‘Dangerous’ to think B.C.’s decriminalization plan will reduce OD deaths: researcher
By Camille Bains in Vancouver
Decriminalization of people with small amounts of illegal drugs for their own use has become a reality in British Columbia, but substance users and researchers say the change is expected to make little immediate difference because of a toxic drug supply.
The policy shift came after Health Canada allowed an exemption from federal drug laws so people 18 and over could carry up to 2.5 grams of opioids such as heroin and fentanyl, as well as crack and powdered cocaine, methamphetamine and MDMA.
Users will not be arrested or have their drugs seized by police starting Tuesday in what is a three-year pilot project.
Dean Wilson, who began working as a peer facilitator at the B.C. Centre on Substance Use in 2017 as a heroin user, said decriminalization is a welcome change to prevent drug users’ interactions with police.
However, he said it needs to be accompanied with a bold plan to provide more people with a broad range of safer alternatives to toxic street drugs, which profiteers often cut or contaminate with the powerful opioid fentanyl.
“They’ll cut their cocaine for five minutes, then they’ll cut their fentanyl on the same scale and all of a sudden there’s fentanyl on the cocaine. And when somebody who’s never done opioids at all gets the one (hit) that had a little bit of fentanyl, they’re dead,” Wilson said.
A regulated supply of pharmaceutical alternatives should be available through multiple routes, including compassion clubs, to save the lives of people at risk of fatally overdosing, he said.
“There’s nothing out there that’s safe unless you test your dope every time. And you can’t do that if you’re an active addict.”
Insite, a supervised consumption site that opened in Vancouver in 2003 as North America’s first such facility, is among the few places to have a specialized machine that drug users can access to get their substances analyzed for contaminants including fentanyl.
Take-home fentanyl test strips are also available there and at designated sites to allow people to test their drugs within seconds.
Despite such services, over 11,000 people have fatally overdosed in B.C. since 2016, when the province declared a public health emergency.
Those deaths led to the policy to stop criminalizing people who use drugs as a way to reduce stigma so they’re more likely to get help for an addiction.
“If people think there’s some kind of correlation between the decriminalization of drugs and the decrease of overdoses resulting in deaths, that is not gonna happen,” said 64-year-old Wilson, who has been on a methadone treatment program since last May to help reduce his cravings for opioids, which he said he began using at age 13.
Researchers and people who use drugs say the 2.5-gram threshold is too low for those who may be forced to have more contact with sellers on the black market as they try to avoid interactions with police. The province requested the limit be 4.5 grams, while police called for a total of one gram for all the drugs allowed under the exemption.
They say decriminalization requires adequate supports so people get the help they need when they ask for it.
In Portugal, for example, decriminalization includes various harm-reduction and social services as well as treatment.
B.C.’s Mental Health and Addictions Minister Jennifer Whiteside said the province has expanded harm-reduction programs and since 2017, more than 360 new treatment and recovery beds have been opened. A prescription-based safer supply program was beefed up in July 2020, making B.C. “the first province to do so in Canada,” she added.
More than two-thirds of officers with the RCMP and municipal departments in B.C. have so far taken training on aspects of decriminalization, which involves handing out so-called resource cards to people who use drugs, Whiteside told a news conference Monday.
They include information on contacting new “substance-use navigators” hired by health authorities specifically to build connections with local service providers and connect people referred by police, Whiteside said.
“Decriminalization is a historic change, but we know it will not solve the toxic drug crisis on its own.”
Mike Serr, co-chair of the Canadian Association of Chiefs of Police, said while the group has long advocated for decriminalization, he is concerned that getting more services to people in areas such as northern B.C. will be a “challenge.”
“These are things that I’m going to be watching and this is something that the government is going to have to address. That’s a very key, critical part of this,” said Serr, who is also deputy chief of the police department in Abbotsford, B.C.
Federal Mental Health and Addictions Minister Carolyn Bennett said the plan is to move people away from the criminal justice system to health and social services so such programs will need to be ramped up.
As for safer alternatives, some doctors are still uncomfortable about prescribing them despite guidelines from the College of Physicians and Surgeons of B.C., and its counterpart in Ontario, Bennett told The Canadian Press.
“We were very worried that some of the doctors who are prescribing were being reported to the college by some of their colleagues,” she said.
“I am worried about the number of deaths that are from people in the construction, trades or natural resources (sectors). Or even at parties, the fact that somebody can die for having used once. We are going to have to really explore the options and I think that we’ve been persuaded that just the prescriber model will not stop this tragedy.”
Bennett noted that one project in Vancouver, where a small number of drug users are prescribed powdered fentanyl, could be promising as part of an increased, regulated supply for more people.
Decriminalization will be monitored and evaluated, and some changes may be made based on the evidence that emerges during the pilot, Bennett said.
“The evidence we had was that most of the confiscations were well under 2.5 (grams) and so we will continue to monitor this, but we are prepared to adjust in any way to be able to fulfil our promise that this project will remain in the public interest.”
Kora DeBeck, a research scientist at the B.C. Centre on Substance Use, said although the cumulative 2.5 grams is low, the fact that substances up to that amount will no longer be seized is a positive step for those who may otherwise borrow drugs or money and put themselves at risk of violence or even endure painful withdrawal symptoms.
“I would describe decriminalization of drug possession as an incredibly progressive, important move and a recognition that criminalization is harmful,” she said. “It’s responding to what I see as decades of research that shows that prohibition has been a failure and a disaster.”
However, the poisoned drug supply is the major problem leading to overdose deaths, said DeBeck, who is also an associate professor in the school of public policy at Simon Fraser University.
“I think it’s incredibly dangerous, actually, to think that (decriminalization) will have an impact on overdoses in the immediate term.”
This report by The Canadian Press was first published Jan. 31, 2023.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
Premier Smith urges PM Trudeau to talk Ethical Energy Security in meeting with US President Biden
Dear Prime Minister Trudeau:
The arrival of President Joe Biden presents our nation with an opportunity of great significance. It is my request that the federal government uses its platform to focus on collaboration between the U.S. and Canada, highlighting the critical need for North American energy security.
We have a deep, long-standing relationship with the U.S. at both the federal and state levels, which is only growing in importance. In 2022, Alberta surpassed Ontario and Quebec as the largest provincial exporter of goods to the U.S. at $182.5 billion, with energy making up 85 per cent of exports to the United States. Alberta, by far, remains the single largest source of U.S. energy imports.
This economic reality, along with Russia’s invasion of Ukraine, has highlighted that North American energy security must be a top priority for the Government of Canada. I urge you to raise the need for better collaboration between Canada and the U.S. to ensure the continued and enhanced supply of sustainable, affordable, and reliable energy to the U.S.
I recommend that the two governments work to fast-track energy projects in the name of economic security for our democratic partners, as committed to by Deputy Prime Minister Chrystia Freeland. A similar effort is needed in critical minerals as the world shifts to lower emitting sources of energy.
Alberta, through both government policy and industry action, is leading the way on reducing emissions and driving the transition to new sources of energy. New investments in the province are global flagships in clean energy and emissions reductions technology. For example, Pennsylvania’s Air Products will create a world-scale net-zero hydrogen energy complex in Alberta, and Dow is advancing the world’s first net-zero carbon emission integrated polyethylene complex at its existing site near Edmonton. It is also worth noting that Canada’s oil sands operators have announced plans to spend $24 billion on emission-reduction projects by 2030 as part of their commitment to reach net zero by 2050. All of this amounts to a herculean effort undertaken by industry partners, and Alberta’s government, to position ourselves as the foremost leader in emissions reduction and responsible energy production.
As you know, management of oil and gas methane emissions is one of this country’s greatest climate success stories. Collaboration with the U.S. on methane emissions would both advance climate action, and address regulatory inconsistencies between the two countries. As of 2020, methane emissions from the upstream oil and gas sector in Western Canada have decreased by around 44 per cent from the 2014 baseline – ahead of our schedule of 45 percent by 2025. More evidence of Canada, and Alberta, leading the way.
Alberta is home to vast geological potential, an experienced, skilled, workforce, and has the necessary processing and transportation infrastructure in place to support a growing critical minerals sector. For example, technological advances to extract minerals from underground brine solutions are found throughout Alberta. These extraction technologies could result in a low emission, sustainable source of lithium to meet the demand of our emerging battery value-chain. We would encourage your government to work with the provinces, especially Alberta, on critical minerals and seize the opportunity to collaborate with the U.S. on enhancing North American supply chains.
As the owners and stewards of our world-class natural resources, any discussions involving energy security, natural resources, and trade must fully involve the provinces. I would be pleased to help assist you, and the federal government in advancing the work on North American energy security as well as developing the business cases to increase exports of clean Alberta energy, critical minerals and technologies to the U.S. As is only appropriate when discussing natural resources, and areas of exclusive provincial jurisdiction, I would also request that Premiers be invited to participate in a meeting with the President and his delegation.
I look forward to your response and welcome an opportunity to collaborate. We both agree that the world needs more Canada. It’s imperative that in a time of such uncertainty, and unaffordability, that Alberta, and Canada profile ourselves as the preferred supplier of responsibly produced, ethical energy to the U.S., North America, and the world.
Surgery wait times for cancer, joint replacement patients still lagging amid backlog
A surgery is performed in the operating room at Toronto’s Hospital for Sick Children on Wednesday, November 30, 2022. THE CANADIAN PRESS/Chris Young
By Nicole Ireland
Hospitals across Canada are performing surgeries at close to pre-pandemic levels, but many patients continue to face longer-than-recommended wait times due to the backlog created by COVID-19, a new report from the Canadian Institute for Health Information says.
The report, published on Thursday, looked at knee and hip replacements, cataract surgeries and cancer surgeries performed in 2019 versus those performed in 2022.
Thousands of joint replacement and cataract surgeries were cancelled or delayed when COVID-19 hit.
“Things like knee and hip replacements and cataracts are what we call scheduled surgeries and they were particularly affected during the pandemic because they’re not life-threatening,” said Tracy Johnson, director of health system analytics at CIHI.
“They are very uncomfortable for patients. They cause them more pain. They might even have economic pain. But those are the kinds of things that had to be delayed, especially in the first part of the pandemic when we didn’t know what kind of COVID stuff was going to come at us,” Johnson said.
Those delays created a backlog of surgical procedures that health-care providers still haven’t been able to catch up on.
“The most recent data shows that while the monthly number of scheduled surgeries is nearing pre-pandemic levels, this is insufficient to clear the backlog and improve wait times,” the CIHI report said.
“It also shows that catching up has been more challenging for joint replacement surgeries, which are primarily performed in hospital operating rooms, than for cataract surgeries, which can be done in day procedure rooms or community clinics.”
The longest recommended wait time for knee and hip replacements is six months.
Only half of Canadian patients got their knee replacement surgery within that time frame between April and September 2022, the researchers found. Prior to the pandemic, about 70 per cent of knee replacements were done within the recommended period.
About 57 per cent of hip replacement patients had their surgery in the recommended six-month window in 2022 compared to 75 per cent of patients in 2019.
Cancer surgery wait times haven’t been as dramatically affected because the most urgent cases were prioritized during COVID-19 shutdowns, said Johnson.
Still, during the first several months of the pandemic, there were about 20 per cent fewer cancer procedures performed than before. Those delays and cancellations created the initial backlog, the report said.
Half of patients needing breast, bladder, colorectal and lung cancer surgery waited one to three days longer between April and September 2022 compared to before the pandemic, it said. For patients with prostate cancer, that average wait time jumped to 12 days longer.
Andrea Seale, CEO of the Canadian Cancer Society, said it’s critical for the health-care system to reduce those wait times.
“A day or two might not sound like a lot but it truly is when it comes to cancer because it’s just a disease that cannot wait,” she said.
In a survey of 700 patients and caregivers conducted by the Canadian Cancer Society in November, about a quarter of respondents reported they are still experiencing cancelled or postponed appointments, Seale said.
“Any delay is extremely distressing to people who are facing cancer.”
For cataract surgery, the recommended maximum wait time is 112 days. Although two-thirds of Canadian patients, on average, are getting their surgery within that time frame — the same proportion as before the pandemic — there is “considerable variation” across the provinces, the CIHI report said.
More patients in Newfoundland and Labrador, Quebec and Ontario are waiting longer for cataract surgery, while a higher proportion of patients in B.C., Alberta, Manitoba and P.E.I. are getting their cataract procedures within the recommended 112 days.
Dr. Thomas Forbes, surgeon-in-chief at University Health Network in Toronto, said the CIHI report is “valuable” as it highlights patients most affected by surgical backlogs.
“It is really an all-hands-on-deck effort at our hospital and at, I suspect, all other hospitals,” he said.
Forbes agreed with the report’s findings that hospitals have to do even more surgeries than they did before the pandemic to catch up, noting that an aging population increases the demand even more.
UHN has expanded its operating room capacity between 110 and 120 per cent compared to before the pandemic, he said.
That means extending operating room hours during the week, as well as scheduling surgeries on weekends, which had previously been limited to emergencies only.
UHN has also reopened old operating rooms that had been decommissioned, Forbes said.
“Everything is on the table,” he said, including the possibility of transferring patients to a different physician who has a shorter waiting list.
The current staffing shortage, particularly among nurses, is another issue that has to be resolved for hospitals to be able to catch up, Johnson from CIHI said.
“You have a list of people who need surgeries, but you also need people to be able to either perform the surgeries or care for those people post-op,” she said.
This report by The Canadian Press was first published March 23, 2023.
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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