From the Toronto Star article

Toronto’s supervised drug consumption sites are seeing a record number of overdoses, while the city’s paramedics responded to more fatal overdoses in 2021 than any other recorded year — all signs that experts say point to a worsening opioid crisis both in Ontario and elsewhere.

The toll comes as front-line staff struggle with burnout and grief while navigating the unpredictability of COVID-19 and the latest Omicron wave. And a lack of swift action on the part of policy-makers to reduce opioid-related harms, some critics say, has exacerbated an already dire situation.

“The drug poisoning crisis is not getting better,” said Shaun Hopkins, manager of The Works, a supervised consumption site run by the city of Toronto. “We’re continuing to see records being set in terms of paramedic calls, deaths, overdose numbers.”

The Works saw a record 165 overdoses in December, accounting for 8.8 per cent of all visits to the site that month. It is a marked increase from December 2019, where the rate of overdoses hovered around 1.4 per cent. In January 2022, the rate of overdoses remained high at 5.6 per cent.

Paramedics in Toronto also saw a record number of opioid deaths in 2021, responding to a total of 357 fatal suspected overdose calls. In 2020, paramedics responded to 268 fatal calls. Because paramedics aren’t involved in every opioid fatality, the numbers for opioid-related deaths in 2021 may be higher, said Gillian Kolla, a post-doctoral fellow at St. Michael’s Hospital with expertise in drug policy.

Due to a data lag in Ontario, preliminary numbers of opioid-related fatalities for 2021 are only available up until June, but they hover at 1,415 deaths. In all of 2020, the province saw 2,431 deaths. British Columbia, which released its 2021 data on Monday, saw its deadliest year yet for opioid-related deaths, with 2,224 fatalities.

Op-ed by Dr. Tara Kiran published on Healthy Debate

Every day, thousands of Canadians are infected with COVID. But this isn’t March 2020. As a result of high rates of vaccination and the particulars of Omicron, the overwhelming majority of those getting COVID currently will not need hospital care. What Canadians do need to be able to ride out this wave is information, support at home and timely access to primary care.

And what primary care teams need is reliable resources to help guide us through the ever-changing thicket of research, public health guidance and tools for prevention and treatment. We need to support most people to manage on their own while also identifying and helping people who need timely interventions to keep them from becoming seriously sick.

On the ground and at the front line, it seems that information – our most valuable asset in the Omicron wave – isn’t getting through clearly.

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February 1, 2022 – As children in provinces across Canada settle back into in-person school, new research highlights how important it is to focus on helping kids recover healthy habits – particularly related to diet, physical activity, mental health and screen time.

“Our kids have now spent many months total in lockdown,” said Dr. Katerina Maximova, scientist at MAP Centre for Urban Health Solutions, St. Michael’s Hospital. “Now that many are back in school, the negative effects won’t just disappear. There’s a lot to recover from.”

Maximova gathered in-depth information on students’ lived experiences of COVID-19-related lockdowns, and how they affected kids’ mental health and lifestyle behaviours. Her research found that school closures prompted deteriorating lifestyle behaviours, mental health, and well-being of children. Disruptions led to feelings of boredom and lack of purpose, and limited opportunities for social interaction led to loneliness and an increase in screen time. Unchecked, these changes could mean an increased risk of chronic disease and mental illness in adulthood.

Concerningly, the negative effects were more pronounced for kids in socioeconomically disadvantaged settings.

“Pre-COVID, kids with lower socioeconomic status were already at higher long-term risk of chronic disease, including mental illness,” said Maximova. “However these findings indicate that this generation could be facing an extraordinary burden.”

The study is among the first COVID-19 research based on young kids’ first-hand reports and experience (other research is based mainly on parent views).

The findings underscore the crucial need for investments into evidence-based programs to promote health and wellness for all kids, particularly in schools in disadvantaged neighbourhoods. The APPLE Schools initiative, designed by Maximova and colleagues at the University of Alberta, is one such school-based innovation that has helped thousands of kids improve some of the health behaviours explored in this study. It impacts the lives of 21,000 students annually in 74 schools across British Columbia, northern Alberta, Northwest Territories, and Manitoba, with plans to expand to Ontario.

Read the research:

• Perceived changes in lifestyle behaviours and in mental health and wellbeing of elementary school children during the first COVID-19 lockdown in Canada (view the complimentary infographic)
• Related: “It’s very stressful for children”: Elementary school-aged children’s psychological wellbeing during COVID-19 in Canada

Aider les enfants à se rétablir après les confinements : l’importance de saines habitudes

Le 1^er février 2022 – Alors que les enfants des provinces canadiennes reprennent le chemin de l’école, une nouvelle étude souligne l’importance de les aider à retrouver de saines habitudes, notamment en ce qui concerne l’alimentation, l’activité physique, la santé mentale et le temps passé devant les écrans.

« Nos enfants ont passé de nombreux mois en confinement total », a déclaré la Dre Katerina Maximova, scientifique au MAP. « Même si de nombreux élèves sont de retour à l’école, les effets négatifs ne vont pas disparaître. Il leur faudra du temps pour s’en remettre. »

La Dre Maximova a recueilli des informations approfondies sur les expériences vécues par les élèves lors des confinements liés à la COVID-19, et sur la manière dont ils ont nui à la santé mentale et aux habitudes de vie des jeunes. Ses recherches ont révélé que les fermetures d’écoles ont entraîné une détérioration des habitudes de vie, de la santé mentale et du bien-être des enfants. Les perturbations ont suscité des sentiments d’ennui et de vide; les possibilités limitées d’interaction sociale ont conduit à la solitude et à une augmentation du temps passé devant les écrans. Si on les ignore, ces changements pourraient entraîner un risque accru de maladies chroniques et de troubles mentaux à l’âge adulte.

Il est inquiétant de constater que les effets négatifs étaient plus prononcés chez les enfants issus de milieux socio-économiques défavorisés.

« Avant l’arrivée de la COVID-19, les enfants ayant un statut socio-économique faible présentaient déjà un risque plus élevé de maladies chroniques à long terme, y compris de maladies mentales », a déclaré madame Maximova. « Ces résultats suggèrent que cette génération pourrait être confrontée à un très lourd fardeau. »

L’étude est l’une des premières recherches en temps de COVID-19 basées sur les témoignages et l’expérience des jeunes enfants (les autres recherches sont principalement basées sur les points de vue des parents).

Ses conclusions soulignent le besoin crucial d’investir dans des programmes fondés sur des données probantes pour promouvoir la santé et le bien-être de tous les enfants, en particulier dans les écoles des quartiers défavorisés. L’initiative APPLE Schools, conçue par la Dre Maximova et ses collègues de l’Université de l’Alberta, est un exemple de ce type d’innovation scolaire qui a aidé des milliers d’enfants à améliorer certains des comportements de santé examinés dans cette étude. L’initiative a une incidence sur la vie de 21 000 élèves chaque année dans 74 écoles de la Colombie-Britannique, du nord de l’Alberta, des Territoires du Nord-Ouest et du Manitoba, et bientôt de l’Ontario.

Lisez l’étude scientifique (en anglais) :

• Perceived changes in lifestyle behaviours and in mental health and wellbeing of elementary school children during the first COVID-19 lockdown in Canada (regardez l’illustration informative)
• Document associé : « It’s very stressful for children » : Elementary school-aged children’s psychological wellbeing during COVID-19 in Canada

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.”

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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.

Lire cet article en français

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.

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.

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.

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.

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.