Latest / Morning Medical with Dr. Chow / Opioid Crisis, Vaccine Benefits, and Digital Family Dynamics

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Opioid Crisis, Vaccine Benefits, and Digital Family Dynamics · Morning Medical with Dr. Chow

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Good morning, everyone, and welcome to Morning Medical with Dr.
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Chow.
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I am your host, Dr.
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Chi-Ming Chow, coming to you from Toronto, Ontario.
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As always, I am here to bring you the latest updates in medical and health news from around
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the world.
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Today, we are going to start with an important topic that has been a significant public health
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concern in recent years: the opioid crisis.
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According to recent data from the Canadian federal government, there has been a notable
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decrease in opioid-related deaths across the country.
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Last year, these deaths fell by 23 percent.
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This decline is attributed to several factors, including the distribution of naloxone, which
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is an opioid overdose reversal medication, and changes in the drug supply.
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However, despite this progress, the crisis remains complex and fragile.
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While the reduction in opioid-related deaths and hospitalizations—down 12 percent last
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year—is encouraging, officials have emphasized that the problem is far from resolved.
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The number of opioid-related deaths is still alarmingly high, with 5,608 apparent deaths
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reported last year.
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This equates to an average of 15 lives lost each day in Canada.
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Additionally, there were 4,920 opioid-related poisoning hospitalizations, averaging 13 per
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day.
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Dr.
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Joss Reimer, the chief public health officer, highlights the importance of remembering that
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behind each statistic is a person whose life has been tragically affected, leaving a lasting
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impact on families and communities.
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She stresses the need for sustained and coordinated efforts to continue reducing these
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numbers.
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One of the significant challenges in managing this crisis is the evolving nature of the
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illegal drug supply.
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While naloxone is effective for reversing opioid overdoses, the presence of other
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substances like benzodiazepines in the drug supply poses new challenges, as these do not
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respond to naloxone.
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In response to this crisis, the government is implementing various initiatives, such as
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scanning wastewater for drug traces and enhancing efforts at the border to detect and
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disrupt illegal drug trade activities.
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Health Minister Marjorie Michel acknowledges that addressing this crisis requires tackling a
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wide array of underlying issues, including mental health, poverty, trauma, and the need
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for more housing and access to care.
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Provinces across Canada have adopted different approaches to supervised consumption sites,
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some expanding services while others have closed sites or imposed restrictions.
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Although Health Canada plays a role in supporting public health responses, it is up to
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local governments to make decisions regarding these sites.
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Indigenous communities are particularly affected, with many experiencing high overdose
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rates and related challenges.
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Indigenous Services Minister Mandy Gull-Masty reports that efforts are being made to expand
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community-led mental wellness and substance use supports in First Nations and Inuit
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communities.
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Kevin Brosseau, known as the "fentanyl czar," is leading federal actions to combat the
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illicit drug trade.
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He expresses cautious optimism with the latest data but emphasizes that the fight is far from
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over.
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His role involves updating American officials on Canada's progress, given the concerns about
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fentanyl.
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The opioid crisis is a complex public health issue that requires a multifaceted approach to
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address effectively.
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While the recent decrease in opioid-related deaths in Canada is promising, continued
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efforts and cooperation across all levels of government and communities are essential to
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sustain this progress and save lives.
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Recent studies have highlighted the significant benefits of the COVID-19 vaccines in reducing
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cardiovascular risks.
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Three distinct studies have collectively shown that receiving a COVID vaccine is still
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beneficial for adults, especially in terms of lowering the risk of major adverse
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cardiovascular events.
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This includes events such as heart attacks, strokes, and heart failure hospitalizations.
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In a cohort study involving over one million veterans who received the 2024-2025 COVID
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vaccine, the vaccine was found to be 37.7 percent effective in preventing major adverse
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cardiovascular events related to COVID-19.
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This is a composite endpoint that encompasses cardiovascular death, myocardial infarction,
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stroke, and hospitalizations due to heart failure.
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The study, led by Dr.
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Ziyad Al-Aly from the Veterans Affairs St.
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Louis Health Care System, was published in the Journal of the American Medical Association
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Internal Medicine.
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The study demonstrated that the vaccine's effectiveness was particularly pronounced among
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older adults.
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For those over 75 years old, vaccine effectiveness against major adverse
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cardiovascular events was 50.7 percent, highlighting a significant reduction in risk
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for this age group.
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This group also saw the largest absolute risk reduction, with 5.48 fewer events per 10,000
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people.
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These findings are crucial as they underscore the ongoing value of COVID-19 vaccination, even
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in the face of widespread immunity from previous infections and vaccinations.
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Dr.
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Al-Aly and his colleagues emphasized that while the magnitude of vaccine effectiveness is lower
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compared to the early phases of the vaccine rollout, the protection against cardiovascular
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outcomes remains substantial.
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Further support for the benefits of COVID-19 vaccination comes from another study that
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focused on the 2024-2025 vaccines, which showed effectiveness against COVID-related emergent
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care, hospitalization, and critical illness.
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Conducted by Dr.
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Ryan Wiegand from the Centers for Disease Control and Prevention's National Center for
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Immunization and Respiratory Diseases, the study found that the vaccine was 26 percent
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effective against emergency department or urgent care visits, 35 percent effective
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against hospitalization, and 41 percent effective against critical illness.
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For older adults and those who are immunocompromised, the vaccine's effectiveness
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in reducing severe outcomes was similarly strong.
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This reaffirms the importance of annual COVID-19 vaccination, especially within the
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first six months post-vaccination, to significantly reduce the risk of severe health
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outcomes.
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A European case-control study also indicated that the 2025-2026 COVID vaccines mirrored the
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effectiveness of the previous season's vaccines.
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For older patients, the overall vaccine effectiveness against symptomatic COVID-19 was
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59 percent.
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In an editorial accompanying these studies, Dr.
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Robert Califf, a former Food and Drug Administration Commissioner, emphasized that
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while COVID-19 should no longer be seen as an exceptional disease, the cardiovascular
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benefits of vaccination are much greater than any potential risks.
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These findings provide strong evidence supporting the favorable balance of benefits to
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risks for updated COVID-19 vaccine boosters across various populations.
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Lastly, the studies also explored the vaccine's impact on all-cause major adverse
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cardiovascular events, hospitalizations, and deaths.
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The findings showed a 6.2 percent effectiveness against all-cause major adverse cardiovascular
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events, 6.6 percent against all-cause hospitalizations, and 7.1 percent against
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all-cause deaths.
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These results suggest that COVID-19 vaccination could potentially avert thousands of adverse
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events and deaths in a large population over a period of eight months.
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Although the study population was predominantly older, white, and male, which might limit the
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generalizability of the findings, the research still provides critical insights into the
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broader cardiovascular benefits of COVID-19 vaccination.
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Today, we're diving into an intriguing topic that touches on modern parenting and
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technology: the practice of parents tracking their adult children using digital technology.
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A recent poll conducted by the C.S.
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Mott Children’s Hospital at the University of Michigan reveals that more than half of parents
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use such technology to monitor their adult offspring.
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While the intention behind this is often rooted in concerns for safety and peace of mind, the
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practice raises questions about its actual effectiveness and potential drawbacks.
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The poll highlights that nearly 25 percent of parents who engage in tracking report that it
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can sometimes increase their anxiety rather than alleviate it.
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Kara Alaimo, a professor of communication at Fairleigh Dickinson University, explains that
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having only one data point can lead parents to make assumptions and jump to potentially
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inaccurate conclusions.
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This can, in turn, heighten their apprehensions rather than provide reassurance.
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Interestingly, the survey found that 68 percent of parents tracked their adult children to ease
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their own worries, while 64 percent did so for emergencies.
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Some parents, about 17 percent, tracked their children to ensure they were in locations
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deemed acceptable.
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However, Sarah Clark, a research scientist at the University of Michigan and co-director of
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the poll, argues that none of these reasons justify the need to track adult children.
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She notes that without clear communication and boundaries, such monitoring could harm
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parent-child relationships and impede the development of independent thinking in young
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adults.
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The emphasis on safety is understandable, with many parents wanting to ensure their children
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are secure.
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Yet, Clark and Alaimo caution against overestimating the ability to provide safety
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from afar.
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The mere act of tracking does not necessarily equate to understanding the situation or being
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able to intervene effectively.
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Alaimo suggests that teaching young adults to make responsible decisions themselves is a
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better approach to ensuring their safety, rather than relying on constant surveillance.
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The survey also revealed that while most children are aware they are being tracked, only
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half of the parents indicated that the tracking was optional.
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Clark underscores the importance of dialogue during the transition from childhood to
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adulthood, suggesting that families should discuss whether mandatory location monitoring
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remains appropriate.
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Clark and Alaimo agree that location tracking can be beneficial in certain situations, such
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as when a child is going out on a first date or visiting a new place.
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However, they stress the importance of building trust and maintaining open communication about
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concerns.
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Empowering children to share their location with a trusted friend as an alternative can
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also be effective.
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Ultimately, the goal should be to teach young adults to recognize potentially dangerous
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situations and avoid them, thus fostering their autonomy.
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Clark points out that excessive monitoring can strain relationships and contribute to a sense
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of distrust.
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Reflecting on how previous generations managed without such technology can provide insights
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into striking a balance between safety and independence.
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Alaimo encourages parents to treat their adult children as the adults they are, allowing them
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to make decisions about surveillance.
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This approach not only respects their autonomy but also avoids normalizing constant
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monitoring, which can facilitate unhealthy dynamics in relationships.
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In conclusion, providing young adults with the space to grow and learn from their mistakes is
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crucial.
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As Clark aptly puts it, parents need to honestly assess their motivations for tracking
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and consider whether it's truly necessary or beneficial.
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By fostering open communication and trust, parents can support their children in becoming
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independent and responsible adults.
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Opioid overdose deaths across Canada have seen a significant drop, falling by nearly a quarter
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last year compared to the previous year, 2024.
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Health officials are viewing this data as a positive indication that the federal
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government’s drug policy is having a beneficial impact.
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Nationwide, there were 5,630 opioid overdose deaths recorded in 2025, which is 23 percent
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fewer than the year before.
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This decline builds on a 17 percent decrease in overdose deaths in 2024, showcasing a trend of
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improvement.
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Health Minister Marjorie Michel described these declines as real progress, emphasizing that the
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current data offers 'cautious optimism.' Dr.
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Joss Reimer, the Chief Public Health Officer, shared similar sentiments, noting that acting
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on evidence can indeed make a real difference.
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He stressed that this progress provides a foundation upon which more lives can be saved.
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However, he also cautioned that while moving in the right direction, there is still much work
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to be done to tackle the opioid crisis effectively.
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One of the contributing factors to this decline is the changes in the illegal drug supply,
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alongside broader access to and use of naloxone, a medication designed to reverse the
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effects of an opioid overdose.
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Despite these positive trends, Dr.
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Reimer warned that opioid overdoses remain far more common than before the pandemic,
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indicating that the problem is still very much present and pervasive.
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Although hospitalizations and emergency department visits for suspected opioid
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overdoses decreased in 2025—by 12 and five percent respectively—emergency medical services
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responses to suspected overdoses actually increased by nine percent.
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This rise in responses may be attributed to the presence of fentanyl analogues and the mixing
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of other drugs, such as benzodiazepines, in fentanyl supplies.
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Such polysubstance overdoses often necessitate more complex interventions, adding a layer of
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challenge to the existing crisis.
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The opioid crisis also disproportionately affects certain regions and communities.
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Three provinces—British Columbia, Alberta, and Ontario—accounted for 78 percent of opioid
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deaths.
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Indigenous Canadians, while making up only 2.6 percent of the population, represented 10
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percent of opioid deaths.
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Minister of Indigenous Services, Mandy Gull-Masty, reflected on these statistics as a
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"sobering reminder" of the inequities that persist in Indigenous communities.
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The federal officials, including Health Minister Marjorie Michel, discussed the
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potential impact of supervised consumption site closures in Ontario and Alberta but refrained
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from making predictions about how these closures might affect opioid death rates.
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Michel acknowledged that while safe consumption sites do save lives, they are not the only
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solution, and decisions ultimately lie with the provinces.
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Kevin Brosseau, Canada's 'fentanyl czar,' highlighted the importance of addressing
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domestic drug production, noting that the drug trade in Canada is largely based on domestic
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production for domestic consumption.
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He pointed out that while the Canada Border Services Agency seized 2.8 kilograms of
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fentanyl in 2025, this represents a relatively minor disruption to the opioid crisis, which is
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primarily driven by the importation of precursor chemicals used to manufacture illegal
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drugs domestically.
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Brosseau’s role involves updating American officials on Canada’s efforts to combat the
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opioid crisis.
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He expressed confidence in Canada’s unwavering resolve to address the issue, highlighting that
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the federal government’s public health measures are making a noticeable impact.
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He mentioned his upcoming trip to Washington, D.C., to brief the U.S.
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administration on Canada’s latest figures, noting that the messages being conveyed have
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been received positively.
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Today, we're delving into a recent study that explored the impact of timely "nudges" on
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encouraging end-of-life conversations between oncology providers and patients with
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poor-prognosis cancers.
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This study, published in the Journal of the National Comprehensive Cancer Network, was
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conducted by Dr.
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Christopher R.
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Manz and his colleagues at the Dana-Farber Cancer Institute in Boston.
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The researchers examined whether reminders to both clinicians and patients could increase the
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frequency of serious illness conversations.
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The study found that dual reminders, or "nudges," significantly increased the
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likelihood of these important discussions.
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Patients who received a nudge along with their clinicians were 79 percent more likely to have
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serious illness conversations within sixty days compared to those who received no nudge at all.
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However, even with the dual nudges, conversation rates remained low, highlighting
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the need for improved strategies to foster these critical dialogues.
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Dr.
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Manz emphasized that past research has shown these conversations can alleviate patient
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anxiety, enhance quality of life, and ensure that care aligns with patients' goals,
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especially near the end of life.
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He pointed out that having these discussions with a trusted provider and documenting them in
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an accessible manner allows the healthcare team to honor the patients' wishes if the patient
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becomes too ill to advocate for themselves.
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The study involved over one thousand patients and was limited to those starting treatments
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associated with poor prognosis.
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Nudges were precisely timed, targeting clinicians at the right moments to avoid
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overwhelming them with alerts.
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Dr.
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Cody E.
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Cotner from Harvard Medical School, a co-author of the study, noted the importance of precision
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in delivering these reminders to avoid burnout and alert fatigue among healthcare providers.
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Elise Carey, M.D., from the Mayo Clinic, who was not involved in the study, expressed
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optimism about the findings.
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She highlighted that a relatively simple approach of identifying high-risk patients and
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sending reminders can significantly enhance serious illness communication in routine cancer
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care.
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Dr.
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Carey remarked that the clinician nudges were particularly effective, suggesting that small,
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well-timed supports can help clinicians prioritize these essential conversations even
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amidst a busy practice.
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The study's participants were identified through the Dana-Farber Cancer Institute's
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Clinical Pathways Program, which prospectively identified poor-prognosis cancers linked to a
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survival of less than one year.
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The study's nudges were informed by previous research and were delivered through emails to
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clinicians and mailed questionnaires to patients, encouraging them to discuss their
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care plans during their next visits.
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Despite these efforts, the overall rates of serious illness conversations remained low,
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with only around 32.5 percent of patients in the combined nudge group having these
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discussions.
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This underscores the need for more effective strategies to overcome barriers to these
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crucial conversations.
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The authors suggest that future interventions might benefit from incorporating a more
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personal, 'human touch' approach to better engage patients.
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Let's turn our attention to an intriguing study that examines the potential link between
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shingles vaccination and a decreased risk of dementia among older adults.
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This research, spearheaded by Dr.
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Kaleen Hayes and her team at the Brown University School of Public Health, analyzed
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data from 500,000 residents of skilled-nursing facilities across the United States.
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The findings suggest that receiving the recombinant zoster vaccine, known as Shingrix,
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is associated with a 24 percent lower risk of being diagnosed with dementia over four years
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compared to those who did not receive the vaccine.
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This is a significant discovery, considering the high-risk nature of the population
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studied—older adults in skilled-nursing facilities often have increased vulnerability
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to both shingles and dementia.
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The study utilized a method called target trial emulation, which is a sophisticated approach to
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mimic the conditions of a randomized trial.
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The researchers compared dementia risk among those who received at least one shingles
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vaccine dose within twelve months of admission to a skilled-nursing facility against those who
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did not receive the vaccine in this timeframe.
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It's worth noting that previous studies had already hinted at a connection between shingles
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vaccination and reduced dementia risk, particularly with the older live-attenuated
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vaccine, Zostavax, which is no longer available in the United States.
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The newer recombinant zoster vaccine has been shown to offer a similar protective effect,
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possibly due to its robust immune activation properties.
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While the exact mechanisms behind this association remain unclear, one hypothesis is
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that reducing shingles infections—which can cause neuroinflammation and increase stroke
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risk—might in turn lower dementia risk.
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Another theory suggests that the immune activation triggered by vaccines could play a
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protective role.
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The study's cohort included over half a million participants, with a mean age of 79 years, none
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of whom had a dementia diagnosis at the start.
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Interestingly, only 1.73 percent received at least one dose of the vaccine within the first
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year of their admission, highlighting the low uptake of the vaccine even among those at high
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risk for both shingles and dementia.
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The researchers also found that the association between the shingles vaccine and reduced
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dementia risk was less pronounced in men than in women and was weaker among those who had
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previously received the live shingles vaccine.
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This suggests that there may be varying degrees of benefit depending on previous vaccination
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history and gender.
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Despite the promising findings, the researchers caution that residual confounding factors, such
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as the 'healthy vaccinee bias,' might influence the outcomes.
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This bias occurs when healthier individuals are more likely to receive vaccinations,
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potentially skewing results.
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Nonetheless, these insights are crucial as they underscore the potential benefits of shingles
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vaccination beyond just preventing the disease itself.
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As the Centers for Disease Control and Prevention recommends shingles vaccination for
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healthy adults aged fifty and older, and for those nineteen and older with weakened immune
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systems, this study adds another layer of evidence supporting these guidelines.
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As we wrap up today's episode of Morning Medical with Dr.
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Chow, I want to thank you all for joining me.
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It has been a pleasure to delve into these important topics and share the latest medical
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insights with you.
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Stay informed, stay healthy, and I look forward to having you with us again tomorrow.
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Have a great day, everyone!