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Time for a regular checkup? Here’s what doctors say you should ask about

Dr. Tara Kiran speaks with CBC White Coat, Black Art’s podcast The Dose

Listen to the podcast episode here.

The pandemic interrupted routines for health, work and family — including regular checkups.

So if you haven’t been to see your family doctor since before March 2020, now may be the time. 

“There’s a lot of diseases still going on,” Dr. Peter Lin, a Toronto-based family doctor and a director at the Canadian Heart Research Centre, told CBC podcast The Dose.

“If you have diabetes, high blood pressure, all of those things need some fine-tuning.”

Those who have a chronic illness or new pain should see their health-care provider right away, he said.

And if you’re overdue for an age-related cancer screening test, like a Pap smear, colonoscopy or a mammogram, get in touch with your family doctor.

If you’re unsure whether you need a checkup, several physicians told The Dose about what to consider before making an appointment. 

Who should book an appointment?

Contrary to its name, an annual checkup isn’t something most people need every year, said Dr. Tara Kiran, a family physician at St. Michael’s Hospital.

“That’s a little bit of a misnomer.”

Instead, most practitioners and their staff look at several factors before seeing someone. 

“What we do is really try and target preventive care based on people’s health history and their age, sex and the [medical] history of their family,” said Kiran, who is also the Fidani Chair for improvement and innovation at University of Toronto’s department of family and community medicine.

Winter taking heavy toll on people who are homeless, from amputations to freezing to death

From the CBC News article

Health-care practitioners say this is the second difficult winter in a row for those who live outside. Pandemic pressures on an already-stretched shelter system as well as restrictions prohibiting eating — and getting warm — in fast-food restaurants have left many with nowhere to go on cold nights.

Toronto’s shelter system has been full or near capacity for years. This winter, Harrison and others say they have often called the city’s central intake office only to be told no beds are available.

Emergency departments have become ad hoc warming centres, says Dr. Stephen Hwang, a physician and researcher at the MAP Centre for Urban Health Solutions at the Unity Health Toronto hospital network. 

He says the network has an outreach worker who calls intake on cold nights in an effort to find spots inside shelters.

“There’s just been not enough space for people,” he says.

The city says it has added 400 new shelter spaces and 165 spots in warming centres this winter. It has also kept warming centres open since Jan. 7, instead of only during extreme cold weather alerts.

Advocates say that’s not enough. 

At least two homeless people have died as a direct result of the cold, although data on the subject is hard to come by.

Alberta’s safe-supply committee is missing an opportunity to protect people from harm

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Op-ed in The Globe and Mail by Zoe Dodd, Eris Nyx, Corey Ranger, and Mark Tyndall

In December, the Alberta government set up a committee to consider the merits of providing access to a regulated supply of pharmaceutical-grade drugs, also called safe supply, in response to the continuing drug-poisoning crisis.

This crisis has killed more than 27,000 Canadians since 2015, and there is no end in sight. The introduction of fentanyl, unpredictable drug combinations and other deadly contaminants into the drug supply has resulted in a protracted massacre of people who were already being left behind.

As a group, we have declined the invitation to appear before the Alberta government’s committee. We feel that this is a deeply flawed process and that the conclusions have been predetermined. While we remain committed to saving lives through providing access to a safer drug supply, we refuse to lend any credibility to the process.

While governments across Canada have largely been sitting on the sidelines as this crisis has unfolded, Alberta’s United Conservative Party has taken an aggressive stance against people who use drugs by actively opposing harm-reduction interventions, targeting both evidence-based supervised injection sites and injectable opioid agonist treatment programs. The government has instead promoted abstinence-based treatment programs and tougher law enforcement.

Further, its safe-supply committee clearly lacks impartiality: It consists of only MLAs from the UCP. Members of the Opposition NDP walked away from the legislative committee. The party’s mental-health and addictions critic, Lori Sigurdson, described it as a “rigged process” after reviewing the list of more than 20 “experts” who were invited to present.

Le comité d’approvisionnement sûr de l’Alberta rate une occasion de protéger la population

Article d’opinion publié dans le Globe and Mail par Zoe Dodd, Eris Nyx, Corey Ranger et Mark Tyndall

En décembre, le gouvernement de l’Alberta a mis sur pied un comité chargé d’examiner les avantages d’un accès à un approvisionnement réglementé en médicaments de qualité pharmaceutique, également appelé approvisionnement sûr, en réponse au problème persistant des intoxications médicamenteuses.

Cette crise a tué plus de 27 000 Canadiens depuis 2015, sans que la fin ne soit en vue. L’introduction du fentanyl, de combinaisons de médicaments imprévisibles et d’autres contaminants mortels dans l’approvisionnement en médicaments a provoqué un carnage chez des personnes qui étaient déjà marginalisées.

En tant que groupe, nous avons décliné l’invitation à comparaître devant le comité du gouvernement de l’Alberta. Nous pensons que ce processus est profondément déficient et que les conclusions ont été préalablement établies. Alors que nous restons déterminés à sauver des vies en donnant accès à un approvisionnement en médicaments plus sûrs, nous refusons d’accorder une quelconque crédibilité à ce processus.

Alors que les gouvernements de tout le Canada sont restés en retrait face à cette crise, le Parti conservateur uni de l’Alberta (PCU) a adopté une position ferme à l’encontre des personnes qui consomment des drogues en s’opposant activement aux interventions de réduction des risques, ciblant à la fois les sites d’injection supervisés fondés sur des données probantes et les programmes de traitement des agonistes opioïdes injectables. Le gouvernement a plutôt encouragé les programmes de traitement fondés sur l’abstinence et l’application plus stricte de la loi.

De surcroît, son comité d’approvisionnement sûr manque manifestement d’impartialité : il est composé uniquement de députés du PCU. Les membres de l’opposition du NPD ont quitté le comité législatif. La porte-parole du parti en matière de santé mentale et de toxicomanie, Lori Sigurdson, a qualifié le processus de « truqué » après avoir examiné la liste de plus de 20 « experts » invités à faire une présentation.

Join MAP panel to guide equitable primary care

MAP scientists Drs. Aisha Lofters and Nav Persaud are forming a citizen panel that will make recommendations to promote equitable access to preventative care interventions – including cancer screening and screening for cardiovascular disease – during the pandemic recovery period.

Who is encouraged to apply?

  • People who have experience with primary care (as a provider, administrator, and/or patient).
  • Racialized women and others who are typically underrepresented in clinical practice planning are especially welcome.
  • No research experience is needed, and panel members will be supported with opportunities for learning about relevant health care terms, practices, and concepts.

We strive to create a supportive environment for this work focused on health equity. Panel members will be compensated at a rate of $100 per hour using funding for this project from the Canadian Institutes of Health Research. We estimate that over the coming year, panel members will spend approximately 10 hours reviewing materials and approximately 10 hours participating in meetings that will take place during normal working hours (usually from 1 to 3 pm EST). Panel members will be co-authors of the resulting article presenting the recommendations aimed at promoting health equity through preventative health care during the pandemic recovery period.

Questions? Please contact Dr. Nav Persaud at nav.persaud@utoronto.ca

Is mandatory COVID-19 vaccination for school attendance the answer to increasing vaccine uptake in children?

Op-ed in the Toronto Star by Dr. Sloane Freeman, Dr. Ripudaman Minhas and Dr. Kevin Schwartz

The COVID-19 vaccine is safe, effective, and recommended for children aged 5 years and older, yet, nationwide, COVID-19 vaccine uptake has been low in children 5-11 years of age. To date, only 28 per cent have received two doses.

Increasing vaccination rates in this age group must be our priority. Some provinces have mandatory immunization programs for school-aged children, and questions have been raised about the suitability of this approach for the COVID-19 vaccine.

As pediatricians and child health advocates, our considerations surrounding COVID-19 vaccine mandates in children include: Will they prevent serious disease in the individual? Will they protect the community by decreasing transmission? Will they address the root cause of low uptake in children? There is much debate as to whether mandating the COVID-19 vaccine for school attendance is an ethical and equitable way to increase uptake in this age group.

A key benefit of a mandatory COVID-19 child vaccination policy would be its effectiveness in increasing vaccination rates and preventing serious illness in children. With more children exposed to Omicron each day, increasing vaccination in this age group is essential, especially for children with medical and developmental complexity.

Furthermore, COVID-19 has disproportionately impacted marginalized and racialized communities in Canada, with higher rates of hospitalization in children. Requiring the COVID-19 vaccine for school attendance could increase protection of children in hard-hit communities and accelerate the pace of vaccination in all school-aged children.

A mandate would also improve parents’ perception of the importance of the COVID-19 vaccine. Historically, vaccines that were mandated have been viewed as essential by the public.

Many advocates have suggested that mandating COVID-19 vaccination to increase uptake would reduce transmission. A recent preprint study from Ontario demonstrated that two or three vaccine doses were very effective at preventing hospitalizations and death from Omicron in adults. However, two doses provided only 40 per cent protection from mild infection within two months and no protection after six months.

Opioid crisis: More access to take-home treatments didn’t raise risk of overdoses, study says

From the CTV News article

A new study tracking patients receiving treatment for opioid addiction in Ontario has found that a recommendation change in March 2020 which allowed for more take-home treatments during the pandemic resulted in less overdoses and in more patients staying in the program.

Researchers followed more than 21,000 people who were receiving opioid agonist therapy (OAT) in 2020, and found that among those who were receiving daily doses of methadone, those who moved to take-home doses were actually 27-per-cent less likely to have an opioid-related overdose.

Study authors believe this could support giving more flexible access to treatments in the future – an important step given Canada’s opioid crisis has worsened during the pandemic.

“Allowing people to have that agency over treatment and given that opportunity is really important in independence and in confidence building,” Charlotte Munro, one of the study’s co-authors and a member of the Ontario Drug Policy Research Network’s (ODPRN) lived experienced advisory board, told CTVNews.ca in a phone interview.

The gold standard in treating opioid addiction is OAT, in which patients take regular doses of either methadone or buprenorphine, also called Suboxone, which are both long-acting opioid drugs. 

“They’re oral medications that are taken that replace opioids that people might have taken instead and help people prevent themselves from going into withdrawal and maintain a steady state of opioid in their system,” said Dr. Tara Gomes, a Principal Investigator of ODPRN and lead author of the study published Tuesday in the journal JAMA.

However, because OAT involves controlled substances that could pose a risk of overdose, particularly methadone, the treatment is delivered in-person every day in a pharmacy for a period of time until a physician decides to slowly prescribe more doses to take at home.

Toronto’s homeless population had twice the odds of testing positive for COVID-19, study shows

From Unity Health Toronto

People experiencing homelessness had more than twice the odds of testing positive for COVID-19 than those not experiencing homelessness in the first wave of the pandemic, according to new research led by Unity Health Toronto.

The study, published in Healthcare Policy, analyzed data from over 2,000 patients who visited the COVID-19 testing centre at St. Michael’s Hospital in downtown Toronto from March to April 2020 and found the higher positivity among the homeless population was present even after researchers adjusted the data to account for differences in age, sex and comorbidities.

The data also showed that approximately 10 per cent of people seeking a test were experiencing homelessness – far higher than the estimated proportion of the city’s homeless population, which is an estimated 8,715 of nearly 3 million people. People at the COVID-19 assessment centre were classified as homeless if the checkboxes for “shelter” or “unhoused” were marked in their records, or if the address field indicated no fixed address or listed the name or address of a shelter.

The study shows that people experiencing homelessness are at high risk of contracting COVID-19 and suggests that better strategies are needed to control COVID-19 transmission among people experiencing homelessness, particularly at shelters.

“Unfortunately, we still have a long way to go to make shelters a safe space and protect residents from infections that spread from droplets and air,” said Dr. Tara Kiran, first author of the study and a scientist at the MAP Centre for Urban Health Solutions at St. Michael’s Hospital. 

“Shelters are a stop-gap measure that we have unfortunately continued to rely on. They don’t meet people’s needs and this has just become more apparent during the pandemic. The findings are a reminder that we need to address the core issue of not enough affordable housing,” said Dr. Kiran, who is also a family physician at St. Michael’s Hospital.

The study builds off of the authors’ previously published research that suggested a more robust testing strategy was needed to prevent COVID-19 outbreaks in shelter settings. The authors say in addition to increased PCR and rapid antigen testing, this new study points to the need for improved ventilation in shelters and a full series of vaccination for people experiencing homelessness and those who work at shelters, including third doses.

“Our study shows that residents of homeless shelters had twice the odds of testing positive for COVID compared to those with stable housing,” said Dr. Joel Lockwood, co-author of the study and co-lead physician at the COVID-19 Assessment Centre at St. Michael’s Hospital.

“A lack of safe housing makes it difficult to practice physical distancing, mask-wearing, and other preventative measures. This is especially important since people experiencing homelessness are at a higher risk of severe COVID due to a higher rate of chronic medical conditions than the general population,” said Dr. Lockwood, who is also an emergency physician at St. Michael’s Hospital.

Omitting indoor air quality from COVID-19 guidance for shelters and long-term care homes is a grave mistake

From The Conversation

Forty per cent of COVID-19 deaths in Ontario have taken place in long-term care homes. Chronic and in some cases devastating outbreaks have also been reported in sheltersdetention centres and group homes for adults with disabilities. Residents and workers have died, and thousands more have been infected.

In these group facilities, termed “congregate settings” in Ontario, people eat together, and bedrooms and bathrooms are often shared. Because of this, they are very high-risk for acquiring airborne diseases.

It is imperative that congregate settings receive the best, most rigorous guidance available from Public Health Ontario (PHO). But that is not what is happening. A key aspect of infection prevention and control — indoor air quality — has been omitted from PHO’s public, written COVID-19 guidance specifically designed for these types of facilities.

Sub-standard guidance for congregate settings

Our team, which includes researchers with expertise in indoor air quality, engineering, epidemiology, public health and knowledge translation, conducted a detailed study of the public, written guidance PHO has produced specifically for institutions such as long-term care homes, shelters, group homes and correctional facilities. (The study is shared here as a pre-print, and has been submitted to a journal for peer review.)

We found no references to ventilation, HVAC (heating, ventilation and air conditioning) systems, portable air filters, bathroom exhaust fans or even opening windows. This includes PHO’s COVID-19 checklists for long-term care homes and congregate settings, which target those who are responsible for facility health and safety.

While our formal study concluded at the end of October 2021, we’ve continued to explore guidance on PHO’s website. Even as outbreaks continue in facilities such as long-term care homes and shelters, nothing much has changed, almost two years into the COVID-19 pandemic.

A Q&A with Dr. Dan Werb about coronaviruses and the predictability of pandemics

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By Jennifer Stranges, Unity Health Toronto

Now in our third year of the COVID-19 pandemic, questions about the lessons learned and the path forward are top of mind. When will this pandemic end? How can we prevent future pandemics? What lessons did we learn from not just this pandemic, but the ones that came before it?

These questions and more are addressed in the new book The Invisible Siege: The Rise of Coronaviruses and the Search For a Cure, written by Dr. Dan Werb, a scientist with MAP Centre for Urban Health Solutions in the Li Ka Shing Knowledge Institute of St. Michael’s Hospital. The book was named a named a top 10 science book of the season by Publishers Weekly and will be released by Penguin Random House on March 1.

We spoke with Dr. Werb about the book, the most effective way to end the COVID-19 pandemic, and what he thinks is the “major failure” of the pandemic response.

What is the book about?

The book is an optimistic counter-narrative to all the stories we’ve heard about pandemic failure. There are failures captured in the book, but it’s a story of optimism and hope told through the lives and ideas of scientists who have been studying coronaviruses since the 1980s. It’s also about some scientists who accidentally moved into a space in their careers where they were able to advance a number of the different vaccines and cures that have charted our path through this pandemic and, potentially, future pandemics as well. Really, it’s about scientists as people and the way in which scientific discovery intersects with the real world in very strange and unpredictable ways. Finally, it’s a “family history” of coronaviruses. This viral family itself is a kind of character, and the book charts how that family has evolved for thousands and maybe millions of years.

The book is described as “putting boundaries on our anxiety” by placing COVID-19 in its scientific and historical context. What does this mean and why is it important?

I started writing this book in the early days of the pandemic when nobody knew where it was going to go, how bad it was going to get or how scary it was going to be. Part of what was so brutal about that time was not knowing the depth of the threat and how much our lives would get up-ended.

For the book, I talked to scientists who explained the outer bounds of how bad it could get and the other outer bound of how mild it could be. Science is all about putting ranges on things and if you have that range to work in, that can be incredibly comforting.

We’ve skirted the worst possible scenarios so far – that’s not to minimize how bad it is across the world and how poor the vaccine distribution has been, which is the real major failure of the pandemic – but we avoided the very worst case scenario, and we’re able to understand what exactly that worst case scenario was.

The book feels like a love letter to this small group of scientists who have been studying coronaviruses for decades, and also to the past discoveries that allowed us to learn as much about COVID-19 as quickly as we did. What is the book trying to say about science and scientists?

One of the things that the book does is show how the work that went into creating COVID-19 vaccines started with totally abstract questions about viruses way back in the 1980s. What the book is trying to demonstrate is the need for publicly-funded science to support those big, abstract pursuits. Public-funded science is at threat and what the book describes is how public-funded science – that a lot of the time had nothing to do with coronaviruses at all – got us to a place where we could get through this pandemic.

The more I learned about where all these ideas came from, I started to understand how deliberate all the testing and how rigorous the science is behind it. Misinformation threatens science, and publicly-funded, open-ended science is the only way that we’re going to land on solutions for problems that we have not considered – so that’s what we should be protecting.

One concept explained in the book is the epidemic triangle. What is this and how does it make epidemics “predictable”?

The epidemic triangle is this notion that every single epidemic is driven by the relationship between three factors: the pathogen (or the agent, the virus or bacterium), the host (the animal that harbours that pathogen), and the environment (within which those pathogens and hosts are interacting). Epidemics can always be traced back to a shift in that relationship.

This was where the book started for me. I wrote an op-ed in The New York Times early on in the pandemic outlining the epidemic triangle. It was a concept that comforted me because it outlined that whatever happened in the epidemic, at the very least it was going to obey this basic rubric.

In the case of how coronaviruses fit into the epidemic triangle, I discovered that there has been this movement primarily driven by changes in environment – from climate change, deforestation, from humans moving into areas formerly the homes and habitats of wild animals – which has caused a massive shift in the ways in which humans and animals co-exist. And that has in turn intensified contact between humans and coronaviruses. This is not something that started with SARS-CoV-2, it started decades ago and the first signal of this shift was SARS in 2002, and then MERS in 2012.

The book explains how the “wrong lessons” were learned from SARS. What didn’t the world learn to be able to anticipate and respond to COVID-19?

The thing about SARS is that it was essentially an unfit virus. It wasn’t able to transmit itself efficiently enough to remain replicating in human bodies and infecting human population. That wasn’t really a result of a human response, it was more the result of the virus just not being fit enough to survive.

Unfortunately, we took two wrong lessons from that. The first was that coronavirus pathogens don’t emerge frequently, and if they do, they aren’t terribly deadly or efficient when they do gain purchase in human populations. The second was that we can control coronavirus epidemics pretty easily when they emerge in human populations – and we can do that without vaccines, mainly with quarantines and public health restrictions. These were obviously wrong.

How can we blunt the threat of future pandemics?

It all comes back to the epidemic triangle. We know epidemics are driven by a shift in the relationship between pathogens, hosts and the environment they live in. Humans are not becoming more physiologically vulnerable to pathogens. It’s also not necessarily that the pathogens are becoming more pathogenic or becoming more effective at transmitting across species – that threat has always been there.

It’s really the environment – it’s the intensification of the frequency with which pathogens are able to engage with human populations. And that is driven by climate change on the one hand, by the wildlife trade, and also mass global production of meat for eating, which requires so much land and habitat, and ultimately ends up bringing humans into places where they’re displacing animals.

If the system continues this way we will see more of these pathogens emerge. More pandemic-potential pathogens emerged in the first 20 years of the 21st century than emerged across the entire 20th century. So there’s an acceleration of pathogens making their way into human populations, and it’s all related to the way that our food chains work, the way we use land for meat production and our ongoing conquest of natural spaces.

How do you describe how vaccines work and their purpose?

Ultimately, if a vaccine was meant to protect a single person, there would be no reason to invent one. Yes, vaccines are effective at preventing you from becoming very ill and offer some protection against infection, but they are primarily a population health tool. They are meant to be deployed across an entire population to achieve herd immunity – in a funny way, they’re actually designed to protect the people who don’t have vaccines.

In the book, I liken vaccines to a scenario wherein, if I bought a pair of glasses, your vision would get better. And for every additional person who got glasses, your vision would just keep improving. Once you remove yourself from the equation, it’s a lot easier to understand what the utility of vaccines is and why it’s so important for as many people as possible to get vaccinated.

How do you feel as there’s a real transition towards “living with COVID”?

My greatest sadness and frustration comes from the lack of global vaccine distribution. It makes me sad because it’s one of the few times in the system we live in where the ethically correct response is also the most selfish response.

As long as there are populations that are vulnerable to infection, and within which SARS-CoV-2 can replicate freely, there will be ongoing variants that will emerge. Inevitably, variants will emerge that will undercut the effectiveness of vaccines – and that’s bad for everyone.

If we want to stop new variants from emerging, and thereby stop the weakening of vaccines, we need to get vaccines out to everyone in the world, and right now access to the vaccines is completely lopsided for rich countries versus low and middle income countries.

As long as that inequity exists, this thing will not end. It will transform, yes, and maybe we’ll find a way to live with it. But it will constantly be there, we will constantly be adapting our defenses, and almost certainly requiring new boosters, and the production of new treatments. When really the fastest, most effective way to end the pandemic is to get the vaccine to people who do not currently have it.

The book is dedicated “to those who science could not save.” Why was that important to you?

There’s a lot of reasons why people were not saved by science. It was timing, it was which countries they lived in, and it’s also people that did not believe the science. It felt important for me to acknowledge that in the book, and to have the grounding as I wrote the book to make sure what I was writing was not too salacious of hyperbolic, that it was honouring the stark reality of what’s happened. I want to make sure it honours people who have lost something or those people who were lost.

You can order The Invisible Siege: The Rise of Coronaviruses and the Search For a Cure here, and subscribe to Dr. Werb’s newsletter here.

Entretien avec le Dr Dan Werb sur les coronavirus et la prévisibilité des pandémies

Par Jennifer Stranges, Unity Health Toronto

Alors que nous sommes dans la troisième année de la pandémie de COVID-19, les questions sur les leçons apprises et sur la voie à suivre sont au cœur des préoccupations. Quand cette pandémie prendra-t-elle fin? Comment pouvons-nous empêcher de futures pandémies? Quelles leçons avons-nous tirées non seulement de cette pandémie, mais aussi de celles qui l’ont précédée?

Ces questions et plusieurs autres sont abordées dans le nouveau livre The Invisible Siege : The Rise of Coronaviruses and the Search For a Cure du Dr Dan Werb, scientifique du Centre MAP pour des solutions de santé urbaine du Li Ka Shing Knowledge Institute de l’hôpital St. Michael. Le livre a été désigné comme l’un des dix meilleurs ouvrages scientifiques de la saison par Publishers Weekly et il sera publié par Penguin Random House le 1er mars.

Nous nous sommes entretenus avec le Dr Werb au sujet de son livre, de la manière la plus efficace de mettre fin à la pandémie de COVID-19 et de ce qu’il pense être le « grand échec » de notre réponse à la pandémie.

De quoi traite ce livre?

Ce livre est une contre-narration optimiste de toutes les histoires que nous avons entendues à propos des erreurs commises en temps de pandémie. Le livre fait état des échecs, mais il relate une histoire d’optimisme et d’espoir à travers la vie et les réflexions de scientifiques qui étudient les coronavirus depuis les années 1980. L’ouvrage traite également de scientifiques qui, par hasard, sont arrivés à un moment de leur carrière où ils ont pu faire progresser un certain nombre de vaccins et de traitements différents qui nous ont permis de traverser cette pandémie et, possiblement, d’autres pandémies à venir. On y découvre les scientifiques en tant que personnes et la façon dont les percées scientifiques s’entrecroisent avec le monde réel de manière tout aussi étrange qu’imprévisible. En d’autres mots, on y raconte l’« histoire familiale » des coronavirus. Cette famille virale constitue elle-même une forme de personnage, et le livre relate l’évolution de cette famille depuis des milliers, voire des millions d’années.

Flexible access to methadone during the pandemic associated with greater likelihood of staying on treatment for opioid use disorder: study

From Unity Health Toronto

New research has found an Ontario provincial guidance change during the early days of the COVID-19 pandemic that recommended that individuals receive rapid access to take-home doses of medication for their opioid use disorder helped people stay on their treatment without increasing their risk of overdose in the subsequent six months.

The research, published in JAMA and led by researchers at St. Michael’s Hospital of Unity Health Toronto, suggests that providing people with more flexible access to their medication for opioid use disorder could be a successful strategy to keep patients in treatment and while not increasing the risk of overdose.

New guidance recommending low barrier access to take-home doses of opioid agonist therapies (OAT) was introduced on March 22, 2020 to accommodate COVID-19 public health measures, including limiting trips outside one’s place of residence, distancing requirements and isolation requirements.

People receiving OAT, such as methadone, are typically required to go to a pharmacy each day to consume their dose under medical supervision. Once they are stabilized on treatment and with agreement from their clinician, they are able to begin receiving doses to consume at home, typically beginning with one observed dose, followed by one take-home dose, and increasing over time. With the changing guidance in March 2020, the goal was to more quickly provide people with multiple take-home doses based on their clinician’s assessment of their social stability and ability to store doses safely.

“For a long time, people with opioid use disorder have been asking for more flexible access to OAT,” said Dr. Tara Gomes, lead author of the study, a Scientist at the Li Ka Shing Knowledge Institute of St. Michael’s Hospital and ICES, and a Principal Investigator of the Ontario Drug Policy Research Network (ODPRN).

“It can be hard to hold down a job, go on vacation, or maintain some degree of autonomy and freedom on a day-to-day basis when accessing opioid agonist therapies because you are so tied to visiting a pharmacy on a daily basis. This pandemic-related change in guidance allowed us to see what would happen if these rigid rules were changed, and the findings suggest that more flexible treatment is actually safe and helps keep people in OAT programs.”