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Alberta’s opioid public health crisis
April 2017. Written by Erika Roy, APHA SCiP Intern
In Alberta and across much of the rest of the country, opioids fentanyl and carfentanil are causing a rapidly increasing number of deaths. In Alberta in 2016, 343 individuals died from an apparent drug overdose related to fentanyl. For comparison, in 2015, there were 257 fentanyl-related deaths.
Fentanyl and carfentanil are powerful synthetic opioid analgesics. Fentanyl exists both as a prescription drug and in illicit form. Illicit fentanyl is highly potent. It is often diluted with substances such as powdered sugar before it is sold or consumed. It is also mixed into other drugs, and sold under street names such as China white, China girl, and Apache. Fentanyl can be severely harmful or fatal, with death usually caused by respiratory failure. Carfentanil is a much more powerful analog of fentanyl. Drowsiness, difficulty breathing, and slowed heartbeat are symptomatic of a fentanyl overdose. A dose of fentanyl the size of a seed is enough to cause an overdose.
In the face of the fentanyl crisis, harm reduction measures have a capacity to help save lives. For instance, naloxone is an antidote to opioid overdoses. It can block or reverse the effects of opioid drugs such as fentanyl. Naloxone injections can be used to treat fentanyl overdoses in emergency situations, and can provide vital extra minutes before emergency medical care arrives. Naloxone has been on the World Health Organization’s list of essential medications since 1983. It is available under the brand name Narcan and in several generic forms.
On March 22, 2016, Health Canada amended the Prescription Drug List (PDL) to exempt from prescription status the emergency use of naloxone outside hospital settings for opioid overdose. As a result, naloxone is now an unscheduled drug, meaning that Albertans can obtain it without a prescription. It can be obtained free of charge from all sites registered with the Alberta Health Services (AHS) Take Home Naloxone program. This may help to combat the crisis posed by the fentanyl.
Alberta has recently expanded its naloxone program. For instance, Alberta now allows firefighters to administer injectable naloxone, and is providing injectable naloxone kits as an addition to fire apparatus, which increases live-saving potential in the event that firefighters respond to an overdose call. Making naloxone more widely available to individuals and organizations, especially those in high risk environments, also has live-saving potential.
Naloxone alone is not enough to combat the fentanyl crisis—opioid dependency treatment measures are needed as well. The Alberta government is moving ahead with the opening of an opioid dependency treatment clinic in Grande Prairie. Recently, opposition MLAs in Alberta have called upon the government to open more addiction treatment beds and offer more access to outpatient services.
The Alberta government is also moving ahead on other measures to counter the opioid crisis, including the provision of grant funding to agencies in several communities working to establish supervised consumption services. Alberta has not to date declared a public health emergency.
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Uncomfortable trade-offs: Canadian policy makers’ perspectives on setting objectives for their health systems
A recent study explored health policy makers’ views regarding the objectives and outcomes for their health systems, how they are prioritized, and the underlying processes that yield them to inform the development of health system efficiency measures.
The study found that:
A multi-site, multi-study investigation of prescribing patterns among American physicians is revealing widescale overuse and misuse of antibiotics.
The revelations carry “powerful” implications for Canadian physicians as well, says Edmonton-based Dr. Lynora Saxinger, chair of the Antimicrobial Stewardship and Resistance Committee of the Association of Medical Microbiology Infectious Disease Canada. “Our overall prescribing pattern in Canada is fairly similar.”
Initial study findings, published in May 2016 in the Journal of the American Medical Association(JAMA), showed upwards of 30% of prescriptions written by US doctors for all indications during 2010-11 may have been inappropriate. For example, half of prescriptions for acute respiratory conditions — 110 million — may not have been needed.
About a third of Canadian adults being treated for asthma don’t actually have the disorder, either because they have been misdiagnosed or have gone into remission, a study suggests.
Asthma is a chronic inflammation of the airways that causes shortness of breath, wheezing and coughing.
The condition, which is thought to affect about three million Canadians, can be sparked by a reaction to such allergens as dust, mould and pet dander, by sensitivities to paint fumes and tobacco smoke, and even exposure to cold or hot, humid air.
In a study of 613 adults with asthma led by the Ottawa Hospital Research Institute, doctors found 203 of the participants were being unnecessarily treated because they didn’t have the disorder.
Canada has been fighting a war on obesity for decades. Yet obesity now affects four in 10 of us, often leading to serious complications such as heart disease, stroke and diabetes.
Perhaps that’s because we’ve been targeting the wrong enemy.
Until recently, efforts were focused on fat intake, but research is now pointing to excessive sugar as one of the main culprits. Recent revelations show this misinformation was intentional, with the sugar industry putting forth significant, long-term efforts to hide this connection that are reminiscent of the tobacco industry’s efforts to deny the health impacts of smoking.
Refined sugars are in most of the food we eat—soda, cereals, canned soup, and fast food just to name a few. Sugar-sweetened beverages such as pop, fruit drinks, sports drinks and the like are particularly damaging, as they have minimal nutritional value and, despite the calories, don’t quench an appetite. Drinking just one sugar-sweetened beverage a day has been linked to increased weight gain, a 20 percent increase in the risk of heart disease and a 26 percent increase in the risk of diabetes.
An eye-opening report published this year in JAMA Internal Medicine revealed that as early as 1954, the Sugar Research Foundation—a lobby group for the sugar industry—targeted researchers studying the links between sugar, fat, and health. It paid researchers to produce reviews in prestigious medical journals. Those reviews downplayed sugar’s contributions to obesity, while not disclosing the Sugar Research Foundation as a funder or participant. The goal, ostensibly, was to overstate the role of fat and exonerate sugar as a cause of obesity and related diseases.