‘People are stranded:’ A downtown hospital is seeing a rise in cold-related injuries as shelters struggle to find spots

From the Toronto Star article

Physicians and outreach workers at St. Michael’s Hospital are seeing an alarming rise in the number of homeless individuals coming to the emergency department seeking shelter and suffering from severe cold-related injuries, including frostbite, painful foot infections and life-threatening hypothermia.

Hospital staff say the crisis has escalated in the last two weeks due to a critical lack of space in the city’s shelter system, hit hard by the Omicron variant.

At St. Michael’s Hospital’s emergency department, about 20 per cent of its patient visits are by patients experiencing homelessness, said Dr. Carolyn Snider, chief of emergency medicine at the hospital, a part of Unity Health Toronto. And while the ER does see an increase in the number of underhoused individuals seeking care in the winter, the recent spike caused by Omicron hitting the shelter system alongside frigid temperatures is different, she said.

“We’re seeing more patients. They’re staying longer because there is nowhere else to send them. And they’re coming in sicker, with more cold-related injuries.”

Hospital staff are seeing cases of “trench foot” in underhoused patients. The serious condition is caused when feet are cold and wet for too long. “Their socks are wet, their feet have been in the cold and snow, and their skin is macerated from that,” Snider said, adding that if left untreated patients can get serious infections.

Dr. Stephen Hwang, director of the MAP Centre for Urban Health Solutions, said the recent experiences of St. Mike’s staff offer a window into what is happening in the shelter system and points to the immediate need for more warming centres and more shelter beds.

He noted that some city shelters experiencing a COVID outbreak are directed to not accept new clients for public health reasons, a decision that may be causing additional harm. According to SSHA, some locations can continue accepting clients with appropriate protections and under guidance from Toronto Public Health. And while in some cases shelters may need to close for a short time, “all efforts are being dedicated to ensure access to safe indoor spaces for people in need,” SSHA said.

Hwang, a physician at the hospital and a researcher who studies homelessness and health, said given the current shelter pressures and extreme cold, he hoped city staff would see the importance of offering a person shelter from the cold. “The need for more shelter beds right now in the city, we are seeing it from a health-care perspective. But we know people in the community are seeing it every day as well. We are all very concerned.”

Why drug checking services are essential in the opioid crisis

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From Global News Radio

Hayley Thompson, project manager of Toronto’s Drug Checking Service (launched by MAP’s Centre for Drug Policy Evaluation) explains how the free service works by analyzing unregulated drug samples, and why it’s important in the absence of a regulated drug supply.

Listen to the full interview here

Pourquoi les services de contrôle des substances sont essentiels dans le cadre de la crise des opioïdes

De Global News Radio

Hayley Thompson, gestionnaire de projet du Drug Checking Service de Toronto (lancé par le Centre for Drug Policy Evaluation du MAP) explique comment fonctionne ce service gratuit qui analyse des échantillons de drogues non réglementées, et pourquoi il est important en l’absence d’un système réglementé d’approvisionnement de drogues.

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Help needed for those experiencing homelessness

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From CP24 News

Amid a bitter cold spell, MAP Director Dr. Stephen Hwang speaks with CP24 about the lack of shelter beds in the city and a ‘housing first’ approach to end homelessness.

Watch the full interview here

Les personnes en situation d’itinérance ont besoin d’aide

De CP24 News

En pleine vague de froid, le directeur du MAP, le Dr Stephen Hwang, s’entretient avec CP24 du manque de lits d’hébergement dans la ville et de l’approche du « logement d’abord » pour mettre fin à l’itinérance.

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“They treat you with such disdain:” Experiences of overdose among people who inject drugs

January 25, 2022 – A new report captures and explores people’s experience of overdose – what happened, where, and how others responded to help. Based on surveys with almost 250 people as well as in-depth interviews with 17 people who inject drugs, the report highlights how unwelcoming Ontario’s health-care system can be for people who use drugs.

Of the people interviewed, most who went to hospital after an overdose reported negative experiences with health-care providers, including experiences of stigma and discrimination from hospital staff. Only one person received medication to manage their withdrawal symptoms. Nobody was offered Opioid Agonist Therapy (medications to reduce cravings for opioids) or a referral to a substance-use treatment program.

“It is critical that people who have experienced an opioid overdose are offered supports and treatment for opioid withdrawal in the emergency department, when admitted to hospital, or when leaving detox,” said co-author Dr. Ahmed Bayoumi, a scientist at MAP Centre for Urban Health Solutions and physician at St. Michael’s Hospital. “Our results indicate gaps in these practices in Toronto, and that’s unacceptable.”

The study’s survey recruited 249 people who inject drugs from four Toronto harm-reduction programs. It found that most people who inject drugs have experienced more than one overdose in their lifetime, likely due to the high frequency of fentanyl use in the context of an unregulated, toxic drug supply. Concerningly, almost one-third of people surveyed had experienced two or more overdoses in the six months before completing the survey.

“It is very common for people to experience multiple overdoses due to the toxicity and unpredictability of the drug supply,” said Sarah Greig, manager of the Moss Park Consumption and Treatment Service and one of the report co-authors. “We need new options for people – like safer supply and buyer’s clubs – while also improving the care people are receiving in the health care system.”

The overdoses often occurred when people were alone at their own home, with someone else at home, or at a friend’s home. Most people who overdosed were given naloxone, often by a friend. People who overdosed described receiving help from a friend, family members, strangers, or harm reduction workers if they overdosed in an supervised consumption site.

Only about one-third remember paramedics being called after an overdose.

“We have a lot of research to show that due to criminalization and negative past experiences with police and health care providers, people will often only call paramedics as a last resort,” said co-author and MAP postdoctoral fellow Dr. Gillian Kolla. “Decriminalization of drug use is one measure that may help.”

The authors say that Canada must move quickly to implement more and better harm reduction and treatment options, and to integrate them into housing and shelter programs. Responses must also focus on measures to prevent overdoses from occurring in the first place, through safer supply programs, compassion or buyer’s club models, and the introduction of a regulated drug supply. Additionally, decriminalization and legalization (beyond safer opioid supply programs) need to be at the forefront of dialogue on interventions to address the crisis of drug poisonings, due to the documented harms from criminalization on people who use drugs.

The report authors also note a link between people who overdosed two or more times and the experience of multiple forms of oppression, related to the history and continuing experiences of colonialism in Canada, anti-Black racism, and experiences of homelessness. Culturally safe supports are urgently needed for racialized and Indigenous people who inject drugs.

The report is the second release from the Impacts of Overdose study, co-led by Bayoumi, Kolla, and Dr. Kathleen Kenny of the University of Manitoba. The first report focused on impacts of overdose on front-line harm reduction workers.

Half of Ontario opioid deaths interacted with health-care system the month before: study

From the CTV News Toronto article

Half of Ontarians who died of an opioid overdose in the early stages of the pandemic had interacted with the health-care system in the month before their deaths, a new report shows.

And one in four had seen a doctor, gone to an emergency department or been discharged from hospital just a week prior, the research shows.

“That represents such an important missed opportunity for us to make sure that our health-care system is serving the needs of people who use drugs and helping connect them to the services that they need to help prevent these fatal overdoses,” said Dr. Tara Gomes, an epidemiologist with Unity Health and investigator with the Ontario Drug Policy Research Network who co-authored the study.

The report, titled “Patterns of Medication and Healthcare Use among People who Died of an Opioid-Related Toxicity during the COVID-19 Pandemic in Ontario,” was released Tuesday by Unity Health and the Ontario Drug Policy Research Network. Public Health Ontario, the chief coroner’s office and ICES, the non-profit health research organization, contributed to the report.

The authors are calling for a safer drug supply, expanded access to low-barrier treatment in health-care settings, affordable, supportive housing as well as more harm-reduction services and supervised consumption sites, especially outside cities.

Why letting users know what’s in the drugs they’re taking is important as opioid deaths rise

From the CBC News article

With opioid-related deaths mounting across Canada, health experts are warning that drug checking services are now more important than ever in helping users make informed decisions — and one Toronto pilot program is helping to do just that.

Launched in October 2019, Toronto’s Drug Checking Service helps to keep users aware of the content of the drugs that they are taking by anonymously collecting and analyzing samples from five downtown harm-reduction agencies.

The funding for the pilot program is set to run out by the end of this year, but with volatility in the unregulated drug supply leading to the rise in deaths, some say this type of service — which is free and available to everyone — is crucial for users to be able to make more informed choices.

“We are currently the only drug checking program up and running in Ontario, so we see our service as a vital part of harm-reduction services being offered,” said Hayley Thompson, project manager with Toronto’s Drug Checking Service.

“[We] would like to see … drug checking being available in more Ontario jurisdictions, or Canadian jurisdictions for that matter.”

The program, which is funded by Health Canada’s Substance Use and Addictions Program and St. Michael’s Hospital Foundation, collects anywhere from 10 to 30 samples daily from the agencies, which also serve as safe consumption sites.

High-risk Ontarians lagging on third doses of COVID vaccine

From the Toronto Star article

The call for COVID-19 booster shots to blunt the fast-moving Omicron wave pushed millions of Ontarians to get third doses.

But data shows some high-risk populations — those who would benefit most from the protection — are lagging in third-dose coverage, with experts warning more efforts are needed to reach these vulnerable groups.

Some highest-risk groups that were initially prioritized for third doses, including organ transplant patients, are generally well-protected, according to the most-recent data from non-profit research group ICES, formerly known as the Institute for Clinical Evaluative Sciences.

However, just 22 per cent of pregnant Ontarians — a group among those considered highest-risk — have received third doses. And just 10 per cent of homeless people under age 65 are boosted, the data shows.

Dr. Stephen Hwang, a physician and research scientist at St. Michael’s Hospital and director of the MAP Centre for Urban Health Solutions, said lower vaccination rates among the homeless population highlight the need for sustained and creative ways to offer first, second and third doses to this group at high-risk for COVID.

Among Ontarians under age 64 who have recently experienced homelessness, 64 per cent have their first dose, while 53 per cent have had two doses; just 10 per cent in this age group are boosted. Vaccine uptake is higher in the homeless population over age 65, the ICES data shows, with 80 per cent having at least one dose, 75 per cent with two doses and 32 per cent with three doses.

Hwang called efforts to vaccinate those who use the shelter system “heroic,” but said it’s also vital to find other avenues to offer vaccines, such as in community centres and supervised injection sites.

Doctors are noticing patients are drinking more, fuelling more hospitalizations

From the Toronto Star article

In the first year of the COVID-19 pandemic, Dr. Sam Elfassy noticed a worrying trend.

The gastroenterologist at St. Joseph’s Health Centre in Toronto often asks patients about their drinking habits, as he treats chronic illnesses in the liver. But the responses he began to receive were alarming: most of his patients said they were drinking more than before, even those who never drank regularly.

As the pandemic endures, physicians worry these concerning trends will continue. Dr. Andrew Pinto, a family physician with Unity Health in Toronto, said some signs are already pointing toward yes.

“In my clinical work, I’ve seen more folks who are drinking, and usually it’s part of coping with stress,” Pinto said.

He added stress is creeping up again among his patients as of late, with the rising number of COVID-19 cases and the enduring uncertainty. This, especially when the pandemic felt like it was nearing its end in the fall, when case numbers were low.

“Things seemed like they were getting better, and now again it’s become a very challenging situation,” Pinto said. He worries most about who have lost their jobs or income, those with precarious housing and those coping alone without any social support.

Dr. Andrew Pinto recognized with prestigious Chair

From the Unity Health Toronto article

Dr. Andrew Pinto, scientist at MAP Centre for Urban Health Solutions and founder and director of the Upstream Lab, has been awarded a CIHR Applied Public Health Chair in Upstream Prevention in Primary Healthcare. We spoke with [him] to learn more about the impact of this award.

What does this CIHR Chair mean for you and your research team?

Being awarded this CIHR Chair means we can continue our work with individuals and communities to “go upstream” of the negative social and economic policies that impair their health, and co-design solutions and rigorously evaluate them. This Chair will help sustain our work over the next six years, and achieve our vision of being a resource nationally and internationally.

Which research projects and work will it contribute to?

This will support four new research areas at the Upstream Lab, including bringing together the latest evidence on the most effective upstream interventions and supporting scale-up and studying how health organizations implement upstream action to improve population health.

We will identify gaps in the evidence, and obtain funding to develop and evaluate new upstream interventions. We will also link upstream efforts in health care to rapid responses to future health threats in collaboration with public health.

Is there anything else you’d like to add about this achievement?

We will also host an annual international Upstream Summer Institute to engage more early-career researchers and graduate students in this work. This is one of only seven Chairs funded across the country, and the only one at the University of Toronto. The COVID-19 pandemic has demonstrated the crucial need for these Applied Public Health Chairs.

Dr. Andrew Pinto awarded $1.15 million CIHR Public Health Chair to reduce health inequities

From the U of T Department of Family & Community Medicine News

Dr. Andrew Pinto, an Associate Professor in the Department of Family and Community Medicine (DFCM) and family physician and public health specialist at St. Michael’s Hospital, Unity Health Toronto, has been awarded a prestigious $1.15 million Canadian Institutes of Health Research grant to advance health and health equity in Canada.

One of only seven new Applied Public Health Chairs, and the only one awarded at the University of Toronto, the Chair position will allow Dr. Pinto to continue working with individuals and communities to “go upstream” of the negative social and economic policies that impair health, co-design solutions, and rigorously evaluate them.

The position, a “CIHR Applied Public Health Chair in upstream action at the individual-, organizational- and policy-level to improve health and reduce inequities” stems from Dr. Pinto’s work as director of the Upstream Lab.

“The COVID-19 pandemic has highlighted the dramatic impact that social factors can have on the health of individuals and communities,” explains Dr. Pinto, who is also a Dalla Lana School of Public Health faculty member and Associate Director for Clinical Research for the University of Toronto Practice-Based Research Network (UTOPIAN). “At the Upstream Lab we are working to tackle these social factors and improve health outcomes through research, education and policy change. This Chair position will help sustain our core functions for the next six years, allowing us to develop as a resource nationally and internationally.”

The funding will support four key research areas, including bringing together the latest evidence on the most effective upstream interventions and supporting scale-up and studying how health organizations implement upstream action to improve population health.

It will also complement Dr. Pinto’s role as artificial intelligence lead with EXITE (EXploring Innovative TEchnologies in Family Medicine), a DFCM innovation collaborative that is working to adapt, apply and develop innovative technologies for use in primary care delivery and education.

“As we study existing upstream actions, identify gaps and develop new solutions, big data and artificial intelligence can help us identify patterns and support proactive care. At the same time, we must identify and address negative consequences for individuals communities made vulnerable by social and economic policies.”