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Outreach workers call for new tools to combat toxic new street drugs

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Walking through the Glengarry non-profit housing complex in Windsor, Ont., harm reduction outreach co-ordinator Lacie Krzemien is exhausted.

The recent news that Windsor’s only safe consumption site, Safepoint, will pause operations at the end of December has left her despondent.

“I’m upset, because it’s taking away another resource. It means more of my clients are at a higher risk of death,” said Krzemien, who distributes safe supplies for people using drugs with Pozitive Pathways Community Services.

She says the announcement comes at a time when the drug supply has become increasingly toxic. The arrival of drugs such as “tranq,” fentanyl mixed with xylazine, an animal tranquillizer that’s resistant to naloxone, is making the overdose crisis even more complicated.

Tranq has also become infamous for causing users to develop seeping wounds.

Earlier this year, Health Canada released a report that said tranq was spreading rapidly across Canada. In 2022, 75 per cent of the drug samples tested that contained xylazine were from Ontario. According to Ontario’s coroner, xylazine has been detected in 184 drug toxicity deaths since 2020.

At least two of those were in Windsor.

Lacie Krzemien, left, does outreach in Windsor, Ont., speaking to people about the changing drug supply and how it complicates overdoses. (Mia Sheldon/CBC)

“I’m sure that it’s a lot worse than what we’re seeing, you know, in the statistics right now,” said Krzemien.

She used Safepoint as a resource for clients with tranq wounds and testing the drug supply. It’s one of the few places in Windsor that offers fentanyl drug testing. But that won’t be the case come January.

CBC News spoke with Windsor Mayor Drew Dilkens before Safepoint announced it would be pausing operations. The Mayor, who said he spends the majority of time working on the city’s mental health and addiction problem, was opposed to the site.

“We want to find, and have the money spent, in a way that’s actually going to make a material difference. And that is with mental health and addiction support, and helping people get the treatment that they need to become productive members of society again.”

CBC News asked the Ontario Ministry of Health about the current review and how it impacts drug testing and safety. In an email, they replied that the review will determine the next steps and that, “CTS [Consumption and Treatment Services] sites are expected to build trust in the communities where they are located through consultation and ongoing engagement.”

Krzemien says the decision to pause Safepoint’s operations erodes that trust.

“We want to keep people alive,” said Krzemien. “We want to keep them breathing.”

‘It’s just getting worse’

Xylazine is just one of the many dangerous additives being found in the illicit drug supply. Benzodiazepines, which are depressants, have been present in up to 60 per cent of the fentanyl supply, according to the Toronto Drug Checking Service.

There are also stronger synthetic opioids, like carfentanil, which are even more deadly than fentanyl.

In October, Health Canada announced an extra $21 million in funding to try and get ahead of a worsening overdose crisis. But when the drug supply — specifically synthetic opioids — keeps changing, so do the tactics needed to catch up.

The Toronto Drug Checking Service is one of the recipients of Health Canada’s new funding. The service, which uses a lab in St. Michael’s Hospital, tests street drug samples to identify exactly what’s in them.

“It’s important for people to know what it is that they’re using, just so that they can make safer choices,” said the lead for the Toronto Drug Checking Service, Karen McDonald.

“When we’re using any type of pharmaceutical or when we’re drinking alcohol or eating any type of food … we have, like, an ingredients list or we know exactly what is in those products.”

The Toronto Drug Checking Service is an anonymous public health service that analyzes street drugs to see what is in them. (Mia Sheldon/CBC)

Both tranquillizers like xylazine and depressants like benzodiazepines (benzos) are highly sedative and are especially dangerous when people are unaware they’re consuming them.

Nicknamed the “zombie drug” for the blackout states it can cause, xylazine is normally used to sedate cattle or horses and is not approved for human consumption. As a central nervous system depressant, it dangerously suppresses vital signs like heart rate and blood pressure.

“What that means is the drug supply is getting stronger,” said McDonald, noting that the amount of xylazine found in Toronto samples in the last two years has ranged from six per cent to 20 per cent.

“It’s just getting worse and worse and worse — more contaminated, less predictable.”

B.C., Alberta and Ontario made up 97 per cent of identified xylazine substances in Canada last year, according to Health Canada’s drug analysis service. (Statistics Canada)

A deadly threat

Tranq has not only been detected across Canada but in 48 of 50 U.S. states, and is especially acute in places like Philadelphia, where it is estimated up to 90 per cent of the opioid supply has xylazine in it.

The situation is so bad that U.S. President Joe Biden has called the xylazine-fentanyl mix a deadly threat.

“The thing is, you don’t know you’re doing it,” said Ryan Green, who has been homeless in Philadelphia for more than a year. He’s used fentanyl before, but when he got to the city’s Kensington neighbourhood, it was different.

Ryan Green, 36, shows CBC the ‘tranq sores’ on his body. The wounds are caused by using drugs cut with xylazine. (Mia Sheldon/CBC)

“It just knocks you out,” Green told CBC. “You end up unconscious to the point where people just drop.”

Those who consume tranq also develop wounds and infections. Some people can have dozens of sores on their body.

“I’ve been out here a year, and I thought this was the extent of my tranq sores,” Green said, pointing out some of the lesions on his body. “I guess the way it works is it just kind of goes through your body and it picks a soft spot of flesh. And that’s where it comes out.”

Green was having his wounds treated at a mobile medical clinic operated by the city and a neighbourhood hospital. It started operating in May 2022 because of the dramatic number of tranq wounds in the area.

Michelle Murphy-Rozanski, the nurse practitioner at the clinic, has seen all kinds of wounds, some “going down to the bone, the muscle, the cartilage.” She said some patients have been permanently disfigured or faced amputation.

“It used to be [people who use drugs] would lose their house, they would lose their job, they would lose their kids, they would lose their spouse. Now, they’re losing body parts, arms, legs, fingers, parts of their neck. They’re still unable to quit.”

Nurse practitioner Michelle Murphy-Rozanski treats people in a Philadelphia neighbourhood who have physical wounds caused by using tranq. ‘It used to be [people who use drugs] would lose their house, they would lose their job, they would lose their kids, they would lose their spouse. Now, they’re losing body parts, arms, legs, fingers, parts of their neck.’ (Mia Sheldon/CBC)

Xylazine in Canada

There isn’t much research on how xylazine affects humans, including its addictive nature or withdrawal. Recent papers in the United States have called for more research and understanding of xylazine’s effects.

“[There’s] a lot of fear,” said Krzemien. “There’s a lot of uncertainty.”

The RCMP has been aware of xylazine in Canada’s drug supply since 2012, but since xylazine is a veterinary drug and not technically a narcotic, enforcement is difficult.

The RCMP told CBC News it could be used as a cutting agent with synthetic opioids like fentanyl and trafficked at street level.

It’s not known why xylazine is being added. There is speculation that it prolongs the high of fentanyl or that adding it increases weight to the drug supply, making production cheaper.

Michael Brennan, executive director of Windsor’s Pozitive Pathways Community Services, says that you can see a bad batch of drugs travel from Toronto to Windsor by tracking the overdoses.

“You’ll see an alert come out of Hamilton. Then it’ll show up [in Windsor] a couple of weeks later,” said Brennan.

Regional health authorities and law enforcement agencies across Canada have issued alerts about xylazine being found in the community.

Brandon Bailey, who has been an active drug user in Windsor but is currently clean, says the unpredictability of the drug supply scares him.

Brandon Bailey tells CBC News that it’s not just people who are homeless or on the street who are hurt by a more toxic drug supply. It’s anyone who uses. (Mia Sheldon/CBC)

“In a way, that has helped me … keep away from stuff now, because I don’t know what’s in it. But also, there are times where I’ve relapsed,” Bailey said, noting there is little drug testing in Windsor.

“[Everyone is] susceptible to this. It’s not just people who are living in poverty or people who are homeless. It’s happening to everybody.”


 

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Health Canada approves updated Moderna COVID-19 vaccine

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TORONTO – Health Canada has authorized Moderna’s updated COVID-19 vaccine that protects against currently circulating variants of the virus.

The mRNA vaccine, called Spikevax, has been reformulated to target the KP.2 subvariant of Omicron.

It will replace the previous version of the vaccine that was released a year ago, which targeted the XBB.1.5 subvariant of Omicron.

Health Canada recently asked provinces and territories to get rid of their older COVID-19 vaccines to ensure the most current vaccine will be used during this fall’s respiratory virus season.

Health Canada is also reviewing two other updated COVID-19 vaccines but has not yet authorized them.

They are Pfizer’s Comirnaty, which is also an mRNA vaccine, as well as Novavax’s protein-based vaccine.

This report by The Canadian Press was first published Sept. 17, 2024.

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

The Canadian Press. All rights reserved.

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These people say they got listeria after drinking recalled plant-based milks

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TORONTO – Sanniah Jabeen holds a sonogram of the unborn baby she lost after contracting listeria last December. Beneath, it says “love at first sight.”

Jabeen says she believes she and her baby were poisoned by a listeria outbreak linked to some plant-based milks and wants answers. An investigation continues into the recall declared July 8 of several Silk and Great Value plant-based beverages.

“I don’t even have the words. I’m still processing that,” Jabeen says of her loss. She was 18 weeks pregnant when she went into preterm labour.

The first infection linked to the recall was traced back to August 2023. One year later on Aug. 12, 2024, the Public Health Agency of Canada said three people had died and 20 were infected.

The number of cases is likely much higher, says Lawrence Goodridge, Canada Research Chair in foodborne pathogen dynamics at the University of Guelph: “For every person known, generally speaking, there’s typically 20 to 25 or maybe 30 people that are unknown.”

The case count has remained unchanged over the last month, but the Public Health Agency of Canada says it won’t declare the outbreak over until early October because of listeria’s 70-day incubation period and the reporting delays that accompany it.

Danone Canada’s head of communications said in an email Wednesday that the company is still investigating the “root cause” of the outbreak, which has been linked to a production line at a Pickering, Ont., packaging facility.

Pregnant people, adults over 60, and those with weakened immune systems are most at risk of becoming sick with severe listeriosis. If the infection spreads to an unborn baby, Health Canada says it can cause miscarriage, stillbirth, premature birth or life-threatening illness in a newborn.

The Canadian Press spoke to 10 people, from the parents of a toddler to an 89-year-old senior, who say they became sick with listeria after drinking from cartons of plant-based milk stamped with the recalled product code. Here’s a look at some of their experiences.

Sanniah Jabeen, 32, Toronto

Jabeen says she regularly drank Silk oat and almond milk in smoothies while pregnant, and began vomiting seven times a day and shivering at night in December 2023. She had “the worst headache of (her) life” when she went to the emergency room on Dec. 15.

“I just wasn’t functioning like a normal human being,” Jabeen says.

Told she was dehydrated, Jabeen was given fluids and a blood test and sent home. Four days later, she returned to hospital.

“They told me that since you’re 18 weeks, there’s nothing you can do to save your baby,” says Jabeen, who moved to Toronto from Pakistan five years ago.

Jabeen later learned she had listeriosis and an autopsy revealed her baby was infected, too.

“It broke my heart to read that report because I was just imagining my baby drinking poisoned amniotic fluid inside of me. The womb is a place where your baby is supposed to be the safest,” Jabeen said.

Jabeen’s case is likely not included in PHAC’s count. Jabeen says she was called by Health Canada and asked what dairy and fresh produce she ate – foods more commonly associated with listeria – but not asked about plant-based beverages.

She’s pregnant again, and is due in several months. At first, she was scared to eat, not knowing what caused the infection during her last pregnancy.

“Ever since I learned about the almond, oat milk situation, I’ve been feeling a bit better knowing that it wasn’t something that I did. It was something else that caused it. It wasn’t my fault,” Jabeen said.

She’s since joined a proposed class action lawsuit launched by LPC Avocates against the manufacturers and sellers of Silk and Great Value plant-based beverages. The lawsuit has not yet been certified by a judge.

Natalie Grant and her seven year-old daughter, Bowmanville, Ont.

Natalie Grant says she was in a hospital waiting room when she saw a television news report about the recall. She wondered if the dark chocolate almond milk her daughter drank daily was contaminated.

She had brought the girl to hospital because she was vomiting every half hour, constantly on the toilet with diarrhea, and had severe pain in her abdomen.

“I’m definitely thinking that this is a pretty solid chance that she’s got listeria at this point because I knew she had all the symptoms,” Grant says of seeing the news report.

Once her daughter could hold fluids, they went home and Grant cross-checked the recalled product code – 7825 – with the one on her carton. They matched.

“I called the emerg and I said I’m pretty confident she’s been exposed,” Grant said. She was told to return to the hospital if her daughter’s symptoms worsened. An hour and a half later, her fever spiked, the vomiting returned, her face flushed and her energy plummeted.

Grant says they were sent to a hospital in Ajax, Ont. and stayed two weeks while her daughter received antibiotics four times a day until she was discharged July 23.

“Knowing that my little one was just so affected and how it affected us as a family alone, there’s a bitterness left behind,” Grant said. She’s also joined the proposed class action.

Thelma Feldman, 89, Toronto

Thelma Feldman says she regularly taught yoga to friends in her condo building before getting sickened by listeria on July 2. Now, she has a walker and her body aches. She has headaches and digestive problems.

“I’m kind of depressed,” she says.

“It’s caused me a lot of physical and emotional pain.”

Much of the early days of her illness are a blur. She knows she boarded an ambulance with profuse diarrhea on July 2 and spent five days at North York General Hospital. Afterwards, she remembers Health Canada officials entering her apartment and removing Silk almond milk from her fridge, and volunteers from a community organization giving her sponge baths.

“At my age, 89, I’m not a kid anymore and healing takes longer,” Feldman says.

“I don’t even feel like being with people. I just sit at home.”

Jasmine Jiles and three-year-old Max, Kahnawake Mohawk Territory, Que.

Jasmine Jiles says her three-year-old son Max came down with flu-like symptoms and cradled his ears in what she interpreted as a sign of pain, like the one pounding in her own head, around early July.

When Jiles heard about the recall soon after, she called Danone Canada, the plant-based milk manufacturer, to find out if their Silk coconut milk was in the contaminated batch. It was, she says.

“My son is very small, he’s very young, so I asked what we do in terms of overall monitoring and she said someone from the company would get in touch within 24 to 48 hours,” Jiles says from a First Nations reserve near Montreal.

“I never got a call back. I never got an email”

At home, her son’s fever broke after three days, but gas pains stuck with him, she says. It took a couple weeks for him to get back to normal.

“In hindsight, I should have taken him (to the hospital) but we just tried to see if we could nurse him at home because wait times are pretty extreme,” Jiles says, “and I don’t have child care at the moment.”

Joseph Desmond, 50, Sydney, N.S.

Joseph Desmond says he suffered a seizure and fell off his sofa on July 9. He went to the emergency room, where they ran an electroencephalogram (EEG) test, and then returned home. Within hours, he had a second seizure and went back to hospital.

His third seizure happened the next morning while walking to the nurse’s station.

In severe cases of listeriosis, bacteria can spread to the central nervous system and cause seizures, according to Health Canada.

“The last two months have really been a nightmare,” says Desmond, who has joined the proposed lawsuit.

When he returned home from the hospital, his daughter took a carton of Silk dark chocolate almond milk out of the fridge and asked if he had heard about the recall. By that point, Desmond says he was on his second two-litre carton after finishing the first in June.

“It was pretty scary. Terrifying. I honestly thought I was going to die.”

Cheryl McCombe, 63, Haliburton, Ont.

The morning after suffering a second episode of vomiting, feverish sweats and diarrhea in the middle of the night in early July, Cheryl McCombe scrolled through the news on her phone and came across the recall.

A few years earlier, McCombe says she started drinking plant-based milks because it seemed like a healthier choice to splash in her morning coffee. On June 30, she bought two cartons of Silk cashew almond milk.

“It was on the (recall) list. I thought, ‘Oh my God, I got listeria,’” McCombe says. She called her doctor’s office and visited an urgent care clinic hoping to get tested and confirm her suspicion, but she says, “I was basically shut down at the door.”

Public Health Ontario does not recommend listeria testing for infected individuals with mild symptoms unless they are at risk of developing severe illness, such as people who are immunocompromised, elderly, pregnant or newborn.

“No wonder they couldn’t connect the dots,” she adds, referencing that it took close to a year for public health officials to find the source of the outbreak.

“I am a woman in my 60s and sometimes these signs are of, you know, when you’re vomiting and things like that, it can be a sign in women of a bigger issue,” McCombe says. She was seeking confirmation that wasn’t the case.

Disappointed, with her stomach still feeling off, she says she decided to boost her gut health with probiotics. After a couple weeks she started to feel like herself.

But since then, McCombe says, “I’m back on Kawartha Dairy cream in my coffee.”

This report by The Canadian Press was first published Sept. 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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B.C. mayors seek ‘immediate action’ from federal government on mental health crisis

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VANCOUVER – Mayors and other leaders from several British Columbia communities say the provincial and federal governments need to take “immediate action” to tackle mental health and public safety issues that have reached crisis levels.

Vancouver Mayor Ken Sim says it’s become “abundantly clear” that mental health and addiction issues and public safety have caused crises that are “gripping” Vancouver, and he and other politicians, First Nations leaders and law enforcement officials are pleading for federal and provincial help.

In a letter to Prime Minister Justin Trudeau and Premier David Eby, mayors say there are “three critical fronts” that require action including “mandatory care” for people with severe mental health and addiction issues.

The letter says senior governments also need to bring in “meaningful bail reform” for repeat offenders, and the federal government must improve policing at Metro Vancouver ports to stop illicit drugs from coming in and stolen vehicles from being exported.

Sim says the “current system” has failed British Columbians, and the number of people dealing with severe mental health and addiction issues due to lack of proper care has “reached a critical point.”

Vancouver Police Chief Adam Palmer says repeat violent offenders are too often released on bail due to a “revolving door of justice,” and a new approach is needed to deal with mentally ill people who “pose a serious and immediate danger to themselves and others.”

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

The Canadian Press. All rights reserved.

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