The Prevention Conversation: A Shared Responsibility Project

BY LIZ PAYNE

More Canadians were hospitalized due to alcohol than for heart attacks last year, according to a new report from the Canadian Institute for Health Information.

In 2015-16, about 77,000 hospitalizations in Canada were entirely caused by alcohol, compared with about 75,000 for heart attacks.

The organization that compiles and analyzes health statistics said it is looking at alcohol harm because it is “a serious and growing concern, both in Canada and around the world.”

It is also costly, with economic costs estimated at more than $14 billion in 2002, $3.3 billion of which were direct health costs, according to the report titled Alcohol Harm in Canada.

Hospitalization rates due to alcohol — for mental physical conditions ranging from alcohol withdrawal to cirrhosis of the liver and acute pancreatitis — vary across the country. Remote, rural and northern regions having the highest rates.

In the Champlain region, including Ottawa, rates are below the national average, but higher than the Toronto and Mississauga regions. In Champlain, there were 166 hospitalizations per 100,000 people last year, compared to the national average of 239.

In Ontario, the North West LHIN, which includes Thunder Bay, rates were 603 hospitalizations per 100,000 people, more than twice the national average, and in the Northwest Territories hospitalization rates for alcohol were 1,315 per 100,000 people — by far, the highest in the country.

One of the reasons for the focus on alcohol harms, said Jean Harvey, who is director of the Canadian Population Health Initiative at CIHI, is that alcohol is so pervasive in society. About 80 per cent of people drink.

A comprehensive strategy aimed at reducing alcohol consumption, similar to anti-smoking efforts, could help reduce alcohol harm.

Last year, Ottawa Public Health issued a major report on alcohol use as a way of highlighting the potential harms it can do. The report, called Let’s Continue the Conversation, found that 83 per cent of adults in Ottawa drink alcohol. It also found that 22 per cent of adults exceeded the recommended consumption limits in 2013-2014 and 44 per cent of young adults reported heavy drinking in the previous year.

Excessive alcohol consumption is a risk factor for a number of illnesses, including cancer. CIHI will track rates of hospitalization caused by alcohol over time.

Although CIHI looked at hospitalizations directly caused by alcohol, trauma surgeons see many more patients requiring treatment for injuries associated with alcohol use, said Dr. Jacinthe Lampron, medical trauma director at The Ottawa Hospital.

Despite public campaigns, the hospital still sees patients with injuries that result from drunk driving as well as other injuries related to impairment, she said, including ATV injuries, boating injuries, falls and more.

More than 50 per cent of people being treated for trauma have some form of impairment, she said. And numbers are highest in the summer. “We call it trauma season.”

Among other things, it found that men over the age of 20 are more likely to be hospitalized for conditions entirely caused by alcohol than women. These gender differences mirror drinking patterns.

Among children between 10 and 19, however, more girls than boys are hospitalized for alcohol.

Dr. Sinthuja Suntharalingam, child and adolescent psychiatrist at CHEO, noted that females are more predisposed to anxiety and depression during adolescence than males.

“We have more females admitted for mental health reasons.” That likely translates to more young females self medicating with alcohol and other substances, she said.

Across Canada, an average of six children and youth were hospitalized per day due to alcohol.

At CHEO, alcohol harm as a reason for hospitalization among children is declining, she said, with cannabis and opioid use on the rise.

The Canadian Centre on Substance Abuse published Canada’s low-Risk Alcohol Drinking Guidelines to help reduce long-term health risks from alcohol, including chronic illnesses such as cancer, liver cirrhosis, diabetes and cardiovascular disease. In 2015, there were 5,082 alcohol-attributable deaths in Canada, according to a recent study.

Health officials advise no more than 10 drinks a week for women, with no more than two drinks a day at most, and 15 drinks a week for men, with no more than three drinks a day.

Retrieved from: http://www.ottawasun.com/2017/06/22/alcohol-sends-more-canadians-to-hospital-than-heart-attacks-report

ANDRÉ PICARD The Globe and Mail

How do you minimize the health impacts of marijuana in a country where it is legal to smoke – or otherwise consume – the drug?

As Canada approaches full legalization on July 1, 2018, a blue-ribbon panel of experts has provided an evidence-based answer to that thorny question and, on Friday, they will release a set of “lower-risk cannabis-use guidelines.”

The research, published in the American Journal of Public Health, is essentially a list of practical tips for current and potential marijuana smokers.

The guidelines begin with the statement that the health risks of cannabis – including impairment, pulmonary damage and neurological impacts – are most easily avoided by abstaining.

“It’s a bit of a mandatory, prophylactic statement, but it’s true,” said Dr. Benedikt Fischer, senior scientist at the Institute for Mental Health Policy Research at the Centre for Addiction and Mental Health in Toronto.

“Cannabis is not benign and people should not assume that it’s perfectly safe because it’s being legalized,” he said.

“But, ultimately, legalization should make it easier for cannabis users to make smart choices,” Dr. Fischer added.

About 15 per cent of Canadians – including roughly 30 per cent of adolescents and young adults – report using cannabis in the past year, according to surveys.

The guidelines are aimed principally at helping them reduce potential health risks.

The recommended measures include:

Delay using cannabis until adulthood: The researchers say that there is strong evidence that cannabis can affect the developing brain, so it is best delay use until after age 18, or even 21. The earlier someone starts smoking marijuana, the greater the potential harms, according to the research;

Avoid smoking cannabis products: Much of the harm comes from combustion, so users should favour safer methods such as vaping, bongs, edibles and drinkables. They should also avoid mixing cannabis with tobacco;

If you smoke cannabis, avoid harmful practices such as deep inhalation and breath-holding, which intensify the absorption of both psychoactive components and hazardous by-products;

Choose lower-risk cannabis: The researchers say high-potency products (meaning high THC content) such as “skunk” and “wax dabs” are best avoided;

Limit and reduce use: The greater the intensity and frequency of cannabis consumption, the higher the health risks. If you’re going to smoke cannabis, the guidelines recommend doing it occasionally, such as on weekends;

Don’t use synthetic cannabinoids: Products such as K2 and Spice are much more powerful and the effects are more severe than organic cannabis, so they should be avoided;

Don’t drive or operate heavy machinery: The guidelines recommended that users not drive for at least six hours after smoking or otherwise consuming cannabis and be especially cautious if they combine marijuana and alcohol;

Avoid cannabis altogether if you have a family history of mental illness (particularly psychosis) or if pregnant.

Dr. Fischer, who is also lead author of the guidelines, said it’s up to individuals to decide if and how they use cannabis, but it’s up to government and public-health officials to facilitate making smart choices.

For example, he said that good labelling is essential so users can know the THC content of products.

The guidelines stress that education is also required if people are going to be expected to make reasoned choices.

The dangers of driving while stoned should be heavily publicized, as was done with drunk driving.

While many other drugs, both legal and illicit – from alcohol to opioids – pose more health risks than cannabis, the guidelines stress that is not a reason for the risks to be ignored, and that harm reduction measures need to be embraced.

“Cannabis use carries with it real health risks and mitigating those risks for Canadians – particularly young Canadians – must be the first priority,” said Dr. Laurent Marcoux, president-elect of the Canadian Medical Association.

The guidelines are endorsed by a number of health groups, including the Canadian Medical Association, the Canadian Public Health Association and the Canadian Centre on Substance Use.

Retrieved from: https://www.theglobeandmail.com/news/national/panel-provides-guidelines-for-safe-cannabis-use/article35441871/

The group that represents obstetricians and gynecologists in Canada is watching the pending legalization of marijuana with concern, saying there is growing evidence suggesting its use by pregnant mothers negatively affects brain development in their fetuses.

“Our worry is that because it is made legal, people may think it is not a problem,” said Dr. George Carson, president of the Society of Obstetricians and Gynecologists of Canada.

“While it will be legal, the SOGC’s position is that we believe there are adverse effects on brain development from marijuana consumption until the brain development is finished, which is not until the early 20s. It is legal, but should be strongly discouraged.”

Of further concern is that marijuana is widely promoted among some as an anti-nauseant during early pregnancy.

“There are safe and more effective medications for nausea in pregnancy” said Carson. “My hope is that it is not used because of the adverse effects on brain development.”

Although more research needs to be done, a growing body of evidence points to negative effects on brain development as a result of marijuana exposure which can potentially affect the executive functions of the brain and behaviour.

The Society of Obstetricians and Gynecologists of Canada is issuing new guidelines on substance use during pregnancy later this year, partly because of the upcoming legalization of marijuana and new research into its effects, and partly because increased use of opioids.

It is also planning to conduct research to get a better sense of substance use during pregnancy, as well as during other times in women’s reproductive lifespan.

Substance use is the second leading killer of women during pregnancy, in part, because of fentanyl, said Jocelynn Cook, chief scientific officer at SOGC. A recent review of research, by Cook and others, noted the increased use of opioids among pregnant women is an emerging trend.

“This rise is purported to be a combination of the frequency of prescribed opioids for pain control in pregnant women, illicit use, and an increase in opioid-substitution programs for treatment of addiction … opioids are now being used by a more diverse population that includes pregnant women.”

“We really want to look at what women are doing now related to substance use — what is happening during pregnancy, what do women believe, what are their behaviours and where do they get their information?”

She said the research is important now because the landscape is changing when it comes to substance use.

“We know that 15 per cent of women drink alcohol during pregnancy, we don’t have the same information around cannabis use … we are scrambling to try to figure out how we can help target those populations.”

Canada has some of the highest rates of cannabis use by adolescents among developed nations. In addition, opioid use is rising rapidly. There are increasing numbers of babies born in Canada who are addicted to opioids because their mothers took them during pregnancy.

Carson, who works in Regina, said opioid use during pregnancy is of growing concern, but can also be an opportunity to improve the health of substance-using women in some cases. Women who are drug addicts tend not to be engaged with health care, he said, but will often seek medical treatment when they are pregnant.

He said getting a pregnant mother who is addicted to opioids into a methadone program can improve her health and her baby’s health.

Although there is a general increase in drug use among pregnant women, cannabis remains the most commonly used illicit substance. Estimates of women who use cannabis while pregnant have ranged from just under two per cent to more than 16 per cent, according to the research by Cook and others. It’s widespread use, the report said, “may be due in part to its reputation as a harmless drug.”

epayne@postmedia.com

ELIZABETH PAYNE, OTTAWA CITIZEN

Retrieved from: http://ottawacitizen.com/news/local-news/just-because-it-is-legal-doesnt-mean-it-is-good-obstetricians-worry-about-marijuana-law

The Society of Obstetricians and Gynaecologists of Canada (SOGC) is pleased to announce the release of an exciting new website, PregnancyInfo.ca, to inform women who are pregnant, or planning to become pregnant about the relevant evidence-based information they need for a healthy pregnancy (2017, June 20).

“This site covers questions from A-Z including important facts on nutrition, vaccination and the impact of the environment on pregnancy,” says Dr. Jennifer Blake, CEO SOGC. “In this era of fake news, women are looking for credible information. Our website incorporates the most recent clinical guideline data with practical advice from a committee of medical experts.” Research shows time and time again that when pregnant women are well informed about their needs and the needs of their growing baby, they will have healthier full-term pregnancies.

Click to visit the website!