Month: April 2020

Drug samples expected to be opioids were more contaminated than other expected drug types, according to a report released by the Centre on Drug Policy Evaluation (CDPE), housed within the Li Ka Shing Knowledge Institute at St. Michael’s Hospital of Unity Health Toronto. The report, titled What’s in Toronto’s Drug Supply?, is an initiative of the Drug Checking Service, and is the first of its kind in Canada.

The report amasses results from 543 samples for a variety of unregulated drugs checked by the service from its launch date on October 10, 2019 until March 31, 2020.

Of the 543 samples checked, 46 per cent were expected to be fentanyl and only six per cent of expected fentanyl samples contained only fentanyl. The report also found unexpected noteworthy drugs were often found in Toronto’s drug supply. For example, benzodiazepines and benzodiazepine-related drugs were unexpectedly found in 36 per cent of expected fentanyl samples.

“These results provide a novel portrait of the dangers posed by Toronto’s unregulated drug supply and highlight a gap in our understanding of the drug supply,” said Dr. Dan Werb, director, CDPE and a scientist at St. Michael’s Hospital’s MAP Centre for Urban Health Solutions.

“In the midst of the COVID-19 pandemic, we are seeing a very disturbing spike in overdoses. The findings suggest the need to support people who are drug dependent with a safe supply of drugs. Cities like Vancouver, which has now instituted a city-wide program providing access to standard-dose opioids for people who are at risk of overdose, are a model of success in this area.”

People who use drugs in Toronto have long advocated for access to drug checking. In response, the Centre on Drug Policy Evaluation is coordinating a drug checking pilot operating out of three frontline harm reduction agencies in the downtown core: Parkdale Queen West Community Health Centre (Queen West site), South Riverdale Community Health Centre, and The Works at Toronto Public Health. Samples are transported to laboratories at St. Michael’s Hospital and the Centre for Addiction and Mental Health, where they are analyzed using sophisticated lab-based technologies.

“Many members of the public will be surprised to see in the report that fentanyl was the expected drug for 46 per cent of samples,” said Lorraine Barnaby, Urban Health Manager of Supervised Consumption Services at Parkdale Queen West Community Health Centre.

“This aligns with what we have seen over the past five years, as fentanyl has steadily become the leading cause of overdose deaths in Toronto. With the risk of overdose so high, it’s important that along with access to a safe drug supply program, we also have drug checking services to inform people of what is in the unregulated drug supply so that they are able to make more informed choices.”

Toronto’s Drug Checking Service reports on drug samples checked bi-weekly, which are contributed by people who use drugs to protect themselves from poisoning. The reports are available to the public sign up by emailing drugchecking@cdpe.org. Be sure to follow the Centre on Drug Policy Evaluation on Facebook and Twitter for updates.

Photo: MAP Scientist Dr. Darrell Tan, with his co-leads Dr. Adrienne Chan and Dr. Allison McGeer.

A team of scientists from St. Michael’s Hospital, Sinai Health and Sunnybrook Health Sciences Centre have launched a clinical trial to understand whether an existing drug used for HIV treatment and prevention may work to prevent COVID-19 infection.

The trial will examine whether post-exposure prophylaxis (PEP), which is a medication a person takes once they’ve been exposed to a virus to prevent infection, could halt or slow the spread of COVID-19 in groups of people who have been exposed to a confirmed case. The drug in question – Kaletra (lopinavir/ritonavir as PEP) – has long been used in this capacity to prevent HIV in those who have been exposed to the virus.

“Early studies of the use of this medication as post-exposure prophylaxis therapy in other coronaviruses such as SARS and MERS have been promising,” says Dr. Darrell Tan, the study’s lead investigator who is also a scientist at MAP Centre for Urban Health Solutions and an infectious disease physician at St. Michael’s. “These are so-called ‘cousin’ viruses to COVID-19 and we want to understand whether lopinavir/ritonavir as PEP could impact its spread as well.”

Dr. Tan, along with his co-leads Dr. Allison McGeer, a senior clinician-scientist at the Lunenfeld-Tanenbaum Research Institute of Sinai Health, and Dr. Adrienne Chan, a clinician-investigator at the Sunnybrook Research Institute, will collaborate with Toronto Public Health to identify confirmed cases of COVID-19. They’ll then connect with those exposed to confirmed cases to enroll them in the study.

“A great many people from all across Toronto have worked together to get this study started,” says Dr. McGeer. “We know we need to be finding solutions that contribute to stopping the spread of this disease as quickly as possible.”

The group of contacts of one patient with confirmed COVID-19 will be identified as a ‘cluster.’ Entire clusters will be randomized to receive either the medication or no intervention. The team of researchers will then track whether or not participants develop COVID-19 by asking them to complete self-tests for the virus weekly. To limit contact, the research team will rely on courier and virtual or phone meetings with participants.

This type of a study is called a ring trial design and was an effective method of using vaccines to eradicate smallpox and test treatments for Ebola.

“Kaletra is a drug that the HIV community has been using globally for two decades, and has also been commonly used at scale in low-resource settings. This means it could be easily scaleable not just in Canada, but internationally, if we are able to demonstrate its effectiveness in the prevention of COVID-19,” says Dr. Chan, who is also an infectious diseases physician at Sunnybrook Health Sciences Centre.

Participants randomized to receive the study drug will take it for 14 days, as this is the current estimated incubation period for COVID-19.

“If this strategy works, it could be a major turning point in our global effort to stop a virus where, as we have seen, the outcomes can be devastating,” says Dr. Tan. “We are hopeful that our work will bring us closer to understanding how to slow or contain the spread of COVID-19.”

This research is funded by the Canadian Institutes of Health Research and the St. Michael’s Hospital Foundation. For the purposes of this trial, the medication, Kaletra, has been donated in-kind by AbbVie, a biopharmaceutical company. The CIHR Centre for REACH in HIV/AIDS is also supporting this work.

If you are interested in learning more about this study or how to participate, please contact the study team directly at coriprev@unityhealth.to.

MAP and the UofT Faculty of Medicine Diversity Advisory Council are teaming up to highlight community-led COVID-19 initiatives that we know are making a difference right now.

Since it launched in March, the demand for the Black Creek Community Farm Emergency Food Box program has been overwhelming.

This wonderful, community-organized farm in North York is coordinating with FoodShare to offer free drop-off of healthy food baskets to Jane-Finch neighbourhoods facing food insecurity during the COVID-19 pandemic.

If you are able, please donate here right now.

Please indicate in the ‘company’ field that you were referred by MAP. Your donation is eligible for a tax receipt.

For more information, you can read about what Black Creek Farm is doing here from TVO.

Thank you and take care – from all of us at MAP.

It’s true that COVID-19 doesn’t discriminate: anyone can get sick and potentially die from it. But the social systems that Canada has created often can discriminate. Health treatment and the outcomes aren’t always equal across all communities. Many Indigenous communities face big challenges: fewer doctors, inadequate housing and water that isn’t safe to drink. All of those issues, alongside systemic racism, can lead to especially bad health outcomes during a pandemic, Public health experts, like Canada’s Chief Public Health Officer Dr. Theresa Tam, say the health outcomes of COVID-19 could hit Indigenous communities especially hard.

Canada’s Indigenous populations have a lower life expectancy and higher rate of chronic illnesses compared to national averages. They’re also six times more likely to contract tuberculosis. The historical effects of the residential school system and discriminatory practices stemming from the Indian Act play a big role in the quality of healthcare. But there are big challenges that face these communities in the present day too.

In this 20-minute podcast, Adrian Cheung talks to Dr. Janet Smylie, one of Canada’s first Métis doctors and a lead researcher on the inequities of health care for Indigenous people in the era of COVID-19. She explains why First Nations, Inuit and Métis people are at a disproportionate risk and what must be done to fix the problem now.

Advocates urging governments to provide more shelters, amenities for homeless.

In an unprecedented move, Doctors Without Borders, which usually operates in developing countries, is building a 400-bed facility for the homeless who test positive for COVID-19. It will be run by local health-care workers in Toronto.

“It’s an important effort and one that is really vital, but is also, I think, a sobering reminder of the potential magnitude of the problem that we would be facing if there’s extensive spread of COVID-19,” said Stephen Hwang, a staff physician at St. Michael’s Hospital in Toronto, and director of MAP Centre for Urban Health Solutions.

Hwang understands first-hand the vulnerability the homeless population faces. On top of his two roles, he runs a clinic at Seaton House, a Toronto men’s shelter. But because he works in the hospital and wants to mitigate the risk to those using Seaton House, he’s not going to the shelter.

He’s not just concerned about the homeless. He also worries about the safety of staff working in shelters.

“They are very concerned about the potential for an outbreak in their shelter and getting it themselves,” Hwang said.

By Andrew Pinto (contributors: Pinky Hapsari and Debra Slater)

You’ve likely noticed many grocery workers now wear personal protective equipment (PPE), including gloves and face masks, and have hand sanitizer within reach. It’s comforting to know stores have taken precautions for everyone’s safety.

Now imagine you are in a long-term care facility or require home care, and the workers do not have access to adequate PPE. This is the reality for many of the estimated 100,000 personal support workers (PSWs) in Ontario.

PSWs are a critical part of the health system. They often criss-cross a region to care for the ill and elderly, assisting with key activities important for our health: washing, dressing, eating, and taking medication. They also work extensively in long-term care and other health facilities, in close contact with people at high risk from COVID-19. Because of their efforts, hospitals are able to discharge patients to the community, freeing up acute care beds for others.

However, PSWs are chronically undervalued as front-line health workers. They often cope with precarious and dangerous work conditions. Many PSWs receive schedules with little notice, receive inadequate hours, and struggle to make ends meet given their low pay. We have been engaged in a community-based participatory research project to examine the working conditions of PSWs and the impact on their health. Last week, when we met (virtually), a dozen PSWs shared their mounting frustration and fear around their inadequate protection against COVID-19.

As the COVID-19 pandemic uproots the lives of people everywhere, the global research community is ramping up efforts to find ways to tackle the virus. Scientists at St. Michael’s Hospital were given a boost in the form of funding from St. Michael’s Hospital Foundation’s Research Innovation Council (RIC). 

Members of the Council — a group of St. Michael’s Foundation donors who pool their donations and select high-potential research projects to support — usually meet each June to vote on the projects they will fund. But this year their investment meeting was moved up to support science that take on COVID-19 — in the Foundation’s first-ever online event. 

The 25 RIC members were given the choice of three game-changing projects. Dr. Sharmistha Mishra and her team are creating a mathematical model to deploy population-specific interventions based on geography and demographics. Dr. Paul Dorian and his team aim to build a simple defibrillator to help COVID-19 patients get more oxygen into their lungs. And Drs. Fahad Razak and Amol Verma plan to use artificial intelligence to reduce the rate of COVID-19 transfer from long-term care to acute care. 

After two rounds of intense deliberation, the need for more crucial data won out. Dr. Mishra was awarded $190,000 in funding. 

Dr. Mishra is an infectious disease physician whose research focuses on the mathematical modeling of virus transmissions. She and the Research Group in Mathematical Modeling and Program Science will work with colleagues across a number of institutions (including Drs. Stefan Baral, Matthew Muller, Stephen Hwang, Rafal Kustra, Jeff Kwong, Adrienne Chan, and others) to carry out the research. 

“We are so grateful to the Foundation for the privilege of supporting the local response in the GTA,” Dr. Mishra says. “The funding will help us produce data-driven, population-specific strategies to flatten the curve in our local communities.” 

The closure of the community centres and meal programs and the restrictions around maintaining physical distance are compounding the stresses on people who are homeless. The cost of doing nothing about homelessness and accepting the status quo has never been more starkly apparent. Will COVID-19 force us to change how we deal with this pressing issue?

In this 25-minute podcast, MAP Director Dr. Stephen Hwang talks about these challenges, and what St. Michael’s and MAP scientists are doing to address them.

“This is a real opportunity to do things differently… This is almost like a reset – we can think about all the things that we knew we should do, but now see all the more clearly that we must do, for the sake of everyone in our society.”

At 14:35 Dr. Hwang discusses some of MAP’s COVID-19 research projects in development – and tells a story at 21:06 about how MAP’s Navigator Project has provided rapid and extremely valuable support to patients who are homeless and waiting for COVID-19 test results.

Photo: Angela Robertson of the Parkdale Queen West Community Health Centre says she fears the lack of race-based data in Canada on COVID-19 means “the real health impact on Black community will be hidden.”

…hospitals and clinics don’t collect detailed demographic data including race as a matter of routine. Advocates have long railed against this lack of data, calling it harmful to Black women after research found they may be underscreened for breast and cervical cancer.

Andrew Pinto is a doctor at St. Michael’s Hospital. He is also the director of the hospital’s Upstream Lab — a research group that looks at interventions or remedies to the socio-economic factors that affect health.

The St. Michael’s Hospital Family Health Team, and other groups in Toronto including Toronto Public Health, was part of a pilot program to ask patients questions on income, race, gender, housing, religion, etc., and then use this data to identify health inequities, Pinto said. Researchers found doing such a survey was “feasible and acceptable.”

“Social factors are definitely associated with health outcomes,” he said. Many studies show income and race play a big role. “We lack the data that we need in Canada to really be able to pinpoint inequity by race. That’s what our work is trying to move toward.”

In Toronto, as in many other cities in Canada and the United States, the coronavirus crisis is twinned with a different crisis: homelessness.

Sometimes all it takes is one person to illustrate how the system is failing.

Miriam* has struggled with housing for years. A couple of years ago, when her landlord ended her lease, she was unable to find another apartment that she could afford. Despite days and days on the phone with central intake, she could not get into a city shelter in Toronto. She was eventually advised by a housing worker to go to London, Ontario (a city of about 400,000 two hours drive away) – where she still could not get a shelter bed. She spent several nights in a McDonald’s until she was taken in by a local church.