Health
Safer opioids actively being reviewed for epidemic: chief public health officer
OTTAWA — Public health officials across the country are seriously considering increasing the supply of safer opioids to quell a crisis that newly released data show helped claim more than 2,000 lives in the first half of the year.
Canada’s chief public health officer said Wednesday a toxic drug supply is a key part of Canada’s opioid epidemic.
Creating a safer opioid supply is “being actively reviewed and discussed” with provinces and territories, Dr. Theresa Tam said, and will require exploring what treatments people require.
Tam said clamping down on the market-driven supply of illicit drugs won’t be easy, adding she also hopes Canadians come to understand the seriousness of the problem.
“Across Canada, not everybody is on the same page,” Tam said. “I think my plea is an escalated, compassionate response. To implement a lot of these measures, you need society to be on side.”
British Columbia’s provincial health officer praised the decision to look at a more safe supply — something the province has long pushed for.
“Right now, the issue that we are dealing with in B.C. and increasing across the country, is the poisonous, toxic street-drug supply,” said Dr. Bonnie Henry.
“That is what is killing people in this province right now. We know, that coupled with the stigma and the fact that people who have addictions, they need these drugs. It is not like it is a choice and they can say ‘Oh, I’m not going to take them anymore.'”
Donald MacPherson, executive director of the Canadian Drug Policy Coalition, has said a safer supply of opioids is a “no-brainer” to ensure people are not forced to turn to a “deadly, illegal market.”
Figures released Wednesday by the Public Health Agency show that 94 per cent of opioid-related deaths this year were classified as “accidental poisonings.” Nearly 72 per cent were unintentional deaths involving highly toxic fentanyl and fentanyl-related substances.
Fentanyl — a highly potent and addictive opioid — is estimated to be up to 100 times stronger than morphine and is commonly mixed into opioids sold on the street, meaning users don’t know the potency of the drugs they take.
The Canadian Institute for Health Information also reported data on a 27-per-cent increase in hospitalizations due to “opioid-related poisonings” over the past five years. Hospitalization rates last year were 2.5 times higher in smaller communities, with populations between 50,000 and 100,000, compared to Canada’s largest cities, the institute said.
Canadian health-care experts have also encouraged Ottawa to adopt Portugal’s approach to drug policy, which decriminalizes limited amounts of drugs for personal use, while offering education and social supports. Henry argued the Liberals should consider decriminalization.
“The federal government at this point is not look at decriminalizing people at a national basis,” Henry said.
“We are facing a crisis in B.C. where we need to do more.”
—Follow @kkirkup on Twitter
Kristy Kirkup, The Canadian Press
A Calgary medical student has developed a new app that allows future doctors to work on their diagnostic and communication skills before they set up their practices. Eddie Guo, seen in an undated handout photo, is a second-year student at the University of Calgary’s Cumming School of Medicine. He says that one of the challenges in medical school is becoming better at interacting with patients. THE CANADIAN PRESS/HO-University of Calgary
By Bill Graveland in Calgary
A Calgary medical student has developed an app that allows future doctors to work on their diagnostic and communication skills before they set up their practices.
Eddie Guo, a second-year student at the University of Calgary’s Cumming School of Medicine, said one of the challenges beyond the book learning in medical school is becoming better at interacting with patients.
As a result, he’s turned to the rapidly growing area of artificial intelligence to create a number of virtual patients, with a variety of health conditions, that a student can talk to.
“It’s good to get more than just two or four hours of the practice we get in medical school to really be able understand what it’s like to communicate in a real-life scenario,” said Guo.
“We think it’s a good idea to have more than a few hours of practice before actually going out into the wild and seeing patients for the first time.”
Guo created a program, called OSCE-GPT, where the computer is the patient. Users choose the patient’s gender and can select a scenario or let the computer decide on one for them.
“I’m Ben Johnson and I’ve been having some really bad abdominal pains over the past two days. It’s in the right upper quadrant and it spreads to my back,” said the robotic male voice in the program.
“I’ve also been feeling nauseous and vomiting. I’m here in the emergency department because of the pain.”
The AI patient can answer questions about its condition and, after the conversation, provides feedback to the student along with a list of other questions that could have been asked.
Guo said until he is finally allowed on the medical wards, the only other interactions he gets are with standardized patients, professional actors who present with various conditions.
“As you can imagine, they’re really quite good at their job, but they’re also very expensive,” Guo said.
“We don’t get that much opportunity really to practise speaking with a patient, and so what this app was born out of was a lack of possibility to practise.”
Guo collaborated with medical resident Dr. Mehul Gupta. He said this kind of additional help will make for better doctors.
“One of the things we learn again and again in medical school, and that’s reinforced again in residency, is that the history you take from a patient is almost 99 per cent of the diagnosis that you make and the impression you make on a patient the first time you speak with them is long-lasting,” Gupta said.
“If you have the opportunity to practise to tailor your questions to see how you could have done better, you really do become a better doctor overall.”
Guo said the app is still being upgraded and at this point there is no image of a patient that shows up on the screen. He said he is hoping that things like a chest X-ray, a CT scan or a picture of someone’s skin could be incorporated into the program.
Within the first month of the app’s launch, more than 550 health-care trainees from Canada and across the world including Europe, India, Saudi Arabia and the United States signed on.
This report by The Canadian Press was first published Sept. 22, 2023.
The Emergency Department at Calgary’s Peter Lougheed Hospital at the height of the E. coli outbreak, Sept 7, 2023
As hospital admissions and daily numbers of new E. coli cases continue to decline, health officials are seeing signs that the initial outbreak that affected several Calgary daycares has peaked.
The number of secondary transmissions connected to this outbreak remains low, indicating there is limited transmission of the E. coli bacteria beyond the initial outbreak.
The kitchen connected with the original outbreak remains closed indefinitely. In addition, precautionary measures at specific daycare facilities remain in place. Parents and operators have been made aware of these measures directly and through communication with Alberta Health Services.
“I am relieved every time I hear of a child who is well enough to leave hospital. My heart goes out to each family member who has been impacted, and I want them to know that we will get to the bottom of this. Thank you as well to our front-line staff for supporting these children and their families on the road to recovery.”
“Families have had their lives turned upside down by this outbreak. I’m relieved many of them are seeing their children recover and start to get back to their normal routines. I want to reassure parents they can place their trust in our high-quality child-care system and that they are not alone. We are here to support them in any way we can.”
“We are cautiously optimistic that the outbreak has peaked and that we will continue to see case numbers drop. That said, this does not diminish the fact that we still have some children who remain very ill, and my heart goes out to them, their parents and their loved ones.”
Hospitalizations and cases
As of Sept.19, there were a total of 348 lab-confirmed cases connected to this outbreak, no increase from Sept. 18. Between Sept. 9 and Sept. 14, there was an average increase of 33 new cases a day. Since then, the average case numbers decreased to fewer than four a day to no increase on Sept. 19.
There have been a total of 27 lab-confirmed secondary cases, with no additional secondary cases confirmed, since Sept. 16. Some cases of secondary transmission are common and expected in significant outbreaks such as this.
Currently eight patients are receiving care in hospital, down one from Sept. 18. All these patients have been confirmed as having hemolytic uremic syndrome (HUS), including two on dialysis (a decrease of one since Sept. 18). All patients are in stable condition and responding to treatment. Front-line health care teams continue to provide the best care and support possible.
A total of 707 children connected to the outbreak have been cleared to return to a daycare facility.
Daycares
As of Sept. 19, six daycare facilities are under closure or partial closure orders:
- Active Start Country Hills – Dolphin and Starfish preschool classes
- CanCare Childcare – Scenic Acres location – Busy Bees, Bumble Bees and Butterflies classrooms
- CEFA Early Learning Calgary South – JK 3-1 classroom
- Renert Junior Kindergarten – all four Junior K classrooms
- 1st Class Childcare Shawnessy – “Main daycare” area is being closed
- Calgary JCC Child Care – a closure order was issued for infant and toddler rooms on Sept. 15
Closure orders were rescinded for Classrooms 3 and 4 at Vik Academy on the afternoon of Sept. 18 following negative test results for E. coli.
Additionally, while MTC Daycare site is not being closed, affected children and staff in Prominade and McKenzie classrooms are being notified that they are excluded from attending all child-care facilities until they test negative for E. coli and remain symptom-free.
All closure orders are posted on the Calgary Zone Alberta Health Services website.
Initial results suggest these cases affecting additional daycare facilities are predominantly cases of secondary transmission. Either these new cases were in contact with children from the original daycare or children from the original daycares were in contact with the facility.
Parents and staff from all the daycare facilities involved are being provided with information about what to do if they experience symptoms, test positive or have concerns about the health and safety of their child.
Investigations
The public health investigation into this outbreak continues, and work continues to identify the source of the outbreak. Additionally, the ministries of Health and Children and Family Services are conducting a review of all shared kitchens serving child-care facilities across Alberta.
The food histories of more than 1,150 children and 250 daycare staff are being reviewed by public health officials. This includes those who became ill and those who did not, all of whom were at the 11 affected daycares between Aug. 15 and Aug. 31.
Guidance to parents
If children develop symptoms, including bloody diarrhea, families are encouraged to visit an emergency department. If a child is not symptomatic, do not take them to hospital. Families with concerns or questions can call Health Link at 8-1-1 or contact their family physician for advice and support.
In addition, Alberta’s government is providing families with a one-time payment of $2,000 per child enrolled in the original facilities that were closed due to the outbreak.
Alberta’s government is committed to working with parents and operators through this challenging time and encourage them to reach out to Child Care Connect at 1-844-644-5165 with questions or concerns.
Related links
- Supporting Those affected by the E. coli Outbreak (Sept. 15, 2023)
- Update on E. coli outbreak in Calgary (Sept. 12, 2023)
- Alberta Health Services – E. coli Outbreak
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