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‘They’re quicker than we are’: Inside the fight against the opioid crisis

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They call it the opioid crisis: a rapid uptick in the use of both prescription and non-prescription opioid drugs across Canada and the United States.

The phenomenon began in the 1990s but has peaked in recent years with increased restrictions on prescribed opiates and the appearance of fentanyl, a powerful synthetic painkiller that’s become the street drug of choice for many.

Highly addictive, cheap to buy, and lucrative to those who sell it, fentanyl has been responsible for thousands of deaths across the country.

The death toll is staggering. Since January 2016, more than 8,000 Canadians have died of an accidental opioid overdose, according to the Public Health Agency of Canada, and most of those deaths are from fentanyl.

  • This is the third instalment in a four-part series in conjunction with the Calgary Eyeopener about how the fentanyl crisis is affecting people in the city 

In Alberta, fentanyl deaths continue to rise. Alberta Health reports that in 2016, 348 people died of accidental fentanyl poisoning. In 2017, that number had grown to 569 people, and in just the first half of 2018, 330 people had died of accidental fentanyl poisoning — around two people per day in this province alone.

Fentanyl « is a more potent formulation than what years before was out there, » said pharmacist Amy Rego, owner of Beacon Pharmacy in the Sheldon Chumir Health Centre.

The centre is also home to the city’s only supervised consumption site.

Amy Rego is the owner of Beacon Pharmacy in the Sheldon Chumir Health Centre. (David Bell/CBC)

Fentanyl doesn’t discriminate

Fentanyl doesn’t discriminate, she said; her clients who receive opioid maintenance medication range in age from 14 to their 70s.

« [The drug is] a hundred times more potent than morphine. So that in itself — we’re talking a granule. You don’t need much. The second thing is the affinity for the drug to the receptors in your brain. It’s a very high affinity. So it attaches, and the euphora. They’ve made it such that it’s highly addictive that way, » Rego said.

That highly addictive quality of fentanyl has caused an « epidemic, » according to Calgary police Staff Sgt. Kyle Grant, who works in the Strategic Enforcement Unit.

« It’s very cheap for the manufacturers to bring in and produce, and highly profitable for them to sell. It’s thousands per cent profit, versus what they put out to get it, and when you’re making that much money, I don’t think it’s ever really going away. »

A fentanyl user prepares to smoke the drug in downtown Calgary. (Elizabeth Withey/CBC)

Calgary police and the RCMP say most of the drug comes into North America via China, though some is coming up through Mexico, with a small amount being made here in labs in Canada.

China is attempting to regulate exports, but with thousands of fentanyl analogues or recipes, banning export of particular analogues is akin to banning house designs instead of banning bricks.

« The illegal supply side of this problem, they’re quicker than we are, » said MP Karen McCrimmon, parliamentary secretary for Public Safety Minister Ralph Goodale.

« They’re quicker to finding a way around things. The exporters of this product out of China, they’re pretty quick on their feet. Sometimes we’re playing catch up. »

Crackdown on pill presses, imports

The federal government has taken some action to tackle the opioid crisis in Canada.

In May 2017, it passed Bill C-37 to tighten control of pill presses, which are being used in the drug trade to press raw fentanyl powder into pill form, often after being diluted with a cutting agent such as caffeine powder or baking soda.

The federal government also gave Canada Border Services agents the power to open international mail under 30 grams,to check for drugs being imported.

Fentanyl comes in small amounts and is easy to mail.

Over a one-year period between 2017 and 2018, border agents seized 14 kilograms of fentanyl, enough for potentially 15,000 fatal doses, McCrimmon said.

The RCMP also has 130 sniffer dog teams specially trained to detect fentanyl, she added, and border services is investing in more technology to detect the drug upon arrival to Canada.

Grant said that police in Calgary are doing what they can. Border agents alert local police when a package containing fentanyl is destined for a particular city and police then follow up with the addressee.

‘Overwhelming’

« We’re on top of it as much as we can be, » he said. « The subject itself is overwhelming. But there’s never a shortage of work. »

When investigators make fentanyl drug seizures, they’re « potentially saving lives. They’re saving lives they don’t even know about. »

He added that « any seizure is a success. Because as we know and see, it only takes a portion of a pill to kill somebody, right? »

Katherine Pederson and Matthew Faulds lost their daughter Angelina (Lina) to fentanyl in 2017. (CBC)

Katherine Pederson knows all too well how deadly the drug is.

Her daughter Angelina (Lina) developed a drug problem in her early teens; Pederson and her husband Matthew Faulds tried everything to help.

In 2017 when she was 16, Lina took a fentanyl pill at a Calgary Stampede party and died.

« Lina touched every single public service and a private centre and still we lost her. So there’s something wrong with that. Like, how do you think a parent feels when they’ve done everything they can? »

Lina was among 12 case studies reviewed in a June 2018 report on youth opioid use issued by the Office of the Child and Youth Advocate of Alberta.

Angelina (Lina) Pederson was 16 when she died after taking fentanyl at a Calgary Stampede party. (Supplied)

The report highlights that youth are particularly vulnerable to the opioid crisis and require special strategies to respond to their substance use. In Alberta in 2017, 71 youth between the ages of 15 and 24 died from fentanyl, and 35 more youth died in the first half of 2018.

In May 2017, Alberta set up the Opioid Emergency Response Commission. Made up of experts from diverse backgrounds including parents and frontline workers, the commission makes recommendations on how the provincial government can combat the opioid crisis.

This summer the commission made 32 recommendations, all of which are being implemented by government.

Dr. Elaine Hyshka, co-chair of the commission, said the crisis can be resolved but it’s going to take some unconventional strategies.

« No one would say that increasing rates of overdose deaths is success by any measure, » Hyshka said, but added that the government’s quick response to the commission’s recommendations is a sign of hope.

« We’ve seen a significant amount of progress in terms of building our system capacity to respond to the crisis in a relatively short period of time. »

[Pharmaceutical companies] were certainly the kindling that set the stage, but fentanyl was the match.– Dr. Elaine Hyshka

But until accidental overdose numbers begin to significantly decline, she said, « there is more work to do. »

McCrimmon agrees the problem isn’t unsolvable — but that international cooperation with China is needed to stop the flow of the drug across international borders.

Lawsuits may be coming to help pay for the toll fentanyl is taking on the healthcare system.

In early October, the British Columbia government tabled the Opioid Damages and Health Care Costs Recovery Act — legislation to fast-track a class-action lawsuit against players in the opioid industry, including drug manufacturers, drugstore chains, distributors and wholesalers.

Hyshka supports any efforts to garner more resources for the opioid response, but said the « issue goes deeper. »

Safer alternatives

« [Pharmaceutical companies] were certainly the kindling that set the stage, but fentanyl was the match, » she said.

« At the end of the day we have to get people off the illegal market. We have to get people who are struggling — even if they’re going to use — onto safer alternatives. »

Hyshka said Alberta is keenly watching how B.C. is handling the crisis; some of the plans, she said, are « promising. »

That province is considering implementing a low-threshold hydromorphone program, she explained, which would help get people off illicit fentanyl.

« If we’re willing to think outside the box and recognize that what we’ve been doing traditionally has not been effective, then we can get on top of it but it’s going to require significant willingness to move into uncharted territory, » she said.

Many Calgary drug users are taking advantage of Safeworks, the city’s supervised consumption site where clients who use illicit substances can receive clean needles and be monitored to prevent overdoses.

Many of Beacon Pharmacy’s clients access treatment services in the Chumir and use Rego’s pharmacy to « dose, » receiving daily opioid maintenance medications such as methadone or Suboxone — putting Rego’s pharmacy at the epicentre of the epicentre.

Some clients at Beacon Pharmacy receive daily opioid maintenance medications like Suboxone. (Sally Pitt/CBC News)

The Calgary Zone continues to have the highest rate of fentanyl deaths in Alberta (20.1 per 100,000 person years, according to Alberta Health’s Opioid Response Surveillance Report from Aug. 31, 2018, compared with the provincial average of 15.1).

The work at Beacon Pharmacy isn’t for everyone.They’ve gone through numerous staff.

While it’s not what she’d envisioned when she and Rich opened the pharmacy a decade ago in 2008, Rego finds the work rewarding, especially when she fosters solid relationships with opioid users in treatment who’ve been mistreated or demeaned at other pharmacies.

Of her work she said, « It’s great the way it is. I wouldn’t have it any other way. »

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Anglais

Nostalgia and much more with Starburst XXXtreme

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Get a taste of adventure with Starburst XXXtreme based on the legendary NetEnt Game. The nostalgic themes are sure to capture fans of the classic version as they get treated to higher intensity, better visuals, and features. The most significant element of the game is its volatility. Patience will not be an essential virtue considering the insane gameplay, and there is a lot of win potential involved. It retains the original makeup of the previous game while adding a healthy dose of adrenaline. 

Starburst Visuals and Symbols

The game is definitely more conspicuous than before. The setting happens over a 5-reel, 3-row game grid with nine fixed win lines, which function if a succession from the left to the right reel is present. Only those players that that attain the highest win per bet line are paid. From a visual standpoint, the Starburst XXXtreme slots illustrates lightning effects behind the reels, which is not surprising as it is inherited from the original version. Available themes include Classic, Jewels, and Space. The game is also available in both desktop and mobile versions, which is advantageous for players considering the global pandemic. According to Techguide, American gamers are increasingly having more engaging gaming experiences to socialize to fill the gap of in-person interaction. Starburst XXXtreme allows them to fill the social void at a time when there is so much time to be had indoors. 

Starburst XXXTreme Features

Players get to alternate on three features which are Starburst Wilds, XXXtreme Spins, and Random Wilds. The first appears on reels 2,3, or 4. When these land, they expand to cover all positions while also calculating the wins. They are also locked for a respin. If a new one hits, it also becomes locked while awarding another respin. Starburst XXXtreme offers a choice between two scenarios for a higher stake. In one scenario with a ten times stake, the Starburst Wild is set on random on reels 2,3, or 4, and a multiplier starts the respin. The second scenario, which has a 95 times stake, starts with two guaranteed starburst wilds on reels 2,3, or 4. it also plays out using respin game sequence and features. The game also increases the potential with the Random Wilds feature to add Starburst Wilds to a vacant reel at the end of a spin. Every Starburst Wild gives a random multiplier with potential wins of x2, x3, x5, x10, x25, x50, x100, or even x150.

The new feature is sure to be a big hit with the gaming market as online gambling has shown significant growth during the lockdown. AdAge indicates the current casino customer base is an estimated one in five Americans, so Starburst XXXtreme’s additional features will achieve considerable popularity. 

What We Think About The Game

The gambling market has continued to diversify post-pandemic, so it is one of the most opportune times to release an online casino-based game. Thankfully Starburst XXXtreme features eye-catching visuals, including the jewels and space themes. These attract audience participation and make the gameplay inviting. The game also has a nostalgic edge. The previous NetEnt iteration featured similar visuals and gameplay, so the audience has some familiarity with it. The producers have revamped this version by tweaking the features to improve the volatility and engagement. 

That is characterized by the potential win cap of 200,000 times the bet. Starburst XXXtreme does not just give betting alternatives for players that want to go big. The increase of multipliers also provides a great experience. If the respins in the previous version were great, knowing that multipliers can go hundreds of times overtakes the game to a new level. 

Players should get excited about this offering. All of the features can be triggered within a single spin. Whether one plays the standard game or takes the XXXtreme spin route, it is possible to activate all of the features. Of course, the potential 200,000 times potential is a huge carrot. However, the bet size is probably going to be restricted and vary depending on the casino. It is also worth pointing out that a malfunction during the gameplay will void all of the payouts and progress. Overall, the game itself has been designed to provide a capped win of 200,000 times the original bet. 

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Anglais

‘We’re back’: Montreal festival promoters happy to return but looking to next year

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In downtown Montreal, it’s festival season.

In the city’s entertainment district, a musical act was conducting a sound check on stage Friday evening — the second day of the French-language version of the renowned Just For Laughs comedy festival. Tickets for many of the festival’s free outdoor shows — limited by COVID-19 regulations — were sold out.

Two blocks away, more than 100 people were watching an acoustic performance by the Isaac Neto Trio — part of the last weekend of the Festival International Nuits d’Afrique, a celebration of music from the African continent and the African diaspora.

With COVID-19 restrictions continuing to limit capacity, festival organizers say they’re glad to be back but looking forward to next year when they hope border restrictions and capacity limits won’t affect their plans.

Charles Décarie, Just For Laughs’ CEO and president, said this is a “transition year.”

“Even though we have major constraints from the public health group in Montreal, we’ve managed to design a festival that can navigate through those constraints,” Décarie said.

The French-language Juste pour rire festival began on July 15 and is followed by the English-language festival until July 31.

When planning began in February and March, Décarie said, organizers came up with a variety of scenarios for different crowd sizes, ranging from no spectators to 50 per cent of usual capacity.

“You’ve got to build scenarios,” he said. “You do have to plan a little bit more than usual because you have to have alternatives.”

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Anglais

MELS new major movie studio to be built in Montreal

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MONTREAL — MELS Studios will build a new film studio in Montreal, filling some of the gap in supply to meet the demand of Hollywood productions.

MELS president Martin Carrier said on Friday that MELS 4 studio construction will begin « as soon as possible », either in the fall or winter of next year. The studio could host productions as early as spring 2023.

The total investment for the project is $76 million, with the Quebec government contributing a $25 million loan. The project will create 110 jobs, according to the company.

The TVA Group subsidiary’s project will enable it to stand out « even more » internationally, according to Quebecor president and CEO Pierre Karl Péladeau. In the past, MELS Studios has hosted several major productions, including chapters of the X-Men franchise. The next Transformers movie is shooting this summer in Montreal.

Péladeau insisted that local cultural productions would also benefit from the new facility, adding that the studio ensures foreign revenues and to showcase talent and maintain an industry of Quebec producers.

STUDIO SHORTAGE

The film industry is cramped in Montreal.

According to a report published last May by the Bureau du cinéma et de la télévision du Québec (BCTQ), there is a shortage of nearly 400,000 square feet of studio space.

With the addition of MELS 4, which will be 160,000 square feet, the company is filling part of the gap.

Carrier admitted that he has had to turn down contracts because of the lack of space, representing missed opportunities of « tens of millions of dollars, not only for MELS, but also for the Quebec economy. »

« Montreal’s expertise is in high demand, » said Montreal Mayor Valérie Plante, who was present at the announcement.

She said she received great testimonials from « Netflix, Disney, HBO and company » during an economic mission to Los Angeles in 2019.

« What stands out is that they love Montreal because of its expertise, knowledge and beauty. We need more space, like MELS 4, » she said.

There is still not enough capacity in Quebec, acknowledged Minister of Finance, the Economy and Innovation Eric Girard.

« It is certain that the government is concerned about fairness and balance, so if other requests come in, we will study them with the same seriousness as we have studied this one, » he said.

Grandé Studios is the second-largest player in the industry. Last May, the company said it had expansion plans that should begin in 2022. Investissement Québec and Bell are minority shareholders in the company.

For its part, MELS will have 400,000 square feet of production space once MELS 4 is completed. The company employs 450 people in Quebec and offers a range of services including studio and equipment rentals, image and sound postproduction, visual effects and a virtual production platform.

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