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Ottawa opioid users find hope in program that promises safe drug supply

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  • OTTAWA — Katrina Adams has thought about getting a tattoo for all of her friends who have died in the past two years from opioid overdoses but she doesn’t think she has enough room on her body for all the names.

    Instead, the 27-year-old has pictures of many of them in her Ottawa apartment, along with images of her two children.

    Opioid addiction leads to daily Russian roulette, she said. The supply of drugs on the street is unpredictable, a mix of different chemicals of different potencies. Ottawa police recently tested a sample of stuff being sold as heroin and found it contained no heroin — it was extra-potent fentanyl, mixed with fillers.

    Adams knows from experience: she’s overdosed seven times, including during her last pregnancy.

    “There’s no way to tell what you’re taking out there from one day to another,” Adams said. “I have died; I have come out the other side.”

    Adams said she has found new hope, however, through a program in Ottawa where she can take intravenous hydromorphone — an opioid known commercially as Dilaudid — up to seven times a day, prescribed to her by a doctor. Participants live in an apartment building in a neighbourhood west of downtown where they can get regular medical care and support.

    “I’m not sitting in an alley … shooting up with puddle water and (with) drugs that I have no idea where they came from,” Adams said. “As much as safe injection sites have saved lives because they are there to intervene when the overdose actually happens, these safe injection sites actually have no way of preventing the overdose itself.”

    Dr. Jeffrey Turnbull, a former chief of staff at the Ottawa Hospital and president of the Canadian Medical Association who has worked closely with the city’s homeless population for 20 years, is instrumental in the program. It began about a year ago as Ottawa faced the enormity of the opioid epidemic, with numerous daily overdoses and frequent deaths, and it’s aimed at exceptionally high-risk opioid users.

    “They were injection-opioid drug users but it was all the poison that was in the heroin that were placing them at an even higher risk — fentanyl, carfentanil, newer metabolites,” he said.

    “We felt that if we could take away the challenge of getting drugs, the criminality of that, take away the risk of a poisonous drug supply, stabilize the craziness of their lives … then we could start to work on some of their other, underlying medical and mental health challenges.”

    The Public Health Agency of Canada released new data this month showing that more than 3,200 Canadians died of apparent opioid-related overdoses between January and September last year alone — a window into the epidemic that rages across the country, particularly in B.C., Alberta and Ontario, despite government interventions.

    The federal agency also reported fentanyl and other fentanyl-related substances continue to be a “major driver” of Canada’s opioid crisis, with 73 per cent of deaths from apparent accidental opioid overdoses in the nine-month span involving the drug.

    The rising death count has prompted numerous health experts, including B.C.’s provincial health officer, to urge the federal look at ways of supplying safer opioid drugs — an avenue being explored by the country’s chief medical officer Dr. Theresa Tam and Health Minister Ginette Petitpas Taylor.

    The latest federal budget proposes funding of $30.5 million over five years, starting this year, on targeted efforts to address “persistent gaps in harm reduction” and treatment.

    “Specifically, funding will support efforts to expand access to a safe supply of prescription opioids,” it says.

    Conservative health critic Marilyn Gladu said pursuing a safe supply focuses on the wrong things.

    “I think they need to be looking at a more holistic solution with prevention and recovery,” she said. “I think people have compassion for those that are addicted but we need to get them off drugs.”

    It is critical to both decriminalize and medically regulate the supply to save lives, said NDP health critic Don Davies.

    “The problem, if we name it, is there is a toxic, poisoned, street supply,” he said.

    Davies notes the death toll from opioids has gone up every single year. “Does that tell you that (the Liberal government’s) policy response is working? It’s not.”

    As political discussions unfold on policy, the crisis carries on.

    The rationale for the program Adams is in is similar to the one behind a managed alcohol program that has operated in Ottawa for almost 20 years, which Turnbull also helped launch. Participants live in a building run by a shelter organization and get rations of wine once an hour. When they aren’t always thinking about finding their next drinks, and can’t binge, they can attend to other things.

    Studies have found that people with severe alcohol disorders who are in such programs — there are versions in cities across the country — have fewer hospital visits and fewer problems with the law than those who aren’t.

    It would be a “game changer” to think of making safe opioids available through different channels, depending on users’ needs, Turnbull said. He believes Canada needs to have a broader discussion about whether it’s on the right track in its anti-overdose efforts.

    “I believe that we are going to have to think seriously about drug policy in this country in the face of an epidemic that kills more people than motor-vehicle accidents and suicides,” he said. “It is very hard for the police to arrest their way out of this problem and we are really going to have rethink how we deal with drugs and how we think of the criminality of drug use.”

    Addiction accelerates to a point where using drugs stops being a choice, Adams said.

    She said expanding access to safe drugs would help give opioid users like her the chance to also see what they’re capable of, like rebuilding relationships, working toward employment and being able to make scheduled appointments.

    “These might seem like small things in the grand scheme of things but for us, this is huge,” she said. “We are becoming functioning members of society again.”

    —Follow @kkirkup on Twitter

    Kristy Kirkup, The Canadian Press

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    Healthy eating obsession can be a sign of mental-health struggles: study

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  • TORONTO — While we should all strive for a balanced diet, York University researchers say the extreme pursuit of healthy eating can be a sign of mental-health struggles.

    Jennifer Mills, an associate professor in York’s psychology department, co-wrote a recent paper on orthorexia nervosa, which she describes as an unhealthy obsession with healthy eating, published in the journal Appetite.

    In reviewing academic literature on the subject, the authors found that people with a history of eating disorders, obsessive-compulsive tendencies, perfectionism and other psychological and behavioural tendencies were at higher risk of developing orthorexia.

    “There is nothing wrong with healthy eating. Healthy eating is something we should all aspire to,” Mills said in an interview. “But (we need) to be aware that mental-health difficulties can manifest through food.”

    Orthorexia has not been recognized in the standard manual psychiatrists use to diagnose mental disorders, and the York study found research on the subject is limited.

    But as so-called clean diets have picked up steam, Mills said there’s been growing interest in medical and research circles about the social and psychological side-effects of a “pathological” preoccupation with healthy eating.

    While there’s overlap between the risk factors for orthorexia and certain eating disorders — such as poor body image, a drive for thinness and dieting — Mills said the conditions differ in key ways, particularly their motivations.

    People with a restrictive eating disorder like anorexia will typically reduce their food intake in order to reach a low body weight or change their appearance. But for those with orthorexia, Mills said the focus on food is about quality rather than quantity.

    Many people with orthorexia are proud of their bodies, she said, but are decidedly picky about what they put in them.

    This often involves eliminating certain types of food from their diets, such as sugar, saturated fat, gluten, animal products, artificial flavours and preservatives.

    For some, she said, the list of forbidden foods can grow so long that their diet may be lacking in essential nutrients, which in severe cases can lead to health hazards such as anaemia, vitamin deficiencies or excessive weight loss.

    But Mills said one of the reasons orthorexia tends to go overlooked, including by medical professionals, is that many people with the condition are physically healthy, even though they may be suffering psychologically.

    “When people go to their doctors and say, ‘I eat really healthy,’ the most typical response they’ll get is, ‘That’s great… Keep doing what you’re doing,'” said Mills.

    “But they may be struggling more privately with just this sense that they’re starting to lose control, that this is actually taking away from their life.”

    For individuals with orthorexia, eating foods that conflict with their diets is likely to cause extreme guilt or anxiety, said Mills. This distress is usually bound up in perceived risks of disease or physical impairment. But in treating their bodies as temples of health, some may lose sight of their mental welfare, she said.

    They may spend a lot of time and money planning and preparing meals, and can find it difficult to eat food made by others, Mills said.

    Some strict dieters find these sacrifices are worth it given the health benefits, Mills acknowledged. But people with orthorexia may feel their fixation on food is so all-consuming that it interferes with their work, family and social activities, she said.

    “When we’re extremely stressed or overwhelmed, we look for ways of coping. And for some people, having very, very tight control over their eating is a way for them to feel like they’re in control, but then the irony is that they’re not,” she said.

    “Being healthy mentally means having flexibility, and having time and mental space freed up for other kinds of things, and not having your world revolve around food.”

    Mills said one of her research team’s most surprising findings was that orthorexia occurs in relatively equal rates between men and women. This suggests the condition may be less like an eating disorder, which disproportionately affect women and girls, and more like anxiety or obsessive-compulsive disorder, which are similarly prevalent across genders, she said.

    She said diagnosing orthorexia can be slippery, because it isn’t defined by specific eating habits, but rather, a pattern of problematic thoughts and behaviours that detract from a person’s quality of life.

    Mills hopes the study increases awareness about orthorexia, a condition she believes is on the rise, fuelled by a culture that prizes healthy eating and wellness among its ultimate virtues.

    “It’s all around us: messages about how we should be doing better; we should be eating better; we should be constantly striving to improve ourselves,” she said.

    “I think it has a way of encouraging black-and-white thinking about food … and (that) can make people feel worse about themselves.”

    Adina Bresge, The Canadian Press

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    Ontario researchers invent way to store vaccines at higher temperatures

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  • Ontario researchers say they’ve come up with a simple way to store vaccines at higher temperatures for weeks at a time, potentially solving a major problem in the fight against preventable diseases around the world.

    The cheap technology from the team at McMaster University involves the use of a sugary gel that allows for easier, longer shipments of vaccines that typically need to be consistently stored at cold temperatures.

    “If we can make vaccines easier and more accessible through technology, then we can save a lot of lives,” said Vincent Leung, a chemical engineering professor and the lead author of the study that was published Tuesday in the journal Scientific Reports.

    Most vaccines require the “cold chain,” an uninterrupted refrigerated supply chain where they’re stored at temperatures between 2 C and 8 C at all times. Otherwise, the effectiveness of vaccines can be greatly affected, the study notes.

    Leung worked for four years on the project as part of his doctoral research and had help from other disciplines, including biochemists and immunologists, he said.

    The solution the researchers devised is simple.

    McMaster chemical engineers had previously created a sugary gel for use in various applications, including an edible coating that can prolong the shelf life of fruits and vegetables.

    The research team mixed two sugars — pullulan and trehalose — with the vaccines and let them dry, either by air, or vacuum to speed up the process. The gel seals in the vaccine, which can later be reconstituted with water by clinicians in the field and given to patients.

    “It’s easier to think of Listerine breath strips because that’s the main material,” Leung explained. “It will form a film like that, then (is) put into a vial for deployment.”

    For the study, the research team stored mixtures of the sugary gel and numerous vaccine types at various temperatures for different lengths of time and then tested the vaccines.

    They found, for example, that “enveloped DNA vaccines” that usually require consistent cold storage, such as the herpes simplex virus type 2 vaccine, retained their efficacy for at least two months of storage at 40 C with the use of the sugary gel. The team also showed the inactivated influenza vaccine remained effective after three months of storage at 40 C.

    “This can really improve deployment and give easier access to those that don’t have refrigeration or access to electricity,” Leung said.

    The fact that the dried gel vaccine can easily be reconstituted by clinicians in the field could make the storage and transportation method invaluable in certain situations, such as the delivery of Ebola vaccines in remote areas of Africa.

    “Part of our goal was to have a very simple and cost-effective solution to address this accessibility issue for vaccines,” Leung said.

    The research team is now looking at partnerships and more funding to further develop the technology, and is also going through the proper regulatory procedures to be approved by the likes of Health Canada and the U.S. Food and Drug Administration.

    “The good thing is the sugars we’re using are already used in the food and drug industry and approved by FDA and Health Canada,” Leung said. “On that end, it should not be as hard to get it approved.”

    Liam Casey, The Canadian Press

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