Author: Samira Prasad

From Sudbury.com

The risk of opioid addiction has prompted some Ontario doctors to study how prescribing Oxycodone for pain after childbirth has resulted in some new mothers continuing to use the drugs for weeks and months afterward.  

Details were published this week in the current edition of the Canadian Medical Association Journal (CMAJ).  

The study was authored by Jonathan S. Zipursky, Karl Everett, Tara Gomes, J. Michael Paterson, Ping Li, Peter C. Austin, Muhammad Mamdani, Joel G. Ray and David N. Juurlink, a group of doctors and researchers connected with Sunnybrook Health Sciences Centre, the Institute of Health Policy, Management, and Evaluation at the University of Toronto, ICES (Institute for Clinical Evaluative Sciences), the Faculty of Pharmacy at U of T, and the Li Ka Shing Knowledge Institute at St. Michael’s Hospital.

The study said Oxycodone was increasingly being prescribed for postpartum analgesia (pain relief) in lieu of codeine owing to concerns regarding the neonatal safety of codeine during breastfeeding.

The authors wrote that among postpartum mothers “we found that an initial prescription for Oxycodone was not associated with a higher risk of persistent opioid use relative to codeine overall, although a disproportionately high risk of persistent use after initiation of oxycodone was seen after vaginal delivery.”

The study was carried out over an eight-year period in Ontario involving more than 70,000 patients between the ages of 12 and 60 who gave birth and filled a prescription for medications containing either codeine (30 per cent) or Oxycodone (70 per cent).

“We chose codeine as the comparator because it has historically been perceived as a ‘weak opioid’ and, until recently, was the preferred opioid prescribed postpartum,” the study authors write. “Owing in large part to concerns about neonatal safety with breastfeeding, codeine has been supplanted over the past decade by more potent opioids (including oxycodone). In the last decade, in Ontario, Oxycodone has become the most commonly prescribed opioid postpartum.”

The study further stated that a key outcome was an increased use of prescription opioids.

From Global News

Opioid deaths among those aged 15 to 24 surged during the first year of the pandemic, according to research led by the Ontario Drug Policy Research Network at Unity Health Toronto. That figure came partly through contaminated drugs used recreationally, according to Dr. Tara Gomes, a scientist at Unity Health Toronto who leads the research group.

“We might be seeing increasing harms because teens and young adults are more likely to be using drugs occasionally,” she explained.

“Our drug supply is incredibly unpredictable and potent, and so if you’re only using drugs once in a while, then when you use them, if you are exposed to a very high dose or a drug that has multiple different substances in it, then you can be at really high risk of an overdose.”

At the beginning of July, police said five people had taken an unknown drug that was likely an opioid near Toronto’s waterfront; one died. In April, police said four people suffered overdoses in the downtown after taking a drug believed to contain fentanyl. Many other similar warnings have been issued across the province.

From The Globe and Mail

For years, large numbers of Quebeckers didn’t have timely access to doctors, creating a pool of potential clients, matched by a pool of unhappy doctors itching to leave the public system. Meanwhile, a significant court case led to the normalization of a competing system outside of medicare.

Quebec has some of the worst indicators for access to primary care. According to Statistics Canada, in 2021, one in five Quebeckers (21.6 per cent) didn’t have a regular health care provider, compared with 10.3 per cent in Ontario and 14.5 per cent nationally.

Those numbers mirror a poll of 9,000 Canadians conducted last fall for OurCare, a countrywide initiative looking at the future of primary care. The survey found that 31 per cent of Quebec respondents didn’t have a family doctor or nurse practitioner they could see regularly, compared with 22 per cent nationally.

Of those without a regular primary-care provider, 37 per cent in Quebec said they have had to pay a fee for non-urgent care, compared with 21 per cent across Canada.

OurCare’s lead investigator, Tara Kiran, said the poll doesn’t differentiate whether respondents paid a doctor or other professionals, such as nurses or pharmacists.

“People who didn’t have access … are turning to all sorts of places to try and get care that’s not urgent but worrisome. And in many cases, they have to pay out of pocket,” said Dr. Kiran, a family physician and scientist at St. Michael’s Hospital and the University of Toronto.

The migration of GPs out of RAMQ is “a crisis for us right now,” said Nebojsa Kovacina, a researcher for OurCare in Quebec.

From CBC News

Three and a half years after the virus behind COVID-19 began its rampage around the world — eventually killing tens of thousands of Canadians — a group of top medical experts is calling on federal officials to launch a full national inquiry into Canada’s pandemic response.

In a sweeping set of editorials and analysis papers published on Monday in the British Medical Journal (BMJ), more than a dozen physicians and health advocates are shining a spotlight on what they’ve dubbed the country’s “major pandemic failures,” from the devastation in long-term care homes, to vaccine hoarding, to higher death rates among lower-income communities. 

Those shortcomings all played out against the backdrop of the country’s complex, fragmented health-care system. That decentralized approach, the authors argue, led to dramatic differences in how each province handled the spread of SARS-CoV-2, the virus first reported in Canada in Jan. 2020.

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“We weren’t closing the gaps, and by then, really we should have,” said Dr. Sharmistha Mishra, an infectious disease epidemiologist at the University of Toronto and Unity Health.

Governments still need to push for workplace improvements to address those systemic issues, she argued, including adequate sick days, strategies to reach communities with lower incomes and higher population densities, and ensuring vaccine equity. 

Op-ed in The Globe and Mail by Sharmistha Mishra, Tania Bubela, and Sharon Strauss

Scientific reviews detail “what” happened and “why”. What worked and what didn’t; how can we repeat successes and avoid, or at least mitigate, failures?

In reviewing the ‘what’ and the ‘why’ of the COVID-19 pandemic response, researchers use rigorous methods to tease apart the policies and intervention strategies that worked, how they worked, and for whom. The approach is analogous to understanding a medication. What’s the right dose and formulation? What populations does it work in? What are the potential side effects? When should it be replaced by a new, better medication?

We need to ask the same questions about how the epidemic was managed and how we did or did not use evidence in making decisions. What type of evidence informed decisions about policies, programs, and the allocation of resources? Why did it take so long to do research to collect evidence on health inequities and the social determinants of health? We know that the burden of the pandemic was not equally felt across communities. Why, then, was that evidence not used to provide science advice and inform policies, and services?

We argue that part of the problem was the types of research and insights that were privileged over others, and the voices that were excluded from advisory or decision-making tables. Saying that equity was at the core of an advisory group, report, or recommendations did not make it so. In reality, the tables and the evidence considered mirrored existing structural inequities in science, scholarship and decision-making. Questioning why means looking deeper than a word search for “equity” or “diversity”.

From CTV News

A panel of experts made further calls for an independent inquiry into Canada’s COVID-19 response on Tuesday, stressing that the country’s pandemic response must be reviewed before it’s tested once again.

The experts, who penned a series of articles on Canada’s pandemic response that were recently published by the BMJ medical journal, shared their findings at a webinar on Tuesday.

Dr. Sharmistha Mishra, one of the authors, and an infectious disease epidemiologist and physician at University of Toronto and Unity Health Toronto, started her presentation with a number. “52,750,” she said in the webinar, referring to the reported deaths in Canada directly related to COVID-19 as of June 2023.

Dr. Mishra said an independent, public inquiry into the country’s COVID-19 response would summarize what happened over the past three years and allow the country to better prepare for the future.

“An independent, public inquiry could systematically — and with scientific humility — get at why. And getting at the why in a nuanced way has to come with transformative action, implementation, and would also come with evaluations of the changes that are being made and that have been made,” Mishra said.

“We are going to be tested again.”

Published Monday, the experts’ seven-article series was a collaboration from 13 organizations across the country, including physicians, nurses, researchers, legal experts, and humanitarian specialists, aiming to understand the medical and societal complexities of pandemic responses on a national scale.

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From the Toronto Star

Canadian researchers are calling for an independent national inquiry into the country’s COVID-19 strategy, stating that major pandemic failures hampered Canada’s emergency response, including its ability to protect the most vulnerable.

In a series of papers published Monday in the BMJ (British Medical Journal), researchers point to data that shows Canada did not fare well in some aspects of its pandemic response, highlighting how COVID ravaged the country’s long-term-care homes — leading to a disproportionate number of deaths.

And, they warn, Canada’s relative successes, such as its high vaccination rates, obscure persistent geographical, social and economic COVID inequities across the country.

As of June, Canada’s cumulative COVID death rate of 1,372 per million exceeded the global average of 855 per million and was higher than Australia’s rate of 814 deaths per million people, according to figures released Monday.

And while Canada has one of the lowest death rates among G10 nations, lower-income Ontarians have died of COVID at much higher rates than those with higher incomes — even after the rollout of vaccines, antiviral medications and COVID treatments.

New data published in the BMJ series shows that rates of COVID hospitalizations and deaths in Ontario remained threefold higher in the lowest-income neighbourhoods, compared to the highest-income areas across seven pandemic waves.

“We are calling for an inquiry that will hold our governments and our public health systems accountable,” said Dr. Sharmistha Mishra, one of the co-authors of the series and an infectious disease physician and mathematical modeler at St. Michael’s Hospital, a part of Unity Health Toronto.

« Il est impossible de déplorer 50 000 morts sans s’interroger sur les raisons de ces décès » : Des chercheurs demandent au Canada d’organiser une enquête nationale sur la COVID-19

Tiré du Toronto Star

Des chercheurs canadiens réclament une enquête nationale indépendante sur la stratégie COVID-19 du pays, affirmant que les échecs majeurs dans la lutte contre la pandémie ont entravé les mesures d’urgence du Canada, y compris sa capacité à protéger les personnes les plus vulnérables.

Dans une série d’articles publiés lundi dans le BMJ (British Medical Journal), des chercheurs soulignent les données qui montrent que le Canada n’a pas été à la hauteur dans certains aspects de sa réaction à la pandémie, soulignant la façon dont la COVID-19 a fait des ravages dans les maisons de soins de longue durée du pays, entraînant un nombre démesuré de décès.

Selon eux, les résultats relativement bons du Canada, notamment en ce qui concerne ses taux élevés de vaccination, masquent des inégalités géographiques, sociales et économiques persistantes dans à l’échelle du pays.

From the BC Centre for Disease Control newsroom

A new clinical trial is set to test whether taking the antibiotic doxycycline daily or after a sexual encounter can help prevent the bacterial sexually transmitted infections (STIs) syphilis, gonorrhea and chlamydia. 

The study is co-led by Dr. Troy Grennan, medical lead for STI/HIV Services with the B.C. Centre for Disease Control (BCCDC), and involves multiple sites across the country. Recruitment has started in Vancouver, with other Canadian sites to follow, and the goal is to recruit 560 people who are likely to be exposed to STIs. 

Study participants will be randomly assigned to one of two groups, to assess whether taking the antibiotic doxycycline reduces the chances of getting an STI after having sex with someone with an infection. The first group will take doxycycline daily as a pre-exposure prophylaxis or PrEP. The second will take doxycycline only after a sexual encounter as a post-exposure prophylaxis or PEP. This is the first study globally to compare these two STI prevention approaches.

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“Rates of bacterial STIs have been increasing for well over a decade. We need new tools that are effective, safe, and acceptable to the people who use them, to help reduce the risk of infection and improve sexual health,” said Dr. Ann Burchell, a co-principal investigator based at St. Michael’s Hospital, a Unity Health site in Toronto. 

“The DISCO trial will provide important new evidence on whether the PrEP and PEP approach, so effective for HIV, can also work for other STIs.”

From Bloomberg News

Zunera Hashmi, a Toronto resident, has been anxiously waiting in line for three years to be assigned a family doctor. When she gets stressed, the 28-year-old marketing professional calls the provincial help line but hears the same message: “Wait just a bit longer.” She emails them occasionally but gets no reply.

Over 2.2 million like Hashmi don’t have a regular family physician in the province of Ontario, according to data from health-care researcher Inspire Primary Health Care, up from 1.8 million two years ago. The shortages are dire in Toronto, Canada’s most populous city and its financial capital. One in five Ontarians, most of them Toronto dwellers, could be without a family doctor in the next three years, according to the Ontario College of Family Physicians (OCFP), which represents 15,000 family doctors in the region.

“We have a full-blown health-care crisis on our hands,” said Dr. Mekalai Kumanan, president of the OCFP, which is raising an alarm. Canada’s population saw record growth in 2022, spurred in large part by an immigration-friendly policy. Older physicians are retiring but fewer medical students are choosing family medicine. And Toronto’s aging population faces ever-more medical issues.

“It’s a perfect storm,” Kumanan said.

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In 2021, a survey by the hospital network Unity Health Toronto found that one in five Toronto family physicians are considering closing their practice in the next five years.

“The pandemic caused health-care professionals around the world to rethink work,” said Dr. Tara Kiran, the Fidani Chair of Improvement and Innovation at the University of Toronto. “It’s particularly challenging for those in family medicine where doctors aren’t as respected as specialists.”