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Forbes
3 days ago
- Health
- Forbes
2 Lies A Person With An Addiction Tells Themselves, By A Psychologist
Millions of people struggle with addiction every day. But some people struggle in silence because ... More these mental defenses keep them from accepting the truth. Living a life with addiction is like living in a prison. Many people in recovery from a long-term addiction will often speak of how freeing it feels not to have a substance controlling everything you do. Unfortunately, many people struggle to accept that they have a problem in the first place, delaying their recovery. A 2015 study published in Drug and Alcohol Dependence shows that denial can be the biggest barrier to sobriety or abstinence. Researchers highlight that despite how much addiction can lower your quality of life, it's common for people to deny having a problem — even though its effect on their lives is quite evident to everyone else. One reason for this is that many people view addiction through a stereotypical lens. Popular media has taught us to 'spot' a person with an addiction through the way they look, act or their lack of a functioning, socially acceptable lifestyle. According to an article by the National Institute on Drug Abuse, addiction is a 'chronic, relapsing disorder characterized by compulsive drug seeking and use despite adverse consequences.' These symptoms are not limited to drugs alone — they can apply to food, sex or even social media. Even though it's one of the most detrimental reasons, denying you have an addiction is not the only thing keeping you tied to your substance of choice. People with addictions tell themselves many things to make sure they never have to lose what they depend on most, and so they don't alarm those around them. Here are two lies that keep people with addictions trapped in harmful cycles of behavior. Unfortunately, most people will only believe they have a problem when they see the direct effects an addiction is having on their lives. If you are still making it to work appointments or making it in time to pick up the kids from school, it can be hard to see the impact your substance of choice has on your day-to-day life. A 'high-functioning' person with an addiction refers to someone who can maintain work, relationships and other responsibilities while still falling victim to their addictions. This perception of functionality makes them less likely to get help. According to a 2014 article in the Canadian Medical Association Journal (CMAJ), such individuals are at higher risk of being impacted by their addiction as people around them often do not intervene, likely because they do not recognize the issue at first. Dr. Steven Melemis, who specializes in addiction, tells CMAJ, 'The job is always the last thing that goes. A (person with an addiction) knows you need your job first and foremost to continue with your addiction.'a In such situations, rather than solely considering one's quality of life to understand the impact of addiction, it's important to reflect on your relationship to a particular substance. Are you unable to go one day without using it? Have you tried and failed in the past to put your addiction behind you? Do you have to work hard to fit your life around your addiction? These all could be signs that you may appear high-functioning, but are still someone that requires help. Hiding it better doesn't make it go away; it only delays the inevitable. Have you ever side-eyed the 10 am drinker even after you finished two bottles of wine the night before? Or perhaps you thanked your stars that you're not like that person at the party who gets blackout drunk everytime. Many people with addictions will compare themselves to others to prove that they're doing fine. However, just because you manage to control your impulses in specific situations or might even use substances from a place of privilege, it does not mean you aren't struggling with addiction. Addiction takes on various forms and can look different for different people. A 2024 survey from reports that at least 22% of 9-5 workers admit to using drugs or alcohol in the workplace. The survey also found that 16% of employees have noticed that one or more of their co-workers use illegal drugs or alcohol at work. However, these people are often dismissed as 'heavy drinkers,' or 'recreational users.' As long as they are contributing members of society, many people struggle to see themselves mirrored in the person with an addiction who has lost everything. This keeps them stuck in their own struggle. A 2011 study published in the International Journal of Environment Research and Public Health lists these behavioral patterns that can help identify if someone has an addiction: Admitting you have an addiction is never easy. Many people with addictions struggle with feelings of shame, feeling as though they have somehow failed in life or would be a burden if they asked for help. While the road to recovery is not linear, it's only possible through the acceptance of support and learning to have self-compassion. Self-awareness is a powerful first step to recovery, and it often starts with questioning our own mental defenses. Do you cope with life's challenges in healthy ways? Take this science-backed test to learn more: Coping Strategies Scale
Medscape
29-05-2025
- Business
- Medscape
Canada Targets PCPs With New Hypertension Guideline
Hypertension Canada has released a guideline that aims to enhance the standard of hypertension management in primary care settings with evidence-based, pragmatic, and easy-to-implement recommendations. The guidance is based on the World Health Organization's HEARTS framework to improve hypertension control and reduce cardiovascular burden. The previous guideline was published in 2020. 'For the 2025 guideline, a new approach was selected in view of the declining rates of hypertension control in Canada,' guideline committee co-chairs Rémi Goupil, MD, University of Montreal, and Gregory Hundemer, MD, McGill University, both in Montreal, told Medscape Medical News . 'The first step is this Primary Care Hypertension Canada guideline, which is tailored specifically to primary care providers, who manage 90% of people with hypertension.' Gregory Hundemer, MD The guideline, published online in the Canadian Medical Association Journal, was designed from inception with primary care in mind, and most members of the writing committee were primary care providers, they said. The target users are family physicians, nurse practitioners, nurses, and pharmacists, as well as policymakers and patients and caregivers affected by hypertension. 'The guideline provides pragmatic diagnostic and treatment algorithms, listing specific drugs, their dosage, and the sequence in which they should be prescribed,' they added. 'Patient voices were included in all steps of the process, and a patient-specific guideline is published alongside the primary care guideline.' Rémi Goupil, MD Key Recommendations The guideline committee made nine recommendations covering hypertension diagnosis and treatment. The most important recommendations , according to Goupil and Hundemer, are: 1. Defining hypertension as a blood pressure (BP) ≥ 130/80 mm Hg, provided it is confirmed with an out-of-office BP assessment. 'Lowering of the hypertension diagnosis threshold will significantly increase the number of people labeled with hypertension in Canada, although only a small fraction is expected to require pharmacotherapy initiation,' they said. 'This new threshold reflects the growing evidence regarding the cardiovascular risk reduction associated with lower blood pressure levels.' All adults with hypertension should initiate treatment (healthy lifestyle changes with or without pharmacotherapy) to target a systolic BP < 130 mm Hg. Start with low-dose combination therapy (ideally as a single pill combination) when pharmacotherapy initiation is needed. Specifically, this includes drugs from two of the following three complementary classes of medications: Angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs), thiazide or thiazide-like diuretics, and long–acting dihydropyridine calcium channel blockers (CCBs). Other recommendations include: Healthy lifestyle changes for all adults with hypertension. Pharmacotherapy initiation for hypertension for adults with BP ≥ 140/90 mm Hg and for adults with systolic BP 130-139 mm Hg at high cardiovascular disease risk. If BP remains above the target despite the recommended two-drug combination therapy, three-drug combination therapy consisting of an ACEI or ARB, a thiazide or thiazide-like diuretic, and a long–acting dihydropyridine CCB is recommended. If BP remains above target despite three-drug combination therapy at maximally tolerated doses, the addition of spironolactone is recommended. 'This guideline is only the first step in Hypertension Canada's approach,' Goupil and Hundemer said. 'The next step is the comprehensive guideline, in which specific topics will be evaluated in-depth to provide recommendations for more specific situations, such as the optimal management of hypertension in diabetes or in resistant hypertension.' The comprehensive guideline is expected in 2026. HEARTS to Boost Implementation Canadian Cardiovascular Society spokesperson Sheldon Tobe, MD, professor of medicine at the University of Toronto and Northern Ontario School of Medicine, Toronto, commented on the guideline for Medscape Medical News . Sheldon Tobe, MD 'We have evidence that Canada's position of best blood pressure awareness, treatment, and control in the world has been slipping, and that was before the pandemic,' he said. 'One of the reasons is loss of support for dissemination and implementation by the Public Health Agency of Canada more than a decade ago. The promotion of the HEARTS framework will help to bring policymakers into the implementation of blood pressure control again. The simplified approach to one BP target will facilitate dissemination efforts as well.' A concern, however, is the small number of people involved in creating the guideline. 'In the past, a very large part of the hypertension community was involved, which ensured that there was widespread agreement with the process and results,' said Tobe, who was not involved in developing the guideline. 'This included the interprofessional community of nurses and dietitians, in addition to pharmacists and doctors. If the HEARTS framework is formally adopted by Canada, this will be very helpful.' Regarding specific recommendations, he said, 'The guideline has suggested that the preferred initial combination therapy will be irbesartan and hydrochlorothiazide, including splitting the pill, which strays off-label. This might be off-putting to some Canadians who don't realize that almost all of our antihypertensives are now generic and are fairly inexpensive.' Furthermore, he said, 'I was disappointed that the issue of drug shortages, which have greatly impacted blood pressure management in Canada recently, was not mentioned in more detail. There does not seem to be any focus by policymakers on a sustainable supply for these lifesaving medications.' The funding for this initiative was provided by Hypertension Canada. Goupil reported receiving research grants from the Canadian Institutes of Health Research (CIHR), the Kidney Foundation of Canada, Fonds de recherche du Québec — Santé, and Université de Montréal, as well as holding unpaid positions as a board member of the Canadian Society of Nephrology and vice president of the Société québécoise d'hypertension artérielle. Hundemer reported receiving research grants from the CIHR, the Kidney Foundation of Canada, and The Ottawa Hospital Academic Medical Organization, and is the Lorna Jocelyn Wood Chair for Kidney Research at The Ottawa Hospital Research Institute. Tobe reported receiving honoraria for lectures and payments to support accredited continuing medical education programs from AstraZeneca, Bayer, Boehringer Ingelheim, CHEP+, Eisai, GSK, Janssen Pharmaceuticals, KMH, Novo Nordisk, and Otsuka. He also reported participation in a living kidney donor safety study sponsored by the CIHR, serving as a volunteer board member for the American Hypertension Specialist Certification Program, a volunteer co-chair for C-Change, and serving as physician organization chair of the implementation arm of C-Change for CHEP+.
Global News
21-05-2025
- Health
- Global News
The secret to faster hip and knee surgeries? Fixing referrals, study says
About one in three Canadians needing a new hip or knee are waiting longer than they should, but instead of turning to private clinics, researchers say a more centralized referral system could help fix the backlog. A study published Tuesday in the Canadian Medical Association Journal (CMAJ) found that organizing referrals and surgeries through a coordinated, team-based approach could help with long wait times for hip and knee replacements. 'Canada performs poorly for access to scheduled surgery … access to care is a weakness in the Canadian health system, this has really been the Achilles heel of the Canadian health system,' said Dr. David Urbich, study author and head of the department of surgery at Women's College Hospital in Toronto. 'But the good news is, there are very good solutions. They're not difficult. They are not expensive.' Story continues below advertisement 2:24 Health Matters: Long wait times for surgery, treatment costing Canadians Reducing wait times for hip and knee replacement surgeries could be as simple as reorganizing how patients are referred to surgeons — no need for extra operating rooms, more surgeons or additional funding, the study argued. In Canada, the benchmark wait time for hip and knee replacement surgery is 182 days — six months. According to the latest data from the Canadian Institute for Health Information, around 66 per cent of patients get their surgery within that window. But that still leaves a third waiting longer. The numbers are even lower for knee replacements, with just 59 per cent getting the procedure within six months. Get weekly health news Receive the latest medical news and health information delivered to you every Sunday. Sign up for weekly health newsletter Sign Up By providing your email address, you have read and agree to Global News' Terms and Conditions and Privacy Policy To address this issue, some Canadian provinces have been experimenting with private for-profit delivery of some surgeries to help ease wait times. Story continues below advertisement However, this study proposes creating a central list, saying it could impact wait times more effectively. How to cut down on wait times For many Canadians, the process of getting a knee or hip surgery starts with a 'direct physician-to-physician referral,' Urbich explained. That means a family doctor refers the patient to a specialist — but they might not know if it's the right one or even the next available one. Most surgeons work as independent practitioners, managing their own waitlists for consultations and surgeries. Once a surgeon takes on a patient for a procedure, they typically don't share care with other surgeons, according to the study. To see if there's a better way to tackle long wait times, the researchers looked into a few different intake models aimed at helping patients get seen faster. Story continues below advertisement Using data from Ontario, they broke things down into three models of care. 1:48 Albertan seeks surgery outside province amid long wait times The study focused on patients referred by a family doctor or general practitioner in 2017 for non-urgent hip or knee replacements. In total, the simulations were based on 17,465 surgeries performed on 17,132 patients, involving 7,783 referring doctors, 274 surgeons and 71 hospitals across five regions in Ontario. The models included: Single-entry referral model . This is when all patients' referrals in a region are pooled together and then directed to the next available surgeon for consultation, rather than being sent to specific surgeons individually. . This is when all patients' referrals in a region are pooled together and then directed to the next available surgeon for consultation, rather than being sent to specific surgeons individually. Team-based care model . After consultation, patients who need surgery enter a shared regional queue and are scheduled for surgery on the next available date with any surgeon in that region, instead of waiting for a specific surgeon. . After consultation, patients who need surgery enter a shared regional queue and are scheduled for surgery on the next available date with any surgeon in that region, instead of waiting for a specific surgeon. Fully integrated model. This combines both the single-entry referral and team-based care models. Patients are pooled into a single queue both for consultations and surgeries, and they see the next available surgeon for each step. Both team-based and fully integrated models had much larger effects on reducing wait times than the single-entry referral model, the study found. Story continues below advertisement 'The best model is when surgeons work together in teams and share the care of patients together and patients are referred to a team,' Urbich said. 'So they're seen by the next available surgeon for consultation. And then when it comes time to have surgery, they also have surgery by the next available surgeon.' 1:34 Surgery wait times in New Brunswick have increased, health council says That is what it takes to prevent anybody from waiting too long for a joint replacement surgery, he added. He also stressed that in these models, all surgeons are qualified and experts in the operations they do. 'Adoption of these models will require strong leadership among health-system leaders and the active participation of surgeons,' the study concluded. 'It will also require some investment in system infrastructure, instead of one-time investments to increase surgical volumes during times of crisis.'
Medscape
20-05-2025
- Health
- Medscape
Mixed Results for BC's Opioid Standard for Noncancer Pain
An opioid prescribing practice standard for chronic noncancer pain (CNCP) was associated with accelerated declines in opioid doses and high-dose prescribing in British Columbia (BC) but also with more aggressive and inappropriate dose tapering, a new analysis showed. In addition, the standard resulted in restricted access to opioids for patients who may have benefited from them. For some individuals, this restriction continues today, despite a subsequent update, experts said. Shifting Standards and Guidelines The practice standard 'Safe Prescribing of Drugs with Potential for Misuse/Diversion' was released by the College of Physicians and Surgeons of British Columbia in 2016, then revised in 2018 to clarify that clinicians should not use aggressive tapering or reduce access to opioids for patients with cancer or those receiving palliative care, according to the new analysis, which was published on May 12 in CMAJ. The 2016 standard, which was legally enforceable, was associated with the acceleration of preexisting declines in opioid prescriptions to patients with CNCP, as well as declines in high-dose prescribing. However, it also 'reflected the most worrisome recommendation by the US Centers for Disease Control and Prevention guideline,' which was published earlier [and has since been updated], Jason Busse, MD, professor of anesthesia at McMaster University in Hamilton, Ontario, told Medscape Medical News. Jason Busse, MD The 2016 standard recommended against increasing the dose of opioids to 90 morphine milligram equivalents or more per day for patients with CNCP but failed to clarify whether the recommendation pertained to new or legacy patients, said Busse. The result was that patients already on high doses risked being tapered aggressively to meet the new dose requirements. In addition, the standard 'seems to have limited access for populations that have historically benefited from opioids, including patients with cancer or those receiving palliative care,' study author Dimitra Panagiotoglou, MD, associate professor in the Department of Epidemiology, Biostatistics and Occupational Health at McGill University in Montreal, told Medscape Medical News. Dimitra Panagiotoglou, MD The study's findings 'demonstrate the ability of practice standards to modify physician behavior but also highlight how misinterpretation can harm patients,' Panagiotoglou added. In 2017, between the publication of the original practice standard and its subsequent update, the Canadian government released the 'Guideline for Opioids for Chronic Noncancer Pain.' The 2017 guideline was not legally enforceable and was more open to interpretation than the 2016 practice standard, however, and so the effects of the guideline on physician prescribing in BC 'appear to be small, if present at all,' the study authors noted. The 2018 practice standard update is legally enforceable. But because appropriate access to opioid medications remains limited even now, clinicians on Panagiotoglou's team and patients they've spoken with have 'mixed feelings' about the updated standard and the 2017 prescribing guideline. Furthermore, Busse said, 'There are now several recent guidelines for opioids and chronic pain that make different recommendations. Some recommend against use of opioids for CNCP under any circumstances, while others do not. Research is needed to understand why these discrepancies have arisen and to provide guidance on which recommendations are most trustworthy.' One step in that direction is an update to the 2017 guideline, he noted. A quick reference summary of the update is available now, and full recommendations are expected to be published next winter. 'Unlearning' the Past Why did BC health officials decide to address opioid prescribing in 2016? 'Today, there is an overall understanding that overprescribing can lead to opioid use disorder, but for a long time, that wasn't the case,' said Monty Ghosh, MD, an addiction physician and researcher and assistant professor at the University of Alberta, Edmonton, and the University of Calgary, Calgary. Monty Ghosh, MD 'The previous philosophy was that pain was the fifth vital sign, that we should be prescribing opioids freely for all types of pain, and that they didn't have addictive potential,' he told Medscape Medical News . 'That is all being undone right now.' In 2016, health officials saw higher than normal rates of drug poisonings and overdoses, spurring the declaration of an opioid 'crisis' in BC as well as in Alberta, Ghosh said. 'An alert went out to ensure that physicians were not fueling the crisis because at points in time, we were. That is when we started to see the gears change in terms of prescribing. Changes started trickling in before but really ramped up in 2017 to 2018.' Nevertheless, he noted, 'It's much harder to unlearn than it is to learn, and the standards and the guideline increased awareness of the potential harms.' Prescribing changed due to other practice modifications as well, he said. For example, in Alberta, prescribers now receive quarterly memos showing the amount of opioids they've prescribed and where they fit in the spectrum of prescribers. The memos show, for example, whether the prescriber is in the top or bottom 5% of prescribers. 'Those memos link to information on how to properly prescribe for patients with CNCP that are pretty much in keeping with the guideline and standard,' said Ghosh. Nonopioid Options If the goal is to reduce inappropriate opioid prescribing, then it's important to take advantage of nonopioid options, Busse said. But although opioids are a 'treatment of last resort' for CNCP, several nonopioid options are inaccessible for many patients with chronic pain because services are unavailable where they reside, out-of-pocket costs are high, or waiting lists are long. One potentially more accessible option is remote, therapist-guided cognitive-behavioral therapy, which seemed to be as effective as in-person therapy for chronic pain in a recent study by Busse's team. 'In addition, some emerging therapies for chronic pain, such as pain-reprocessing therapy, suggest large effects, and further high-quality trials are needed to confirm findings,' he said. Evidence-based preventive strategies for CNCP also should be incorporated into clinical practice, he added. For example, a recent study showed that a program of education and progressive walking effectively reduces recurrence of low back pain. Ghosh advised using as many adjunct interventions as possible when treating patients with CNCP. These interventions include physical therapy, proper sleep habits, and, if needed, treatment of concomitant depression and anxiety that can worsen pain perception. Potentially helpful medications could include acetaminophen, gabapentin, or selective serotonin reuptake inhibitors. 'We need to be maximizing those interventions before we start initiating, reducing, or tapering opioids,' he said. In a related commentary, Kiran Grant, MD, and colleagues at the University of British Columbia, Vancouver, pointed out that evidence-based treatments for chronic pain are often inaccessible for many people with a concurrent diagnosis of opioid use disorder. They suggest integrating chronic pain management into the care for these patients to reduce overdose rates and improve outcomes. 'Prescribe Diligently' When an opioid prescription is appropriate, Ghosh said, 'We should be prescribing it and making sure we do it diligently and that we really deal with the patient's pain. Importantly, people who have a substance use disorder should not be prevented from accessing pain medications if they're in acute pain. In fact, they should be worked with to make sure we're not underprescribing for the acute pain because we're worried about feeding their substance use. 'We need to prescribe higher amounts of pain medications to treat their acute pain: For example, if they've pulled a muscle or if they've been in a motor vehicle accident and sustained a fractured rib,' he said. 'That prescribing should trend down over time as their pain resolves, and we wean them from the extra opioids.' 'We know that the evidence for chronic pain management for all patients is limited and that opioid use can be detrimental,' he said. 'So, when we decide to prescribe, we need to be careful, and we need to do it appropriately.' The study was supported by a Canadian Institutes of Health Research Project grant. Panagiotoglou, who holds a Tier 2 Canada Research Chair in the Economics of Harm Reduction, declared having no relevant financial relationships. Ghosh cofounded Canada's National Overdose Response Service, belongs to the Canadian Society of Addiction Medicine, and reported having no relevant financial relationships. Busse holds government grants to study opioids and chronic pain, including for the update of the opioid guideline, and he is on a funded grant with Panagiotoglou to study the spillover effects of opioid guidelines but reported having no relevant financial relationships.
Yahoo
14-05-2025
- Health
- Yahoo
B.C. opioid rules were to reduce overdoses. But they cut cancer patients' pain meds
Rule changes designed to reduce opioid overdose deaths in British Columbia in 2016 inadvertently harmed cancer and palliative-care patients by reducing their access to pain killers, a new study has found. The study published this week in the Canadian Medical Association Journal describes the impact of a practice standard issued by the College of Physicians and Surgeons of B.C. that June, about two months after the province declared a public health emergency over opioid deaths. The rule changes were designed to mitigate prescription drug misuse, including the over-prescribing of opioids among patients with chronic non-cancer related pain. The rules weren't meant for cancer and palliative-care patients, but lead author Dimitra Panagiotoglou said there was a "spillover" effect as doctors applied "aggressive tapering" of the painkillers. "(With) the ongoing messages that physicians were getting at the time — opioids being bad — individuals decided to pull back on their prescribing, but there was this larger population-level effect in doing so," she said. "We focus on these two groups because far and wide, it's considered completely acceptable to prescribe opioids for these groups and the concerns around opioids are very different," she said of cancer and palliative-care patients. There were already downward trends in opioid prescriptions for people with chronic non-cancer pain and those receiving palliative care, Panagiotoglou said, and the study shows that trend continued after the change. But among cancer patients, there was a surprising "nose dive" in access to opioids right after the release of the new standard, said Panagiotoglou, who is an associate professor in the department of epidemiology, biostatistics and occupational health at McGill University. The rules were legally enforceable, and physicians found non-compliant could be disciplined or fined under the Health Professions Act and College of Physicians and Surgeons of BC bylaws. The rules were revised in 2018 to address concerns that they were being misinterpreted. The changes in 2016 set a recommended dose ceiling at 90 morphine milligram equivalents or less per day and used "strong language" around co-prescribing with benzodiazepines given the drug poisoning risk, Panagiotoglou said. Among cancer patients, the study found opioid dispensations were 15 per cent lower per person than expected two years after the implementation of the 2016 rules. Over 30 days, that translates to 4.5 fewer days of supply, it says. For people receiving palliative care, the per-person dosage was 6.1 per cent lower, translating to 1.8 fewer days' supply, the study says, while for patients with chronic non-cancer pain — the target population of the rules — dispensations were 8.2 per cent lower. "Over time, people were seeing a meaningful decline in their doses and in the days supplied," Panagiotoglou said of the period between the implementation of the 2016 practice standard and its revision in 2018. The study did not include opioids dispensed in hospitals or long-term care facilities, rather for prescriptions for people living at home. The study says the changes led doctors to increase "aggressive tapering" of patients' medication. Panagiotoglou said evidence suggests this can lead to pain and increase in overdose risk by pushing people toward illicit opioids. The B.C. college revised its standard in 2018 in response to concerns that misinterpretation was leading to "more conservative prescribing to all patients," not just those with chronic non-cancer pain, the study says. "When the language relaxed and ceiling thresholds were removed, for example, there's this rebound effect where you see, in fact, the amount being prescribed kind of stabilizes or inflects upwards," Panagiotoglou said. The study concludes that its findings show how practice standards can modify physician behaviour, but also highlight "how misinterpretation can harm patients." Panagiotoglou said the findings underscore the potential for "unintended consequences" of sweeping changes to practice standards. Physicians must be careful prescribing opioids, she said, especially given the underlying context of the toxic drug crisis that has claimed more than 16,000 lives in B.C. since the health emergency was declared in 2016. But Panagiotoglou said it's important to include a diversity of voices at the decision-making table, such as patient-care advocacy groups. The College of Physicians and Surgeons of B.C. said in an email it could not comment on the study because it was not directly involved in the research. But it said the 2016 practice standard was informed by the "best available guidance at the time," and it has since been "revised substantially." "In the 2016 practice standard, (the college) was explicit in acknowledging and endorsing the use of aggressive pharmacotherapy in the context of active cancer, palliative, and end-of-life care," it said in the statement. This report by The Canadian Press was first published May 14, 2025. Brenna Owen, The Canadian Press Error in retrieving data Sign in to access your portfolio Error in retrieving data Error in retrieving data Error in retrieving data Error in retrieving data
