PUBLIC POLICY B. C. invests $3 million in arthritis research British Columbia Health Minister Terry Lake has announced $3 million in funding to the Arthritis Research Centre of Canada to boost developments in prevention, diagnosis and treatment of arthritis, which affects more than 600,000 British Columbians. “With this investment, our government aims to help the Arthritis Research Centre continue to improve the lives of British Columbians living with arthritis, as well as reduce the burden arthritis puts on our healthcare system,” said Lake. With more than 100 different forms of arthritis, and as a leading cause of disability, the impact on the Canadian economy is estimated to be $33 billion each year in health-care costs and lost productivity. “Many people aren’t aware arthritis can be a debilitating chronic condition that affects people of all ages, from children to the elderly,” said Dr. John Esdaile, scientific director of the Arthritis Research Centre. “With further research into this complex illness, we can work to prevent arthritis, as well reduce work disability, improve pain management, and address the special needs of arthritis patients in the province.” Though osteoarthritis is the most widely recognized form of the condition, arthritis can range from mild forms of tendinitis and bursitis to crippling systemic disorders, such as rheumatoid arthritis. It also includes pain syndromes such as fibromyalgia and diseases such as systemic lupus erythematosus. “Arthritis Research Centre scientists address and answer questions that are meaningful in enabling patients to keep moving, working, playing and contributing to life in B.C.,” said Alison Hoens, an arthritis patient. The Ministry of Health’s Health Link BC website provides information and resources for arthritis patients and their families. The ministry also supports programs to help British Columbians get active, eat healthy and quit smoking, so they may avoid chronic diseases like arthritis. The Arthritis Research Centre of Canada (ARC) was created in 2000 in recognition of the significant impact research could have on arthritis treatment in the country. ARC is a patient- oriented research centre, conducting clinical research and trials related to arthritis prevention, diagnosis, prognosis and quality of life issues. For more stories on public health policy visit canadianchiropractor.ca CONCUSSION New report calls for comprehensive concussion management protocols A coalition of health and sporting groups across the country is calling for Canada’s athletic organizations to get more proactive about protecting participants from head injuries. The Canadian Concussion Collaborative, consisting of nine national sports advocacy groups, has laid out two specific recommendations in the September issue of the British Journal of Sports Medicine. Most sports organizations don’t have policies in place that address the needs of a concussion patient at every step of the process. The group’s first recommendation is to put such policies in place immediately and to review them once a year. The collaborative said the protocols should address concussion education, prevention and treatment, as well as an athlete’s return to action. The collaborative also urged organizations to consult with medical professionals and local community resources when developing their concussion protocols. The recommendations come at a time when awareness of concussion risks and repercussions are at an all time high, according to collaborative members such as the Canadian Centre for Ethics in Sport (CCES). CCES CEO Doug Mac- Quarrie acknowledged many parts of society are equipped to deal with the various aspects of concussion management. He said the time has come for spor t i n g associations, school boards and other organizers of athletic activities to bring all concussion management tools under one roof. “Oftentimes these things are left to discrete parts of the system,” MacQuarrie said in a phone interview from Ottawa. “A sport organization may deal with, ‘what do we do on the field?’ A public health agency or local health care unit may deal with, ‘what do we do when they’re in the hospital,’ and the family practice might say, ‘OK, how do we get the person back into sport?’ What’s optimal is that all of those links are contemplated in advance so that people who get involved in sport know that system exists in their community to assist them should the unfortunate circumstance of a concussion arise.” MacQuarrie said an ideal concussion protocol would address four key points – training coaches, parents and participants to watch for signs of head injuries, setting up guidelines to make the environment safe for athletes, establishing a treatment protocol should a concussion take place and developing a process to help injured players get back in the game slowly and safely. The Royal College of Chiropractic Sports Science (RCCSS) welcomed the report and supports the idea of a comprehensive protocol for providers and coaches to follow on concussion management. “Ultimately, proper diagnosis, management and return to play is so important and we should all be on the same page when providing care and advise to athletes,” said Dr. Michelle Laframboise, chair of the RCCSS public health committee. Laframboise and the RCCSS have been actively pursuing interprofessional collaboration on concussion management. In an email to Canadian Chiropractor magazine, Laframboise said while professional sport may be addressing concussion in the higher level, the case may not be the same in the grassroots level and “this being the most vulnerable group may in fact be the most important level to address the impacts of concussion.” “There is a lot of new emerging research on the importance of the cervical spine. This is where chiropractors (being spine specialists) can be extremely beneficial in the treatment of concussions,” Laframboise said. Collaboration among health-care professionals is also key, she said, “to come up with a strategy of how to address, treat, diagnose and ultimately manage concussions. We need to not only educate health-care providers but also parents, athletes and coaches alike.” Putting in place a protocol for concussion management, she adds, will ensure transparency and that ultimately the patient is cared for appropriately without confusion. – Michelle McQuigge, The Canadian Press, with files from Mari-Len De Guzman HEALTH CARE Chronic illnesses cost Albertans billions Alberta’s auditor general says caring for people with chronic health problems is costing the provincial government billions of dollars each year. Merwan Saher says in a report that conditions such as high blood pressure and diabetes are the biggest challenges facing health care. Saher looked at figures from 2012 and 2013 when about 735,000 people in the province were known to have at least one chronic ailment. The cost to the health-care system at that time was $4.5 billion. That figure didn’t include lab tests, long-term care and home care. Saher’s report points out that the top 10 per cent of health-care users – most of whom have at least one chronic condition – account for more than 75 per cent of health-care spending. He suggests the way to lower that cost is to slow progression of diseases by better managing their conditions. The auditor’s report also says Alberta generally does a good job providing care for people with chronic diseases, but the care tends to be fragmented. Saher says no one has overall responsibility for making sure all healthcare providers are working together or that everyone is receiving the same level of care. His 18 recommendations include stronger supports for family doctors and more information sharing between different health-care sectors. He urges that nine of his recommendations should be addressed within a year, including one that suggests Alberta Health Services identify and provide care to patients who don’t have a family doctor. Another nine recommendations are longer-term and deal with healthcare organization and outcomes. – The Canadian Press PAIN MANAGEMENT Health minister says feds slapping stronger warning labels on opioids The federal government is putting stronger warning labels on extended-release painkillers like OxyContin in an effort to prevent the abuse of opioids. “Too many people are abusing prescription drugs,” Health Minister Rona Ambrose told the annual conference of the Canadian Medical Association held in August. “Too many people are suffering and dying as a result.” In prepared remarks, Ambrose reminded the conference that Canada is now the second-largest per capita consumer of prescription opioids in the world, behind the United States. As well, she pointed out, a 2012 study suggests that close to a million young Canadians between the ages of 15 and 24 reported using prescription drugs in the previous 12 months. The Canadian Alcohol and Drug Use Monitoring Survey also found that 410,000 Canadians said they’d abused prescription drugs like opioid pain relievers, including Demorol and OxyContin; stimulants like Ritalin and Adderall; and tranquilizers and sedatives that include Valium, Ativan and Xanax. “Quite frankly, these numbers are frightening, unacceptable and the reason why our government is taking action,” Ambrose said. The Conservatives’ new initiatives include stronger warnings on opioid labels that emphasize the risks and safety concerns associated with the drugs. The new labels also remove reference to “moderate” pain to clarify opioids should only be used to manage severe pain. Ambrose is also calling for the development of other practical solutions that will prevent opioid abuse while keeping the painkillers available for patients who truly need them. A year ago, the U.S. Food and Drug Administration announced safety labeling changes for all extended-release and long-acting opioids intended to treat pain. David Juurlink, a medical toxicologist at the University of Toronto, said it’s “hard to argue” with label changes, adding OxyContin and related drugs should have been restricted for treating only patients in severe pain as soon as they came onto the market. “The change will limit what drug companies can say in advertisements to doctors, but it’s not likely to change how doctors prescribe opioids,” he said in an interview. “That horse has bolted.” Ottawa needs to go much further, Juurlink added. “What we really need are federal initiatives to quantify the toll of opioid misuse, to properly educate doctors about the risk/benefit profile of opioids and perhaps even federal support for an investigation into how these drugs were marketed in Canada,” he said. “That’s happening in the United States, and for good reason. Why it’s not happening here, I don’t know.” – Lee-Anne Goodman, The Canadian Press INTEGRATED HEALTH CARE New Brunswick rheumatology clinic offers interdisciplinary care A rheumatology clinic in Edmundston, New Brunswick, is using interdisciplinary care and telemedicine to cut down on travel for patients living with arthritis in the region. “This new clinic is a good example of how, by working in teams and using technology, we can bring specialized care closer to patients, in the language of their choice, no matter where they live,” said Social Development Minister Madeleine Dubé on behalf of Health Minister Hugh Flemming. The clinic has been operating at the Edmundston Regional Hospital since December, and is a service being offered as part of the government’s five-year action plan for an equitable distribution of health services. The clinic, which is open two days per week, is serviced by a team of allied health professionals including a nurse, a physiotherapist, an occupational therapist and a dietician. Patients wishing to access these services can do so by contacting the hospital. With a referral from their family doctor, patients can also meet with a specialist at the clinic. Follow-up appointments with a rheumatologist can be conducted via telemedicine to reduce travel for patients. A specialized camera is used to provide the rheumatologist with extreme close-ups of skin, tissue and fingernails. “The addition of this clinic to Edmundston Regional Hospital’s service offering is an important component for our patients,” said Gisèle Beaulieu, Northwest Zone chief operating officer for Vitalité Health Network. “This addition is part of the network’s strategic direction as we optimize our approach towards ambulatory and community care.” Patient reviews to date have been positive and a second clinic is now in development for the Chaleur Regional Hospital. “The Arthritis Society wishes to congratulate the provincial government for investing in the residents of northern New Brunswick,” said Susan Tilley-Russell, executive director of the Arthritis Society’s Maritime Region. “The clinic will ensure timely access to care for this very important chronic disease and was the focus of our volunteer advocacy committee and advocacy staff in New Brunswick. The five-year action plan for the equitable distribution of health services consists of a list of new or expanded services in all regions of the province that are designed to address gaps in the health-care system. It fulfills the provincial government’s commitment to improve distribution of services to the francophone population. MENTAL HEALTH Ottawa summit aims to find relief for dementia sufferers Leading researchers and industry experts gathered in Ottawa in September to discuss how to accelerate the development of new treatments and technologies to help people with dementia, their families and caregivers. The Canada-France Global Dementia Legacy Event was the second in a series of four such events stemming from the Summit on Dementia held last December in London. Delegates in the two-day event heard from global dementia experts, as well as people living with dementia and their family members. Federal Health Minister Rona Ambrose told delegates that dementia has a significant impact on individuals, families and caregivers. The delegates were provided updates on the development of an action framework to address the challenges and barriers for collaboration between academia and industry. The framework aims to accelerate the transformation of dementia research into real life products and services to prevent or delay the onset of dementia and improve the lives of people living with it. “The impact of dementia on individuals, caregivers, families and national economies are significant,” Ambrose said. “We must continue to work together to stem the tide and improve our understanding of these conditions, to alleviate the suffering it causes.” – The Canadian Press INJURY PREVENTION Single moms more likely to stay off work longer after injury, study finds One might expect that single parents with children living at home may be less inclined to take time off work following a work-related injury. After all, they tend to shoulder a greater burden of putting food on the table than people raising kids in marriages or common-law relationships. However, according to a new study, single mothers are more likely to need long recovery time than moms and dads with partners, and even single dads. In that study, Institute for Work & Health (IWH) researcher Dr. Imelda Wong defined long recovery time as seven days off work or more. Her finding is all the more surprising given that single moms are less likely than other types of parents to receive workers’ compensation. “Despite being more likely to experience longer work absences, single moms are less likely to access workers’ compensation,” says Wong, a Mustard Post-Doctoral Fellow at IWH. Her study on work-injury absence and compensation among partnered and lone mothers and fathers has been published online, ahead of print by the American Journal of Industrial Medicine. Wong’s theory at the outset of the study was that single parents would come back to work sooner than others following a work injury. She believed this would be the case because time away from work can mean financial strain and higher risk of job loss, especially for parents working in jobs that offer fewer benefits and less job protection. For the study, Wong drew on the Survey of Labour and Income Dynamics (SLID), an annual Statistics Canada survey of a representative sample of Canadian households. After filtering for wage earners aged 16 to 69 living with children under 25, she had a sample of about 88,000 respondents. In Wong’s sample, 11 per cent were single mothers and three per cent were single fathers. As a group, the single parents tended to be younger than parents with partners. They also had significantly less education and less job tenure. Single parents were more likely to be low earners. The proportion of single moms in the lowest income bracket (40 per cent) was nearly twice that of single dads (22 per cent) and nearly three times that of married or common-law mothers and fathers (15 per cent and 16 per cent respectively). When it comes to time off work after an injury, single moms were considerably more likely – 50 per cent more – than partnered fathers (the reference group) to be off work for seven or more days. This greater likelihood was seen after taking into account different factors, including socioeconomic and job-related factors. No difference was seen between single dads and partnered dads. Partnered moms were slightly less likely than partnered dads to be off work for seven or more days, but that difference was so small it may have been due to chance. “There’s something going on with single moms,” says Wong. Among the other parents, those who tended to be off work seven days or more after a work injury were also the ones who tended to get benefits. Not so for single moms, however. Although they’re 50 per cent more likely than the others to be off work seven days or more, they’re less likely to receive benefits. And while single moms are more represented in groups that are both less likely to get workers’ compensation benefits and less likely to be off work – i.e. those who are young, who have less work tenure, and who work in temp, seasonal or casual jobs – for some reason, they’re more likely to be off work longer after an injury. Due to the kind of data available, however, Wong is unable to probe further for what the reasons might be. “We don’t know what it is about being a single mom that’s putting them at greater risk of being off work for seven days,” says Wong. “Could it be the type of injuries they incur? Or could it be the type of work they do?” It may also be, for example, that single moms work in the kinds of jobs that are less modifiable or in workplaces that are less able to offer accommodation. – Institute for Work and Health PUBLIC POLICY Manitoba seeks public input on health care Manitobans will have a chance to share views and weigh in on health-care priorities by becoming part of a local health involvement group. “We all have personal experiences within the healthcare system. It’s those experiences we can draw from to help shape and develop strong regional plans to ensure health-care needs are being met in communities across this province. Not only right now, but for years to come,” said Manitoba Health Minister Erin Selby. Effective Sept. 2, under the Regional Health Authorities Amendment Act, Manitoba’s five health regions will be responsible for developing health involvement groups and each region will have at least four groups made up of a minimum of 10 members. Groups are required to meet four times per year and provide reports back to regional board. The findings will be shared annually with the minister. “It’s vital that Manitobans are involved with the healthcare system to ensure safe, quality health care is available where and when it’s needed,” said Jan Currie, board chair, Manitoba Institute for Patient Safety. Manitobans wanting to take part in or gather more information about the health involvement groups can contact their local regional health authority office or visit the website, www.manitoba.ca/ health. NUTRITION Study looks at effectiveness of dietary approaches It’s a question that bedevils dieters on a regular basis: Is a low-fat or a low-carb diet the true path to weight reduction? A new study suggests either will do – so long as one actually works at whichever one he or she chooses. The study is what is called a meta- analysis; it groups together and reanalyzes data from 48 different randomized trials of various diets. The work was done by researchers at Toronto’s Hospital for Sick Children, McMaster University and a number of other institutions in Canada and the United States. The authors say that of the socalled branded diets, those that espouse a low-fat or a reduced-carbohydrates approach work better than the others. But when those two approaches are compared, the results are more or less equal. “Our research has shown that... low-carbohydrate and low-fat diets result in the most weight loss, about 18 pounds (8.2 kilograms) in six months and 16 pounds (7.3 kg) in 12 months, and there’s very small differences between the two,” said first author Bradley Johnston, a senior scientist at the Hospital for Sick Children’s Research Institute. “If there’s minimal differences between the diets, both at the brand level and at the diet class level... individuals shouldn’t buy into the latest study that comes out that shows that maybe one diet is better than another.” The publication of the work – in the Journal of the American Medical Association – is timely. On Monday, a study published in the Annals of Internal Medicine reported that people who eschew carbohydrates and eat more fats lose more weight than people who follow a low-fat diet. Johnston acknowledges it is hard for people to interpret the shifting sands of dietary science. So he and his colleagues set out to try to see what the compilation of studies reveals. While their study talks about diets by name, Johnston is keen not to appear to be promoting one over the other. But he says the findings make it clear that these diets can lead to weight loss, if people do the work. That said, the results were modest. The median weight loss for people following a low-carb diet was nearly nine kilograms at six months; the median loss for low-fat diet followers was eight kilograms. At 12 months, both groups slipped a bit – a common occurrence in diet studies – to just over seven kilograms for both types of diets. “For those who believe that they don’t work, short-term, this evidence suggests that they do. And we need a lot more research in terms of the long-term effectiveness of these types of interventions and we need to look closely at adherence,” said Johnston, who began the project while doing post-doctoral studies at McMaster. “If they’re relatively equal, then you should choose something that you feel that you can adhere to.” Obesity expert Dr. Yoni Freedhoff agreed with that premise. Freedhoff practises at the Bariatric Medical Institute of Ottawa and is the author of The Diet Fix: Why Diets Fail. He says it has been clear for quite some time that there is no one single answer. “The quest for the holy diet is one that society’s been on for quite a long time. And I don’t think there is such a thing, just like I don’t particularly believe in a Holy Grail,” said Freedhoff. “The key to picking the best diet for a person as an individual is the one they actually like enough to keep living with...Ultimately people need to live lives that they enjoy enough to sustain. And the same for sure goes for food and diet.” He doesn’t believe in weight loss by suffering, saying it simply isn’t sustainable over the long term. And weight shed by cutting carbs or avoiding fat will come back if the intervention is treated as a shortterm fix. “Not enjoying your low-carb diet versus not enjoying your low-fat diet will have the same likely outcome, which is you quitting your diet down the road,” Freedhoff said. The study looked only at the ability to lose weight on various diets. It did not examine whether some diets do a better job of reducing cardiovascular disease risks, such as lowering cholesterol. Johnston said that work is currently underway. – Helen Branswell, The Canadian Press PAIN MANAGEMENT Study offers suggestions on what to do when sex is a pain in the back For many people, intimacy in the bedroom often takes a back seat to low back pain, say researchers, who have scientifically determined the best sexual positions to prevent spinal muscles from seizing up at an inopportune moment. In what they believe is the first biomechanical study of its kind, researchers at the University of Waterloo have found that certain positions are better than others for keeping different kinds of back pain at bay. And they’ve thrown out the long-held belief that spooning – where partners lie sideways curled back to front – is the only pose for back-saving sex. “Before now, spooning was often recommended by physicians as the one position that fit all. But as we’ve discovered, that is not the case,” said Natalie Sidorkewicz, a PhD candidate and lead author of the paper published in September in the journal Spine. “What that failed to do was recognize that there are all sorts of triggers for back pain,” she said. “So someone may find relief in one position that may cause pain for someone else.” To conduct the study, the researchers recruited 10 heterosexual couples, with an average age of about 30, to have sexual intercourse in a controlled laboratory setting. Each participant was fitted with remote sensors, which tracked how their spines moved when they engaged in five common sex positions. Infrared and electromagnetic motion capture systems – such as those used to animate figures in video games and films – showed how the men’s and women’s spines flexed when they assumed each position. “So we were able to actually determine what angle the spine is at, at each moment in time that they’re having sex,” said Sidorkewicz, adding that electrodes on participants’ skin also captured activity in their core and hip muscles. The findings were used to create an atlas, or set of guidelines, that recommends different sex positions and thrusting techniques based on what movements trigger a patient’s pain. Overall, the study found both men and women employ a lot of spinal motion during sex, said Sidorkewicz. “In general, to make any position more spine-sparing, we’re recommending that the individual who’s controlling the movement use more of their hips and knees, rather than their spine,” while their partner keeps a more neutral supine position. “A great example of both these recommendations is the missionary (position),” she said, advising that a woman lying on her back place a cushion or other support under the curvature of her spine. The researchers also found, for instance, that kneeling behind one’s partner during intercourse can prevent back pain caused by flexion in both partners. “Any family doctor will tell you that couples often ask them how to manage their back pain during and after sex,” said senior author Stuart McGill, a professor in the faculty of Applied Health Sciences. “Many couples will remain celibate because one night of love-making can lead to months of back agony. “Until now, doctors have never had any hard science to base their recommendations upon.” And having a bad back that interferes with one’s love life is more common than many people realize. Survey studies suggest that 84 per cent of men and 73 per cent of women report significant decreases in sexual relations due to lower back pain, Sidorkewicz said. “Right now, if a patient were to come to a chiropractor, physiotherapist or a physician asking for resources on this, anything that is currently out there is not based on scientific data,” she said. “So we are now providing that to help guide those clinicians to make better recommendations for those patients. So the idea is to improve the quality of life of these couples by helping them maintain more of a healthy sexual relationship.” Although this study focused on how a man’s spine and muscles move during intercourse and orgasm, the scientists also gathered data on female participants, which they hope to publish later this year or early next. Future papers include similar studies on people with existing back and/or hip pain to test the effectiveness of their initial recommendations, which would then be further refined for various patient groups. The guidelines should also help doctors and other health providers feel more comfortable about discussing the delicate topic of sexual positions, Sidorkewicz said. “We’re hoping to help facilitate that dialogue between the patient and practitioner and also between couples who are struggling with this daily.” – Sheryl Ubelacker, The Canadian Press CONCUSSION Ontario docs call for public policy reform to address sports concussion in youth Sports-related concussions in children and youth constitute a significant public health issue that requires serious reform in public policy to address the harm associated with them, a new Canadian paper argues. The article, which appeared in Neurosurgeon, an online publication of the American Association of Neurological Surgeons, suggests there is an ethical responsibility to take action on the issue. “It’s not a sport issue, it’s not just a medical issue, it’s a public health issue which affects the population as a whole and it’s been identified that way – it’s research based, it’s epidemiologically backed and it has facts behind it,” said Dr. Paul Echlin, who runs a sports medicine clinic in Burlington, Ont. Echlin, who co-authored the article with Dr. Ross Upshur, director of clinical research at Toronto’s Bridgepoint Health, said there’s a need to make an “urgent statement” on sports-related concussions in children and youth, which the World Health Organization classifies as minor traumatic brain injuries. “We really have to move on this now,” said Echlin. “There’s no helmets or mouth guards or safety devices that can change this, it is about a shift in the way that we allow our youth to play games.” The article notes that the U.S. Centers for Disease Control labelled sports-related concussions a public health problem in 2003, but youth continue to suffer “often preventable brain injuries” while playing sports. “If you know what’s going on and you refuse to do anything major or significant about it, then you’re ethically wrong,” said Echlin. “It shouldn’t be silent anymore, it is an epidemic in our youth culture, in sport. Sport was made to... improve the culture of fitness, and socially, but not to cause long-term impairment, not to promote violence which is the underlying factor of a lot of these head injuries.” To deal with concussions as a public health issue, the article suggests “dramatic rule changes” be made to games children play to “eliminate all purposeful and intentional head contact” while also minimizing incidental head contact. It also suggests increasing the size of playing surfaces to lower the chances of collisions in sports, decreasing the number of participants on a field of play and considering the elimination of the use of the head in games like soccer. The article goes on to suggest enforcing significant suspensions to participants or supervising adults who are involved in games in which head injuries occur. Youth who do suffer concussions must also be given appropriate time to recover, Echlin added. The paper further underlines the importance of publicly funded education on concussions for the next generation of athletes, parents and educators, highlighting an example in Ontario, where the province’s education ministry has mandated publicly funded schools to institute concussion curriculum education from all students Grade One to 12. “You’re going to educate the 10-year-old to say ‘yes there is a big problem here’ and to give them the ability to advocate for themselves and others to say ‘I got hit, I don’t feel well, I’m going to take myself off the field,’” said Echlin. “Handing out pamphlets and stuff, it doesn’t work. But what does work is getting the kids involved and getting them to make their own decisions, and also continuing dialogue with parents.” Alison Macpherson, an assistant professor of kinesiology and health sciences at York University in Toronto, agreed that sports-related concussion in children and youth requires action, but urged parents not to pull their children from sports altogether. “We need to protect kids, we also have to be very careful not to scare parents and kids away from sports,” she said. “Learning how to play sports is also part of healthy child development.” Macpherson drew a parallel to smoking, saying it often takes a long time to alter people’s perceptions about the risk of certain activities. “Health behaviours take a long time to change but I think we have the obligation as professionals to continue to work at this in every setting.” – Diana Mehta, The Canadian Press CLINICAL High-dose opioids prescriptions rising: study Prescriptions for highdose formulations of opioids like oxycodone and morphine jumped significantly in Canada between 2006 and 2011, despite guidelines advising doctors against giving such elevated doses to most patients, a study has found. Researchers at St. Michael’s Hospital in Toronto and the Institute for Clinical Evaluative Sciences found the rate of high-dose opioid dispensing across Canada increased 23 per cent during the six-year study, from 781 units per 1,000 people in 2006 to 961 units in 2011. Put another way, that’s almost one high-dose opioid pill or patch for every person across Canada, say the researchers, who reported their findings in the journal Canadian Family Physician. “We found that high-dose prescribing was widespread across the country, but the prevalence differed considerably between provinces,” said lead author Tara Gomes. Dispensing rates in Saskatchewan and Newfoundland and Labrador spiked dramatically, rising almost 85 per cent and 54 per cent, respectively; Alberta, up six per cent, and British Columbia, rising eight per cent, remained relatively stable. Ontario had the highest dispensing rate at 1,382 units per 1,000 people – more than one per resident – while Quebec had the lowest rate at 368 units per 1,000 people. – Sheryl Ubelacker, The Canadian Press