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Health

Small communities grapple with ‘huge challenge’ of opioid crisis

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OTTAWA — In the small town of Arnprior, nestled into the Ottawa Valley, at least five suspected opioid overdoses in the span of week prompted police to issue a public warning.

Access to extremely dangerous opioids is not limited to larger cities, said the Renfrew detachment of the Ontario Provincial Police, and the drugs have “infiltrated every corner of our province in some form or another.”

“When you are purchasing drugs illegally, you actually don’t know exactly what is in those drugs,” said OPP Const. Tina Hunt, a community safety officer with the detachment. “Even though you think you’re buying one drug, it could be laced with another type of drug.”

The problem plaguing Arnprior — a town of 9,000 — is shared by small communities across Canada, according to 2017 data presented late last year by the Canadian Institute for Health Information (CIHI), indicating they in fact have hospitalization rates for opioid poisonings more than double those in Canada’s largest cities.

In its public release, Renfrew OPP also warned of something known as “purp” or purple heroin, typically a combination of heroin and its more-potent cousins fentanyl or carfentanil.

Fentanyl is 40 times more powerful than heroin and carfentanil (which was developed as a veterinary painkiller for very large animals) is 100 times stronger than fentanyl, figures that illuminate the challenges of tackling what experts say is increasingly a toxic drug supply.

The synthetic opioids are comparatively easy to manufacture and transport. They can be cut with fillers and sold as heroin or pressed into pills that can be indistinguishable from pharmaceuticals that come from legitimate manufacturers. But a tiny excess in the dose can be deadly.

The data from CIHI indicated that although hospitalization rates for overdoses varied across the provinces and territories, communities of 50,000 to 100,000 people saw some of the highest rates of opioid poisonings. 

Brantford, Ont., had an opioid-poisoning hospitalization rate more than 3.5 times the Ontario average. Kelowna, B.C. had one of the highest rates of opioid-poisoning hospitalizations in Canada in 2017. Each has about 100,000 people.

Helen Jennens, who lives in Kelowna and lost both her sons, Rian and Tyler, to opioids, said Monday that resources in her community have been improving but said appropriate supports were not in place in her family’s darkest hours.

Larger communities offer more places for people to go to find help, she said. “There’s more outreach centres; the access to help is just better.”

Both Rian and Tyler had become addicted to opioids after being prescribed painkillers for injuries.

Donald MacPherson, the director of the Canadian Drug Policy Coalition, said Monday that smaller communities are “incredibly underserved” by some basic types of programs such as harm-reduction services, adding that reduced capacity, funding issues and higher costs create challenges outside urban centres. The group promotes more liberal drug policies, arguing that the war on drugs does more harm than good.

There has been an effort in British Columbia to create community action teams to try to address the need for more on-the-ground services, MacPherson said, noting an enormous problem remains “because the drug market doesn’t discriminate.”

“It exists everywhere, from the smallest places to the largest places,” he said. “I think in many places they are left behind … The rural-urban divide when it comes to the basics of life-saving services is immense.”

Canada’s Rural Economic Development Minister Bernadette Jordan has witnessed some of the impacts in her own community.

Jordan, who represents the Nova Scotia riding of South Shore-St. Margaret’s, said anyone who think the opioid crisis is an urban issue is wrong.

“We are seeing it right across the country, in small communities, in rural communities,” she said in a recent roundtable interview with The Canadian Press. “It is a huge, huge challenge; there is no question.”

She said she has discussed the issue with the health minister.

“This isn’t just happening in Vancouver, in Toronto, in Montreal,” she said. This is happening right across the country.”

In a statement, a spokesperson for Health Minister Ginette Petitpas Taylor pointed to commitments the Liberals made in their most recent budget.

It proposed additional funding of $30.5 million over 5 years, beginning in 2019-20, with $1 million a year committed after that, for targeted measures to address persistent gaps in harm reduction and treatment.

“We will continue to do all we can to save lives, because this crisis continues to be one of the most serious public-health issues in Canada’s recent history,” said Petitpas Taylor’s press secretary Thierry Belair.

MacPerson said the federal government could accelerate rural innovation in overdose prevention and harm-reduction.

“I think there should be a rural strategy developed that the federal government could fund and co-fund maybe with the provinces,” he said.

“This epidemic is presenting a huge challenge and if one good thing comes out of this disaster, is that we begin to do things differently. So the opportunity is to seize that moment and really be serious about changing the way we operate.”

—Follow @kkirkup on Twitter

Kristy Kirkup, The Canadian Press

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Alberta

Alberta seeing spike in syphilis cases

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Syphilis rates way up in Alberta

Rates of syphilis in Alberta on the rise

Infectious and congenital syphilis rates have escalated across the province over the past five years, with a sharp increase in 2018.

The rapid increase in syphilis cases has spurred Alberta’s chief medical officer of health, Dr. Deena Hinshaw, to declare a provincial outbreak and encourage Albertans to get tested and protect themselves.

“We need to emphasize for all Albertans: Sexually Transmitted Infections (STIs) are a risk to anyone who is sexually active, particularly people who have new sex partners and are not using protection. I encourage anyone who is sexually active to get tested regularly. Anyone in Alberta can access STI testing and treatment for free.”

Dr. Deena Hinshaw, Chief Medical Officer of Health

In response to the sharp rise in 2018, a provincial outbreak coordination committee composed of Alberta Health, Alberta Health Services (AHS) and other provincial health officials has been activated. Over the next three months, the committee will develop a coordinated strategy and determine concrete actions to increase STI testing, promote public awareness and reduce the overall number of syphilis cases in Alberta.

“Sexual health is an important part of overall health. We are working with community partners to remove stigma and increase awareness about STI testing services throughout Alberta. If you are sexually active, make regular STI testing part of your health routine.”

Dr. Laura McDougall, Senior Medical Officer of Health, AHS

 

A total of 1,536 cases of infectious syphilis were reported in 2018 compared to 161 in 2014, almost a tenfold increase. The rate of infectious syphilis has not been this high in Alberta since 1948.

Congenital syphilis, which occurs when a child is born to a mother with syphilis, is a severe, disabling and life-threatening disease. While congenital syphilis cases were rare before the outbreak, there were 22 congenital syphilis cases between 2014 and 2018, one of which was stillborn.

Consistent and correct condom use is important protection against STIs such as syphilis. Like other STIs, the symptoms of syphilis may not be obvious. Health experts recommend sexually active people, regardless of gender, age or sexual orientation, get tested every three to six months if they:

  • have a sexual partner with a known STI
  • have a new sexual partner or multiple or anonymous sexual partners
  • have previous history of an STI diagnosis
  • have been sexually assaulted

Prenatal care including syphilis testing is available for all Albertans. It is critical that anyone who is pregnant seeks early prenatal care and testing for syphilis during pregnancy.

Anyone experiencing STI-related symptoms should seek testing through their local health-care provider. Call Health Link at 811, visit a STI or sexual health clinic or speak to a family doctor to find testing and treatment options.

 

Quick facts

  • 2018 case counts for infectious syphilis by AHS zone:
    • South Zone: 31 cases, an increase of 138.5 per cent compared to 2017
    • Calgary Zone: 206 cases, an increase of 7.3 per cent compared to 2017
    • Central Zone: 88 cases, an increase of 266.7 per cent compared to 2017
    • Edmonton Zone: 977 cases, an increase of 305.4 per cent compared to 2017
    • North Zone: 208 cases, an increase of 324.5 per cent compared to 2017
  • For further breakdown of STI 2018 numbers, see the 2018 STI and HIV Summary Report.
  • Alberta Health works with AHS and community organizations towards prevention, health promotion, outreach testing, education, harm reduction, and addressing stigma. Previous actions include:
    • Grants to the Alberta Community Council on HIV to support community organizations across the province to prevent and reduce STIs, reduce harm associated with the non-medical consumption of substances and support health in their own geographic locations.
    • Alberta Health has provided three one-time grants totalling a combined $2 million since 2017 to combat the rising rates of STI, including syphilis, focusing on raising awareness and education, reducing stigma and increasing testing and treatment.
    • Since 2016, Alberta Health Services and Alberta Health have been working with over 100 provincial partners to develop innovative approaches to increasing access to STI services across the province.
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Education

Manitoba university cuts ties with Ebola researcher pending RCMP investigation

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Manitoba university severs ties with researcher escorted off premesis

WINNIPEG — The University of Manitoba says it has cut ties with an Ebola vaccine researcher pending the results of an RCMP investigation.

A spokesperson says the school is ending the non-salaried adjunct appointments of Dr. Xiangguo Qiu and her husband Keding Cheng.

Qiu, a renowned virologist who received her original medical training in China, helped develop a vaccine for the Ebola virus at the National Microbiology Laboratory in Winnipeg.

Cheng also worked at the lab as a researcher.

The Public Health Agency of Canada said on Monday that it was taking steps to address an “administrative matter” at the lab after it advised the Mounties of possible policy breaches.

The laboratory is Canada’s highest-security infectious disease research facility dealing with deadly contagious germs.

Public Health said there is no risk to the public and the work of the lab continues.

The Canadian Press has been unable to reach Qiu or Cheng for comment.

The RCMP in Manitoba has confirmed it received a referral from the health agency, but has not confirmed whether Qui or Cheng is being investigated.

The Canadian Press

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