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Health

Drug users, advocates fear federal election may sideline safer opioids policy

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VANCOUVER — The co-founder of a national group of parents whose children have died of overdoses fears the looming federal election will derail any policy changes that could make a safer supply of opioids a priority, even as the country’s chief public health officer has promised to review such a plan.

Leslie McBain of Moms Stop the Harm said the overemphasis on addiction treatment has not worked because drug users are continuing to use the black market to access fentanyl-laced substances that have killed thousands of Canadians.

“In implementing a safe supply (policy), it brings the people who need it into an environment where they can then also be offered different forms of treatment. It keeps them alive. It takes courage to make that step to recovery,” said McBain, whose 25-year-old son fatally overdosed five years ago.

“I think the federal government is trying to do the right thing but in an election year the Liberals don’t want to do anything that might further impact their base.”

McBain, who advocates for families with the BC Centre on Substance Use, said Health Canada needs to provide the public with information about the process involved in a safer-opioids review by Canada’s chief public health officer, Dr. Theresa Tam, who announced in December she will gather data from provinces and territories.

“We are committed to exploring additional options for creating the conditions for a safer supply of opioids,” the agency said in a statement, adding its work is “ongoing.”

Last week, British Columbia’s mental health and addictions minister, Judy Darcy, called on the federal government to “open a courageous conversation” on safer opioids.

The ministry says it expects to respond to the federal government’s information request for its review by the end of April. 

Pharmaceutical-grade heroin has been provided since 2014 at the Crosstown Clinic in Vancouver, the only such facility in North America, but the program requiring users to have up to three injections a day under the supervision of nurses can accommodate only about 100 patients at a time and has not been adequately expanded since B.C. declared a public health emergency in 2016.

Dr. Scott MacDonald, lead physician at Crosstown, which also offers the injectable form of the opioid hydromorphone, said there’s no reason why British Columbia can’t increase access to the program, which an estimated 500 entrenched drug users needed back in 2013.

“So clearly there’s a need for expansion, not only in Vancouver and British Columbia but across the country,” he said. “And that could be part of the safe supply.”

However, he said the pure heroin, or diacetylmorphine, must be imported from Switzerland and Health Canada has not made it possible for it to be produced domestically.

MacDonald said injectable opioids have been available in B.C. as more than 3,000 people have died in the province since the emergency was declared three years ago.

“I don’t understand the delay,” he said.

“This is not a partisan issue. It’s about care for people who are at risk for overdose and death and have not responded to any other treatment. It just needs to be made available,” he said, adding diacetylmorphine is an option for five to eight per cent of drug users.

Three clinics in British Columbia offer injectable hydromorphone, two sites have made it available in Alberta — one each in Calgary and Edmonton — while Ottawa has one facility, MacDonald said.

B.C.’s Mental Health and Addictions Ministry said it is working with health authorities “to expand injectable hydromorphone therapy as quickly as possible as an additional tool to support people with opioid use disorder.”

Jordan Westfall, president of the Canadian Association of People Who Use Drugs, said expanding addiction treatment programs has been “too timid” a response and that’s obvious in British Columbia, where the coroner’s service recently reported 1,489 people fatally overdosed in 2018, slightly higher than the previous year.

“It shows that the government’s direction and policy was ineffective,” Westfall said. “It sounds politically much nicer to say we need treatment. This is a systemic issue and no amount of treatment will change that fact. People are going to continue dying.”

Shanelle Twan, a member of the same network in Edmonton, said the group is planning a day of action across the country in April to draw attention to the need for safer opioids.

“Something needs to be done quickly but it just seems that everything is moving at a glacial pace right now,” she said. “It’s unfortunate that politics have to come into play when you’re talking about the lives of ordinary Canadians.”

Donald MacPherson, executive director of the Canadian Drug Policy Coalition, said not providing legal opioids to people who have the “disease” of addiction is “barbaric.”

MacPherson, who was the drug-policy co-ordinator for Vancouver from 2000 to 2009, said starting in the spring, his coalition plans to launch a three-year campaign to educate people across the country on drug policy.

He said while Prime Minister Justin Trudeau has been criticized for saying no to decriminalizing drugs, movement on that issue would not solve the problem of toxic drugs that have killed thousands of Canadians.

— Follow @CamilleBains1 on Twitter.

Camille Bains, The Canadian Press

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Environment

Lyme-spreading ticks so common thanks to mild winters, some places stop testing

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Lyme infected ticks becoming common in Canada

OTTAWA — Lyme disease has settled so deeply into parts of Canada many public health units now just assume if you get bitten by a tick, you should be treated for Lyme disease.

In Ottawa, where more than two-thirds of the ticks tested in some neighbourhoods carry the bacteria that causes Lyme disease, the public-health unit no longer bothers to test ticks at all.

Dr. Vera Etches, the unit’s top doctor, said that in 2016 and 2017 more than one-fifth of black-legged ticks tested in Ottawa came back positive for Lyme.

“That’s a threshold,” she said. “Once you know that more than 20 per cent of the ticks in your area carry Lyme disease bacteria then we don’t need to check in on that. That is what we now call an ‘at-risk area.’ “

That means if a tick is found on a person, and is believed to have been there for more than 24 hours, then the patient should get antibiotics to prevent Lyme infection, even without any testing of the tick. It takes 24 hours before bacteria in the tick’s gut move to its salivary glands and are transferred to a person.

After three days, the preventive treatment won’t work so patients then wait for symptoms or enough time for antibodies to evolve to show up on a test. It can take more than a month before symptoms appear. They’re mostly similar to the effects of influenza, including fever and aches, as well as — usually but not always — a rash. It typically takes just about as long for the immune system’s antibodies to show up on a lab test.

If left untreated, Lyme disease can cause serious illnesses such as meningitis, but Etches is quick to point out that because it is caused by a bacteria, it’s treatable with drugs.

“It’s a good-news story, actually, that there is antibiotics that work to treat Lyme disease,” she said.

Most public-health offices in Canada used to test ticks submitted by the public, as well as conducting their own surveillance by actively seeking out tick populations and testing them. Some, including Ottawa’s, have decided now that Lyme is endemic, they should shift to public education and prevention as well as treatment.

Lyme disease was named after the town of Lyme, Conn., where the first case was diagnosed in 1975. It is caused by bacteria that are traded back and forth among black-legged ticks and migratory birds and small mammals like mice and chipmunks. Ticks bite birds and small mammals infected with the bacteria and get infected and then spread the disease when they bite their next victims.

Before 10 years ago, most of the cases diagnosed in Canada were in people bitten by ticks while travelling in the United States. But climate change has led to southern Canada seeing milder winters, which means the ticks that migrate to Canada on the backs of migratory birds are now surviving the winter in larger numbers, spreading the Lyme-causing bacteria more rapidly.

Canada started keeping track of Lyme disease cases in 2009, when 144 cases were confirmed or considered probable. Only 79 of those cases were believed to have been contracted in Canada.

In 2017, more than 1,400 cases were confirmed or probable across the country, more than two-thirds of them in Ontario and most of them believed to have been contracted locally.

National statistics for 2018 are not yet available but in Ontario, the number actually fell significantly, from 967 in 2017 to 612 in 2018. Etches said that was because 2018 was hotter and drier than 2017, and ticks thrive in wet, cool weather.

A 2014 study by the National Collaborating Centre for Infectious Diseases at the University of Manitoba suggested the Lyme-carrying ticks are expanding their territory by about 46 km a year, an expectation being borne out in health units’ mapping

In 2017 and 2018, Point Pelee National Park near Windsor, Ont., was considered to be an at-risk region but the rest of Windsor-Essex County in Ontario’s southernmost tip was not. In 2019, almost all of the county has been added as an at-risk area.

In 2017 all of Nova Scotia was declared to be at risk for Lyme Disease.

In New Brunswick, six of 15 counties were declared at-risk as of 2018.

There are also at-risk areas for Lyme in southern Manitoba, northwestern Ontario, British Columbia and Quebec. While some cases of Lyme have been found in the other four provinces, the numbers are very low and mostly contracted elsewhere.

Mia Rabson, The Canadian Press

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Health

Premier wants answers on mental health detainee who fled, calls man a ‘nutcase’

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Premier Ford

TORONTO — Ontario’s premier vowed Thursday to get answers on how a patient detained at a mental health hospital for killing his roommate managed to flee, calling the man a “nutcase,” as two organizations involved launched internal reviews.

Zhebin Cong, who was found not criminally responsible for the death of his roommate, had been on an unaccompanied trip into the community from the Centre for Addiction and Mental Health on July 3 when he failed to return, the hospital said.

CAMH said it reported the 47-year-old’s disappearance later that day to police, who issued a notice asking for the public’s help in finding the man nearly two weeks later. Cong has since fled the country and police say they are working with international law enforcement agencies to track him down.

Police have said CAMH told them Cong presented a low risk to public safety, but the Ontario Review Board, which evaluates the status and assesses the risk of anyone found not criminally responsible, said in its most recent decision in April that he continued to pose a significant threat to public safety.

Premier Doug Ford phoned in to a talk radio show Thursday on NewsTalk1010 to say he’s “disgusted.”

“What is the family thinking of the poor victim that got chopped up with a meat cleaver by this nutcase and then they let him loose out on the streets,” he said.

Ford said he would be speaking with Toronto police, the review board and CAMH.

“Someone’s going to be answering because if you’re calling this low risk, what is high risk?” he said. “These crazy, crazy people that want to go around chopping people up, they’re out on the streets.”

Ford sent letters Thursday to CAMH, the police and federal Public Safety Minister Ralph Goodale, urging them to conduct reviews. The first two organizations have already said they are doing so.

“It is vital that your government act to restore the public’s trust in the procedures in place to ensure that this never happens again,” Ford wrote to Goodale. “Mr. Cong should not have been able to leave the country while detained at CAMH.”

A spokesman for Goodale didn’t say whether the federal government was looking into how Cong left the country.

Toronto Mayor John Tory called on the provincial government to launch an independent review.

“I believe such a review could work with CAMH and the Ontario Review Board to address issues related to Mr. Cong’s disappearance from the facility and the city, but there are other questions which go well beyond that and which require answers if the public is to be confident that this kind of thing won’t happen again,” Tory said in a statement.

He said important questions include when the police were notified, what they were told, did Cong have a passport, and how did he manage to leave the country given his status.

Solicitor General Sylvia Jones said she wasn’t ruling out such a review, but would wait for CAMH and police to conduct theirs first before deciding.

CAMH said it is doing an internal review and is reassessing all existing passes and privileges for patients, especially those who have unsupervised access to the community.

President and CEO Catherine Zahn said in response to the premier’s comments that the hospital takes the incident extremely seriously.

“The mental health system has moved from resignation to recovery, and from institutionalization to integration,” she said in a statement. “Nevertheless, it is clear that there is still work to do to address misperceptions surrounding mental illness, as well as the prejudice and discrimination faced by those who live with mental disorders.”

The CEO of the Canadian Mental Health Association said she shared the premier’s concerns about public safety, but called his language unfortunate and disappointing.

“We’re in the business of breaking down stigma and raising the narrative of how we talk about mental illness as a society,” said Camille Quenneville. “There are many, many people who have a diagnosis of schizophrenia who lead healthy, productive lives. I don’t want the public to believe that that diagnosis is automatically going to lead to violent behaviour.”

Jones, when asked about Ford’s comments, said “emotions are high right now.”

“The individual in question, frankly, did a very heinous crime so the community is concerned,” she said. “What the premier was communicating was the strong emotion that people feel about ensuring their safety is protected.”

Toronto Police Chief Mark Saunders said Thursday that in addition to investigating how Cong fled — including checking if he received help to leave the country — the force is doing an internal review to look at their own processes, training and communication with community agencies.

“I can clearly say there were some gaps,” he said. “The fact that this was reported to us on July 3rd and then…it’s 11 days before it goes out to the public. That definitely causes some issues for us to have a look at. That’s the first thing I’m going to do.”

Records from the Ontario Review Board show Cong killed his roommate with a meat cleaver in 2014 and was found non-criminally responsible on a charge of second-degree murder as a result of his mental illness.

Cong was an in-patient at the secured forensic unit of CAMH and deals with schizophrenia, the records show.

He was granted a pass to the community by medical officials that allowed him to leave the hospital for a fixed purpose on the condition that he return at a fixed time.

In its April decision, the board found Cong’s condition had slightly improved with ongoing anti-psychotic medication, but that he did not fully understand his mental illness, its symptoms and his risk of relapse and violence.

Review boards — independent tribunals made up of at least five people, including at least one psychiatrist — can order that the NCR person remain detained in a hospital, with varying levels of privileges, release the person on a conditional discharge or order an absolute discharge, based on risk.

The review board system lets NCR people into the community — once they’re deemed ready — for short periods of time under close supervision to see how well they can cope. If they do well, they can be granted more privileges at subsequent hearings, step by step. If they don’t fare well, the review board pulls the reins of supervision a little tighter.

— with files from Shawn Jeffords

Allison Jones, The Canadian Press

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