Mac enjoys his cake at his retirement party at the University of the Fraser Valley last week. University of the Fraser Valley
After 13 years, Mac the golden retriever will no longer wear the blue-and-yellow vest that identified him as a working dog.
The canine counsellor — the Pacific Assistance Dog Society’s (PADS) longest-serving member — retired last week after a career that saw him become the first registered therapy dog in the world to work with a counsellor in a non-residential setting.
He was also the first to work full time in a hospice and the first to work as a therapy dog with students at the University of the Fraser Valley.
“He’s a trailblazer — or maybe we should say a tail-blazer,” said his owner Dawn Holt, a clinical counsellor who works in UFV’s counselling department. “I think some of those firsts are due to him doing it for so long.”
In addition to supporting students, Mac has helped dozens of people across B.C. through traumatic events, including some of the province’s biggest disasters. He received an “Above and Beyond” award for selflessness in service after the 2017 wildfires. He’s also supported police, consoling officers during funerals, and calmed victims in crisis.
Mac has always had a “calm, mellow, gentle, sweet nature,” said Holt. From his puppy days, he’s been able to detect stress and sadness. “In a room full of people, he’ll go to the person who needs him the most.”
PADS trainers noticed this trait when Mac was young and began to train him as a therapy dog. A volunteer with PADS at the time, Holt began her career as a clinical counsellor at the same time Mac did. The two have always been partners, working in hospice, at UFV and in private practice.
But while Mac is officially retired, he won’t disappear from campus or from his patients’ lives. He can still be seen at the university, albeit without his recognizable vest. Instead, he now wears a UFV T-shirt.
“He doesn’t have that mantle of responsibility anymore,” said Holt.
Students have been surprised to discover that without his vest, Mac is a little more goofy. He’s now allowed to roll around on the campus lawns and sniff bushes.
“I guess he’s been wanting to sniff those bushes for the last 13 years,” quipped Holt. “He knows the difference between the vest, which he wore when he was working, and the T-shirt. He knows the T-shirt is somewhere between full-on work and relaxing at home.”
Holt explained a therapy dog works in two ways. First, they create a physiological response in patients, offering unconditional friendship, which can slow breathing, calm the body and reduce stress hormones. They also work to “build a bridge” between counsellor and patient, calming fears and building trust so the counsellor can do her work.
Mac doesn’t take his work home with him. A good therapy dog can “shake off” a heavy session, literally shaking his coat like he’s just gotten out of a lake.
“I’m so proud of him and the work he’s done,” said Holt.
Ending Canada’s opioid overdose crisis will likely require much more than sophisticated drug therapies. In fact, it might mean following the lead of First Nations health-care providers and transforming how we think about and deliver medical services.
First Nations people are dying of opioid overdoses at three times the rate of the general population. Hidden in that data are Canada’s most-neglected victims — Indigenous women.
Unlike in the general population where men comprise 80 per cent of the victims, Indigenous women are as likely to overdose or die as their brothers, fathers, husbands and sons.
They are eight times more likely to overdose than other women, and five times more likely to die from an overdose.
It’s not really surprising, says Dr. Evan Adams, the First Nations Health Authority’s chief medical health officer. The terrible numbers track other devastating indicators of how their health and longevity diverge from those of other Canadians.
“A lot of First Nations women who have substance-use disorders are exploited women. They are women who are victimized by the sex trade. They’re victimized by their partners,” said Adams, who worked for five years in Vancouver’s notorious Downtown Eastside, the epicentre of Canada’s opioid crisis.
What the opioid crisis highlights for him is the endemic problem of the western medical model, where people go passively to doctors’ offices and say, “Heal me.”
“Our (First Nations) model is that the doctor gives you a chance to get better. But, you make yourself better,” he said. “It’s your family that does most of the work of helping you get better, not that doctor who you visit for 15 minutes every week, if you’re lucky.”
Unlike in the western model, healing and wellness in the traditional Indigenous way involve mind, body and spirit. For First Nations men and women to achieve wellness, Adams said they require much more than medicine.
“They need healers who can do ceremony. Maybe they need love. They need justice.
“How can a woman recover from opioid use disorder when you won’t let her see her children? It’s disgusting,” he said.
The day Adams and I met, the FNHA offices were being “swept” by a group of elders carrying cedar boughs and candles using traditional ceremonies to restore the spirits of the people who work there.
“Some people would say an elder is less trained in opioids than an addictions physician,” Adams said. “But wouldn’t it be nice to have both?”
It’s not that FNHA rejects modern medicine. It continues to expand access to opioid agonist treatments such as methadone and Suboxone, which quell cravings, making it available at all FNHA nursing stations and at four of the nine FNHA-funded residential treatment centres. FNHA reimburses treatment fees charged by private clinics and has spent $2.4 million in grants to 55 communities for harm-reduction programs.
Yet, for Adams and his staff, drug therapies are only a small part of what he calls harm reduction’s suite of services.
“Harm reduction is not just, ‘Let’s make sure you don’t overdose.’ It’s the whole person that you have to treat, not just this one aspect of the person that is craving opioids.”
To incorporate First Nations wisdom into other programs, FNHA created two peer coordinator jobs at the Crosstown Clinic in the Downtown Eastside. Its compassion inclusion initiative has engaged another 144 Indigenous people with lived experience across B.C., and its Indigenous wellness team has taught indigenous harm-reduction and wellness programs in 180 communities.
“Opioid use disorder is everyone’s business. It’s yours and it’s mine and it’s everyone around us. It’s not just the domain of physicians with 24 years of training,” he said. “Why can’t Grandma help, or a family member?”
What concerns Adams about the response to the opioid crisis that is heavily grounded in the medical model is that it could widen the gap between his people and mainstream Canadians.
Indigenous people don’t necessarily trust health providers who don’t look like them or where there is no acknowledgment of the historical trauma they have suffered and their unique experiences in the world.
That’s just one more reason why the FHNA, which is unique in Canada, is so adamant that it must transform the way health care is delivered to its people so that they are empowered to help in their own healing within their own circles of trusted friends, family and elders.
This current crisis is rooted in the western medical model. The seeds were sown by an aggressive marketing campaign by Purdue Pharma, which falsely promoted its Oxycodone as being non-addictive. What followed was an epidemic of opioid over-prescription by physicians and other health-care professionals that eventually created a demand for synthetic opioids on the black market.
With so many deaths and no end in sight, this might be the time for all of us to reconsider whether the best responses to this crisis ought to be done within a much broader context of healing and an expanded understanding of what wellness really means.
VANCOUVER — A medical health officer in Vancouver says measles is not expected to spread beyond a cluster of patients but anyone travelling to other parts of the world should ensure they are vaccinated against the contagious disease.
Dr. Reka Gustafson of Vancouver Coastal Health says people often go to a travel clinic before a trip to get protection against diseases that don’t circulate locally and it’s a good opportunity to ensure all childhood vaccinations are up to date.
She says most people in B.C. are vaccinated and older adults may already have had measles but anyone born after 1970 should ensure they have two doses of a vaccine, which is routinely given to children at age one and then between the ages of four and six.
Two new cases were reported in the province Sunday, bringing the total to 13, with most of them linked to two French-language schools after an unvaccinated child contracted the disease during a trip to Vietnam.
Gustafson says it took a week to get all the students’ immunization records and improvements are needed to ensure a quicker system limits disruption to families as well as use of health-care resources.
Symptoms of measles include a runny nose, cough, fever, red, itchy eyes and sometimes a rash, and Gustafson says parents who suspect their child has the disease should call their doctor’s office in advance in order to get a separate room.
ANOTHER RECORD: First-time co-chairs Carman Chan, Isabel Hsieh and Pao Yao Koo hit a home run when the Chinese community’s 24th annual For Children We Care gala reportedly raised a record $4.1 million. That will go toward a $14-million campaign for relocating the development-and-rehabilitation Sunny Hill Health Centre for Children to the B.C. Children’s Hospital’s main campus.
Last year’s event brought in close to $$3.4 million, which exceeded 2017’s by $836,000. Contrasting the hospital’s fiscal prudence, the gala’s theme was Versailles, the extravagant palace and estate that helped bankrupt 18th-century France and send King Louis XVI and Queen Marie Antoinette to the guillotine. Conductor Ken Hsieh and the Metropolitan Orchestra entertained gala-goers with music from Parisian Jacques Offenbach’s 1858 Orpheus In The Underworld that also enlivens the cancan dance. Happily, the gala’s fundraising co-chairs proved that they could-could and did-did.
FOR PAINT JOBS WE CARE: Open Road auto dealer Christian Chia showed a $500,000-range Rolls-Royce Cullinan SUV at the For Children We Care gala. Viewers included the event’s third-time presenter, Peterson development firm executive chair-CEO Ben Yeung. Few buyers of the off-road-capable Cullinan would likely subject its flawless, porcelain-like surface to damage along bush-and-rock-flanked trails. Ditto when parking by night in certain DTES zones, including one where developer-to-be Yeung located his fresh-from-varsity dental practice.
STARRED: Local self-made billionaire Jim Pattison and entertainers Seth Rogen and Evan Goldberg have received Hometown Stars from the Canada Walk of Fame organization. The local ceremony followed a flossier one in Toronto where Paul Anka and investments supremo Warren Buffett serenaded Pattison with Frank Sinatra’s My Way. Rogan and Goldberg were lauded here by fellow walk-of-famer Howie Mandel. Also by teacher Mike Keenlyside from Point Grey Secondary where their stars will be embedded. Of their alma mater, “Everybody needs to know that Seth was a dropout and didn’t graduate,” Goldberg cracked.
When John Oliver Secondary grad and legendary toiler Pattison was asked if he really ought to be at work during daylight, he replied: “The answer is: Yes.” As for working for Pattison as former NDP premier Glen Clark does, successor John Horgan said: “I’ve got a job right now, but that’s an option.” That option would doubtless pay more than his current $205,400.16 salary. Meanwhile, Horgan and others might heed Pattison’s words: “Do the little things well and the big things will follow.”
BEAR FACTS: Another billionaire hit town recently. That was Seaspan Marine Corp. head Dennis Washington whose US$6-billion-range net worth is close to Pattison’s but whose 332-foot yacht Atessa IV overpowers the latter’s 150-foot Nova Spirit. Washington arrived for the premiere of Great Bear Rainforest, an Imax movie executive-produced by his son and Seaspan ULC executive chair, Kyle. Its director, Ian McAllister, met the younger Washington three years ago at a luncheon for the Pacific Wild Foundation that McAllister co-founded. Rather than conventional digital shooting, three-decade Bella Bella resident McAllister argued for Imax’s costlier 70mm film system that promises worldwide access to young audiences. The picture’s own young characters include Mercedes Robinson, who lives in 350-population Klemtu and retrieves DNA from trees where bears scratch themselves. Of her debut movie role, Robinson said: “You can get a lot of information from bears … who are guardians of the eco-system and have the ability to make it thrive and make the land more healthy.” When grown up, “I hope to provide information to the younger generation so that they protect the (bears’) territory and save it from those taking it from them.”
NEED FOR SPEED: B.C. Women’s Hospital Foundation president-CEO Genesa Greening and board chair Karim Kassam reported $300,000 was raised at the recent Illuminations luncheon. That’s where guests were illuminated regarding thousands of women plagued by slow-to-diagnose health concerns. A tenfold increase in research funding is said to be needed to address complex chronic diseases that are up to nine times likelier to affect women than men.
MEADOW MONEY: Attending the luncheon, the B.C. lieutenant-governor and former Women’s Hospital Foundation board member, Janet Austin, called the hospital’s researchers “some of the best in the world.” Then, pointing to retired Vancouver police inspector Bob Usui, who is one of her 35 ceremonial aides de camp, she told guests: “People think he is the lieutenant-governor, not me.” Her joke likely reminded some of an earlier LG, David Lam, who claimed that children sometimes misheard his title as “left-handed governor.” As for research-funding, Austin sounded in tune with rancher-predecessor Judith Guichon by saying: “Money is like manure — no good if it isn’t spread.”
NEW CARR: Bonhomie, not money, was spread on Great Northern Way recently with Gillian Siddall’s induction as Emily Carr University of Art and Design’s second president and vice-chancellor. She succeeds 22-year incumbent Ron Burnett who oversaw the much-enlarged academy’s move from Granville Island.
DOWN PARRYSCOPE: February 23 is International Dog Biscuit Day or, for humans taking a mouthful, World Sword Swallowers Day.
Not long ago, measles cases were far and few in between.
There were two cases in 2016 and just one in 2017. There were six cases confirmed in 2018.
The last outbreak of measles in B.C. was in 2014 when 343 cases were reported. Those cases were linked to an outbreak in a religious community that objects to vaccination.
Last week, Vancouver Coastal Health declared a measles outbreak in the city after as many as nine cases were reported in Vancouver.
Here’s how we got here and what you need to know.
January / February 2019: An individual who has been confirmed as having measles visited the emergency room at B.C. Children’s Hospital during the following times: • Jan. 21, 2019 – 10 a.m. to 6:10 p.m. • Jan. 23, 2019 – 4:45 p.m. to 11:10 p.m. • Jan. 24, 2019 – 8:13 a.m. to 11:40 a.m. • Feb. 1, 2019 – 2:05 p.m. to 6:55 p.m. If you also visited on those days during those times, contact your health care provider.
Jan. 25, 2019: Washington state declared a state of emergency due to the measles outbreak. As of Feb. 17, a total of 62 cases were confirmed, but there was no evidence the cases in Washington are linked to those in B.C.
Feb. 9, 2019: The first B.C. case of measles leading up to the current outbreak was confirmed. By the time this case was confirmed, it was past the point of being infectious.
Feb. 13, 2019: VCH announced a second case of measles was confirmed in the city; there are no indications it is linked to the first case. The patient was a school-aged child who was infected locally, not while travelling abroad.
Feb. 14, 2019: An online petition calling on the province to make vaccinations mandatory in B.C. schools has picked up traction. Just one day after the second case of measles was announced, the petition had already garnered more than 1,800 signatures. Another five days later, the petition now has nearly 27,000 signatures.
Feb. 15, 2019: Health officials confirmed there were several cases of measles at three French-language schools in Vancouver: École Jules‐Verne, École Anne‐Hébert and École Rose-Des-Vents. The cases are occurring in staff, students and family members linked to the schools.
More to come.
What’s the deal with measles and what should I know?
Measles is highly infectious. Highly. It can be spread through coughing, sneezing, breathing the same air as an infected person, sharing food or drinks, sharing a cigarette and yes, even through kissing a person with measles.
The measles virus can survive for several hours in small droplets in the air.
Most people will recover but those with a weak immune system or infants could experience serious complications. Those could include encephalitis (an infection and swelling of the brain), meningitis, pneumonia, deafness and infection of the liver.
Measles in B.C. is usually rare and linked to cases of unvaccinated residents returning from overseas travel.
How do I know if I have measles?
The incubation period is about 10 days and the symptoms include fever, cough, runny nose and red eyes, followed by a rash that starts on the body and spreads to the limbs. The rash lasts at least three days. You may also have small white spots inside your mouth.
The symptoms can begin as early as a week after being infected.
Some people may have measles, be infectious and not even know it. Those who are infected can spread the virus anywhere from four days before to four days after a rash appears.
How do I protect against measles? How do I know whether I’ve been vaccinated?
Health officials recommend two doses of the MMR (measles-mumps-rubella) vaccine to be fully protected against measles. The first immunization is usually received at the age of one, while the second usually comes before starting kindergarten.
If you’re unsure if you’ve been vaccinated, the first stop is to check your health records.
Born in or after 1994 here in B.C.? You’re likely to be immune because those born in or after 1994 here in B.C. will have had two doses of the MMR (measles-mumps-rubella) vaccine, the first dose when they turn a year old and a second before starting kindergarten, as part of routine vaccinations.
Born between 1970 and 1994? Grew up outside of B.C.? You may have only received one dose of the MMR vaccine. You’ll need a second dose to be protected.
Born before 1970? Or you’ve already had measles in the past? You’re likely to be immune.
Can’t remember if you’ve had one or two doses of the vaccine? The Canadian Centre for Disease Control says adults who do not have evidence of immunity should get at least one dose of MMR. It’s entirely safe to get the vaccine again.
I’m not vaccinated and I’ve been exposed to measles. What now? How do I treat it?
If you’ve been exposed to measles and you’re not vaccinated, you’ll need to get a dose of the MMR vaccine within 72 hours of exposure to prevent the illness.
But wait – don’t go to the emergency room or a doctor’s office without calling first. You’ll be highly contagious and the last thing you want is to spread it even further. Calling ahead will allow doctors make arrangements for your arrival and to ensure you’re isolated from other vulnerable patients.
Students at Fleetwood Park Secondary School in Surrey are being told to stay away from class if their measles immunization is not up to date. Sean Gallup / Getty Images
A second case of measles has been confirmed in the Vancouver area.
It was transmitted locally, meaning the patient was not infected while travelling abroad, Dr. Althea Hayden of the Vancouver Coastal Health Authority said at a news conference on Wednesday. She would not give details about the patient but said they are a school-age minor.
The other case, acquired abroad, was confirmed on Saturday but past the point of being infectious. Hayden said there is no clear link between the two cases. Her health authority’s region includes Vancouver, Richmond, the North Shore and the Sunshine Coast.
“We are working very hard to find out how measles may have been introduced into our community,” she said. “We would be much less concerned about it if we knew exactly where it came from.”
The health authority last released a public measles alert in September, after an infected person attended the Skookum Festival.
Spokespeople at the Fraser, Interior, Island and Northern health authorities said Wednesday that they had not heard of any suspected or confirmed cases of the disease in their regions.
In the State of Washington, a surge in measles cases prompted Gov. Jay Inslee to declare a state of emergency on Jan. 25. As of Wednesday, 54 cases had been confirmed. Health officials are urging residents to get immunized. Four more cases have been confirmed in Oregon.
Measles spreads through the air when an infected person coughs or sneezes, according to Vancouver Coastal Health. Complications can include inflammation of the brain, convulsions, deafness, brain damage and even death.
Infection does not require close contact and measles can survive in close areas, such as a bathroom, for up to two hours after an infected person has left. It causes fever, red eyes, coughing, a runny nose and a rash. Most people recover within a week or two.
Measles is easily prevented through vaccination, which Vancouver Coastal Health recommends. People who have previously had the infection do not need immunization.
B.C. children born in or after 1994 routinely get two doses of the measles, mumps and rubella (MMR) vaccine, one dose when they turn a year old and another before they start kindergarten.
People born before 1994 or who grew up outside of B.C. may need a second dose. People born before 1970 are likely immune; but if they aren’t sure whether they have had the infection, they can safely get the MMR vaccine.
The World Health Organization named “vaccine hesitancy” one of its top 10 threats to global health in 2019. Measles saw a 30 per cent increase in cases globally between 2016 and 2017, and a resurgence in some countries that were close to eliminating it, according to the organization.
“The reluctance or refusal to vaccinate despite the availability of vaccines – threatens to reverse progress made in tackling vaccine-preventable diseases,” according to the WHO. “Vaccination is one of the most cost-effective ways of avoiding disease – it currently prevents 2-3 million deaths a year, and a further 1.5 million could be avoided if global coverage of vaccinations improved.”
In Canada, immunizations are not mandatory. But Ontario and New Brunswick require proof of immunization for children and adolescents to attend school, according to Immunize Canada.
In the U.S., all 50 states and the District of Columbia have laws that require children entering childcare or public schools to have certain vaccinations. All state laws provide medical exemptions, 17 states allow religious or medical exemptions only, and five states expressly exclude philosophical exemptions, according to the Centers for Disease Control and Prevention.
The B.C. Centre for Disease Control tracks child immunization and reports that 82.1 per cent of children aged seven had been immunized for measles in 2018, compared to 88.4 per cent in 2017 and 90.2 per cent in 2016.
Across Canada, only a single new case of laboratory-confirmed measles was reported between Dec. 30, 2018, and Jan. 26, 2019, according to Health Canada’s most recent measles and rubella monitoring reports.
The agency said there have been large measles outbreaks reported across Europe which have affected many countries.
Prescribed pills to treat HIV. Jenelle Schneider Jenelle Schneider / PROVINCE
HIV-positive mothers with at least one child give birth to more babies than HIV-negative mothers, a new B.C. study spanning the years from 1997 to 2015 shows.
The analysis of live births published in a medical journal called PLOS One shows that among women who have already given birth, HIV-positive mothers have on average more children than a control group of HIV-negative mothers. The trend applies across all ages.
In the study span, there were a total of 669 live births among 270 HIV-positive women aged 15 to 49 and 1,577 births to 871 HIV-negative controls. The birth rate for HIV-positive women aged 15 to 24 was 1.88 live births per woman, while in the HIV-negative control group it was 1.52 per woman.
In the 25 to 34-year-old age group, the birthrate among women living with HIV was 2.62, compared to 1.76 in a HIV-negative control group. And in the 35 to 49-year-old category, the birthrate among HIV-positive mothers was 2.58, versus 2.11 in the HIV negative group.
The majority of HIV-positive women across Canada are in their reproductive years, and previous research has shown that motherhood is important to them.
There was an average of about 42,700 births annually to all women in the province during the study’s 1997 to 2015 time period. Babies born to HIV-positive women represented 0.05 per cent of all the births over the term of the study.
A study published in 2017 and based on a large group of Canadian women with HIV, showed that nearly a quarter of them between 2013 and 2016 got pregnant, but 60 per cent of such pregnancies were unintended. The new study did not look at whether pregnancies were planned.
There are about 1,200 women and 6,100 men living with HIV in B.C.
The Oak Tree Clinic at B.C. Women’s Hospital specializes in care for women and children with HIV, but the study’s authors say females with HIV need access to comprehensive reproductive health care, whether they live in urban areas like Vancouver or rural and remote areas.
Hélène Cote, a co-author, and researcher at the Women’s Health Research Institute at B.C. Women’s Hospital, said in an interview that the vast majority (over 80 per cent) of women living with HIV in Canada are receiving treatment, and most are attaining viral suppression success on such treatment. She said there has never been a baby born in B.C. to a woman aware of her HIV status and on such treatment during her pregnancy.
Cote said the fact that young women with HIV are having more babies would suggest they are conceiving at younger ages because of socio-cultural factors, in addition to feeling secure knowing that while on treatment, their risk of transmitting HIV to their baby is “almost zero.”
“Primary care physicians in communities across B.C. must not assume young woman are not having unprotected sex. And when they have HIV-positive patients, they must counsel them about sexual and reproductive health, including contraception, pregnancy plans, desires, and risks, among many other things. When a 17-year-old with HIV goes to a doctor and says, ‘I want to get pregnant,’ appropriate health care is required to ensure a safe pregnancy,” she said.
Women account for 18 per cent of all HIV cases in B.C., and since many have been on anti-retroviral treatment for a long time, researchers were keen to learn whether birth rates were going up over time for women in various age groups. Cote said for those aged 25 to 49, they found that as time went on, they did, suggesting women with HIV are “increasingly likely to feel confident about bearing children later in life.”
“The results of this study are an important step toward further understanding the reproductive health trends of women living with HIV, especially now that (they) can have pregnancies with little or no risk of … transmitting HIV to their child if engaged in care and appropriately treated,” says the study, funded by the Canadian Institutes of Health Research.
Previous research showed associations between HIV infection and lower childbirth rates in low- and middle-income countries, while the latest study is among the few done on women in high-income jurisdictions.
2018 was British Columbia’s deadliest year for illicit drug overdose deaths despite the hundreds of millions of dollars poured into mitigating the continuing public health crisis.
An average of four British Columbians died each day, a rate that has resulted in a drop in the predicted life expectancy for everyone living here.
British Columbia — and Vancouver, in particular — is the centre of the national crisis even though it has long been the testing ground for harm-reduction strategies that have included free needles, supervised injection sites and opioid replacement therapies including methadone, Suboxone and, more recently, pharmaceutical grade heroin.
B.C. has led Canada in getting free naloxone — the antidote for opioid overdoses — into the hands of emergency responders and users. It has set up free drug-testing sites.
Earlier this year, the City of Vancouver funded an expansion of a pilot project to provide pharmaceutical-grade heroin to users on the Downtown Eastside. Soon, addicts may be able to get their daily dose from vending machines.
Yet, the number of the dead hasn’t decreased, it’s only plateaued.
Also unchanged are the characteristics of the majority who died. Men aged 30 to 59 made up 80 per cent of the dead. Of those who died, 86 per cent were at home alone. Four out of every five had contact with the health care system within a year of their deaths, with 45 per cent reporting having pain. Of those dead men, 44 per cent were employed in the trades, transport or service industries.
But Vancouver is unique. It has the highest rate of overdose deaths and those deaths are concentrated in the Downtown Eastside in the low-barrier shelters, supportive housing units and SRO rooming houses that exist cheek-by-jowl with supervised injection sites, naloxone stations and testing sites.
Heading into the fourth year of a public health emergency, politicians need to set a new course.
The course that Dr. Bonnie Henry, B.C.’s chief medical health officer, plans to recommend is even more harm reduction. She said it will include “de facto decriminalization,” more pharmaceutical grade heroin, more drug testing sites, more Suboxone, more naloxone, more supervised injection sites.
On Thursday, Henry did admit that her plan will require that she “evaluate it effectively so that there are not unintended consequences.”
Chief among those unintended consequences is that if British Columbia goes it alone, it would be at risk of becoming even more of a magnet for users from across Canada, even from other countries. What drug user, let alone addict, could resist the allure of free, pharmaceutical grade drugs?
There is also a financial risk to going it alone. Last year, British Columbians’ bill for methadone and Suboxone was $90 million. The number of people on the opioid replacement therapy had risen to 22,012 people from 11,377 in 2009 and is predicted to double again by 2020-21.
British Columbians are already paying for more than 300 people who get injectable hydromorphone (pharmaceutical heroin) daily at a cost of approximately $25,000 a person every year and in January, 50 Vancouverites were enrolled in a pilot program where they get it in the cheaper pill form, which they then crush and inject under supervision.
While a provincial strategy is needed, the crisis isn’t unique to B.C. From 2016 until June 2018, more than 9,000 Canadians have died of overdoses largely from fentanyl-laced drugs.
The opioid crisis isn’t just a big city problem. According to the Canadian Institute for Health Information, hospitalization rates were 2.5 times higher in small communities of 50,000 to 100,000 compared with Canada’s largest cities.
Across Canada, hospitalization for opioid-related poisoning has risen 27 per cent in the past five years to an average of 17 a day.
While there is no good data on damage suffered by survivors of near-fatal overdoses, it’s estimated that 90 per cent of drug-overdose patients in intensive care have some sort of brain trauma. The trauma ranges from temporary memory loss to complete loss of brain function.
A comprehensive national plan is required. But it must focus not only on keeping people alive, but on helping them to get healthy.
Decriminalization — as opposed to legalization — might be part of the answer. Certainly, evidence from Portugal, which was the first in the world to decriminalize possession of small amounts of all drugs, indicates that it can be effective.
But Portugal’s success has come only because decriminalization is accompanied by strict enforcement of the amounts that individuals can possess as well as a dissuasion system that provides both a carrot and a stick to get users into treatment.
The opioid crisis is complicated. It’s been fuelled by over-prescription of highly effective pain reducing synthetic opiates, whose manufacturer convinced physicians that it wasn’t addictive.
Those synthetics then made their way to the street and while some users are unaware that their illicit drugs are laced with fentanyl, others go looking for its intense and often fatal high.
So far, staunching the flow of those drugs on to the street has proven to be little more effective than the harm reduction measures aimed at keeping users safe.
For this crisis to abate, there needs to concerted efforts on all fronts by all governments. It won’t be cheap, but then neither is the alternative.
VANCOUVER — Inhaling smoke from a wildfire can be equal to smoking a couple of packs of cigarettes a day depending on its thickness, says a researcher studying wildfires in Western Canada.
Mike Flannigan, a professor with the Department of Renewable Resources at the University of Alberta, said the smoke is like a “chemical soup” that can be trapped in the lungs and cause a number of health issues.
“They are all kinds of particles, mercury, carbon dioxide, carbon monoxide, methane … there’s a whole long list.”
Depending on the size of the particles, they get trapped in the lungs, accumulate over time and cause “all kinds of problems,” Flannigan said.
“The more we are finding out about smoke and health, the more we are finding out it is bad for us, which isn’t a surprise but its worse than we thought.”
Sarah Henderson, a senior environmental health scientist at the British Columbia Centre for Disease Control, said the smaller the particles, the worse they are.
Both Flannigan and Henderson will make presentations at the BC Lung Association’s annual workshop on air quality and health on Wednesday.
Their presentation is timely after extreme wildfire seasons in British Columbia in 2017 and 2018. Smoke from forest fires last year reached Atlantic Canada and even as far away as Ireland.
Emissions vary depending on the differences in fuel, burning conditions and other environmental factors, Flannigan said.
The spread hinges on how high smoke and fire columns rise. Winds can carry the particles north to Europe and Asia, across the world and back again, Flannigan said.
“They can travel long distances for long periods of time.”
Henderson said most people living in polluted places face a risk of chronic diseases and slightly shorter life expectancy but that data comes from cities such as New Delhi, one of the most polluted cities in the world.
The air quality in British Columbia is “extremely good” except for a few weeks during wildfire season, she said.
“If we have a season like 2017 and 2018, year after year for the next 20 years, we probably will have a health impact on the population but we don’t know what that will be yet,” Henderson said.
People should protect themselves from the smoke by spending time indoors, using air filters and not exercising strenuously when outside, she said.
In 2017, the area burned in B.C. was 12,000 square kilometres, which was a record until last summer when 13,000 square kilometres of the province was consumed by fire. The B.C. government declared a state of emergency for both seasons.
The intensity of wildfires, as shown through remote sensing, is also increasing, Flannigan said, noting that as fuels get drier it is easier for fires to start and spread.
And the wildfire season is also starting much sooner, he said.
In Alberta the wildfire season used to begin April 1 but it’s now starting March 1 and is lasting longer.
“In Canada our area burned has doubled since the 1970s. And my colleagues and I attribute this to — I can’t be any clearer — human-caused climate change,” he said. “Our climate is changing and this has affected fire activity in Canada, western United States and other parts of the world.”
The last two years saw over four per cent of forested area burn in B.C. and the province is nowhere close to exhausting how much can burn, Flannigan said.
Historically, he said, it would have been unlikely that the province would have seen a third bad fire season.
“But its entirely possible,” he said.
Climate change is making the jet stream weaker, which is causing hot, dry summer days, which are conducive to fire activity, he said.
“Will things get worse? Absolutely. Not every year. Some years will be cooler, some years will be wetter,” Flannigan said.
“On an average we’re going to see a lot more fire, and they’re going to be longer fire seasons, more intense, and the primary reason why climate change influences fire activity is that the warmer it gets the more fire we see.”
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