Drug checking, harm reduction sites needed to combat spike in opioid overdoses in Toronto

From CityNews featuring Hayley Thompson

As Toronto Public Health (TPH) warns of yet another increase in suspected opioid overdose deaths, several agencies working in harm reduction across the city say they don’t have enough resources to combat the crisis.

Last week, TPH said paramedics attended 10 suspected opioid deaths over five days from July 17-21. Calling the cluster of deaths “very tragic,” Toronto police tells CityNews they saw similarly high clusters of death in November 2020, January 2021, and May 2021.

The City of Toronto says the COVID-19 pandemic exacerbated the already devastating opioid crisis and contributed to the “unprecedented increase” in opioid-related deaths.

There have been 143 suspected opioid overdose deaths recorded so far in 2022. The average number of deaths a month before March 2020 was 13; it is now 27.

Drug alerts, like the one issued last week, are done when an abnormality is detected that is usually informed by various sources, including harm reduction partners and their overdose monitoring system.

One of the harm reduction partners in the city is Toronto’s Drug Checking Service, funded as an overdose prevention measure by Health Canada and St. Michael’s Hospital Foundation.

The service provides people who use drugs with detailed information about the contents of their narcotics.

“We’re just allowing them or facilitating them to make the most informed decision by knowing what’s in their drugs because when you’re accessing drugs from an unregulated market, there’s no way of knowing exactly what’s going to be in them or even if you do know what’s in them the potency of what’s in it,” said Project Manager Hayley Thompson.

The drug checking service also then takes that data from the samples they have checked and shares that information publicly on their website. “[It’s to] help inform the care that people who use drugs receive as well as to inform clinicians, policymakers who are creating drug-related policies and researchers,” said Thompson.

They have checked over 7,000 samples of drugs since they opened in Oct. 2019, the majority (50 per cent) of which is fentanyl. The other 50 per cent is made up of various stimulants like cocaine, methamphetamine, psychedelics, and other opioids.

‘It’s bad’: Opioids killed more Ontarians in second year of pandemic than first

CTV News Toronto

Opioids killed more people in Ontario in the second year of the pandemic compared to the first, but the province saw a drop in those deaths this past March, newly released data shows.

About eight people per day died from opioids in the second year of the pandemic, preliminary data from Ontario’s Office of the Chief Coroner shows. From April 2021 to March 2022, 2,790 opioid-related deaths were recorded, up slightly from 2,727 in the first year of the pandemic.

Those were both large leaps from 2019, when opioids killed 1,559 Ontarians — about four people per day.

“It’s ongoing and it’s bad and it got heck of a lot worse during the pandemic,” said Dr. Dirk Huyer, Ontario’s chief coroner, in an interview.

But the data also shows the death rate dropped by 10 per cent in the first quarter of this year compared to the same time frame last year. The data is considered preliminary because it includes both confirmed and probable opioid-related deaths and is subject to change, Huyer said.

“Should we be celebrating the fact that we’ve gone down 10 per cent?” Huyer said. “No. We still have a lot of people dying, but, yes, we’re not continuing to go up, so that is good.”

The number of overall deaths dropped by 31 per cent in March 2022 compared to March 2021. Ontario lifted most COVID-19 restrictions that month, although Huyer said at this point that is simply a correlation, not necessarily the cause for the drop.

Tara Gomes, an epidemiologist at Unity Health in Toronto who studies opioid use, is cautious about the recent dip in deaths, saying that data remains preliminary.

“It’s so hard to know for certain right now, but it’s better than the alternative, which is what we keep seeing during the pandemic,” she said.

“But it’s important to remember that eight deaths a day compared to four deaths a day before the pandemic is just such a big change.”

Her work has focused on the disparities between cities and rural areas as well as the challenges up north.

“I think that a lot of the harm reduction services that we have are really designed to work well in an urban setting, but in larger areas or rural areas, it’s a lot more difficult to plan and manage,” she said.

Gomes said the province and the federal government need to relax rules on proven opioid treatments like suboxone and methadone, vastly expand harm reduction and safe spaces to use drugs, as well as a safe supply of drugs.

Knowing your status, education key to fighting AIDS, experts say

From CBC Nova Scotia

One out of 10 people living with HIV, around 7,000 people, don’t know they have the virus, according to Dave Miller of REACH Nexus, a national research group that deals with sexually transmitted and blood-borne infections.

Miller, who is based in Nova Scotia, attended the International AIDS conference that wrapped up earlier this month in Montreal. 

It was the first time since the beginning of the COVID-19 pandemic that people working in the field of HIV were able to meet in person at the conference. 

Miller told Jeff Douglas, host of CBC’s Mainstreet in Halifax, that the conference was a great opportunity to hear about the latest research and science around HIV and for people living with HIV to have their voices heard.

Federal funding for self-testing

During the conference, Federal Health Minister Jean-Yves Duclos announced $17.9 million to expand HIV testing in Canada.

Duclos said $8 million of the total would go toward purchasing and distributing HIV self-testing kits.

Sean Rourke, a scientist with the MAP Centre for Urban Health Solutions at St Michael’s Hospital in Toronto, who also attended the conference, told Mainstreet in Halifaxthe investment was a game changer on many levels. 

It’s working with people like Dave, and being on the front lines, where we need to really just let people know about what’s possible, who are not coming forward for testing,” Rourke said.

This offers them an alternative, an option to get a test and really, positive or negative, get people connected to the care they need in their community.”

In terms of the Atlantic region, Miller said the I’m ready to know program, a national initiative that connects people with  HIV self-testing, is working to educate communities about HIV and the importance of testing. 

‘It’s crazy what they expect’: Newmarket Residence part of a troubled housing system for Ontario’s most vulnerable

From the Newmarket Era article

What Lynn Steele witnessed, as caregiver to a woman living in a group home on the outskirts of Newmarket, haunts her still.

“I was beyond shocked,” says Steele, a personal support worker and founder of the Canadian PSW Network, describing what she saw at The Newmarket Residence, a privately-ran, for-profit facility known as Housing with Supports (HWS).

“I was appalled by the amount of wandering, the smell. The place reeked of urine, floors were sticky and I couldn’t find staff anywhere.”

Formerly called Domiciliary Hostels, HWS have faced criticism across the province for lack of regulation and oversight.

They offer housing and meals for people who need supervision for daily living — with mental health diagnoses, physical or developmental disabilities or frail and elderly — who can’t find housing anywhere else.

Studies show over one-third of guests have a history of homelessness.

Steele says she was one of only two PSWs employed by a large agency who were willing to work with clients at the home east of Newmarket.

The other agency staff felt unsafe, she says.

“Our ‘do-not-send’ list was massive. People would go once and never go again, or just refuse because of the reputation. It was very scary to work there.”

When asking for help from residence staff, she says was met with arrogance and hostility.

Steele was assigned to Newmarket Residence for three months, caring for a client, a woman in her early 30s, placed there after surgery on her leg. A rehabilitation facility would have been more appropriate, Steele says, but there were no beds available. The client had multiple medical issues limiting her ability to be mobile and care for herself, get in and out of bed or to the commode.

“That was the very sad part. If we, as the PSWs from the agency, could not go there that day, she was left in her bed.”

Steele says she visited the client twice a day for three months. The halls and grounds were filled with wandering, sometimes emotionally volatile residents.

“She cried every single visit …. She kept saying ‘I don’t understand why they put me here.’

“I didn’t see how she’d ever get well with no nurses, no exercises, fearing for her life, not sleeping. The only time she felt safe was when police were in the room responding to an assault on her roommate.”

And police were there often, she adds. After every shift, Lynn filed reports to her agency about her concerns, but she never learned if there was follow up, nor what happened to the woman.

It’s not the first time alarm bells have gone off regarding Newmarket Residence.

Unlike long-term care and retirement homes — subject to inspections with results publicly posted online — results of complaints and inspections of HWS are not as readily available, said Jane Meadus, staff lawyer and institutional advocate with Advocacy Centre for the Elderly.

Dr. Stephen Hwang one of the world’s most renowned researchers in homelessness and part of the MAP Centre for Urban Health Solutions at St. Michael’s Hospital, agrees.

“If it were a shelter, or a long-term care home or retirement residence, there’d be someone who tracks it, but because of this kind of odd in-between category and because it’s run through the municipalities, there’s no standardization.”

Jeff Burch, NDP MPP for Niagara Centre, introduced a private members bill that would do just that.

In response to what he describes as “horrific, unlivable conditions” in some of the homes across the province, Bill 164 called for provincial regulation of supportive living homes.

It passed second reading unanimously but did not become law before government broke up for the 2022 provincial election.

Burch plans to reintroduce it again.

Despite rising OD deaths linked to smoking drugs, no supervised inhalation services exist in Ontario

From the CP24 article

Currently in Ontario, the provincially-funded Consumption and Treatment Services (CTS) program does not include supervised inhalation services.

Casey House, however, does not rely on money from the province to run its SCS and could offer supervised inhalation if it is “in compliance with other applicable federal, provincial and municipal legislation to maintain public health and public safety,” Natalie Mohamed, a spokesperson for Health Canada/Public Health Agency of Canada, told CP24.

At this time, there are no supervised consumption sites in this province that provide inhalation services.

Any organization that wants to offer supervised consumption services in this country must have an exemption under Section 56 of the Controlled Drugs and Substances Act (CDSA) to operate.

Epidemiologist Dr. Tara Gomes, the lead principal investigator of the Ontario Drug Policy Research Network, said it’s hard to quantify how many people who use drugs in Ontario choose to smoke them.

Instead, Gomes told CP24 that she and her team look to data from the Office of the Chief Coroner/Ontario Forensic Pathology Services to form a better understanding of how drugs are consumed when a person dies of an overdose.

The latest data from the Ontario Coroner’s Office found those who died from “smoking opioids” represented 30 per cent of Toronto’s 164 accidental opioid toxicity deaths between April 1, 2020 and March 31, 2021. All of these “opioid toxicity deaths” had evidence of smoking drugs and represented a 43 per cent increase in the proportion of overall overdose fatalities in Toronto compared to 2019 and a 178 per cent spike in overdose deaths with only evidence of pipe or foil present.

Gomes’s May 2021 report, Changing Circumstances Surrounding Opioid-Related Deaths in Ontario during the COVID-19 Pandemic, pointed to a “significant shift away from opioid-related deaths with evidence of injection only … towards deaths with evidence of a pipe/foil for inhalation at the scene.”

Seven months on, Toronto awaits drug decriminalization decision

From the Toronto Star article

As Toronto waits to hear whether the federal government will grant its request to decriminalize the possession of illicit drugs for personal use, harm reduction advocates say approval is urgently needed as governments fail to match the gravity of the opioid crisis.

This week marks seven months since the city sent its decriminalization request to Ottawa, the same amount of time it took for the federal government to greenlight a similar request from British Columbia.

Health Canada says the application is being examined, noting that such requests are “carefully and thoroughly reviewed on a case-by-case basis.”

But harm reduction workers say a rise in opioid deaths has underscored the need for action.

“I see no urgency. I see complacency,” said Dan Werb, director at the Toronto-based Centre on Drug Policy Evaluation, which was contracted by the city to help work on the decriminalization request.

“We’re seven years into this epidemic of overdose driven by high-potency opioids. We have all the data we need at this point. And we’re looking at a government that is delaying responding, and also responding in ways that do not actually engage with the thing that is killing people.”

Toronto – which asked Health Canada for an exemption under the Controlled Drugs and Substances Act for personal drug use in the city – has seen a spike in overdose deaths during the pandemic. More than 1,000 people in the city died from overdoses in 2020 and 2021, almost double the number of reported deaths in the two previous years.

Canada urges gay, bisexual men to reduce their sexual partners to stem monkeypox. Advocates say focus should be on funding

From the Toronto Star article

The federal government is asking gay and bisexual men to reduce their number of sexual partners to curb the spread of monkeypox. But community health workers and advocates say that spread is being fuelled by the lack of government support, financial and otherwise, for those who are at risk.

“The Public Health Agency of Canada recommends practicing safer sex (and) having fewer sexual partners, particularly anonymous partners, even when they don’t have symptoms, can also reduce your risk of getting infected,” said Dr. Theresa Tam, Canada’s chief public health officer, at a news conference Wednesday. Tam also stressed the value of vaccination in thwarting the disease.

Dr. Darrell Tan, an infectious diseases physician at St. Michael’s Hospital, told the Star that he and his colleagues who are rushing to study the virus to improve public policy and patient care are noticing many patients struggling with the financial consequences of isolation.

The illness spread mostly after prolonged close contact, through respiratory droplets — from breathing, talking, coughing or sneezing — or through skin-to-skin contact, or contact with objects that have been used by someone with the virus.

Lamb said there needs to be compensation for lost wages and funding services that support patients through isolation. Tam stating that she is encouraging provinces and territories to implement supports is not enough, he said.

“Municipally, Toronto Public Health have been very good in trying to reach out to the community and take direction when needed. But when someone gets monkeypox and they aren’t able to isolate at home, what are they going to do?” he said.

The Canadian bid to turn the tide against monkeypox

From the Toronto Star article

As cases of monkeypox continue to grow in Canada and globally, academics and advocates are urging governments to bring in paid sick days for all, as illnesses like monkeypox are unpredictable and can require extended periods of isolation.

And with rising cases, observers in Canada are welcoming a World Health Organization move to declare monkeypox a global health emergency, saying they hope it will lead governments and institutions to take the outbreak seriously and improve care.

Researchers are quickly studying the virus and its impact on Canadian patients, including concerns around stigma, to help inform patient care and public policy.

That declaration by the WHO has been overdue, says Dr. Darrell Tan, an infectious diseases physician at St. Michael’s Hospital. Tan is a co-principal investigator and operational co-lead of the monkeypox rapid research response led by the Emerging and Pandemic Infections Consortium (EPIC) at the University of Toronto.

“Monkeypox has been spreading to more and more non-endemic countries countries at a really rapid pace in the last two months,” said Tan. “The rapidity of that spread was alarming to those of us who work in this field. And we’re seeing these patients suffering.”

Monkeypox should have been deemed a global health emergency weeks ago, he said, and stigma toward gay and bisexual men, whom the virus is currently affecting in large numbers, is likely a reason for the delay.

“It was perhaps not perceived as ‘important enough’ of a threat,” and that can be read as quite problematic, stigmatizing and hurtful to our communities who have been suffering.”

Tan hopes the WHO announcement will lead more institutions to mobilize on a global scale, and spark funding for front-line community organizations that are engaging with public health and stretching shoestring budgets to care for the LGBTQ+ community.

“There’s tremendous research that needs to happen at breakneck speed,” he said.

“I hope it can enable more support for people who are living with this infection. One of the key points that myself, my colleagues have observed … is that people have difficulty adhering with public health requirements because of the financial toll.”

Dr. Sharmistha Mishra is an assistant professor at the Institutes of Health Policy Management and Evaluation at the U of T and also a co-principal investigator and operational co-lead of EPIC’s monkeypox research initiative. She said supporting individuals and households with isolation is a public health necessity with a virus such as monkeypox, and that means paid sick leave.

Mishra, Tan and colleagues are engaged in cohort studies to understand symptoms, viral shedding (when a person releases a virus’s particles through pathways like talking or eating), examining how the immune system responds to monkeypox, how the virus is transmitted, and looking at the virus’s genetic code.

Though research is at its early stages, they have learned that the virus’s incubation period can be from five to 21 days (with an average of about seven), as well as of difficulties isolating, she said.

Community leadership and working with researchers has allowed them to study the virus more quickly, know what issues to prioritize and understand that more supports need to be in place, she said.

Are thousands of uninsured people about to lose health coverage in Ontario? Fears grow about end to COVID-era OHIP rules

From the Toronto Star article

Even with her teenage brother in extreme pain, his knee swollen from a bad fall and looking like a melon, Luna Garcia’s family hesitated to take him to hospital.

Instead, they waited a day to see a doctor, acting only when the suffering became excruciating for the 15-year-old — all because the undocumented Toronto family feared hospital staff would ask for their immigration status and demand fees upfront that the family couldn’t afford.

But thanks to the Ontario government’s temporary measure to extend health care to uninsured residents during the pandemic, there was none of that. Garcia’s brother got the medical attention he needed and avoided lasting damage to his knee.

Health-care providers say that during the pandemic they saw first-hand the improvement in the care of the uninsured. They now hope the “milestone changes” will stay.

“As a front-line provider, I have seen many patients access urgent health-care services, life-saving treatments at times, that they would otherwise either have been denied or felt afraid seeking,” said Dr. Ritika Goel, a Toronto family physician.

“We have seen the benefits of these changes and we want for them to be made permanent.”

However, as many pandemic-driven health policies have been either relaxed or scrapped, advocates in Ontario fear that the province’s interim health coverage for the uninsured will be next on the chopping block.

Prior to the start of the pandemic in Canada in March 2020, advocates say about half a million children and adults in Ontario were without public health insurance at any given time. They included new immigrants, returning Canadian citizens caught up in the three-month waiting period, temporary foreign workers between contracts, international students and non-status residents.

To reduce barriers to access health care during the pandemic, the province has not only relaxed eligibility to include the uninsured, but also removed the three-month waiting period for OHIP coverage.

Goel is part of a coalition of front-line health professionals and community groups that has launched a petition to urge the province to make the existing directives a permanent program to ensure universal access to health care services for all Ontario residents. They have planned a rally at Queen’s Park next Wednesday.

“Many things during COVID have been unpredictable. What we know is that the pandemic has unearthed so many inequities, including that between people who have health insurance and those who do not. We worry that many of the social benefits that have come through in this time are being rolled back,” said Goel.

“But it’s in the interest of the government and the people of Ontario, health-care providers and the health-care system to ensure access for all people living in Ontario.” (Campaign organizers say Quebec and British Columbia also made health care more available to the uninsured during the pandemic, to lesser extents.)

Toronto pediatrician Dr. Shazeen Suleman said that before the pandemic, she would see uninsured children coming into her office only when they were “acutely unwell”; sometimes she would have to refer them to emergency.

She said that conditions such as asthma and even chronic illnesses like diabetes benefit from community physicians monitoring patients’ conditions so they don’t have to show up in hospital only when they are in crisis.

“We’re still in COVID and to turn back the clock at this point is going to have disastrous outcomes. We hear every day about how our system is at its breaking point and to then add another extra burden of having individuals come in at death’s door will be disastrous,” said Suleman.

The interim policy has also simplified the administrative work for health-care providers and alleviated their stress and burnout, Suleman noted, saying that in the past “I might have been one who was trying to rack my brains (about) how to get care for someone who didn’t have insurance. Now it’s opened up.”

Ontario construction workers accounted for 1 in 13 opioid deaths in recent years, report finds

From The Globe and Mail article

Construction workers have been disproportionately affected by the worsening opioid crisis, accounting for about one in 13 opioid-related deaths in Ontario between 2017 and 2020, according to a new report published Thursday.

The report, led by researchers from the Ontario Drug Policy Research Network (ODPRN), found 428 Ontarians who were working or previously employed in the construction industry died of opioid toxicity during the 30-month period they investigated. That amounted to 7.9 per cent of the total 5,386 opioid-related deaths within that time span, even though those working in the construction industry represent 3.6 per cent of the province’s overall population.

Nearly 80 per cent of these deaths occurred at the individual’s home, the researchers found. Very few occurred on a construction site or at a hotel or motel used for work purposes.

“That was really the first thing that stood out to us is that these are overdoses happening in people’s homes and they’re happening when there aren’t people around to intervene,” said lead author Dr. Tara Gomes, who is a principal investigator of the ODPRN, a provincial network of researchers.