Category "Men"

29Oct

Daphne Bramham: Will a ‘safe’ drug supply ease Vancouver’s overdose epidemic?

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Opinion: As a harm reduction measure, Vancouver Coastal Health and others want Ottawa to allow drug clubs to give free, tested drugs to members.

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Harm reduction’s truism is hard to argue with: You can’t help drug users if they’re dead.

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In fact, it’s usually a conversation stopper. But it is also a convenient cudgel when someone suggests that in the midst of the long-running overdose crisis that governments have leaned-in rather too hard on reducing harm and not hard enough on addressing the root causes fuelling the drug-use epidemic.

So it is with a proposal that Vancouver city council endorsed that urges Health Canada to allow drug clubs or co-ops to buy heroin, cocaine and methamphetamines, test them, repackage them, and give them away to members.

This is harm reduction pure and simple, untethered from health-care providers and any pretense that it is part of a treatment plan. These would be pharmacies without pharmacists, providing users with the drugs they crave in the quantities they want.

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With an average of six British Columbians a day dying from illicit drugs with increasingly high concentrations of fentanyl, carfentanil and benzodiazepines, there is no disputing that Vancouver and most other B.C. cities have a deadly problem.

Desperate times, they say, require desperate measures.

But if Health Canada accedes to the request from the city and Vancouver Coastal Health to exempt the Drug Users Liberation Front (DULF) from the Controlled Drugs and Substances Act, would drug clubs work?

Nobody knows because it’s never been done before.

“It wouldn’t make drug use safe. But it would make it safer than what (users) are currently doing,” Mark Lyshyshyn, the deputy medical health officer, said in an interview.

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“We don’t know if it would be a successful program, but I felt it had the potential to reduce the risk of overdose. … The whole point is for them to get safer drugs.”

He sees DULF’s proposal as an extension of Vancouver Coastal Health’s drug-checking services and supervised injection sites.

The whole idea of a “safe supply” or even a “safer supply” is a relatively new one first used by groups like the Vancouver Area Network of Drugs Users (VANDU) more than a decade ago before the illicit supply was rife with synthetic opioids like fentanyl and before a public health emergency was declared in 2016.

Critics of “safe supply” say that there is no such thing, pointing out that the genesis of the emergency was the false and aggressive marketing of OxyContin as non-addictive followed by its over-prescription.

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Even before that, Vancouver’s drug problem was bad enough that in 2001 the city approved a “four pillars” approach — prevention, treatment, enforcement, and harm reduction. Over the years, the policy debate has devolved into harm reduction versus treatment.

“It comes down to a matter of philosophy of what the right balance is,” Lyshyshyn said. “And right now people are dying, so the most important pillar is harm reduction, to stop people from dying.”

He said governments spend “100 times as much on addiction treatment” as on harm reduction, as well as more on enforcement even after a decade of de facto decriminalization in Vancouver.

Police are going after drug traffickers and illegal drug producers, Lyshyshyn said. And that only “incentivizes people to create more potent drugs.”

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Still, he hopes that with a safer drug supply, more users would seek treatment. Unfortunately, that doesn’t quite line up with users’ letters appended to Vancouver council’s motion. For them, the treatment isn’t working.

Greg Fresz gets diacetylmorphine (heroin) twice daily from Crosstown Clinic, which is licensed by Health Canada to provide it. But he wants a take-home supply (aka “carries”) and has been denied that.

“You can’t use crack if you’re going to get carries. … For me, that’s not feasible because sometimes I can’t get anything else, so I’ll buy pills, dilaudids, benzos, something to help me sleep because I’m in pain.”

Martin Steward quit Crosstown Clinic because it was “too tedious.”

“I had to wait for my turn, wait for my medication, after the medication, I had to sit for 20 minutes before I could leave.”

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A man identified as Steel, who described himself as a “social user”, tried and quit the B.C. government’s “safer supply program” that allows doctors and nurses to prescribe opioids (including fentanyl patches), alcohol, stimulants and benzodiazepines.

“The government supply is weak. It doesn’t satisfy. Yes, it might be free, but it doesn’t do what the drugs are meant to do for many of us.”

Steel also complained about the drugs that DULF has handed out freely on three occasions in the Downtown Eastside: “I found that I needed more.”

Samona Marsh, an “ethical use substance navigator” with VANDU, wrote: “I don’t go to the doctor at the best of times. Why would I go to the doctor to get high? Existing safe supply programs give you pills. I want to get high on drugs, not on their pills.”

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Lorna Bird complained about being in an opioid replacement program that requires daily witnessed ingestion of drugs such as methadone and suboxone at a pharmacy: “It was a real hassle and interfered with my life a lot.”

Before that, she quit an injectable heroin program. She didn’t like being watched as she used.

VANDU “peer navigator” Laura Shaver spends about $100 a day on “a range of street and safe supply drugs” that includes heroin, hydromorphone, Dexedrine, metadol-D, Seroquel and gabapentin.

She has asked for prescription benzodiazepines, but her doctor refused because there were traces of fentanyl in her urine.

“The feeling (on benzos) can be euphoric — and reminds me of the type of high I would have before I was on methadone.”

For more than two decades, the Canadian consensus has been that addiction is a health issue, not a moral failing, and ought to be treated like every other chronic, recurring disease.

But the challenge set before Carolyn Bennett, Canada’s new mental health and addictions minister, is deciding whether harm reduction includes the right to get high.

dbramham@postmedia.com

Twitter: @bramham_daphne

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28Oct

Daphne Bramham: Vancouver’s support for drug clubs’ free-for-all misses the mark

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Opinion: Vancouver has endorsed a drug club plan that would provide members with free drugs in unlimited quantities. “F—ing crazy,” say critics.

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When Vancouver’s city council unanimously agreed to ask Health Canada to allow “clubs” or “co-ops” providing heroin, methamphetamines and cocaine to drug user members, one can’t help wonder if they actually read and understood the proposal before them.

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Loosely based on the 2019 report by the B.C. Centre on Substance Use, this is a more radical plan that would allow a group of drug users with no medical training to buy and sell drugs in unlimited amounts to other drug users.

No medical oversight. No safeguards. No consequences.

The only thing that council balked at was endorsing the purchasing, testing and repackaging of drugs bought from the dark net, which is what the Drug User Liberation Front (DULF) has done in the past.

Not that any of this matters.

DULF co-founder Eris Nyx rallies the crowd at a march calling for the safe supply of street drugs, on East Hastings Street in Vancouver.
DULF co-founder Eris Nyx rallies the crowd at a march calling for the safe supply of street drugs, on East Hastings Street in Vancouver. Photo by Jason Payne /PNG

“We’re going to run this program by hell or high water because it will save lives,” DULF co-founder Eris Nyx told The Tyee. “We’re a radical organization. We don’t need state sanctioning. But it helps.”

The differences between what the BCCSU recommended and what council endorsed point to myriad potential problems.

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The BCCSU report was only about heroin. There was NOTHING about cocaine and methamphetamines. It made it clear that health-care providers should be involved in the screening of members. Membership would also require taking overdose prevention and naloxone training and receive education on various risks from overdose to mixing drugs.

“Due to the inherent risks involved” the BCCSU said clubs should operate alongside other public health and social services.

It also insisted that members would pay for drugs to limit the risk of diversion, citing evidence that when drugs are free, it’s more likely that people will sell them. And to limit risk of bulk purchases from organized criminals, BCCSU said individuals should only be allowed enough for short-term personal use.

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None of that is reflected in the council-endorsed proposal.

DULF’s only criteria for membership is that people would need to be over 18 and currently using illicit drugs.

“People would access the compassion clubs through their local drug user groups who would act as the main point of contact,” under DULF’s plan.

Drugs would be sent to the clubs “on an as-needed basis to drug user groups to distribute to members.” Those distributors would need to keep active membership lists, ensure secured and double-locked storage, keep records for amounts distributed and to whom, and maintain financial records.

There is no indication of who would be monitoring the clubs. No mention of who would bear the liability for any overdoses.

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While the BCCSU report said clubs would pay for themselves through membership fees and sales, DULF would rely on donations or some undefined “parallel revenue streams to subsidize the cost of substances.”

Alternately, DULF said, it could produce its own heroin, meth and cocaine and “significantly undercut market prices”.

It’s an open question how these clubs would protect themselves against their organized crime competitors.

But it’s worth noting that Vancouver has had de facto decriminalization for more than a decade, and that British Columbia has been providing a so-called “safer supply” of pharmaceutical drugs to opioid users since March 2020 under a special pandemic-related exemption from Health Canada.

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B.C. expanded that program in July even though it has acknowledged that there is limited clinical evidence to support it. In fact, the only evidence available is for heroin provided in highly supervised, clinical settings.

Because of that, physicians have been slow to register as prescribers. As the College of Physicians and Surgeons told members , “The need for caution is heightened in the absence of clinical practice guidelines or strong clinical evidence.”

It urged doctors to prescribe in a way that “minimizes the risk of harm and the introduction of unintended consequences that may negatively impart patients or the public more broadly (e.g. diversion).”

If access to pharmaceutical drugs is the answer to the overdose crisis, the B.C. experiment has yet to prove it. Since July, overdose deaths have continued to rise, with an average of six people dying every day.

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DULF’s proposal and testimonials from drug users provides an answer to why it’s not working: It doesn’t give users exactly what they want, when or where they want it.

Two addictions experts, who asked not to be named, described the drug club proposal as ‘”f—ing crazy”.

Others said they aren’t opposed to trying new and different things, but providing free drugs in unlimited quantities is a step too far.

“From where we started, this has truly crossed the line from harm reduction to harm facilitation,” said Carson McPherson, an adjunct professor in Simon Fraser University’s health sciences department.

SFU psychology professor Julian Somers was disappointed that Vancouver council wasted time on this but has done little to push for a large-scale strategy that includes a continuum of care from harm reduction to housing and other psycho-social supports and services.

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His own peer-reviewed research published nearly a decade ago concluded that, given options, even hard-core users with mental health issues made choices that resulted in less-frequent drug use, less crime and fewer hospitalizations.

But instead of dealing with the “glaring social needs” of drug users, he said, Vancouver council has chosen to support “a relatively desperate action.”

“In some ways it’s a charming story: People doing things for themselves in the spirit of camaraderie,” Somers said of DULF’s proposal.

“But those in a position of responsibility ought to know there is a science of addiction from the molecular level on up to the psycho-social. To do something because it’s a charming story? That’s not a good look for an elected official.”


In my next column, Vancouver Coastal Health’s Mark Lyshyshyn makes an argument for why these are desperate times that may demand desperate measures.


dbramham@postmedia.com

Twitter: @bramham_daphne

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Postmedia is committed to maintaining a lively but civil forum for discussion and encourage all readers to share their views on our articles. Comments may take up to an hour for moderation before appearing on the site. We ask you to keep your comments relevant and respectful. We have enabled email notifications—you will now receive an email if you receive a reply to your comment, there is an update to a comment thread you follow or if a user you follow comments. Visit our Community Guidelines for more information and details on how to adjust your email settings.

17Oct

SAD plus COVID: A bit of light and a bit of exercise can make all the difference

by admin

The best way to prepare for the winter blues is to anticipate, prepare and plan to add light and exercise, say experts.

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As the season of darkness and rain descends, the spectre of lowered mood, heightened anxiety and seasonal depression looms. The global pandemic has added an additional stressor to those vulnerable to mood disorders.

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“Stress plays a role,” said Dr. Raymond Lam, an expert in seasonal affective disorder. “People who have clinical depression can have their depression start earlier, have symptoms worsen, and people with mild or winter symptoms can have major symptoms such as sadness, lowered mood, oversleeping, overeating.”

According to a recent Ipsos Reid poll , nearly three in 10 Canadians have reported a deterioration in mental health since the beginning of the pandemic, and according to Stats Canada , more Canadian adults screened positive for anxiety or major depressive disorder in 2021 than in 2020.

Lam, professor and B.C. leadership chair in depression research at UBC, said the best way to prepare for the season is to anticipate it, and understand our defences may be down due to the pressures of the pandemic.

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“Not having the usual things that help with our resilience, such as exercise, gatherings, and friendships, means our coping behaviours are reduced,” said Lam.

Raymond W. Lam, professor and B.C. Leadership Chair in depression research, UBC, in his office.
Raymond W. Lam, professor and B.C. Leadership Chair in depression research, UBC, in his office. Photo by Handout /PNG

For those who have seasonal affective disorder, or SAD, a mood disorder that strikes during the autumn and winter seasons, light therapy , or exposure to 30 minutes of bright, artificial light a day, is a well-known, safe and effective treatment. However, Lam said research shows that even when skies are grey, exposure to natural light is beneficial.

Lam also suggests we get moving. “Exercise by itself helps depression, even clinical depression, and specifically for winter depression it is helpful.”

So what happens when restrictions, fear of COVID-19 infections or a dislike of being outdoors in bad weather keeps us from staying active?

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New research by Dr. Eli Puterman has found that at-home exercise through fitness apps is an effective tool in managing depression.

At the beginning of pandemic restrictions in 2020, Puterman, an associate professor in the school of kinesiology at UBC, said that he heard countless stories from people he met who were suffering from isolation, loneliness and depression.

Puterman, a health psychologist, had maintained his workouts during lockdown using Down Dog, an app that provides a variety of exercise programs. He researched whether at-home exercise apps could provide some relief.

The results of his study, published last week in the British Journal of Sports Medicine , showed that at-home app-based workouts, especially those using a combination of high intensity interval training and yoga, provided significant reductions in depressive symptoms.

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The study randomized a group of 334 women and men between 18-64 years old who were not involved in high levels of exercise, and assigned them to either yoga, HIIT, or both, and a control group was asked to maintain their current level of exercise.

Participants using the app all exhibited a steady decrease in their depression symptoms regardless of the type of exercise they did, and those with the most significant depression symptoms had the most dramatic improvements.

“The people in the study group categorized as having some kind of significant depression saw a drastic change,” said Puterman. “A good 70 per cent of them could no longer be categorized as having significant depression by the end of the study.”

Twenty minutes of vigorous exercise, four times a week, was enough to make a difference, said Puterman with those who used a combination of yoga and HIIT training receiving the greatest benefit.

Puterman said he hopes that public policy will shift to providing tools, tax incentives and education programs to help people incorporate more exercise into their routines.

At the individual level, Puterman reminds people to start slowly.

“Even a walk around the block can help,” he said.

Puterman also suggests using covered spaces in parks and school grounds to exercise outdoors, to get the added benefit of natural light exposure and fresh air.

dryan@postmedia.com

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Postmedia is committed to maintaining a lively but civil forum for discussion and encourage all readers to share their views on our articles. Comments may take up to an hour for moderation before appearing on the site. We ask you to keep your comments relevant and respectful. We have enabled email notifications—you will now receive an email if you receive a reply to your comment, there is an update to a comment thread you follow or if a user you follow comments. Visit our Community Guidelines for more information and details on how to adjust your email settings.

15Sep

COVID-19: Police say they hope for voluntary compliance on vaccine cards

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Both the Vancouver police and the RCMP say they’re hoping for compliance rather than confrontation with COVID-19 vaccine cards

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Both the Vancouver police and the RCMP are asking the public for voluntary compliance rather than confrontation when it comes to the new COVID-19 vaccine card.

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VPD media relations officer Sgt. Steve Addison said two gyms called police Monday, the day the vaccine cards came into effect, after two customers refused to show their cards. He said there was “no public safety risk or criminal offence in either case” because the people eventually left without incident.

“We trust that business owners and staff will do their best to resolve conflicts that arise over vaccine passports,” he said by email. “We will attend if there is a public safety issue or a criminal act.”

RCMP Staff Sgt. Janelle Soihet said she’s not aware of any tickets being issued since the card came into effect. Soihet, senior media relations officer for E Division, said the RCMP isn’t tracking incidents where officers have been called relating to disturbances about the COVID vaccine card.

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“We are hopeful enforcement will not be required and that voluntary compliance and co-operation will be the norm,” she said in an email. “The RCMP will continue to use a measured approach when dealing with calls related to COVID-19 non-compliance. Calls will be assessed on a case-by-case basis and our response will be based on this assessment and triaged based on current detachment operations.”

The vaccine card is required to enter restaurants, movies, ticketed sporting events, gyms and other non-essential venues. By Oct. 24, only fully vaccinated people will be able to access all those services and venues.

Businesses and groups that don’t comply with the public health officer order may be issued a violation ticket. Individuals could be fined $230 or $575. For owners, operators and event organizers, the fine could be up to $2,300.

E Division is the largest police body in the province with 144 detachments serving about 3.3 million people. Its 7,100 sworn members provide policing for all but 12 municipalities in B.C.

Soihet said police are asking people to respect the fact that businesses and owners are doing their best to get through the pandemic.

“There is no cookie-cutter approach that can be applied to each call, as such we will make an assessment based on the circumstances surrounding each incident,” she said.

kevingriffin@postmedia.com

15Sep

Police say they hope for voluntary compliance on vaccine cards

by admin

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Both the Vancouver police and the RCMP are asking the public for voluntary compliance rather than confrontation when it comes to the new COVID-19 vaccine card.

Article content

VPD media relations officer Sgt. Steve Addison said two gyms called police Monday, the day the vaccine cards came into effect, after two customers refused to show their cards. He said there was “no public safety risk or criminal offence in either case” because the people eventually left without incident.

“We trust that business owners and staff will do their best to resolve conflicts that arise over vaccine passports,” he said by email. “We will attend if there is a public safety issue or a criminal act.”

RCMP Staff Sgt. Janelle Soihet said she’s not aware of any tickets being issued since the card came into effect. Soihet, senior media relations officer for E Division, said the RCMP isn’t tracking incidents where officers have been called relating to disturbances about the COVID vaccine card.

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“We are hopeful enforcement will not be required and that voluntary compliance and co-operation will be the norm,” she said in an email. “The RCMP will continue to use a measured approach when dealing with calls related to COVID-19 non-compliance. Calls will be assessed on a case-by-case basis and our response will be based on this assessment and triaged based on current detachment operations.”

The vaccine card is required to enter restaurants, movies, ticketed sporting events, gyms and other non-essential venues. By Oct. 24, only fully vaccinated people will be able to access all those services and venues.

Businesses and groups that don’t comply with the public health officer order may be issued a violation ticket. Individuals could be fined $230 or $575. For owners, operators and event organizers, the fine could be up to $2,300.

E Division is the largest police body in the province with 144 detachments serving about 3.3 million people. Its 7,100 sworn members provide policing for all but 12 municipalities in B.C.

Soihet said police are asking people to respect the fact that businesses and owners are doing their best to get through the pandemic.

“There is no cookie-cutter approach that can be applied to each call, as such we will make an assessment based on the circumstances surrounding each incident,” she said.

kevingriffin@postmedia.com

2Aug

Health Scams: a growing problem in the age of misinformation

by admin

“Everybody wants to be healthy. Everybody has been taken in by some sort of health scam at one point in their life — a product to improve their skin, or lose weight. It’s a normal human desire to try and improve our lives.” — UBC professor Bernie Garrett

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Bernie Garrett, author of The New Alchemists, in Pender Harbour.
Bernie Garrett, author of The New Alchemists, in Pender Harbour. PNG

In the opening of his book, The New Alchemists, author and UBC professor Bernie Garrett compares the rise of deceptive heath care practices and misinformation to the cons perpetrated by Renaissance alchemists, who swindled desperate people with promises of immortality and claims they could turn metal into gold.

“Everybody wants to be healthy,” said Garrett. “Everybody has been taken in by some sort of health scam at one point in their life — a product to improve their skin, or lose weight. It’s a normal human desire to try and improve our lives.”

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But when lives are at stake — or when a global pandemic hits — the outcomes of believing in pseudo-science, deception, scams and misinformation, can be more serious.

“It’s not just a question about losing money, some of these things can be detrimental and prevent people from getting effective treatment,” said Garrett, who cites several well-known cases that have had tragic outcomes, such as the death of a toddler in Alberta whose parents used natural remedies, rather than seek medical treatment for their seriously ill child.

Garret started writing the book in 2018 after noticing an increase in deceptive health care practices fuelled by the internet. Then came the COVID-19 pandemic, with its plethora of misinformation and fraudulent tests, cures, immune-boosting agents, anti-vaccination rhetoric, and fake cures, from bleach to sunlight.

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Watching the explosion of misinformation play out in real time as he wrote the book was fascinating, said Garrett, who compared it to bailing out a leaky boat: for every theory that was debunked, a new one would replace it.

“For my colleagues working in the ICUs and acute care units across the country, the effects of this pandemic are horrific, and any misinformation that prolongs it has serious consequences,” said Garrett, who has 35 years of experience in nursing and health care research.

Bogus health care claims come in many guises, whether it’s a “magical health machine” or magical technology, unproven supplements, super-juices, fake products, fake clinics, or even fake doctors like teen Malachi A. Love-Robinson, who was caught fraudulently practicing in Florida.

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“The most egregious are the fake cancer clinics in the way in which they prey on very vulnerable people,” said Garrett.

Mistrust of conventional medicine has led to distrust of some public health options, said Garret, in part, because of scandals associated with big pharma.

“We’ve had scandals with Abilify, OxyContin, Respiridal and others, where these pharmaceutical companies have behaved very poorly in terms of marketing, and that’s encouraged some people to move away from traditional medicine. ”

Deceptive healthcare providers have capitalized on that growing lack of public trust in science and medicine, and social media has fuelled the fire. Studies show that even “absurd” rumours and easily understood falsehoods spread faster on social media networks than solid science, said Garrett who cites Kaiser Family Foundation research that shows 2/3 of unvaccinated adults believed at least one vaccine lie.

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The psychology of advertising plays a role said Garrett.

“These folks are very good at pushing our buttons with buzzwords that appeal to us or invoke fear.”

Deceptive health care claimants tend to appeal to emotion rather than logic, and rely on techniques that connect positive social imagery and phrases such as “Moms like this,” or use images of nature, or “ancient traditions.”

They tend to rely on testimonials, and claims of groundbreaking or secret research science hasn’t caught up with yet, or the conspiracy theorists favourite: “doctors don’t want you to know this,” said Garrett.

“It’s a complex problem,” said Garrett. “With people in our own lives it’s important to debunk these idea when they come forward by pointing out why things are illogical or irrational and correcting misconceptions.”

Garret said the “wild west” of health care advertising needs to be better regulated, and our health care systems need to be made more user-friendly so fewer people will seek alternatives.

“Some of the key problems we have in health deception in Canada and more broadly are based on this lack of regulation.”

dryan@postmedia.com

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14Jul

Daphne Bramham: When it comes to drug policy, politicians aren’t following the evidence

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Opinion: Why are our politicians ignoring experts on booze and drugs?

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Every day since COVID-19 struck, we’ve been told that evidence matters, that we need to listen to the scientists and researchers.

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Yet, when it comes to drugs, our provincial and municipal governments figure they know better and pay little or no attention. It seems they’d rather give people what they want and damn the consequences.

The B.C. government’s announcements last week that cocktails can now be delivered along with meals and that cannabis stores can now legally do dial-a-dope were greeted enthusiastically. The same has been true of announcements by various municipalities that they are expanding their zones where people can openly drink alcohol.

Cannabis remains mostly a no-go for parks since it falls under the prohibition against smoking — one of the few legal vices deemed worthy of strictly regulating.

But is this good public policy?

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The Canadian Institute for Substance Use Research suggests that it’s not and especially not considering that its December research indicated that private liquor store sales in British Columbia rose 18.5 per cent between March and June 2020, while government liquor stores had an eight-per-cent increase.

At the time, lead researcher Tim Stockwell said, “We suspect part of this increase at private stores has to do with the fact they have been making alcohol more convenient to buy, by offering home delivery with a minimum order or listing its products on third-party delivery apps.”

On Tuesday, institute researchers led by Tim Naimi released Not a Walk in the Park: Alcohol Consumption on Municipal Properties in B.C. It makes recommendations to local governments for assessing and mitigating the risks of unsupervised consumption in public places.

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“This approach carries significant public health and safety risks, may add costs to governments and may divert sales away from regulated, licensed establishments,” they wrote. “Furthermore, this approach may not support the social connection goals of everyone in the community, as not everyone welcomes increased opportunities for alcohol consumption.”

Among the “second-hand harms” cited are increases in assaults, gender-based violence, vandalism and impaired driving. The report also cites an increased risk of drowning and potentially marring the enjoyment of others (including families) sharing public spaces and the higher risk of COVID-19 transmission.

Even before the COVID and the liberalization of liquor laws, the institute noted that B.C. consumption was already higher than the national average, steadily rising since 2013 along with the public costs.

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Those costs are substantial. There is a causal link between alcohol use and 200 types of chronic diseases and acute injuries.

The institute estimated the 2017 economic cost in B.C. of alcohol was $2.38 billion, or $483.10 per capita, surpassing tobacco ($277.80) and opioids ($257.04).

Coincidentally, on Tuesday when institute research was released, the Globe and Mail reported that later this week the B.C. government will be expanding its unprecedented experiment with providing pharmaceutical alternatives as replacements for street drugs.

The program was originally aimed at supporting people with addictions physically distance, self-isolate or quarantine in order to prevent the spread of COVID-19.

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Now, with widespread vaccinations and the reopening of the economy, British Columbia will require all health authorities and their clinicians to provide pharmaceutical grade opioids (including fentanyl), stimulants and other addictive substances to illicit drug users.

Out of hospital drug costs will be paid by Pharmacare, the provincial drug plan.

The expansion is coming even though the number of overdose deaths has continued to rise and is on track to hit a record this year.

But that’s no reason to stop, according to the draft update to the B.C. Centre on Substance Use’s safe-supply guidelines.

“The risk of overdose remains high due to the contaminated drug supply,” says the draft document. “(And) it may be appropriate to continue this prescribing for patients who have shown clear indication of benefit.”

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For evidence, the draft notes that it’s “challenging” to compare mortality rates to opioid-user-only data because safe-supply data mixes opioids, stimulants and alcohol.

Between March 27, 2020 and Feb. 28, 2021, there were 6,498 people in the program including 1,431 who were given alcohol withdrawal medication and 3,771 who were given opioid alternatives.

Of the 82 people in the program who died, the cause of death for 37 was not available “because of a delay in vital statistics data.”

Among the findings was that the urine samples of “many” who were prescribed oral hydromorphone (a narcotic) were laced with fentanyl, suggesting that those “many” were at very least topping up their safe supply with illicit drugs.

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According to the Globe and Mail, the final report notes that “health system partners” expressed “significant reservations” about the approach because their training does not include prescribing potentially fatal substances for other than their medically regulated use.

Still, the document’s unnamed authors concluded, “We recognize that we have been unable to address all concerns, but we also recognize that we have to start somewhere.”

Meantime, Addictions Minister Sheila Malcolmson is still sitting on an evidence-based proposal that would provide housing, addiction and mental health treatment for 1,500 people and whose $37-million cost would be offset by the reduction in hospitalizations and interactions with the police.

Following the evidence worked with COVID. So, maybe with these other longer term and wickedly expensive problems, politicians should give it a try — even if drinking wine and beer from glasses rather than paper bags in parks seems like a good idea.

dbramham@postmedia.com

Twitter: @bramham_daphne

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Postmedia is committed to maintaining a lively but civil forum for discussion and encourage all readers to share their views on our articles. Comments may take up to an hour for moderation before appearing on the site. We ask you to keep your comments relevant and respectful. We have enabled email notifications—you will now receive an email if you receive a reply to your comment, there is an update to a comment thread you follow or if a user you follow comments. Visit our Community Guidelines for more information and details on how to adjust your email settings.

13Jul

Daphne Bramham: When it comes to drug policy, politicians aren’t following the evidence

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Opinion: Why are our politicians ignoring exports on booze and drugs?

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Every day since COVID-19 struck, we’ve been told that evidence matters, that we need to listen to the scientists and researchers.

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Yet, when it comes to drugs, our provincial and municipal governments figure they know better and pay little or no attention. It seems they’d rather give people what they want and damn the consequences.

The B.C. government’s announcements last week that cocktails can now be delivered along with meals and that cannabis stores can now legally do dial-a-dope were greeted enthusiastically. The same has been true of announcements by various municipalities that they are expanding their zones where people can openly drink alcohol.

Cannabis remains mostly a no-go for parks since it falls under the prohibition against smoking — one of the few legal vices deemed worthy of strictly regulating.

But is this good public policy?

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The Canadian Institute for Substance Use Research suggests that it’s not and especially not considering that its December research indicated that private liquor store sales in British Columbia rose 18.5 per cent between March and June 2020, while government liquor stores had an eight-per-cent increase.

At the time, lead researcher Tim Stockwell said, “We suspect part of this increase at private stores has to do with the fact they have been making alcohol more convenient to buy, by offering home delivery with a minimum order or listing its products on third-party delivery apps.”

On Tuesday, institute researchers led by Tim Naimi released Not a Walk in the Park: Alcohol Consumption on Municipal Properties in B.C. It makes recommendations to local governments for assessing and mitigating the risks of unsupervised consumption in public places.

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“This approach carries significant public health and safety risks, may add costs to governments and may divert sales away from regulated, licensed establishments,” they wrote. “Furthermore, this approach may not support the social connection goals of everyone in the community, as not everyone welcomes increased opportunities for alcohol consumption.”

Among the “second-hand harms” cited are increases in assaults, gender-based violence, vandalism and impaired driving. The report also cites an increased risk of drowning and potentially marring the enjoyment of others (including families) sharing public spaces and the higher risk of COVID-19 transmission.

Even before the COVID and the liberalization of liquor laws, the institute noted that B.C. consumption was already higher than the national average, steadily rising since 2013 along with the public costs.

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Those costs are substantial. There is a causal link between alcohol use and 200 types of chronic diseases and acute injuries.

The institute estimated the 2017 economic cost in B.C. of alcohol was $2.38 billion, or $483.10 per capita, surpassing tobacco ($277.80) and opioids ($257.04).

Coincidentally, on Tuesday when institute research was released, the Globe and Mail reported that later this week the B.C. government will be expanding its unprecedented experiment with providing pharmaceutical alternatives as replacements for street drugs.

The program was originally aimed at supporting people with addictions physically distance, self-isolate or quarantine in order to prevent the spread of COVID-19.

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Now, with widespread vaccinations and the reopening of the economy, British Columbia will require all health authorities and their clinicians to provide pharmaceutical grade opioids (including fentanyl), stimulants and other addictive substances to illicit drug users.

Out of hospital drug costs will be paid by Pharmacare, the provincial drug plan.

The expansion is coming even though the number of overdose deaths has continued to rise and is on track to hit a record this year.

But that’s no reason to stop, according to the draft update to the B.C. Centre on Substance Use’s safe-supply guidelines.

“The risk of overdose remains high due to the contaminated drug supply,” says the draft document. “(And) it may be appropriate to continue this prescribing for patients who have shown clear indication of benefit.”

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For evidence, the draft notes that it’s “challenging” to compare mortality rates to opioid-user-only data because safe-supply data mixes opioids, stimulants and alcohol.

Between March 27, 2020 and Feb. 28, 2021, there were 6,498 people in the program including 1,431 who were given alcohol withdrawal medication and 3,771 who were given opioid alternatives.

Of the 82 people in the program who died, the cause of death for 37 was not available “because of a delay in vital statistics data.”

Among the findings was that the urine samples of “many” who were prescribed oral hydromorphone (a narcotic) were laced with fentanyl, suggesting that those “many” were at very least topping up their safe supply with illicit drugs.

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According to the Globe and Mail, the final report notes that “health system partners” expressed “significant reservations” about the approach because their training does not include prescribing potentially fatal substances for other than their medically regulated use.

Still, the document’s unnamed authors concluded, “We recognize that we have been unable to address all concerns, but we also recognize that we have to start somewhere.”

Meantime, Addictions Minister Sheila Malcolmson is still sitting on an evidence-based proposal that would provide housing, addiction and mental health treatment for 1,500 people and whose $37-million cost would be offset by the reduction in hospitalizations and interactions with the police.

Following the evidence worked with COVID. So, maybe with these other longer term and wickedly expensive problems, politicians should give it a try — even if drinking wine and beer from glasses rather than paper bags in parks seems like a good idea.

dbramham@postmedia.com

Twitter: @bramham_daphne

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4Jul

Daphne Bramham: Time for radical change as overdose deaths, involuntary hospitalizations soar

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Opinion: Overdose deaths and involuntary hospitalizations are soaring. Evidence indicates that independent, recovery-based housing is a solution.

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For nearly a month, David Eby and Sheila Malcolmson have had a 27-page proposal on their desks that could radically alter how homelessness, drug addictions and mental health are addressed.

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While the proposal with its Sept. 1 implementation date has been sitting there, the cabinet ministers have made dozens of announcements similar to what’s been done for close to five years. More group housing. More congregated services.

They’ve expressed the usual condolences and regret at the most recent overdose-death numbers — 851 deaths in the first five months of this year already — that has 2021 on-pace to be the worst year ever.

In response to that, they and others have renewed calls for decriminalization — which has essentially been in place in Vancouver for most of the last decade — and more free drugs, a so-called ‘safe supply’ that goes beyond what’s normally prescribed to stabilize users and quell cravings.

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Even with a few dips along the way, the number of deaths have inexorably risen over the past two decades when Vancouver first acknowledged the burgeoning problem with illicit drugs in the Downtown Eastside, and over the past five years since a provincewide public-health emergency was declared.

And, so far, silence on the proposal that has been talked about for close to a year by people including former NDP premier Mike Harcourt, Bill MacEwan, the former head of psychiatry at St. Paul’s Hospital, Simon Fraser University researchers and some non-profit groups.

Based on more than 100 peer-reviewed publications and reports, recommendations of the Truth and Reconciliation Commission and guidance from Indigenous people with lived experiences, SFU psychologist Julian Somers et al insists that there’s a better — and, yes, a cheaper way.

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The $37 million proposal is for three years and would affect the lives of 1,500 people across B.C. who are the most deeply entrenched homeless, addicted and mentally ill.

It’s rooted in research that Somers was involved with nearly a decade ago — the federal government’s $110-million, At Home/Chez Soi project, which involved 2,000 people across Canada in the largest, randomized trial in history to evaluate solutions for homelessness.

Subsequent randomized trials done by SFU researchers supported the findings that people able to live in independent, recovery-oriented housing resulted in a 71 per cent drop in crime, a 50 per cent decrease in their hospital use and improved quality of life and community well-being.

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For context, here’s what the group’s research on the current situation shows:

• There are more than 2,200 British Columbians with mental illness as well as addiction, who over a five-year period average 4.9 hospital admissions, 4.2 court-ordered sentences to custody and 4.4 sentences to community supervision.

• Over 80 per cent of those living in The Downtown Eastside moved there from somewhere outside the Vancouver area.

• Between 2010 and 2017, involuntary hospitalization rose by roughly 50 per cent.

• They are eligible to receive $19,155 in shelter payments and $36,258 in income support.

A five-year study in Vancouver of 107 people with concurrent addictions and mental illness found that they spent an average of 59 days in hospital, received income assistance for 48 of 60 possible months, had 19 criminal convictions, spent 590 days in custody and another 631 days under community supervision.

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So what is independent, recovery-based housing?

It starts with listening to what people need, what they want and what they hope for. It includes asking them where they want to live and, again, research suggests that it’s not the Downtown Eastside, modular housing or an SRO.

A 2020 Vancouver survey found that 84 per cent would prefer to live somewhere else, away from others with similar problems. And before you NIMBY up, consider that the At Home study placed people in regular apartment buildings around the city, provided the necessary supports and recorded no problems or complaints from the neighbours.

Once clients have set their goals, they’re provided with the appropriate psycho-, social and medical services to begin the journey toward improved well-being, health, and meaningful social inclusion.

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Harm reduction will be part of it. For some, opioid replacement therapy may become a permanent part of their lives, while others may choose abstinence.

If they’re able and willing, employment services would be part of it. One international study cited found that between 70 and 90 per cent of people with mental illness and addictions want to work.

In some ways, there’s nothing really radical about this plan. It’s exactly what happens when pilots, physicians, public servants and politicians are identified as having substance-use problems.

With money available from their employee benefits plans, they’re whisked off to psychologists or counsellors for assessments, residential treatment if required, and then months, if not years, of followup counselling and treatment.

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But what happens to the poorest and most vulnerable is that they’re revived with naloxone, patched up in hospital, dealt with in the courts and then sent back to the streets or being warehoused and ghettoized in rundown hotels and social housing that provide few of the supports that they need.

The evidence points to potentially millions of dollars in public savings offsetting any additional costs if we revised our assumptions that only the wealthy, the powerful or those with employee benefit plans are able to get better or at least deserving of the opportunity to try.

The only mystery is why governments haven’t followed the science before and why they’re still slow to do it now.

dbramham@postmedia.com

twitter:@bramham_daphne

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3Jul

COVID-19 update for July 3-4: Fraser Health to set up vaccine clinics at popular beaches | 84 cases, two deaths | Outbreak over at Minoru Residence

by admin

Here’s your daily update with everything you need to know on the novel coronavirus situation in B.C.

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Here’s your daily update with everything you need to know on the novel coronavirus situation in B.C. for July 3-4, 2021.

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We’ll provide summaries of what’s going on in B.C. right here so you can get the latest news at a glance. This page will be updated regularly throughout the day, with developments added as they happen.

Check back here for more updates throughout the day. You can also get the latest COVID-19 news delivered to your inbox weeknights at 7 p.m. by subscribing to our newsletter here.


B.C.’S COVID-19 CASE NUMBERS

As of the latest figures given on July 2:
• Total number of confirmed cases: 147,705 (729 active cases)
• New cases since June 30: 84
• Total deaths: 1,756 (two new deaths)
• Hospitalized cases: 99
• Intensive care: 30
• Total vaccinations: 5,124,693 doses administered; 1,526,711 second doses
• Recovered from acute infection: 145,200
• Long-term care and assisted-living homes, and acute care facilities currently affected: 8

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IN-DEPTH:COVID-19: Here are all the B.C. cases of the novel coronavirus


B.C. GUIDES AND LINKS

COVID-19: Here’s everything you need to know about the novel coronavirus

COVID-19: Here’s how to get your vaccination shot in B.C.

COVID-19: Look up your neighbourhood in our interactive map of case and vaccination rates in B.C.

COVID-19: Afraid of needles? Here’s how to overcome your fear and get vaccinated

COVID-19: Five things to know about the P1 variant spreading in B.C.

COVID-19: Here are all the B.C. cases of the novel coronavirus in 2021

COVID-19: Have you been exposed? Here are all B.C. public health alerts

COVID-19 at B.C. schools: Here are the school district exposure alerts

COVID-19: Avoid these hand sanitizers that are recalled in Canada

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COVID-19: Here’s where to get tested in Metro Vancouver

B.C. COVID-19 Symptom Self-Assessment Tool


LATEST NEWS on COVID-19 in B.C.

5 a.m. – Fraser Health to set up vaccine clinics at popular beaches this week

Starting this week, Fraser Health will set up COVID-19 immunization clinics at two popular local beaches for people 12 years and older who still need to be immunized.

Fraser Health says Crescent Beach in South Surrey and the main beach at Cultus Lake in the east Fraser Valley are popular destinations during the summer months.

The Crescent Beach clinic will start on Tuesday and the Cultus Lake one will start on Friday at Main Beach. Both will be open from 10 a.m. to 4 p.m.

The beach-side clinics aim to meet people where they are, or will be, congregating during the summer season.

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Those attending the beach-side immunization clinics are reminded to take precautions from the heat including wearing sunscreen, staying hydrated, and having something to eat and drink before your appointment.

12 a.m. – Vancouver Coastal says outbreak at Minoru Residence is over

Another care home outbreak was declared over Friday.

Vancouver Coastal Health has declared the COVID-19 outbreak over at Minoru Residence in Richmond.

Three residents tested positive for COVID-19 during the outbreak but there were no deaths among staff or residents.

The home is open to new admissions and transfers and is working to resume all group activities and visitation, said VCH.

12 a.m. – 84 new cases since June 30 and two deaths recorded

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The province recorded a total of 84 new cases of COVID-19, including 49 new cases from June 30 to July 1 and 35 new cases Friday.

There were two new COVID-19 related deaths in B.C. bringing  the total to 1,756 deaths so far.

There is a new outbreak recorded at Royal Inland Hospital in the Interior Health. The outbreak at Glenwood Seniors Community in the Fraser Health region is over.

The province has vaccinated 78.7 per cent of all adults in B.C. and 77.5 per cent of those 12 and older with their first dose of a COVID-19 vaccine. Additionally, 35.2 per cent of all adults in B.C. and 32.9 per cent of those 12 and older have received their second dose.


B.C. MAP OF WEEKLY COVID CASE COUNTS, VACCINATION RATES

Find out how your neighbourhood is doing in the battle against COVID-19 with the latest number of new cases, positivity rates, and vaccination rates:

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B.C. VACCINE TRACKER



LOCAL RESOURCES for COVID-19 information

Here are a number of information and landing pages for COVID-19 from various health and government agencies.

B.C. COVID-19 Symptom Self-Assessment Tool

Vancouver Coastal Health – Information on Coronavirus Disease (COVID-19)

HealthLink B.C. – Coronavirus (COVID-19) information page

B.C. Centre for Disease Control – Novel coronavirus (COVID-19)

Government of Canada – Coronavirus disease (COVID-19): Outbreak update

World Health Organization – Coronavirus disease (COVID-19) outbreak

–with files from The Canadian Press

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Postmedia is committed to maintaining a lively but civil forum for discussion and encourage all readers to share their views on our articles. Comments may take up to an hour for moderation before appearing on the site. We ask you to keep your comments relevant and respectful. We have enabled email notifications—you will now receive an email if you receive a reply to your comment, there is an update to a comment thread you follow or if a user you follow comments. Visit our Community Guidelines for more information and details on how to adjust your email settings.

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