Canada is failing the rising numbers of youth who use opioids

Canadian Medical Association Journal

FacebookXLinkedInWeChatBlueskyMessageWhatsAppEmail

Youth opioid use is increasing in Canada, as are related emergency department visits and deaths, yet governments are not providing adequate support to address this public health crisis, argue the authors of a CMAJ (Canadian Medical Association Journal) editorial https://www.cmaj.ca/lookup/doi/10.1503/cmaj.251682.

“If this crisis is not properly addressed now, Canada’s health systems will play a part in perpetuating the opioid crisis for decades to come,” write Dr. Shannon Charlebois, medical editor, CMAJ, and Dr. Shawn Kelly, a pediatrician and addictions medicine specialist, CHEO and the University of Ottawa, Ottawa, Ontario.

In Ontario, students’ use of prescription opioid pain relievers for nonmedical reasons increased significantly from 12.7% in 2021 to 21.8% in 2023. Students in younger grades (7 to 9) were more likely to report use than older high school students (grades 10 to 12). Youth aged 15 to 24 made up 9% of emergency department visits in Ontario for opioid use, and opioid-related deaths increased 369.2% from 2.6 to 12.2 per 100 000 population from 2013 to 2021.

Paradoxically, youth struggle to access opioid agonist therapy, with evidence showing that fewer prescriptions are written even as the need increases. Other effective treatments, such psychological therapy and substance use disorder programs, are sparse, have long wait-lists, and are often privately funded, making them inaccessible to those most at risk.

“Health systems’ inaction and lack of investment to provide evidence-based addictions services for youth is inexcusable, as the opioid crisis involves this population. Physicians who treat youth need support to be able to care for their patients with OUD [opioid use disorder]. Anything less represents complicity in the next decade of preventable deaths,” they conclude.

---

Journal

Canadian Medical Association Journal

DOI

10.1503/cmaj.251682 

Method of Research

Commentary/editorial

Subject of Research

People

Article Title

Canada’s youth are part of the opioid crisis and need treatment

Article Publication Date

27-Oct-2025

Can inpatient care help address overdose crisis?

Canadian Medical Association Journal

FacebookXLinkedInWeChatBlueskyMessageWhatsAppEmail

Is expanding hospital inpatient, or bed-based, care a way to help address the overdose crisis? An analysis article in CMAJ (Canadian Medical Association Journal) https://www.cmaj.ca/lookup/doi/10.1503/cmaj.240955  describes the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance), which can help provinces determine whether bed-cased care is effective.

British Columbia and Alberta, the two provinces with the highest rate of overdose deaths, are focusing more on bed-based care. British Columbia is considering expanding capacity, and Alberta is planning to build 11 new inpatient facilities to help people with substance use disorder (SUD).

Inpatient care offers a range of supports, from reducing drug use to abstinence, with a range of medications and psychological treatments. However, access to care is challenging, with long wait-lists because of a lack of beds and specialized health workers.

“The RE-AIM framework is flexible enough to incorporate evaluation of the effectiveness of component services, as well as the extent to which they meet the needs of the eligible client base and how facilities expand, adapt, and are sustained over the long term,” writes Dr. Bohdan Nosyk, a professor at Simon Fraser University, Burnaby, BC, and a scientist at the Centre for Advancing Health Outcomes, Vancouver, BC, with coauthors.

“Bed-based models of care for people with SUD offer multifaceted, complex interventions that are resource intensive. Effectiveness is therefore difficult to evaluate. Using the RE-AIM framework helps to highlight suboptimal evidence of effectiveness of bed-based care and likely limited capacity relative to the size of the populations with SUD.”

The authors suggest that the RE-AIM framework can help provinces evaluate whether bed-based care for SUD can meet the needs of their populations and whether it is effective for improving outcomes for people with SUD.

---

Journal

Canadian Medical Association Journal

DOI

10.1503/cmaj.240955 

Method of Research

Literature review

Subject of Research

People

Article Title

Bed-based care as a response to the overdose crisis: an approach to informing and evaluating proposed expansion

Article Publication Date

27-Oct-2025

 

Opioid prescribing for pain is declining in Canada

Canadian Medical Association Journal

FacebookXLinkedInWeChatBlueskyMessageWhatsAppEmail

Efforts to promote safer opioid prescribing in Canada appear to be having an effect, as new research in CMAJ (Canadian Medical Association Journal) https://www.cmaj.ca/lookup/doi/10.1503/cmaj.250670  shows a decrease in opioid dispensing between 2018 and 2022.

In the early 2000s, use of prescription opioids to treat acute and chronic noncancer pain increased substantially in Canada, and with it came a rise in opioid-related harms. The availability of more opioid products, coupled with aggressive marketing of these drugs, contributed to these early increases in Canada and in other countries.

Many initiatives have been introduced with the goal of reducing these harms throughout the country, including policy changes, a focus on continuing medical education for evidence-based prescribing, and a national Canadian guideline for opioid prescribing published in 2017. 

With these changes, a need has emerged for national information on prescription opioid use in Canada and how this varies in different parts of the population. Researchers aimed to help fill this gap with a study of opioid prescribing in 6 Canadian provinces (British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, and Quebec) between 2018 and 2022. The number of people newly starting opioids declined 8% during the study period, and the total number of people accessing opioids declined 11%. In 2022, across Canada, approximately 1.8 million people started an opioid to manage pain for the first time. However, the rate of opioid prescribing varied among provinces, ranging from 55 new opioid starts per 1000 people in Ontario to 63 per 1000 people in Alberta.

“[T]he interprovincial variations in our findings may indicate differences in the implementation of prescribing guidelines, underscoring the need for coordinated national strategies and ongoing evaluation of their effects on patient outcomes,” writes Dr. Tara Gomes, a researcher in the Ontario Drug Policy Research Network at St. Michael’s Hospital, Unity Health Toronto, with coauthors.

Annual rates of new prescriptions were higher for females, older adults, and people living in lower-income neighbourhoods and rural regions. Codeine was most usually prescribed in most provinces, with the exception of Quebec, where people were more commonly dispensed morphine and hydromorphone. Oxycodone dispensing decreased over time, although in Ontario over one-quarter of opioids prescribed were still for oxycodone in 2022.

The authors caution that although lower rates of opioid prescribing may reflect doctors’ efforts to ensure safe and appropriate prescribing, a balance is needed to ensure that people are not left without pain relief or cut off from medications without appropriate supports and coordination of care.

“Importantly, although these recommendations intended to promote safer opioid prescribing, improper implementation can lead to rapid dose tapering, abrupt opioid discontinuation, and reluctance to initiate patients on opioids when clinically indicated. In some cases, these changes have led to patients seeking access to opioids from the unregulated drug supply, which are inherently more harmful,” write the authors.

The researchers suggest that clinicians engage in conversations with patients to ensure shared decision-making, and assess pain levels and ability to function.

“The truth is … that opioids are less effective and less safe than many care to admit,” writes Dr. David Juurlink, an internist and researcher at Sunnybrook Research Institute and the University of Toronto, Toronto, Ontario, in a related commentary https://www.cmaj.ca/lookup/doi/10.1503/cmaj.251666 praising the continued decline in opioid prescribing.

Opioids can be effective when carefully prescribed, particularly for short periods. But, with long-term use, their effectiveness can wane and they can harm patients in ways that are hard to appreciate.

“Most clinicians have seen how well opioids can work when first given,” writes Dr. Juurlink. “But they are at their pharmacologic best in the initial days of treatment. Continue them for weeks, months, or years and the calculus becomes progressively less favourable.”

Juurlink urges thoughtful prescribing, which “begins with recognizing that all patients in pain fall into 1 of 3 mutually exclusive groups: those not yet on opioids, those taking opioids chronically (sometimes called ‘legacy patients’), and those with established addiction. The latter 2 groups overlap and are easily harmed by rapid dose reduction, but they can also be harmed by dose escalation. For such patients, when pain intensifies, nonopioid strategies are preferred. The first group, by contrast, has the most to gain from thoughtful opioid stewardship.”

---

Journal

Canadian Medical Association Journal

DOI

10.1503/cmaj.250670 

Method of Research

Observational study

Subject of Research

People

Article Title

Trends in prescription opioid use for pain in Canada: a population-based repeated cross-sectional study of 6 provinces

Article Publication Date

27-Oct-2025

Discovering six new bat species is a treat for museum researcher

New species of tube-nosed bats identified in protected forests of the Philippines

Royal Ontario Museum

FacebookXLinkedInWeChatBlueskyMessageWhatsAppEmail

 

image: 

M. alvarezi, FMNH 205827

view more 

Credit: Credit: J. Sedlock

Just in time for Halloween, six new bat species have been discovered by researchers from the Royal Ontario Museum (ROM), Field Museum in Chicago, and Lawrence University in Wisconsin. This nocturnal – and slightly spooky – group of mammals is incredibly diverse, and the discovery adds to the thousands of known bat species.

Formally described as new species through the examination of physical and genetic characteristics, these six new species from the Philippines are commonly known as tube-nosed bats.

“This latest research serves to illustrate how much remains unknown about the countless species with which we coexist,” says Dr. Judith Eger, Curator Emeritus of Mammals at ROM. “Expanding our knowledge of biodiversity is essential to understanding and managing our environment on behalf of humanity and the other species on which the vitality of our planet depends.”

In the Philippines, Halloween is celebrated less than in North America, but Filipinos have their own bat-related folklore of aswang – frightening and shape-shifting monsters, some inspired by flying fox bats, the largest bats in the world. And the diversity of bats is echoed in their cultural significance around the world – for instance, they are thought to bring good luck in China; fortune and wealth in India; and worshipped as deities in Guatemala and Mexico.

“I’m astonished at how much we still don’t know about the natural world, such as how many bat species there are. Before we started our research, there were only two species of tube-nosed bats reported from the Philippines,” says Dr. Burton Lim, Assistant Curator of Mammals at ROM. “We confirmed the presence of one of those species, plus another closely related species previously unknown to science. The other previously reported species was actually not present in the Philippines, but we did find five new species that were masquerading as it!”

The six new bat species – Murina alvarezi, Murina baletei, Murina hilonghilong, Murina luzonensis, Murina mindorensis, and Murina philippinensis – were identified as separate species through a combination of morphological examination and genetic testing. Researchers examined tooth pattern, skull shape, fur banding and other visible characteristics, and conducted genetic analyses in the ROM Laboratory of Molecular Systematics.

Bats are found worldwide as they evolved to occupy a wide range of ecosystems, and they perform important ecological functions that support biodiversity. Tube-nosed bats (genus Murina) are insect-eating bats found throughout Asia that depend on forested areas for roosting and are therefore at risk from deforestation. The Philippines, as a country of many large and small islands, is home to remarkably diverse habitats and was known to have 79 species of bats – even before this current discovery.

How bat species of the genus Murina in the Philippines differ from those from other regions in Southeast Asia has been a ROM research focus for many years. The ROM bat collection is among the most extensive in the world and includes dried skins with skeletons and ethanol-preserved specimens. In addition, the collection contains 15,000 frozen tissue specimens from 30 countries, representing 15 of the world’s 21 bat families, 120 of 220 genera, and 400 of 1,400 species.

This current research, now published in the international journal of animal taxonomy Zootaxa, adds six more new species of bats known to science, and their corresponding nucleotide sequences have been deposited in GenBank. With many diverse forest environments in the Philippines, more new bat species are likely to be discovered in the future.

"It has been a long and slow process of discovery, but these six previously unknown species show clearly just how wonderfully extensive Philippine biodiversity is,” says Dr. Lawrence Heaney, Curator Emeritus of Mammals at the Field Museum. “On a per-unit-area basis, the Philippines has the most distinctive mammal fauna of any country worldwide.”

These new species are all small bats, weighing just 4 to 14 grams each. The specimens were collected by the Field Museum starting in 1988, including from protected Key Biodiversity Areas, in collaboration with the Biodiversity Management Bureau of the Philippine Department of Environment and Natural Resources and Protected Area Management Boards.

“These bats are notoriously elusive, so the tube-nosed bat collection this study examined was cobbled together over many years, expeditions, and memorable experiences – one bat at a time. As a result, it’s deeply satisfying to see our collection make such an important contribution to Philippine biodiversity studies,” says Dr. Jodi Sedlock, co-author and Dennis and Charlot Nelson Singleton Professor of Biological Sciences at Lawrence University. “I’m eager to learn what these newly described tube-nosed bats each do with their tube-like nostrils that, presumably, offer them directional smell detection. Describing them is an essential beginning, but there’s still so much to learn!”

The Field Museum has conducted fieldwork, along with colleagues in the Philippines, for over 30 years as part of the Philippine Mammal ​Project. The reference specimens (holotype) and other specimens originally housed at the Field Museum for study are now at the National Museum of the Philippines.

One of the new species is named in honour of James Alvarez, a devoted young bat biologist and student with the University of the Philippines - Los Banos, who tragically died during fieldwork in 2018. Another is named for prominent Filipino biodiversity scientist Danilo (Danny) Balete, who had been involved since 1989 with the Field Museum’s Philippine Mammal Project.

The paper, Systematics and biogeography of tube-nosed bats, Murina (Mammalia, Chiroptera, Vespertilionidae), from the Philippines with descriptions of six new species, was published in Zootaxa, September 8, 2025. DOI: 10.11646/zootaxa.5691.1.1

---

Journal

Zootaxa

DOI

10.11646/zootaxa.5691.1.1 

Subject of Research

Animals

Article Title

Systematics and biogeography of tube-nosed bats, Murina (Mammalia, Chiroptera, Vespertilionidae), from the Philippines with descriptions of six new species

Murina baletei



Credit

Credit: D. Balete

Murina luzonensis



Credit

Credit: D. Balete






Murina philippinensis



Credit

Credit: J. Sedlock

Map of the Philippines and bat collection localities.

Credit: Field Museum





Fieldwork in the Philippines

Credit: Jodi L. Sedlock




Dr. Judith Eger, Curator Emeritus of Mammals and Dr. Burton Lim, Assistant Curator of Mammals in the ROM collections room.

Credit: David McKay, ROM

SPAGYRIC HERBALISM

Henna’s hidden healing: Treating fibrosis with a chemical derived from Lawsonia inermis

A new study suggests that the same henna pigments that change your skin or hair that distinctive orange-red color could be used for another purpose: treating liver disease.

Osaka Metropolitan University

FacebookXLinkedInWeChatBlueskyMessageWhatsAppEmail

 

image: 

Treatment with Lawsone converts a liver with fibrosis into a healthy liver.

view more 

Credit: Osaka Metropolitan University

Lawsonia inermis is best known for making henna, a versatile dye that is used to change the color of skin and clothes. Now, researchers from Osaka Metropolitan University have found another use for the pigments extracted from the dye: treating liver disease.

Specifically, they could treat liver fibrosis, a disease that causes excess fibrous scar tissue to build up in the liver as a result of chronic liver injury caused by lifestyle choices such as excessive drinking. Patients with liver fibrosis have increased risks of cirrhosis, liver failure, and cancer. Despite 3–4% of the population having the advanced form of the disease, treatment options remain limited.

One potential treatment for the disease involves hepatic stellate cells (HSCs). Usually, these cells maintain balance in the liver; however, when too many are activated, such as during liver injury, they produce excessive fibrous tissue and collagen, disrupting normal liver function.

A research group led by Associate Professor Tsutomu Matsubara and Dr. Atsuko Daikoku at the Graduate School of Medicine, Osaka Metropolitan University, developed a chemical screening system that identifies substances that directly act on activated HSCs. Using the system, they identified Lawsone, a chemical component from Lawsonia inermis—also known as the henna tree—as a potential inhibitor of HSC activation.

When the researchers administered Lawsone, the mice that received the treatment showed reductions in markers of liver fibrosis, such as YAP, αSMA, and COL1A. They also found upregulated cytoglobin, a marker associated with antioxidant functions in HSCs, suggesting that the HSCs were reverting back toward the non-fibrotic, quiescent type.

The professors believe that by making drugs based on Lawsone, they could create the first treatment that controls and even improves fibrosis. “We are currently developing a drug delivery system capable of transporting drugs to activated HSCs and ultimately hope to make it available for patients with liver fibrosis,” Matsubara said. “By controlling fibroblast activity, including HSCs, we could potentially limit or even reverse the effects of fibrosis.”

The study was published in Biomedicine & Pharmacotherapy.

---

Journal

Biomedicine & Pharmacotherapy

DOI

10.1016/j.biopha.2025.118520 

Method of Research

Experimental study

Subject of Research

People

Article Title

Lawsone can suppress liver fibrosis by inhibition of YAP signaling and induction of CYGB expression in hepatic stellate cells