From the CTV News piece:

Canada’s street supply of opioids is becoming increasingly toxic, unpredictable and contaminated thanks to ultra-potent and deadly mixtures of fentanyl, prompting renewed calls for safe supply programs that could help regain control of the drug supply and save lives.

It’s believed pandemic border closures have played a role in disrupting the supply chain, prompting the creation of new, more lethal cocktails.

“We’re absolutely losing control of the drug supply, and it’s causing people to die,” Karen McDonald, lead of the Toronto drug-checking service operated by St. Michael’s Hospital, told CTV National News.

“Fentanyl can be used safely … but it can’t be used safely when you have no idea how much fentanyl is in it.”

Launched in 2019 in response to the growing opioid epidemic, Toronto’s anonymous drug-checking service offers drug users detailed information on the contents of their drugs in a bid to reduce overdoses.

From the CBC Radio piece:

…A solution might come from Dr. Dan Werb, an epidemiologist and executive director of the Centre on Drug Policy Evaluation in Toronto.

Over the last four years, he has been developing a cheaper, portable drug-testing device alongside Dr. Drew Hall, a colleague from the University of San Diego where Werb is an assistant professor.

“We’re academics, we’re scientists,” Werb told Day 6 host Brent Bambury, “I’m [not] a technologist, so I think we’re coming at this from a different angle.”

The device, called DoseCheck, is about the size of a smartphone, Bluetooth-enabled and made up of a circuit board, sensor and battery.

When voltage runs through the sensor, different drugs create peaks at different voltages. Each peak’s height signals the concentration of that drug within the sample. Sensors can be changed to detect new contaminants as they’re discovered in the drug supply.

That data is then sent to a smartphone app which performs the analysis and gives the user a breakdown of the drug.

In 2019, the device was announced as a finalist in Health Canada’s Drug Checking Technology Challenge, launched a year earlier to encourage innovations in harm reduction.

Werb said that drug-checking technologies aren’t widely available, and the machines that are remain pricy because of a lack of interest from companies.

“It’s a non-viable business model for major technology companies,” he said. “People who are structurally vulnerable and using drugs, and frontline harm-reduction workers, that’s not a huge market.”

Werb expects DoseCheck will retail between $300 and $350, a price he hopes will be friendlier to centres like VANDU who don’t receive federal funding for drug checking. It is expected to hit the market within the next year to 18 months.

He also hopes DoseCheck will extend access to drug testing into Canada’s more remote areas.

From the Toronto Star piece:

…Parvin Merchant, a director of support services for Houselink and Mainstay, also became concerned about the seemingly premature deaths of residents and added up the names.

The results prompted her to reach out recently to a contact at St. Michael’s Hospital. She wanted someone to explore the circumstances of the formerly homeless who are dying unexpectedly in supportive housing across the city.

Are there strategies that can be used to reduce the death toll, she wondered.

Dr. Stephen Hwang, a research scientist, and James Lachaud, a research fellow and whose expertise includes urban housing and vulnerable populations, liked Merchant’s idea.

In fact the two were so impressed they’ve decided to apply for a $75,000 federal research grant to study premature aging and premature mortality among people living in supportive housing across the city.

…Lachaud submitted the grant application and Hwang is a co-applicant. They are still awaiting word on whether they’ll win the grant.

Lachaud says he believes the number of deaths from people who are alone is troubling.

Once housing is found for homeless people, social isolation and loneliness can become a major concern and an important risk factor for common mental health disorders, such as depression, anxiety, substance use and suicidal thoughts, Lachaud says.

“Inadequately treated physical and mental health conditions can lead to premature and avoidable deaths. Unfortunately, formerly homeless, single older adults living in supportive housing have been dying alone (in their homes) for years, and this phenomenon has been largely ignored,” Lachaud went on to say.

The experts from St. Michael’s Hospital, Merchant, Mainstay and Houselink and other non-profits who support the homeless, mentally ill and substance users will be taking part in the study if it goes forward, including sharing data.

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THE TORONTO STAR

By Dr. Tara Kiran with contributor Dr. Danielle Martin

Imagine moving to a new city and automatically joining a local health-care team, just like children join their neighbourhood school. What if every Canadian had access to a social worker or pharmacist through a family practice team and could easily reach them via phone, video call or email?

The health of Canadians depends on easy and equitable access to high-quality primary care that is integrated with other parts of the health-care system. The need has never been more urgent.

During the pandemic, most doctor’s offices were open, but many Pap tests, diabetes visits and routine immunizations were delayed as patients understandably waited for lower case counts and vaccines. We now face a backlog of missed chronic disease and preventive care.

Additionally, more Canadians are facing mental health and addiction challenges that need primary care attention.

Reconstruire en mieux : Tous les Canadiens devraient avoir un médecin de famille

Par la D^re Tara Kiran, avec la collaboration de la D^re Danielle Martin

Imaginez déménager dans une nouvelle ville et intégrer automatiquement une équipe de soins de santé locale, tout comme les enfants intègrent l’école de leur quartier. Et si chaque Canadien avait accès à un travailleur social ou à un pharmacien par l’intermédiaire d’une équipe de médecine familiale et pouvait facilement les joindre par téléphone, appel vidéo ou courriel?

La santé de la population canadienne repose sur un accès facile et équitable à des soins primaires de haute qualité, intégrés aux autres volets du système de soins de santé. Le besoin n’a jamais été aussi pressant.

Durant la pandémie, la plupart des cliniques médicales sont demeurées ouvertes, mais de nombreux tests de routine comme le dépistage du cancer du col de l’utérus, les suivis pour la gestion du diabète et pour la vaccination ont été retardés, parce que les patients attendaient, à juste titre, que le nombre de cas diminue et que les vaccins soient administrés. Nous faisons maintenant face à un retard considérable dans le traitement des maladies chroniques et des soins préventifs. En outre, de plus en plus de Canadiens sont aux prises avec des problèmes de santé mentale et de toxicomanie qui nécessitent le recours aux soins primaires.

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TVO.org speaks with MAP Director Dr. Stephen Hwang about hidden homelessness, encampments, our Beyond Housing network — and making sure people get the supports they need.

From the TVO.org piece:

Hwang: “We’ve made progress. Things have changed dramatically over the course of the pandemic. And we’re now at a tipping point, because we’re in a new situation that can’t just be sustained as the new status quo. We’re going to either go forward and solve some of these problems permanently or we’re going to just go back to the way things were, and it’ll be even worse than it was before. I think it’s really impossible to imagine that we will go back. Before, we could imagine that homelessness would just kind of grumble along the same way it always had, and nothing would change, except around the edges. Now I think that things have changed, and the system has been destabilized in a way that means we will either make substantial progress toward addressing the problem or things will get even worse. That’s my take on it.”

Comment s’attaquer au problème de l’itinérance en Ontario : Entrevue avec le docteur Stephen Hwang

TVO.org s’entretient avec le directeur du MAP, le docteur Stephen Hwang, au sujet de l’itinérance cachée, des campements, de notre réseau Beyond Housing – et de la nécessité de veiller à ce que les gens obtiennent le soutien dont ils ont besoin.

Tiré de l’article de TVO.org :

Hwang : « Nous avons réalisé des progrès. La situation a radicalement changé au cours de la pandémie. Nous nous trouvons maintenant à un point de non-retour, car nous vivons une nouvelle réalité qui ne peut pas être considérée comme le nouveau statu quo. Soit nous allons de l’avant et nous résolvons certains de ces problèmes de façon permanente, soit nous revenons à la situation antérieure, ce qui serait encore pire. Je crois qu’il est tout à fait impensable de retourner en arrière. Auparavant, nous pouvions imaginer que le phénomène de l’itinérance continuerait d’exister comme naguère et que rien ne changerait, du moins en apparence. Maintenant, je pense que la situation a évolué et que le système a été déstabilisé d’une manière telle que soit nous ferons des progrès substantiels pour résoudre le problème, soit la situation continuera de se détériorer. C’est ainsi que je vois les choses. »

THE GLOBE AND MAIL

Zoe Dodd had just given an emotional presentation to Toronto’s Board of Health when she realized that something wasn’t right. It was mid-November, the COVID-19 pandemic had exacerbated Canada’s runaway toxic drug crisis, and the long-time harm-reduction worker was in tears as she spoke about front-line workers responding to thousands of overdoses and finding bodies in portable toilets and doorways.

“The ripple of death is grim, and it will take decades for people impacted by this loss to heal,” Ms. Dodd told the board. “We are abandoned by all levels of government, who point fingers at one another, and we are burning out.”

A couple of days later, she awoke feeling foggy-headed and disassociated from reality. Her heart raced and the room seemed to vibrate. She felt like she was in another dimension.

From the Global News article:

Dan Werb, executive director of the Centre on Drug Policy Evaluation and scientist at St. Michael’s Hospital in Toronto, said the unregulated drug supply in the illegal market has been getting increasingly more potent and toxic for decades, but the pandemic has made things even worse.

“There were border restrictions and restrictions on movements that affected international drug trafficking and national drug trafficking across Canada,” Werb told Global News. “Every industry has been affected by COVID, and illegal drugs are no different.”

He said deadly amounts of fentanyl, carfentanyl, and even etodesnitazene — a high-potency synthetic opioid — are being found on the streets.“These drugs that are showing up in the drug market are new, but the trends that have led us to seem increasingly potent and toxic chemicals show up in these drug markets [are] not new. This is old. It’s the result of trying to criminalize our way out of the overdose epidemic. And it’s just simply not working.”

CBC NEWS

Several forms of extremely potent synthetic opioids are being found in random samples of Toronto’s street drug supply, which experts say is indicative of increased risk for people in a city grappling with an overdose crisis.

“What’s very dangerous for people who use drugs is just that the supply is getting stronger, and it’s also just completely unpredictable — and what people are buying isn’t necessarily what they’re getting,” said Karen McDonald, the lead for Toronto’s drug checking service, which operates out of St. Michael’s hospital.

“It’s definitely alarming to us.”

From the Toronto Star article:

…The opioids were identified by the Centre on Drug Policy Evaluation (CDPE), a Toronto-based research agency that collects and tests small samples of street drugs collected from users and dealers. The ultra-potent opioids were primarily found in samples that were thought to be straight fentanyl.

An analysis of newly obtained data on opioid overdoses across the country — including numbers from provincial coroners, street drug tests in Ontario and B.C., and a previously unpublished national drug user survey — reveals a national crisis spiking into uncharted territory during the pandemic.

Toronto saw an 81 per cent jump in opioid-related deaths between 2019 and late 2020.

Border closures and drug supply chain disruptions are blamed by researchers for creating a cocktail of new drugs and compounds.

“Any time you disrupt drug trafficking routes, unexpected things will happen,” said Daniel Werb, the executive director of the CDPE and a research scientist at St. Michael’s Hospital. “That’s why you see increasingly potent opioids on the market because the higher the potency, the more efficient the package is, the easier it is to traffic.”