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Concept: Vancouver


Illicit use of high-potency synthetic opioids has become a global issue over the past decade. This misuse is particularly pronounced in British Columbia, Canada, where a rapid increase in availability of fentanyl and other synthetic opioids in the local illicit drug supply during 2016 led to a substantial increase in overdoses and deaths. In response, distribution of take-home naloxone (THN) overdose prevention kits was scaled up (6·4-fold increase) throughout the province. The aim of this study was to estimate the impact of the THN programme in terms of the number of deaths averted over the study period.

Concepts: Opioid, Morphine, Heroin, Naloxone, Canada, Buprenorphine, Drug overdose, Vancouver


Humans use a variety of deliberate means to modify biologically rich environs in pursuit of resource stability and predictability. Empirical evidence suggests that ancient hunter-gatherer populations engineered ecological niches to enhance the productivity and availability of economically significant resources. An archaeological excavation of a 3800-year-old wetland garden in British Columbia, Canada, provides the first direct evidence of an engineered feature designed to facilitate wild plant food production among mid-to-late Holocene era complex fisher-hunter-gatherers of the Northwest Coast. This finding provides an example of environmental, economic, and sociopolitical coevolutionary relationships that are triggered when humans manipulate niche environs.

Concepts: Natural environment, Economics, Pacific Northwest, Archaeology, British Columbia, Vancouver, Excavation, Indigenous peoples of the Pacific Northwest Coast


The Downtown Eastside (DTES) of Vancouver is the subject of considerable research due to high rates of drug use, poverty, crime, infectious disease, and mental illness. This paper first presents a brief background to the DTES and then presents a survey of literature addressing the issues in this area from 2001 to 2011. The literature surveyed includes a range of publications such as those from peer-reviewed journals and the grey literature of reports and dissertations. This survey investigates the themes and outcomes of the extant literature and highlights the notable lack of research on mental health in the DTES.

Concepts: Psychology, Medicine, Epidemiology, Infectious disease, Academic publishing, Downtown Eastside, Vancouver, Chinatown, Vancouver


Canada has long contended with harms arising from injection drug use. In response to epidemics of HIV infection and overdose in Vancouver in the mid-1990s, a range of actors advocated for the creation of supervised injection facilities (SIFs), and after several unsanctioned SIFs operated briefly and closed, Canada’s first sanctioned SIF opened in 2003. However, while a large body of evidence highlights the successes of this SIF in reducing the health and social harms associated with injection drug use, extraordinary efforts were needed to preserve it, and continued activism by local people who inject drugs (PWID) and healthcare providers was needed to promote further innovation and address gaps in SIF service delivery. A growing acceptance of SIFs and increasing concern about overdose have since prompted a rapid escalation in efforts to establish SIFs in cities across Canada. While much progress has been made in that regard, there is a pressing need to create a more enabling environment for SIFs through amendment of federal legislation. Further innovation in SIF programming should also be encouraged through the creation of SIFs that accommodate assisted injecting, the inhalation of drugs. As well, peer-run, mobile, and hospital-based SIFs also constitute next steps needed to optimize the impact of this form of harm reduction intervention.

Concepts: HIV, Pharmacology, Infectious disease, Drug, Drugs, Drug addiction, Drug injection, Vancouver


We document the abundance, composition and distribution of microplastics in sub-surface seawaters of the northeastern Pacific Ocean and coastal British Columbia. Samples were acid-digested and plastics were characterized using light microscopy by type (fibres or fragments) and size (<100, 100-500, 500-100 and >1000μm). Microplastics concentrations ranged from 8 to 9200particles/m(3); lowest concentrations were in offshore Pacific waters, and increased 6, 12 and 27-fold in west coast Vancouver Island, Strait of Georgia, and Queen Charlotte Sound, respectively. Fibres accounted for ∼75% of particles on average, although nearshore samples had more fibre content than offshore (p<0.05). While elevated microplastic concentrations near urban areas are consistent with land-based sources, the high levels in Queen Charlotte Sound appeared to be the result of oceanographic conditions that trap and concentrate debris. This assessment of microplastics in the NE Pacific is of interest in light of the on-coming debris from the 2011 Tohoku Tsunami.

Concepts: Pacific Ocean, Canada, Ocean, Pacific Northwest, British Columbia, Vancouver, Strait of Georgia, Queen Charlotte Strait


Human occupation is usually associated with degraded landscapes but 13,000 years of repeated occupation by British Columbia’s coastal First Nations has had the opposite effect, enhancing temperate rainforest productivity. This is particularly the case over the last 6,000 years when intensified intertidal shellfish usage resulted in the accumulation of substantial shell middens. We show that soils at habitation sites are higher in calcium and phosphorous. Both of these are limiting factors in coastal temperate rainforests. Western redcedar (Thuja plicata) trees growing on the middens were found to be taller, have higher wood calcium, greater radial growth and exhibit less top die-back. Coastal British Columbia is the first known example of long-term intertidal resource use enhancing forest productivity and we expect this pattern to occur at archaeological sites along coastlines globally.

Concepts: Tree, Rainforest, Archaeology, British Columbia, Vancouver, Temperate rainforest, Rainforests, Thuja plicata


Under-screening for cancer may contribute to a greater disease burden in individuals with intellectual and developmental disabilities (IDD) as their life expectancy increases. In 2008, the province of Ontario launched Canada’s first population-based colorectal cancer screening program. Our objectives were to compare the proportions of Ontarians with and without IDD who have undergone colorectal cancer screening and to examine factors associated with screening uptake among Ontarians with IDD. Records for Ontario residents 50-64 years of age were linked across various administrative health and social services datasets to identify individuals with IDD and to select a random sample of the age-equivalent Ontario population without IDD as a comparison group. Logistic regression models were fit to examine the odds of screening uptake among individuals with IDD while controlling for age, sex, urban or rural residence, neighbourhood income quintile, expected use of health care resources, and being enrolled with or seeing a physician in a patient enrolment model (any of several primary care practice models designed to improve patient access and quality of care in Ontario), and to examine the association between these variables and colorectal cancer screening in the IDD population. The odds of having had a fecal occult blood test in the previous two years and being up-to-date with colorectal tests were 32% and 46% lower, respectively, for Ontarians with IDD compared to those without IDD. Being older, female, having a greater expected use of health care resources, and being enrolled with or seeing a physician in a primary care patient enrolment model were all significantly associated with higher odds of having been screened for colorectal cancer in the IDD population. These findings underscore the need for targeted interventions aimed at making colorectal cancer screening more equitable.

Concepts: Health care, Regression analysis, Cancer, Population, Colorectal cancer, Life expectancy, Fecal occult blood, Vancouver


Although the overall rate of antibiotic prescribing has been declining in British Columbia, Canada, the authors conducted a study to explain the increased rate of prescribing by dentists.

Concepts: United Kingdom, Alberta, Provinces and territories of Canada, Canada, British Columbia, Vancouver, Canadian Pacific Railway, 49th parallel north


There has been widespread support for harm reduction programs as an essential component for responding to the HIV and illicit drug use epidemics. However, despite the growing international acceptance of harm reduction, there continues to be strong opposition to this approach, with critics alleging that harm reduction programs enable drug use. Vancouver, Canada provides a compelling case study that demonstrates that many positive impacts of harm reduction can be attained while addiction treatment-related goals are simultaneously supported. While the evidence for harm reduction is clearly mounting, it is unfortunate that ideological and political barriers to implementing harm reduction programs in Canada remain. As evidenced by Vancouver and elsewhere, harm reduction programs do not exacerbate drug use and undermine treatment efforts and should thereby occupy a well-deserved space within the continuum of programs and services offered to people who inject drugs.

Concepts: Drug, Drugs, Drug addiction, Heroin, Illegal drug trade, Harm reduction, Vancouver, Illicit drug use in Australia