Latest news with #opioidCrisis
National Post
a day ago
- Health
- National Post
Derek Finkle: Pro-drug injection site activists were dangerously wrong on closures
'A lot more people are going to die.' Article content This was the dire prediction oft-repeated back in March by a busload of lawyers who supported a legal challenge filed by an injection site in Toronto that claimed recent Ontario legislation forcing the closure of sites within 200 metres of schools and daycare facilities violates the Charter rights of drug users. Article content The two expert witnesses for that site, in the Kensington neighbourhood of Toronto, are employed by the MAP Centre for Urban Health Solutions, a hospital-run research centre. MAP had played a key role in the establishment of the city's first injection sites in 2017. Dr. Ahmed Bayoumi and Dr. Dan Werb both submitted evidence that overdose deaths in Toronto would increase sharply if half of the city's ten injection sites closed at the end of March because of the legislation. Article content Fred Fischer, a lawyer representing Toronto's Board of Health, one of the intervenor groups in the case, also told Justice John Callaghan of the Ontario Superior Court that reducing harm reduction services in Toronto during the ongoing opioid crisis would have severe consequences — more people will overdose and die. Article content Article content A lawyer for another intervenor, a harm reduction coalition, put an even finer point on it. He said that one of the Toronto injection sites not affected by the legislation was anticipating such an immediate and overwhelming increase in overdose deaths in April, after the closures, that the site was in the process of hiring grief counsellors for its staff. Article content More than two months have passed since then, and now that we're in June, you might be wondering: How many more people ended up dying because of the closure of these sites? Article content According to data that's compiled by Toronto Paramedic Services and Toronto Public Health, the answer, so far, is none. In fact, the number of overdoses in Toronto for the month of April, the first month after the sites had closed, dropped notably. Article content Article content Toronto had 13 fatal overdose calls in April, one less than in March, when the now-closed injection sites were still open. Thirteen is less than half the number of fatal overdoses across the city in April of last year, and significantly below the monthly average for all of 2024 (19). Article content Article content Thirteen fatal overdoses are far lower than the average monthly number during the period of Covid-19 emergency between April 2020 and May 2023 (25). The last time 13 was the norm for monthly fatal overdoses was prior to the pandemic. Article content The number of calls for non-fatal overdoses in April was 161. This may sound like a lot but it's the lowest monthly total so far this year in Toronto. And 161 non-fatal overdoses are 55 per cent less than the 359 that occurred in April of 2024. Article content Remarkably, in the third week of April, there were zero fatal overdose calls, something that hasn't happened in Toronto in months.
Medscape
7 days ago
- Health
- Medscape
Rapid Review Quiz: Postoperative Pain Management
Postoperative pain remains a significant concern for surgical patients, with implications that extend beyond immediate discomfort and influence recovery trajectories, patient satisfaction, and long-term outcomes. Effective pain control is not just a matter of comfort — it's a clinical imperative. Yet, this goal must be pursued judiciously, as the overreliance on opioids carries well-documented risks of adverse effects and dependence. The landscape of pain management is evolving. While pharmacologic strategies such as opioids, nonsteroidal anti-inflammatory drugs, n-methyl-d-aspartate (NMDA) receptor antagonists, and regional anesthesia continue to play pivotal roles, their limitations have catalyzed a shift toward a more integrative, multimodal approach. Emerging evidence supports the use of non-pharmacological interventions — ranging from preoperative patient education to mind-body techniques and physical therapy — as effective complements that can reduce pain intensity, curb opioid use, and enhance functional recovery. Recent clinical guideline updates for managing postoperative pain emphasize increased use of non-opioid treatments and multimodal strategies. This reflects growing recognition that while opioids are effective, they pose risks such as dependence and adverse side effects. Nonpharmacological and non-opioid interventions such as nonsteroidal anti-inflammatory drugs, NMDA receptor antagonists like ketamine, peripheral nerve blocks, and techniques like transcutaneous electrical nerve stimulation have been shown to reduce opioid use, improve pain control, and enhance recovery outcomes, especially when healthcare professionals are adequately trained to apply them. Randomized controlled trials support the efficacy of peripheral nerve stimulation for postsurgical pain, and evidence for this and other novel therapies continues to grow. Even patient factors such as sleep quality and the timing of surgery can significantly impact post-operative pain. Programmed intermittent epidural bolus injection was shown to be more effective than other methods in improving both nighttime pain management and sleep quality in post-thoracotomy patients. Oral opioid analgesics can manage pain, but they often cause side effects like nausea, sedation, and sleep disruption, which can worsen postoperative recovery. General anesthesia is used during surgery but has no role in managing postoperative pain or improving sleep afterward. It does not contribute to nighttime pain relief once the patient is in recovery. Learn more about epidural injections. For a patient requiring a minimal hospital stay and quick postoperative recovery, single-injection nerve blocks are often the preferred pain management strategy. These blocks provide effective, targeted pain relief with a rapid onset and are simple to administer, making them ideal for shorter or less complex surgical procedures. Their use has been associated with reduced opioid consumption, quicker mobilization, and high patient satisfaction — factors critical for fast recovery and early discharge. The major limitation to single-injection nerve blocks is the duration of analgesia, typically lasting less than 24 hours. Peripheral nerve blocks and neuraxial blocks are a few types of single-injection nerve blocks commonly used. Continuous catheter techniques are more invasive, require careful monitoring, and carry risks such as infection, catheter displacement, or pump malfunction. These factors can delay discharge and complicate recovery, making them less ideal for rapid recovery cases. Oral analgesics may not provide adequate pain control on their own, especially immediately after surgery. Insufficient pain management can hinder mobility and prolong hospital stay. Multiple-injection nerve blocks are not usually used, instead single-injection nerve blocks are recommended for quick postoperative recovery. Learn more about local and regional anesthesia. A primary benefit of continuous catheter techniques over single-injection nerve blocks for postoperative pain management is that they offer prolonged analgesia, which enhances patient comfort and reduces the need for additional analgesics. Unlike single-injection blocks that wear off within hours, continuous catheter methods — such as continuous peripheral nerve blocks or epidural analgesia — provide sustained pain relief for 2-3 days. This extended duration allows for better pain control, supports early mobilization, and lowers reliance on opioids, ultimately improving recovery outcomes and patient satisfaction. Catheter techniques actually require more monitoring due to risks like infection, catheter displacement, or pump malfunction. Continuous nerve catheters can be used in ambulatory surgery with the evolution of local anesthetic delivery systems and pumps and even in outpatient procedures. While effective, continuous catheter techniques may carry higher complication risks related to catheter management, such as infections or technical failures. Thus, their key advantage lies in providing extended, consistent pain control for patients with significant postoperative pain needs. Learn more about catheter techniques. Nondrug pain management encompasses a range of physical, psychological, and sensory interventions that provide effective, low-risk alternatives to medications. Although effectiveness varies between individuals, TENS can provide pain relief, is noninvasive, and cost-effective. Heat therapy can also relieve muscle tension and pain and improve blood flow, but it can cause burns if used improperly. Cryotherapy can also reduce pain and inflammation, although it can sometimes impair healing and is not suitable for everyone. Cryotherapy can limit blood flow, reduce the delivery of healing agents to the affected area, and cause tissue necrosis or nerve impairment. Individual responses to aromatherapy vary widely, and clinical evidence supporting its effectiveness remains limited. Learn more about heat and cold therapies.
National Post
12-05-2025
- Health
- National Post
Derek Finkle: Controversial drug injection sites among Carney's first challenges
When Mark Carney was asked on the campaign trail about whether federal approval for injection sites would continue under his government, he avoided the contentious topic by saying the effectiveness of those sites was under review. Article content Article content Even in his evasion, our new prime minister was undermining the position staked out by his predecessor, Justin Trudeau. When asked about such controversial initiatives as injection sites and the distribution of so-called 'safer supply' opioids to those with severe addictions, the latter was fond of insisting his government was simply 'following the science.' Article content Article content If science had decided injection sites were wildly successful and necessary, then why does Carney's government need to study them? Article content Article content As it turns out, Carney and his minority government are going to be called on to conclude their alleged study of injection sites sooner rather than later. This is because the federal drug law exemption (required for injection sites across Canada to operate) expired for a site in the Sandy Hill neighbourhood of Ottawa on April 30. Article content The Sandy Hill Community Health Centre, which houses the injection site, applied to renew its federal drug law exemption on Jan. 30. Just a few months earlier, another injection site in the same ward, Rideau-Vanier, which is home to three sites, was granted a five-year exemption renewal under controversial circumstances. Article content So controversial, in fact, that the head of a local arts non-profit has since gone to federal court seeking a judicial review of the insular and secretive process Health Canada utilized in coming to its decision. Article content At the 11th hour, late on April 30, Health Canada advised the Sandy Hill site that it was renewing its exemption — not for five years but only 30 days. The obvious reason for such a short exemption renewal being that Health Canada needs to take direction from the new government. Article content Article content One piece of good news for Mark Carney is that the materials required for his study of injection sites have recently been assembled in a very large, detailed package. This exhaustive analysis of the topic results from a legal challenge filed by an injection site in Toronto's Kensington neighbourhood, claiming that legislation passed in Ontario late last year prohibiting injection sites from operating within 200 metres of schools and daycare facilities violates the charter rights of drug users. Article content Article content The judge overseeing this litigation estimated the case's court record to be 6,000 pages in total. I may be the only journalist to have read it in its entirety. So, free of charge, I will provide Mr. Carney with the Coles notes summary.
New York Times
11-05-2025
- New York Times
In a Beloved Bronx Park, a Neighborhood's Drug Crisis Is on Full Display
When Martin Rogers's family members left their Manhattan tenement in the 1920s, they sought a new home with access to more green space and open air. They found it in the South Bronx, and at a 35-acre park known as St. Mary's. Mr. Rogers, 70, said he spent many childhood summers playing stickball at St. Mary's and swimming in the pool in its recreation center from the early morning until the streetlights came on. It not only afforded him an escape from his family's small, scorching apartment, but also kept him away from the drugs, riots, crime and poverty that choked the surrounding neighborhood. St. Mary's Park, the largest in the South Bronx, was for decades a refuge for many residents in one of New York City's most impoverished areas. But as the city's homelessness and opioid crises worsened in recent years, it became something else: a place where people shoot up and nod off under stately oak trees, and where the grass and rocks are littered with needles and broken glass. Residents see the transformation of St. Mary's as emblematic of the persistent poverty, drug problems and neglect that plague the South Bronx. They worry that the state of the park helps perpetuate the damaging stigmas surrounding the area as it seeks to fend off gentrification. The community has sought help from the city and state for years, but residents say they have yet to see solutions that work. 'What's happening in St. Mary's Park is a symptom of what's happening in the broader South Bronx,' said Carmen Santiago, who lives nearby and advocates cleaning up the park. 'The situation is just a perfect storm.' Ms. Santiago, 61, an Army veteran and retired construction manager, walks the length of St. Mary's picking up litter week after week. On a recent day, she entered at East 149th Street and St. Ann's Avenue and headed up a grassy hill toward a rocky peak, dodging needles, shards of glass and human feces with each step. Atop the hill, an empty blue pouch labeled 'Overdose Rescue Kit' dangled from a tree, flapping in the wind. The ground beneath it was covered with naloxone containers, needle caps and trash. 'Seniors don't come here anymore and walk around,' Ms. Santiago said. 'My mom is 85, and she's like, 'I'm not going there.'' In the back of Ms. Santiago's mind was her nephew, whom she described as a middle-aged man who has struggled with substance abuse. Friends have spotted him using drugs in the park and a few blocks away at the Third Avenue Hub, a busy commercial corridor lined with stores and public transportation stops. Each time she steps outside, Ms. Santiago said, she hopes she won't find her nephew's dead body. Police officers at the 40th Precinct, which covers the Port Morris, Mott Haven and Melrose neighborhoods, have described the Hub as a central location where people buy drugs, score free syringes and steal from stores. If they overdose, they are just blocks away from a hospital. In February, Mayor Eric Adams announced that the city's Community Link program, which creates local coalitions among community leaders, law enforcement and city agencies to address chronic quality-of-life problems, would begin work at the Hub. The program has also focused on six other neighborhoods since 2023. Camille Joseph Varlack, the deputy mayor for administration, said the area's 'systemic challenges' made it a good candidate for the program. She said her office had held monthly meetings with local stakeholders to track the effort's progress. 'I think the local feedback has been incredibly positive,' she said. 'Our goal is to ultimately empower our community stakeholders so that when we do pull back the city resources, perhaps to go to another area that is similarly challenged, they've got points of connectivity we've created.' The city's parks department has said that cleaning up St. Mary's Park is a priority. In recent years, the department has spent about $50 million to improve the park's amphitheater, recreation center, restrooms, dog run and playgrounds, according to Gregg McQueen, a spokesman. It collected more than 34,000 syringes in the park last year alone. Those investments were warmly welcomed, but residents continue to witness the everyday hardships that have contributed to the park's decline. Data gathered by the city's health department in 2023, the most recent year available, showed that neighborhoods in the South Bronx had the highest overdose rates in the city, as they did in 2021 and 2022. The agency found that 858 Bronx residents died of overdoses in 2023. Hunts Point and Mott Haven, near St. Mary's, were particular hot spots. South Bronx residents face 'chronic health, economic and environmental challenges' and have shorter life expectancies than the city at large, according to an economic snapshot of the area produced by the state comptroller's office in 2023. Another report that year, published by the city comptroller's office, found that those disparities pervaded the city's infrastructure. 'Undesirable' facilities, such as homeless shelters and substance abuse treatment centers, were disproportionately concentrated in low-income communities of color, it said, while richer neighborhoods had more parks and plazas for recreation. The report urged city officials to refrain from further flooding certain neighborhoods, including in the South Bronx, with shelters and treatment centers. Such facilities are often viewed as a 'drag on quality of life,' the comptroller's office wrote, while parks are amenities that serve as 'essential infrastructure for New Yorkers' physical, mental and social health.' While neighbors express concern that the park has become a magnet for homeless people and drug users, those who work with New Yorkers struggling with addiction and mental illness emphasize the need for compassion. Joseph Ruffalo is a recovery peer worker with Samaritan Daytop Village, one of several nonprofits providing substance abuse treatment and other services to residents of the South Bronx. 'We see the good, the bad and the other,' he said. 'They are just caught in the grips of addiction and mental health issues.' Mr. Ruffalo, 61, is part of his organization's harm-reduction outreach team. For him, the work is personal. He is almost two years sober after a decades-long battle with addiction. A former Wall Street stockbroker, he said he used drugs to cope after being abused as a child. He found Samaritan Daytop after he was forced to check into a psychiatric ward. He now spends most days in and around St. Mary's with a small cart in tow, offering people sandwiches, overdose rescue kits and wound care. He encourages them to visit his group's headquarters to eat a meal, shoot a round of pool or watch a movie. Sam Rivera, the executive director of another harm reduction nonprofit, OnPoint NYC, said that people using drugs to cope with trauma often do not have anywhere to go. That is what leads them to quiet places like St. Mary's. 'Within those trees you see the poverty, you see dirt, you see trash,' he said. 'And that's not because these are bad people. This is what our folks have been given.' OnPoint sends cleanup crews into hot spots, including the park, to pick up needles and drug paraphernalia left behind. Workers also encourage people to visit overdose prevention centers where they can use drugs in private, under supervision. Despite those efforts, many residents say they avoid St. Mary's, fearful of stepping on scattered needles or otherwise being harmed. Willie Estrada, 68, who has lived in the South Bronx for decades, has watched with frustration as the park fell into disrepair. He often looks down at the park from his window, he said, yearning for the days when children spent all day running among its trees and sliding down its rocks. Mr. Estrada, formerly a member of the Imperial Bachelors gang, said spending time at St. Mary's in his youth helped steer him away from a life of street violence. The recreation center offered a place to hang out and more productive activities, like dance parties and photography lessons, he said. Teenagers were not allowed to wear gang colors inside, and he eventually stopped wearing them altogether and left the gang. He went on to become a professional dancer and promoter. But now, he said, the park has become so 'disgusting' that he does not allow his grandchildren to play there. The poor conditions have reinforced existing stereotypes about the South Bronx, according to Steven Payne, the director of the Bronx County Historical Society. He lamented that the perception of the area as dirty and dangerous has persisted despite the efforts of local leaders and organizations. 'When you spend more than two seconds in the neighborhood, there's so many amazing groups, so many amazing individuals that do work to try and improve the daily lives of other people,' Mr. Payne said. 'But all that gets lost.' South Bronx lifers like Mr. Rogers and Ms. Santiago, who hold out hope that the park can be restored, said they were determined to keep pushing for solutions. 'We endure on behalf of our kids,' Mr. Rogers said, 'and because people don't have a choice.'
National Post
09-05-2025
- Politics
- National Post
Chris Selley: Please, spare us from another impotent, image-obsessed cabinet, Mr. Carney
Last weekend on NBC's Meet the Press, President Donald Trump kiboshed the notion that he might seek a third term as president. That doesn't mean he won't go on CBS's Face the Nation next weekend and say the opposite, of course, but it's a reminder that Trump, who's currently breathing most of the oxygen in Canadian politics, won't be around forever. And when he's gone, all the problems that gave credence to Conservative Leader Pierre Poilievre's 'Canada is broken' narrative will still be around. Housing. Law and order. The opioid crisis. Foreign interference in our politics. Landlocked natural resources. We are an inefficient and economically dysfunctional federation, to the point where breaking down internal trade barriers is a tall order. Article content Article content If Prime Minister Mark Carney wants to go down in history as something other than the federal version of former premier Kathleen Wynne — who snatched victory from the jaws of defeat for the Ontario Liberals, then four years rode them into the ground like Major Kong in Dr. Strangelove — he is going to need help, and I don't mean from a bunch of self-styled communications geniuses. The government-by-comms era has to be over if Carney is going to leave the country any better off than he found it. Article content Article content Carney needs to cobble together a solid cabinet, which is to be unveiled Tuesday, that is noticeably different than Justin Trudeau's cabinet was. Based on April 28's election results, turning the page on Trudeau was clearly the Number 1 priority for huge numbers of Canadians. There are voices we just don't need to hear from anymore: Bill Blair, Steven Guilbeault, Mélanie Joly and the narrowly re-elected Sean Fraser come to mind, but three of those made it into the provisional cabinet Carney quickly assembled in March. Article content Blair has no business there after his alleged meddling in the RCMP's investigation into the 2020 massacre in central Nova Scotia, or after taking 54 days to sign a warrant allowing CSIS to investigate foreign interference in Canadian politics. Really, his handling of the G20 debacle in Toronto in 2010, during which he was chief of the city's police force, should have long ago thwarted any political ambitions he had in the first place. Article content Article content Guilbeault is popular in Quebec, but he makes very little sense to the rest of Canada (and seemingly vice versa). His current position as Carney's Quebec lieutenant might make sense going forward. His reinstallation by Carney in March as heritage minister — now dubbed Minister of Canadian Culture and Identity — does not make any sense. He was a disaster there before, failing completely to defend Trudeau's anti-internet agenda in English Canada, and there is no reason to believe he would be any better at it now. (Ideally, of course, Carney would simply abandon Trudeau's anti-internet agenda.) Article content Article content Former housing and immigration minister Fraser, who decided not to run again to spend more time with his family, then changed his mind when he saw Carney's numbers suddenly improving — and then nearly lost Central Nova to the Conservatives — is always mentioned as one of the most talented communicators in the Liberal caucus. Communicating, alas, doesn't actually get anything done. It doesn't build houses, for example, and it doesn't un-bugger up immigration.
