily disproven, because the rise in young adult cancer has taken place over decades, but the vaccines have only been around for a few years.

What can be done?

To address the rise in younger colorectal cancer, in 2021 the US lowered the recommended age for screening to 45. Other countries have yet to follow suit.

But the researchers hoped that Catherine’s experience would remind people at home that they should consult their doctor if they sense anything is wrong.

“People know their bodies really well,” Sivakumar said.

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“If you really feel that something isn’t right, don’t delay — just get yourself checked out.”

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Almost 3,000 students suspended in Waterloo Region over immunization issues

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Close to 3,000 children attending elementary school across Waterloo Region were suspended from school on Wednesday morning for not having up-to-date immunization records.

The region says Waterloo Public Health suspended 2,969 students under the Immunization of School Pupils Act (ISPA).

For several months, the region has been campaigning for people to get their children’s vaccinations up to date, including sending letters home to parents on a couple of occasions, warning that students’ records needed to be up to date or they would be suspended.

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It announced in January that 32,000 students did not have up-to-date records: 22,000 elementary students and 10,000 high school students.


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“We have made remarkable progress from the original 27,567 immunization notices we sent to parents in November and December 2023,” Dr. Hsiu-Li Wang, medical officer of health, stated.

“Since that time, we have resolved more than 24,500 outdated vaccination records, providing students with valuable protection against these serious and preventable diseases.”

The high school students still have a few weeks to get their records up to date or else face suspension.

The ISPA requires students to have proof-of-vaccination records for diphtheria, polio, tetanus, pertussis, measles, mumps, rubella, varicella (chickenpox) and meningitis, which must be on file with public health.

Public health says caregivers whose children are suspended will need to book an appointment at regionofwaterloo.ca/vaccines for clinics, which will be held in Cambridge and Waterloo on weekdays.

“Given the high number of suspensions, it may take several days before you can be seen at an appointment and return your child to school,” a release from the region warns.

“Record submission and questions must be done in person to ensure immediate resolution.”

The last time suspensions over immunizations were issued was in 2019, when 1,032 students were suspended.

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