Cutting Addictions : Saving Lives

"We need to understand that opioid addiction does not occur in isolation. All these social determinants are intertwined: mental health issues, poverty, housing, food insecurity, trauma. All of these are related to addictions."
"So you need an approach that addresses the whole person rather than just the opioid, or just the cigarette, or just their diabetes."
"It's not black magic: There is neurobiology at play. Tobacco is the king of addiction, and it causes structural changes in your brain, in the receptors, and it amplifies the response."
Dr. Smita Pakhale, respirologist, The Ottawa Hospital

'We’re trying to understand if e-cigarettes can be in our toolbox,' said Dr. Smita Pakhalé of trying to find ways to help homeless people stop smoking. Jean Levac / Postmedia

"When I was able to see that I could reduce my nicotine intake, that gave me a good feeling, and the more I reduced, the better I felt. I thought that if I could do that, why can't I reduce my drinking?"
"Unfortunately, I started [smoking after cessation] again, but I'm still working on trying to quit."
Tara Finnessy, 50, client, Bridge Engagement Centre

Tara Finnessy was, she tells an interviewer, nine years old when she first began smoking. By the age of 11 she was a veteran smoker, completely addicted to tobacco. From there her addiction began to escalate as she grew older until she became dependent on cocaine, followed by heroin, all crutches to help cope with personal tragedies in her life. Hoping to cope in a more reasonable, less-death-defying manner, she turned to methadone, and has been on it for the past fifteen years of her life.

And she is a client at the Bridge Engagement Centre in Ottawa whose mandate is to give aid to people living on the streets, to the addicted, the mentally challenged, the drifters. Medical specialists from The Ottawa Hospital donate their time and expertise to this community project to give help and hope to the seemingly hopeless. Out of this group has come a new study published in the online open access journal, BMJ Open.

Researchers at the Bridge Engagement Centre enlisted 80 inner-city Ottawa residents offering them free nicotine replacement therapies inclusive of patches, gum or inhalers, in concert with peer support, mental health counselling and life-skills training, all of which comprised a study in a comprehensive approach to addictions and the background issues that lead people to become victimized. Dr. Pakhale is director of the Bridge drop-in centre and she led this new study.

Over a six-month period, participants who remained in the program were found to have reduced their daily cigarette use from an average of 20.5 cigarettes a day to 9.3. Study participants reported an 18.8 percent decline in illicit drug use. The breakdown: heroin (6.3 percent), OxyContin (3.8 percent, and fentanyl (2.6 percent) declined among those study participants who had acutely reduced their smoking habit.

The study suggests that smoking cessation represents an opening in people's fixed routine dependencies to be treated for their multiple addictions. Both tobacco and opioids are reactive to the brain's reward centres. One addiction reinforces another, pointed out Dr. Pakhale. Among the homeless and marginalized populations, smoking becomes an endemic addiction.

A study of 858 drug users in Ottawa's inner city undertaken in 2013 concluded that 96 percent smoked cigarettes on a daily basis in comparison to roughly nine percent of the city's general population who did the same. While the vast majority of inner-city smokers would like to quit smoking according to research, a persistent belief exists that smoking represents a minor problem in comparison to housing, mental health and other issues related to addiction.

"That translates into a disproportionate amount of disease and premature death -- preventable deaths -- in this population", pointed out Dr. Pakhale.

"Selfie" Epileptic Seizures

"There's a lot of data already about selfies being potentially dangerous in some circumstances because people don't think."
"There are even reports about people taking selfies while driving ... if you induced a[n epileptic] seizure behind the wheel, that would be a catastrophe, potentially."
Dr. Paula Brna, pediatric neurologist, Dalhousie University

Luca Bruno/AP    Pope Francis poses for a selfie as he arrives at Milan's Linate airport, northern Italy, for a pastoral visit to Monza and Milan, Saturday, March 25, 2017.

 

The ego-boosting selfie so beloved of an ever-expanding range of people -- from politicians to celebrities, sport figures to performers, and the everyday public -- comes equipped with a not-so-innocent precaution: people susceptible to the effects of flickering light on the brain resulting in epileptic seizures had better set aside the ambition to take photographs of themselves at whimsically bored moments. Or even, come to think of it, as efforts to retain special moments photographically.

For the simple reason that the special moment not on the individual's thought-radar may turn out to be their last. Self-portraiture via smart phones and other types of digital photographic equipment that come so readily to hand are of particular danger as a trigger for seizures afflicting some epileptics.
A study of a case where a teen spent three days in a Halifax hospital hooked to an electroencephalogram monitored by camera to routinely assess her epilepsy revealed a surprise.

The camera verified what doctors suspected was the source of sudden bursts of action on the brain monitor, which typified epileptic seizures, matched against the bored teen taking selfies using an iPhone, sending the resulting photos of a head sporting Medusa-like electric leads, on to friends. An idle moment turned out to be a revelation which resulted in a paper published in the journal Seizure. Only one case, to be sure, but more studies will likely follow to validate the conclusions of this one.

Jeff Spicer/Getty Images   Actor Tom Hiddleston takes a selfie with a fan at the Three Empire Awards on March 19, 2017, in London, England. 

 

The reason this is important is that the phenomenon has far-reaching consequences. People who have "photosensitivity", which is to say people who may suffer seizures on exposure to light flickering at specific frequencies, will be found to have experienced triggers through a hitherto-unsuspected source. And since many people use smart phones routinely, even when driving, being put out of executive function commission behind the steering wheel is pretty serious stuff.

Dr. Elizabeth Donner, head of the epilepsy program at Sick Children's Hospital in Toronto is of the opinion that though a fairly limited number of epileptics are photosensitive, the potential of incipient crises would call for counselling patients about such risks. Dr. Brna mentioned that observers were not quite certain whether it was the phone's flash or the pulsing red-eye-avoidance LED light which was responsible for the seizures.

A string of serious accidents have occurred while people taking selfies happened to be driving. Or not necessarily driving, but standing, for example at the edge of a sheer drop, or holding loaded firearms. Close to 150 deaths or serious injuries have been listed, connected with selfie-taking behaviour, between December 2013 and February of this year.

Jure Makovec/AFP/Getty Images    Members of Team Poland take a selfie after winning the Nations Cup of the FIS Ski Jumping World Cup in Planica on March 26, 2017.