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The Current Transcript for April 18, 2024

Host: Matt Galloway

STORIES FROM THIS EPISODE

Prologue

[Music: Theme]

SOUNDCLIP

SPEAKER: What we're really trying to tell people is that they are not responsible for the condition that they have. It's really the responsibility of these companies that put drugs on the market, which were too dangerous and where inadequate information was given to people.

MATT GALLOWAY: They were pitched as a novel way to treat pain. Opioids have played an important role in health care for decades, but many researchers believe a dramatic increase in their prescription years ago laid the foundation for the addiction and overdose crisis we see today. Now, a judge has certified a class action lawsuit in Quebec against 16 companies for their role in marketing and selling the drugs. In 30 minutes, the lawyer leading the charge and a pain doctor on how opioids are prescribed now. Also this morning, your mail on hospitals charging patients who won't leave for a long term care bed not of their choosing. And later: you think your morning jog is tough?

SOUNDCLIP

JASMIN PARIS: I was just telling myself if you don't finish it now, you'll have to do it again.

MG: The Berkeley Marathons is one of the hardest races in the world. A hundred miles through a hilly state park. No trails, lots of thorns, no rest, no map. Jasmin Paris is the first woman to finish the race in the allotted time. In an hour, pickle sandwiches, hallucinations, and the secret to pushing yourself past your limits. But we start with a look inside a boxer's brain for signs of trauma. Good morning, I'm Matt Galloway, and this is The Current.

[Music: Theme]

Inside a boxer's brain

MG: Last summer, the first case of CTE in a female athlete was confirmed. Chronic traumatic encephalopathy is a devastating neurodegenerative condition that can only be diagnosed after death. It's often linked to repeated head trauma from sports like football, hockey, and boxing. CTE can rob people of their memories, cause mood swings and impact their mobility. But now there is a glimmer of hope. A massive study of 900 living athletes hoping to find solutions and provide warnings of potential issues before it's too late. The CBC's Katie Nicholson brings us the story of one of those athletes and her documentary, Boxer Brain.

SOUNDCLIP

SPEAKER: Okay. Give me two hooks to the body, then a left hook.

[Sounds: tsk tsk tsk]

SPEAKER: That's enough of that.

[Laughing]

SPEAKER: Giving you a workout today! Whoo wee. Ha ha!

KATIE NICHOLSON: Edmonton's Cougar boxing club. It's the kind of gym you see in the movies. It's tucked away in a windowless basement of a community centre. The walls are heavy, with championship belts, photos and memories from its 50-year history. The people who come here mean business.

[Sounds: Sparring]

KATIE NICHOLSON: Especially the blonde being put through her paces in the ring.

CLAIRE HAFNER: So, my name is Claire Hafner. I am many things, but most recently, I've been boxing professionally for the last 11 years out of a gym in Montreal. And I've just recently relocated here in Alberta.

KATIE NICHOLSON: Hafner first got into boxing while studying opera in Ottawa. She was having a difficult time with one of her instructors.

CLAIRE HAFNER: There was a sense of helplessness, and I found that through boxing, like I could confront him and stand up to him. And so, boxing really covered that gap of probably where I would have given up singing or just like disappeared in a hole, but it made me stronger, and it made me push back. So, it really gave me strength to finish that. And then once it got me through that, I was like, okay. I started competing. This is a great sport, hard physical sport, which I love. So, it was many things that kept me in it. Every day, just being outside your comfort zone. It's really tough but really good.

KATIE NICHOLSON: Now 46, she's among the top women boxers in the world.

KATIE NICHOLSON: When you step into the ring, what's it like for you? Like, how does the world change?

CLAIRE HAFNER: Hyper focused?

KATIE NICHOLSON: Yeah?

CLAIRE HAFNER: A sense of gratitude for having that opportunity. Thinking about what I'm going to do without trying to think about what I'm going to do.

KATIE NICHOLSON: Yeah.

CLAIRE HAFNER: If it's a fight, I try to think about how it will feel like having my hand raised at the end. [KATIE: Yeah.] For that win.

KATIE NICHOLSON: Claire pounds the practice pads I'm holding. I try to brace against her powerful punches, but it isn't easy.

SPEAKER: Jab, jab, cross.

KATIE NICHOLSON: There are risks, obviously, with boxing. How do you sort of work through that when you're heading into the ring? How do you sort of balance that in your head?

CLAIRE HAFNER: I think you don't. For me, I can't, I think it's like anything. I get in a car, and I don't think about what happens if I crash. But what I do is try and plan for every possible scenario to decrease possible risk. I have to say, injuries that are usually forefront on the mind, though are a broken hand, a sore shoulder, a twisted ankle. But I seldom go deep into the fact of what's happening with my brain until I started to be part of this brain study in Vegas, and then everything came up.

KATIE NICHOLSON: Claire is part of a landmark study of 900 living athletes following the long-term impacts of repetitive head trauma. Every year, she undergoes a series of tests and researchers fill her in on the toll boxing is taking on her brain health. If the results show a decline, Claire has decided she'll throw in the towel and retire from the sport she loves. She's been part of the study since 2020 and her next appointment is coming up.

CLAIRE HAFNER: I'm excited to know what's going on in this noggin. So, there will be a relief when it's done. The next steps are decided.

KATIE NICHOLSON: Yeah. Is there a little bit of fear too, though, that this could?

CLAIRE HAFNER: Be the end?

KATIE NICHOLSON: Be the end? Yeah.

CLAIRE HAFNER: Yeah. I think there's always that fear. And then trying to figure out what the next step is.

KATIE NICHOLSON: Over the years, Claire has clinched American and world titles. She grew up in the States, but she recently became a Canadian citizen. And there's one more trophy she wants.

CLAIRE HAFNER: I would love to fight for a Canadian title. The world title was fun, but I think being an immigrant, being Canadian now, like it'll be hard to hang up the gloves without checking that box.

SPEAKER: And now, ladies and gentlemen, welcome to Las Vegas, Nevada, USA.

KATIE NICHOLSON: Las Vegas, the fight capital of the world.

SPEAKER: Let's get ready to rumble!

[Crowd cheering]

KATIE NICHOLSON: It's also home to the Cleveland Clinic Centre for Brain Health. Housed in a stunning, tangled architectural sculpture designed by Frank Gehry. It's eight a.m., and Claire marches up beneath the building's swooping panels of metal and glass. First there's paperwork and then a brief wait.

KATIE NICHOLSON: How are you feeling right now?

CLAIRE HAFNER: Well, I'm properly nervous. Yeah.

KATIE NICHOLSON: What are you hoping for today?

CLAIRE HAFNER: I'm hoping that there hasn't been a decline in anything that's more than, like, normal ageing or normal stress or normal exhaustion. I'm hoping for a really good clean brain scan.

CLAIRE HAFNER: Hi! Aw...

KATIE NICHOLSON: Claire hugs Rodrigo Palomino, the study coordinator who will conduct most of her testing today.

RODRIGO PALOMINO: Ready for another year?

CLAIRE HAFNER: I am ready. I hope it's a good one.

RODRIGO PALOMINO: It will be. Come on. Okay, so today we're doing the verbal memory test. [CLAIRE: Okay.] We're doing the finger tapping test. Single digit coding test. We'll be doing a strip test. And then the second half, you see where there's a gap right there. [CLAIRE: Yeah.] So, we're actually going to be doing questionnaires about how you been feeling over the last month or the last two weeks.

CLAIRE HAFNER: These are hard, just so you know.

RODRIGO PALOMINO: Yes, they are.

KATIE NICHOLSON: These computerized tests measure for changes in Claire's memory.

RODRIGO PALOMINO: I'm going to show you 15 words, okay? I'm going to ask that you remember them because I'm going to ask you what they are later in the exam. Okay? So, skip over the incorrect ones. Okay?

CLAIRE HAFNER: Okay.

RODRIGO PALOMINO: All right. Go ahead. So, whenever you write.

KATIE NICHOLSON: In another test, she has to react by furiously hitting a key to prompts on a screen.

[Sounds: tippy tappy beeping sounds]

RODRIGO PALOMINO: That's great. Perfect.

CLAIRE HAFNER: I hate this test. I hate this test.

RODRIGO PALOMINO: So now we do the opposite hand.

CLAIRE HAFNER: Yeah. This is brutal.

KATIE NICHOLSON: Another key indicator they're testing, her balance.

RODRIGO PALOMINO: We're doing this barefoot. And any knee or ankle injuries in the last six months?

CLAIRE HAFNER: No.

KATIE NICHOLSON: Claire snaps on some shoulder straps, and Rodrigo attaches an iPad to the back of the rig, which dangles and measures her movement.

CLAIRE HAFNER: Okay.

RODRIGO PALOMINO: Okay?

CLAIRE HAFNER: Oops. Yeah.

KATIE NICHOLSON: As she steps onto a big squishy block of blue foam.

RODRIGO PALOMINO: So, this is the one where you have to lift one leg up. Okay?

CLAIRE HAFNER: Why is it harder with the eyes closed?

RODRIGO PALOMINO: It's your brain telling you that it doesn't trust the situation that it's in. Three, two, one.

[Sound: ding]

KATIE NICHOLSON: Claire teeters and sways as the test gets increasingly difficult.

CLAIRE HAFNER: Mhmm.

RODRIGO PALOMINO: That was good.

CLAIRE HAFNER: Ugh. It's brutal. This is what people who have, like, brain trauma actually feel like sometimes, huh? Just regularly.

RODRIGO PALOMINO: They can. That's why they have to walk with, like, a walker or a cane.

CLAIRE HAFNER: Yeah, well.

KATIE NICHOLSON: Rodrigo takes Claire's blood to the lab to be analyzed for proteins, which could indicate head trauma. They many of the same proteins associated with Alzheimer's and Parkinson's. While Claire changes into a hospital gown for her MRI.

SPEAKER: Yes. Go ahead. And if you don't mind.

CLAIRE HAFNER: No, it's my best look.

KATIE NICHOLSON: And settles in for a long scanning session to capture her brain from every angle. Only about 100 of the study's participants are women. The bulk of what's known about head injuries is based on men's brains.

DR. CHARLES BERNICK: One of our gaps in understanding long term effects of exposure to head impacts is having information on women, because oftentimes that we don't have that so much. So, I think it's just important to be able to have more women participate.

KATIE NICHOLSON: Neurologist Dr. Charles Bernick has been one of the researchers leading the study. And as he and his team review the data, they're finding differences between the sexes.

DR. CHARLES BERNICK: One caveat to this is we have 800 men and 100 women. So, we have a lot more men to study. But generally, in most of our analysis, the women do better. That may be for a lot of different reasons. So, one of the paradoxes is that it's been said that women are more vulnerable, for example, to concussion and to take longer to recover. Yet in our evaluation of long-term effects, it doesn't seem that they're at a higher risk. If we have two groups that are getting hit, and the women are doing better, is there something biological that is protecting them?

KATIE NICHOLSON: The study began in 2011 and as it follows athletes through their retirement, they're making another remarkable discovery.

DR. CHARLES BERNICK: And what we found as a group; people get better. They either get better or stabilize. So, either their scores get better on the testing. Some of the blood testing that we do seems to stabilize or improve. Their MRI scans stabilize. So, I think it just represents that when people are actively exposed to head impacts, it is changing the brain. And once you stop, there is this opportunity for repair.

KATIE NICHOLSON: Much of the work around CTE and traumatic brain injury is focused on athletes, but many of these studies are also looking to serve a wider audience, including people with neurodegenerative conditions.

DR. CHARLES BERNICK: So, markers that are being used to diagnose Alzheimer's disease, and new techniques used in Parkinson's disease. I think we can learn from what has been done in those fields to accelerate how we can learn more about these long-term effects of head impacts. And vice versa, as we learn perhaps things about whether exposure to head impacts is a risk factor down the line for Parkinson's. For Alzheimer's. It will give us a better sense of how we can intervene early, how can we prevent these long-term diseases by intervention earlier in life?

KATIE NICHOLSON: The study embraces athletes from combat sports. Sports many medical professionals have traditionally advised against. Things like rodeo, boxing, mixed martial arts.

[Sounds: crowd cheering]

SPEAKER: Straight punches now landed by Ferea into the clinch! And down goes Taylor Starling. That right there shot intended. There's just a difference when Ferea hits you.

KATIE NICHOLSON: That lack of judgement from the researchers is one of the things that appeals to world bareknuckle boxing champ Christine Ferea. She trains at the Vegas Combat Fight Club not far from the clinic. Ferea and I are leaning against one of the rings as fighters train all around us. She's one of the few other women in the study.

CHRISTINE FEREA: I haven't had any problems yet, but I'm sure the doctor that I've seen year after year, we've kind of formed a relationship and he's super cool. He's going to tell me, Hey, look, I think it's time to quit. And I would, I would accept that because he isn't judging me. He isn't just saying, Oh, don't do this because it's bad for you. So, I will believe him when he tells me to stop.

KATIE NICHOLSON: And staying in the ring means a lot to Ferea. After street fights and run ins with the police, she credits going pro with keeping her out of jail.

CHRISTINE FEREA: It saved my life. I could have been in a really dark place for a really long time. I remember being locked up and looking next to me and people that were older. I was 18 years old, locked up for, I think I did a year right when I turned 18. And just people with no teeth, just drug addicts, 40, 50, 60, 70 years old in there. I mean, that's their life, you know. And that's what they did their whole life. That could have been me if I didn't find this. So, when I'm working hard and I get tired or I have to cut my weight or I'm, you know, getting punched in the face or, you know, taking a lot of damage, it's tough. It's a tough sport. But what would be tougher for me would be that other lifestyle.

KATIE NICHOLSON: Women's combat sports are growing. And so is the debate on whether women's rounds should be as long as the men's.

CHRISTINE FEREA: There's not much research on how much damage we can take. Like, how many rounds can we do? Some people are saying we can't take the three-minute rounds. Some people are saying we can. So, a lot of it, they're saying it's just egotistical. The men don't want, don't think that we can do it. But I think with these tests it'll be able to clarify that over time. Like, okay, can we take as much damage in the ring and still be cognitive after our career? Or should we dial it back to the two minutes? Because three minutes is too long for us and we can't take that much damage. So, I think it's a great thing to have and for, especially for the female fighters, we don't have that research because we haven't been in combat sports for as long as men. And I mean, I'm glad I'm here doing it and I'll be a part of that.

KATIE NICHOLSON: What scares you the most?

CHRISTINE FEREA: What scares me is like, CTE.

KATIE NICHOLSON: Chronic traumatic encephalopathy, or CTE, is a degenerative neurological condition linked to repetitive head trauma. It can only be diagnosed after death.

CHRISTINE FEREA: I just, I've heard so many horror stories about CTE and with athletes or with football players. And then them snapping and then they don't know what they're doing.

KATIE NICHOLSON: Last year, the first case of CTE was diagnosed in a female athlete, an Aussie rules footballer.

CHRISTINE FEREA: And like, memory. I might get to a point where I don't remember things or I don't know what I'm saying, I don't know who I'm talking to. But those are probably the two most scariest things that I hope won't happen. And that's why I like to do the study. Because if he's like, Hey, this, these are what's happening to your brain, this are going to be the consequences, I can make that decision to, you know, quit before that happens.

KATIE NICHOLSON: Dr. Bernick's team is looking for telltale signs of risk in living athletes like Claire Hafner and Christine Ferea, with hopes of one day being able to identify people who are developing patterns of CTE before it progresses too far.

DR. CHARLES BERNICK: But I'll show you kind of the areas that are, um...

KATIE NICHOLSON: In his office, Bernick pulls up an MRI of a male fighter.

DR. CHARLES BERNICK: Normally, there's one membrane that separates the two side, but with a lot of impacts to the head that will split. So, you can see he has, it just split apart. So, there's two. And that's a, it's just a marker of exposure to a lot of head impacts. We find it in about 50 per cent of males that fight. And it's a common finding in CTE brains.

KATIE NICHOLSON: Claire is sitting with those same fears as she waits for her results.

DR. CHARLES BERNICK: Hello! Hello!

CLAIRE HAFNER: Hey! Good to see you again.

DR. CHARLES BERNICK: Well, what's the update? How are you doing? Any changes as far as what you're seeing in yourself? Or...

CLAIRE HAFNER: I struggle to sleep after a heavy sparring session, even though I'm absolutely exhausted. [DR. BERNICK: Exhausted?] I just, and that's, to me, is like the little red flag that maybe I got my bell rung.

DR. CHARLES BERNICK: Well, okay. I do want to check you out, but I will share with you kind of how you did.

CLAIRE HAFNER: This is so stressful.

DR. CHARLES BERNICK: No, no, no, no, no. This is, no, this is good. [KATIE: I don't know.] Yeah.

KATIE NICHOLSON: First, her scores in all those memory balance and reaction time tests.

DR. CHARLES BERNICK: So, we look for two things. One is just the trajectory of things over time. Because this is what five years now. And you can see, I mean, just in general it's a straight line. And you are superior to most people your age.

KATIE NICHOLSON: And then, Dr. Bernick pulls up Claire's MRI scans.

DR. CHARLES BERNICK: This is the memory area, the hippocampus. On both sides. It's pretty close. I mean, you see a little slit here. You see this? But they're not changed. This is, you know, five years--20, 24 years. And if we go higher just in the substance of the brain, the brain should have this consistency. Which yours does. In other words, it doesn't show any scarring or... We'll do more precise measurements. But just looking at it doesn't look like there's any...

CLAIRE HAFNER: Any concerning change or anything.

DR. CHARLES BERNICK: Right. Correct.

KATIE NICHOLSON: No changes. But is it time for Claire to call it quits?

DR. CHARLES BERNICK: I don't think there's any red flags here. I'm glad you're wrapping up your career. [Laughs]

CLAIRE HAFNER: So, I was just going to ask also because, like, of, I guess just of age and, like, trying to get out before there's a lot of damage, but feeling like I've put so much into it, I still have the brain that's good enough to maybe go one more, one more lap. [DR. BERNICK: Yeah, sure.] Or do you throw in the towel when, like-- I'm just teetering on that decision and it's really hard. [DR. BERNICK: Yeah.] Really hard.

DR. CHARLES BERNICK: Well, I think, look. If you're asking, are you going to do irreparable harm to do one more fight? Of course not. I mean, you know, because all this stuff is just cumulative. I mean, it's-- [CLAIRE: Yeah.] So, I mean, unless you got knocked out or something, I mean, then, you know, you'd have a concussion, and you have to recover from and all that. But I just think, you know, if you've achieved what you've wanted to achieve, yeah, it's probably, it's better for your brain not to get hit. I mean, I just, you know...

CLAIRE HAFNER: Well, I think we lose perspective too. Like it's so easy because you like, want that and you need that and you identify with that and you lose perspective that it's just, this is a small thing that could alter like the rest of your life. Like, and I know enough people who have damage from boxing to, I should put it into perspective more.

DR. CHARLES BERNICK: You know, if you want to do this one more fight, be careful about it. And then, you know, maybe shut it off.

CLAIRE HAFNER: Okay.

[Sounds: Crowds shuffling, talking]

KATIE NICHOLSON: As the sky darkens, the bright, carnival-like lights of the strip twinkle and play over Claire's face. She's had a few hours to think about her results and Dr. Bernick's words.

KATIE NICHOLSON: And so, we're in this town where everybody's always rolling the dice. So, after your results today, are you thinking like you're going to roll the dice?

CLAIRE HAFNER: Yeah. I have to say, after today, it's a hundred times more tempting. Is there a Canadian title out there that I could, like, get my little hands on?

KATIE NICHOLSON: You're rolling the dice.

CLAIRE HAFNER: Yeah, I think I'm going to roll the dice. What is it? Lucky sevens.

KATIE NICHOLSON: Yeah. Could be!

MG: The documentary Boxer Brain was produced by the CBC's Katie Nicholson in conjunction with the CBC's audio documentary unit. Your CBC news is next. And then:

SOUNDCLIP

SPEAKER: That covers the period of 1996 to the present day and covers individuals in Quebec who were prescribed opioid medications and developed over time opioid-use disorder.

[Music: Instrumental]

MG: A Quebec class action lawsuit is looking to hold 16 pharmaceutical companies responsible for their alleged role in the opioid epidemic. In six minutes, we'll hear from one of the lawyers bringing this case out, but also talk about what's changed when it comes to how pain relief is prescribed now. My name is Matt Galloway. You're listening to The Current. We'll be back in six minutes. Stay with us.

[Music fades up]

Lawsuit targets pharma giants over opioid crisis

Guests: Margo Siminovitch, Dr. David Juurlink

MG: Hello, I'm Matt Galloway and you're listening to The Current. The overdose crisis is one of the stories of our time. More than 42,000 Canadians have suffered opioid related deaths since tracking began in 2016. Now, a class action lawsuit based in Quebec has been authorized against 16 pharmaceutical companies. The suit alleges that companies like Teva, Pfizer Canada and Sanofi purposely misled consumers about the efficacy and the dangers of opioids. Margo Siminovitch is part of the legal team representing members of the class action suit. Margot, good morning.

MARGO SIMINOVITCH: Good morning, Matt.

MG: What exactly is being alleged in this class action lawsuit?

MARGO SIMINOVITCH: What's alleged is that opioids, which have been used medically for many, many years, were traditionally, had very limited uses. They were used for palliative care, for example, end of life cancer treatment, or for very acute pain post-surgery. And then in the mid 1990s, the pharmaceutical companies developed a new narrative where they took the same drugs and said that they were safe in efficacy for use with chronic pain. So, everything from headaches to low back pain, rheumatoid arthritis, a variety of reasons. And of course, pain is very serious. But the warnings were insufficient in the context of chronic pain, where many of the companies said that the risk of addiction was very rare. And so, obviously that's not true. And it's taken a long time for the companies to bolster their, the warnings that are given to the public and to health care professionals.

MG: And so, in that context, what are you suggesting the role of these companies was in, as I said, one of the stories of our time? This overdose crisis, this opioid crisis that has continued to cause such pain and suffering across Canada.

MARGO SIMINOVITCH: Well, what we are saying is it led to overprescribing of opioids. And the difficulty is once you're addicted, like when you're addicted to anything, if you're taken off the drug, you often can't cope. And many people then seek to get opioids in another way. Or even if they--excuse me--over time they become tolerant to the opioids and they have to have greater and greater doses to alleviate their pain. And ultimately it destroys their lives for many reasons. You talked about the fatalities, but many people who have not died still have their lives destroyed. They're not able to work. They're irresponsible about finances, and it's really not their fault. They were prescribed opioids for a very legitimate reason, and they were really in pain, and they had no idea that they were going to develop opioid use disorder, which ultimately is addiction or dependence on these drugs.

MG: Who are you bringing the case forward on behalf of? I mean, tell me the story of one of the people whose life has been impacted by these drugs.

MARGO SIMINOVITCH: Our class representative is a man, Mr. Jean-Francios Bourassa. He lives in the Laurentians, and as a relatively young man in his 30s, he was running his own roofing business and one day he was on a roof doing the repairs, and he slipped on ice and fell to the ground very seriously injuring and breaking his leg and ankle. He was taken by ambulance to the hospital where he was put on opioids. He was discharged fairly quickly and then still had very serious pain. So, he went to a pain clinic, and he was put on opioids for the next ten years. And as I say, they increased because he just became tolerant. And one of the things with opioids is sometimes you get what's called referred pain. So, you're not even just getting pain in the original area where you might have had the injury. It starts having pain in other parts of your body. And essentially, he feels that he lost his life with his young family. Seeing his kids grow up. He was only able to work intermittently and eventually went on disability. And he just feels this whole process was so, so difficult. And in 2017, he realized that he just couldn't go on like this. So, he sought treatment at a hospital for his addiction. And he was at that time diagnosed with opioid use disorder and gone through a very difficult process trying to withdraw from these drugs.

MG: And the allegation is that despite what he went through in the broken leg and the broken ankle, and that I'm sure extraordinary pain that he was in, that these companies, through their marketing, would have led him to become dependent on a drug that in other circumstances, perhaps he would not have encountered.

MARGO SIMINOVITCH: Exactly. So, he was not given proper warnings at the beginning. He had no idea in these many years that he was put on opioids of the risks of addiction and dependence. And the difficulty is, is that marketing is in many, many forms. We interpret it in a very broad way. And so does the Canadian government, in how they define marketing. It could be interviews with doctors in their offices where the companies say that the drugs are safe and that doctors who aren't prescribing them for their patients are doing a disservice for their patients. It can be in many ways supporting pain conferences and all sorts of kinds of marketing. It's--they're not allowed to advertise anymore in the traditional sense of ads, you know, in a journal. But there are different ways to market. And these companies, like I say, they played down the risks of opioids. And traditionally everybody knew how risky opioids were. So, it wasn't like this was completely hidden in the world of science and medicine. Opioids are addictive. They've always been known to be addictive. And it was only in the mid 1990s when this sort of news story came out that they were safe for chronic pain.

MG: What kind of drugs are involved in this class action? What are the specific drugs that you're talking about?

MARGO SIMINOVITCH: Well, there's many. We actually alleged probably over 200 drugs which is, shows the scope of this class action because there's quite a number of what we call active ingredients or active pharmaceutical ingredients. So, they may contain fentanyl, which most people have heard of because of how dangerous fentanyl is. But the name of the drug might be something else. So, for example, Janssen, which many people know is Johnson and Johnson, marketed under the name duragesic. And so, people should really, really be careful to get their pharmaceutical records because they may not understand which drugs they're taking, because often you're given a drug, and it may have a different name. It may have M Tech or some other drug that they're not, they don't even realize has codeine in it, has HYDROmorph Contin. There are a variety of these pharmaceutical ingredients in these drugs, but they're all narcotics.

MG: These aren't, we're not talking specifically about--when people talk about the opioid crisis, the drug that often comes up in that discourse is OxyContin. You're not including that in this lawsuit.

MARGO SIMINOVITCH: No, because there was a national settlement for OxyContin, which, in around 2012 was changed to OxyNEO [MG: Right.] which was advertised as being more tamper resistant, so safer for use. And so, there was a national settlement. So, we have carved that out from our lawsuit. But people often get very confused because some of the names of the drugs, there is an active ingredient called oxycodone. And people may not realize that that's different than OxyContin. So, as I say, people should be very careful to verify which opioids they have been prescribed.

MG: We contacted a number of the companies that are named in this class action. Most of them don't want to comment because it's before the courts. Sanofi sent us a statement saying, "We respect the highest standards of ethics and integrity and conduct business in a responsible and sustainable way." They also deny any liability. What do you make of that response?

MARGO SIMINOVITCH: It's what you would expect. You know, they'll go down to the end denying liability. But ultimately, it's pretty clear. In fact, when you talk about OxyContin and Purdue is going through trying to get through bankruptcy proceedings in the U.S., and it's not that they've ever admitted liability. And yet, as you know, OxyContin has been known very well and the Purdue company for the wrongs that were done with respect to the marketing of the drug. So, you know, it's what's to be expected. And we have a very strong case. We're very passionate about it, very committed to helping the people that have been harmed by these drugs.

MG: Just finally, I mean, how difficult is it to get those people who, as you say, have been harmed by these drugs to come forward and join an action like this? Because when it comes to issues of addiction, and we've spoken about this broadly, but specifically when it comes to the opioid crisis, there's still a stigma that's attached to that.

MARGO SIMINOVITCH: Absolutely. And people need to understand that they were put on these opioids for very legitimate reasons. Pain is terrible. Anybody who's experienced pain either post-surgery or has back problems is going to understand how terrible pain can be. And for people who have chronic pain, they are suffering. It's completely legitimate. So, there's nothing wrong with the fact that they were put on opioids. The difficulty is that staying on them for a long time is extremely risky in terms of addiction, and we really hope that interviews like this one will allow people the freedom to come forward. It's very, very important that we hear their stories, that we have them know what's going on with the lawsuit and that we get them into the class action and register. And they should go to the website where they can register, and they should be getting all of their information, like their pharmaceutical records, so that we have them preserved.

MG: Margo, we'll leave it there. Thank you very much.

MARGO SIMINOVITCH: My pleasure. Thank you.

MG: Margo Siminovitch is with Fishman Flanz Meland Paquin LLP. It's one of the firms representing members of the class action lawsuit in Quebec against 16 pharmaceutical companies over their alleged role in the opioid epidemic. None of the allegations have yet been proven in court. Dr. David Juurlink has been outspoken in his criticism of the way that opioids have been and continue to be prescribed. He's head of clinical pharmacology and toxicology at the University of Toronto. Dr. Juurlink, good morning to you.

DR. DAVID JUURLINK: Good morning, Matt.

MG: This lawsuit covers anyone who's been diagnosed with opioid use disorder since 1996, in Quebec. Go back in time. From 1996, how were opioids prescribed?

DR. DAVID JUURLINK: Well, I might go back a bit further than that. So, I was a pharmacist in Nova Scotia in the early 90s, 1995, during medical school. And it wasn't that people were never put on opioids for pain, but they weren't prescribed in the same way that they came to be in the late 90s and through the 2000s. So, what happened, and your earlier speaker sort of touched on this, is that in the late 90s, when OxyContin got a real toehold and began to be marketed aggressively, doctors began to prescribe it. And it was approved by Health Canada for chronic pain, for example, in a way that no other opioid had ever been prescribed. And so, we began to prescribe it because we believed that we'd be helping patients. And as it turned out, I mean, we did sometimes help people with these drugs. But more often than not, and especially as the dose got ramped up over time, we ended up hurting people.

MG: How did they become, these drugs, become kind of this go to remedy for pain? I mean, Margo said that everybody knew that they were addictive.

DR. DAVID JUURLINK: So, I don't think that's quite true. So, you put yourself in the doctor's shoes. So, most people go to medical school because they want to help people. That's the motivation for most decisions. And sometimes helping people takes the shape of, you know, treating an infection or fixing a broken bone. But more often than not, what doctors are doing to help people is relieving suffering. That's something we do every day. And sometimes that suffering is emotional, but sometimes it's physical. And I would say that the relief of suffering is probably the overarching goal of medical practice.

MG: Somebody comes in and pain. They want to be, you know, relieved of that pain.

DR. DAVID JUURLINK: Sure they do. And we want to help. And that's why we do what we do. And so, to suddenly be told not just by the drug companies that made these drugs, but by the experts who helped promote them and by the regulators who got them onto the market, let them onto the market, and by drug plans that paid for them, you know, to suddenly be told that we have this class of drugs that we've historically issued for pain, and now we can use was a message we were happy to hear.

MG: I mean, we talked about and talked to Patrick Radden Keefe, the author, about his extraordinary book on On the Sacklers and Purdue Pharma and the what he describes as a push by the company to, through, you know, direct conversations, through sponsoring events and what have you to get these drugs into the hands of doctors. Also talks about how short, you know, people's appointments are and that that can lead things to get to the drug just to kind of get somebody through the system and out the door. But there was also this paragraph that was in the New England Journal of Medicine in 1980 that talked about addiction. Right?

DR. DAVID JUURLINK: Oh, yes. This is a really important point. So, one of the reasons why in the 80s and early 90s, doctors didn't prescribe opioids for long periods of time was because we were worried, I wasn't practising then, but doctors were worried about hurting people and specifically worried about unmasking addiction in a patient who might have a propensity to it, genetic or otherwise. So, one of the key messages that we got beginning in the late 90s was that we didn't need to fear that because addiction was a rare consequence of opioid therapy. So, the paragraph you're referring to that was published in the New England Journal of Medicine, which is arguably the world's leading medical journal, and it's got a very declarative title. It says, Addiction rare in patients treated with narcotics. So this one paragraph study, because it was buried in the back pages of a journal, it never really got read, but it got cited very heavily and promoted as evidence that, doctors, you don't need to worry. This fear that you've had about inducing addiction in a patient just because of a well-intentioned pain treatment is one you don't need to worry about. And as it turns out, that information was also just not... The study, that paragraph told us exactly nothing about the risk of long-term addiction with opioid therapy.

MG: Knowing what we know now, and I mean, I mentioned the number of deaths, opiod-related deaths, in this country, 42,000 plus. The number continues to climb. How is it different? How--what is different now when it comes to how these drugs are prescribed in Canada?

DR. DAVID JUURLINK: Well, I think you've touched on an important point. We talk about the opioid crisis. It's not really one thing. And the most pressing issue today is the toxic drug crisis that you alluded to in your opening. And people who, you know, are at risk of dying today because of a drug supply that's very unpredictable. And so, this we're not talking here, those people need a specific set of interventions, and they need it urgently. But on the treatment of pain front, I think we still use opioids. I prescribe them. I'm an opioid hawk now. I prescribe them all the time, though. I just do it differently than I did, say, 20 years ago. [MG: How so?] I start them less readily. I still use them, but I am mindful of the fact that they've got side effects that can be very, very challenging for even a vigilant doctor to identify. So, I start them more consciously. I'm very, very careful about escalating the dosage. That's something, this is another important point. One of the other messages we got about opioids was that with ongoing use, sometimes the analgesia they afford lessens. And so, what we were taught is just to go up on the dose, gradually increase the dose, to try and overcome that loss of effectiveness. And that's something we do with almost no other class of drugs. And it should come as no surprise that as we progressively escalate doses of opioids in an effort to chase pain, all of the other side effects that can happen with opioids can really accrue. And so, it's very easy to find yourself in a position where after, you know, six months or a year or five years of opioid therapy, patients are often in a position where the doses have gone up over time and they're actually being harmed in ways that are hard to appreciate. That's often an unwelcome claim for people who are on these drugs. But it's just true.

MG: There's a report that was done in 2021. It showed one in eight people in Canada received at least one prescription for opioids from a community pharmacy. That's about four point six million Canadians. That seems like a high number to me.

DR. DAVID JUURLINK: Yeah. I think if you were to do that same study 15 years earlier it'd probably be even higher. I again, I don't want to give the sense that these drugs shouldn't be used. They are very valuable drugs in the right hands. But I still think that we overprescribe them to a certain extent. And I, you know, I see this, most people have had wisdom teeth taken out. And it's very common still to get a prescription for Tylenol 3 or Percocet after you've had that done, even though we know that that's no better, in fact, probably inferior to anti-inflammatories in Tylenol for that kind of pain. It's reflective of a culture that, of a culture of medical practice that still sees opioids as our best, strongest pain relievers. And it's very clear that they are not that.

MG: I mean, ultimately, and this goes back to what you said earlier, people are coming in to the doctor's office, coming out of surgery, coming out of having their wisdom teeth or their hip replaced or what have you and they're looking for pain relief. Are there other alternatives to opioids, new ways of treating pain, perhaps, that are being explored now that would avoid those concerns?

DR. DAVID JUURLINK: Well, there are other drugs we can use. I mean, most doctors have a fairly straightforward approach. We start with, you know, Tylenol and anti-inflammatories if they're safe to use. And when those don't work, we'll often quickly go to opioids, weak ones and then stronger ones. But there are lots of other drugs that we can try. Sometimes antidepressants, sometimes, drugs for nerve pain, sometimes drugs-- in hospitals where I work we have lots of other options because we can use intravenous routes of therapy. You know, cannabinoids, sometimes. So, there are other drugs that we can try. But the reality is that when you start a patient on a pain medicine, like you don't really know in advance whether you're going to really help them or not, and you don't really know in advance whether you're going to cause side effects or not. So, it really is in a real sense, you're conducting an experiment in real time on the patient. And we have different drugs we can try. But you don't know until you've tried them what's going to work.

MG: And if perhaps you're using those less potent, if I can put it that way, treatments, if somebody has chronic pain, they could come back to you and say, I'm sorry, this doesn't work. They could be quite upset by that.

DR. DAVID JUURLINK: Oh, yeah, sure. It happens all the time. But in general, I think most docs can find some combination of medications that, you know, can help patients feel better. I think one of the things that we also have, we do less now than we did say, 15 years ago is try and get that pain score down to zero. I mean, I think if we get someone whose pain is an eight out of ten or nine out of ten and we can get it to a four or three, I mean, I think we need to grant that that's a real win. And that, and nobody wants to be in pain, but the idea that we should try and bring that four or a three down to a one or a zero has led a lot of patients to be harmed by well-intentioned therapies. So, I think sometimes, I hate to say it, but sometimes we need to accept the fact that pain is part of life. And getting it somewhat better is often the best we can do.

MG: In the face of that, just finally, when is it appropriate to prescribe opioids? We've talked a lot, and we've talked talk about stigma around addiction. These drugs have a stigma as well because of everything that we've been speaking about. When is it appropriate to prescribe them?

DR. DAVID JUURLINK: You'll get different answers depending on who you ask. And I think let's keep in mind that there are three groups of people out there. There are people who aren't on opioids right now, there's people who've been on them for years and aren't addicted, and there are people with opioid use disorder. And the answer to that question really depends on which patient population we're talking about. But let's take the people who aren't on opioids. I think that we can still use these drugs. But using them sparingly, not giving a 14 day supply when three or four days is likely to help. Not relentlessly increasing the doses, trying to sort of chase a pain that's, you know, that's always going to be there.

MG: Also talking to the patients about how to taper off of them. Right?

DR. DAVID JUURLINK: That is a very, that's one of the most difficult discussions I as a doctor have with patients. Is people who've been on these drugs for often a decade or more, who've escalated to high doses over that time, and trying to say to them, Listen, you know. I can pull up a chair at the bedside in the hospital and over the span of 45 minutes or an hour, try to convince them that, you know, if we can just taper your dose very, very gradually over time, often you'll feel better. But it's not something that people will typically want to hear. It's, and that's a reflection of the fact, and this is an unfortunate fact about opioids, is they change the structure and the function of our brains in a way that once you've been on them for a while they're very hard to come off of. And people often don't want you to.

MG: David, good to talk to you as always. Thank you very much.

DR. DAVID JUURLINK: My pleasure.

MG: Dr. David Juurlink is the head of clinical pharmacology and toxicology at the University of Toronto. This is The Current on CBC Radio. My name is Matt Galloway. There is a new Lennon and McCartney tune out this week. No, not that Lennon and McCartney. Kind of a different take on this. Sean Ono Lennon and James McCartney have teamed up just like their fathers, John and Paul, to release a new song. That song is called 'Primrose Hill.'

[Music: 'Primrose Hill' by Sean Ono Lennon and James McCartney]

MG: Lennon and McCartney generation two. That is, James McCartney, Sean Ono Lennon and their song 'Primrose Hill.' Coming up after your regional update, the Barkley Marathons, one of the most gruelling races in the world. In its history, only 20 runners have finished in the allotted time. This year, Jasmin Paris became the first woman to complete the 160 kilometre test of endurance. In just a moment, she'll talk about how she stayed strong and sane, and why she did this thing in the first place. Plus, what do you get when 500 Newfoundlanders show up for the same Caribbean cruise? We'll tell you. Coming up, I'm Matt Galloway. This is The Current. We're back in 90 seconds.

Hallucinations and omelettes in a 60-hour marathon

Guests: Jasmin Paris

MG: Hello again. I'm Matt Galloway and you're listening to The Current.

SOUNDCLIP

[Sounds: Crowds cheering, chanting]

MG: After over 160 kilometres of running on uneven terrain with elevation equal to climbing Mount Everest twice, that's the sweet sound of the finish line. Jasmin Paris is the first woman and one of just 20 runners to complete the Barkley Marathons in Tennessee. This race is infamous, known for being one of the most gruelling ultramarathons in the world. Last month, she ran the course and finished with just 99 seconds to spare in the 60-hour cut-off. Jasmin Paris, hello.

JASMIN PARIS: Hello.

MG: I was one of the people, there's no live stream of this race, but I was one of the people who kept refreshing social media to see whether you were going to finish in that cut off time. What was going through your mind in the final moments of that race that we just heard?

JASMIN PARIS: It was incredibly intense. I guess it was intense for the spectators and people watching from home or waiting from home. But for me, it was just, you know, it was a culmination of those 60 hours of effort. And it was all kind of, all that effort was kind of condensed into that final few minutes when I knew that I was, I really had to sprint uphill to get to the gate, and I had nothing left. I was completely exhausted. So, yeah, it was an incredibly yeah, it was very intense moment. And I really had to sort of dig and dig deep and deeper than I've ever had to dig before to get myself to the gate. And the cheers of everybody waiting there at the gate were incredible. Yeah, they were, it was an incredible feeling to be almost there.

MG: There's a photo of you at the gate. You finish the race, you're kind of hanging on this yellow gate. It looks like you are going to die.

JASMIN PARIS: I did feel like that. Yeah, I mean, I honestly, I emptied out the tank completely. I've never had to dig like that before. And I mean, I just, all my focus was on getting to the gate. I didn't even think about what I would do. You know, I didn't think about decelerating or anything like that. It was just I; you can see in the videos, I sort of hit the gate and went right over the top of it because I hadn't even, you know, every ounce of energy and breath that I had was just focused on that, getting there.

MG: This is not a normal race. For people who don't know, explain what the Barkley Marathons are. How they work.

JASMIN PARIS: Well, it's, you know, you do five loops of a forest in Tennessee in Frozen Head State Park. They may be roughly 20 miles long, but who knows, because you're not allowed any sort of GPS or watch or any way of recording it. You've got no way of contacting anyone when you're out there. It's mostly off trail, involves quite a lot of navigation. The terrain is challenging. Very steep. So, you're either, most of the time, you're either going up really steep and kind of pulling yourself up, or you're going down very steeply and slithering down. And there's, you know, fallen trees and things. In sections there are really quite a lot of briers, these thick brambles that sort of, yeah. And they get stuck around you. There is parts and when they get stuck around your neck you have to stop and sort of pull them off rather than trying to push on. But, and all those things kind of combine to make it challenging. There's no real, there's no support out on the course. When you're out there, you're very much on your own. And rather than kind of going through checkpoints to gauge your progress, you have to find books and you pull out a page that corresponds to the number you're given at the start of that loop. So, yeah. It's kind of a bizarre race. And it's really more about the kind of challenge of completing it. When you're out there you kind of work together with the people you're out there with. It's a great sense of camaraderie and spirit. I think it's yeah, it's a fantastic sort of atmosphere out there.

MG: Why would you want to do something like that?

JASMIN PARIS: Well, you know, I mean, I love running in the hills just because I love being in the mountains. Running that way takes me to kind of wild places and makes me happy. And I love that kind of feeling of being fit and that exhilaration of running downhill. But when it comes to specifically to Barkley, I guess I do enjoy kind of challenging myself in, with something that I don't know whether I can finish it. I find that, I find that intriguing and I find it, yeah. It's just kind of exciting, something that I, yeah. When I don't know whether it's possible, that's immediately a challenge that kind of attracts me. Because I know that it's going to take me to kind of a place that I, yeah, where I'm really kind of hitting the wall. And I find that kind of fascinating at those times.

MG: Can you describe that place? I was going to say, like, where in your mind do you go when you are running for close to 60 hours or crawling or sliding non-stop? Where in your mind do you go?

JASMIN PARIS: I mean, at Berkeley, the kind of, one of the things about that challenge is that you can't really go anywhere much. I mean, you have to be in the moment focusing on it, because the minute you start thinking much about anything else, then you would go wrong, you see. Because the navigation's such a key part of it. So, I guess I think that this year especially, I was just incredibly focused on getting to the end. And it was all, you know, just about the next step of getting to the next place and finishing the next leap. But in terms of the really hardest moments, I thought about family and especially my two children who are three and six. And it was nice knowing that they would be well looked after at home. And basically, I imagined being back with them and that helped in the darkest times.

MG: Do you sleep at all when you're doing this? Like, is there the opportunity to catch a quick nap and then reload?

JASMIN PARIS: There isn't, no. And I think one of the people that finished this year managed to get 20 minutes between one of the loops. I didn't and I think I took a, maybe, I said I was going to take a three-minute power nap before the last loop. But there isn't, there isn't time. It's so close now. I think maybe historically, when the course was a bit shorter, there was time to sleep. But now you're sort of cutting it so far in any way that nobody sleeps.

MG: Tell me about the hallucinations. When you don't sleep and you're doing that, your body does strange things, right?

JASMIN PARIS: Yeah, you start to see, I certainly found after, kind of, the second night of no sleep, you start to see things. My case, it's usually animals in the woods. So, like, bits of wood turn into various animals. Especially like broken trees and things. I saw quite a lot of big cats, lions, and that sort of thing. And pigs. I mean, there are wild pigs in the park, but I was seeing different sorts of pigs. And then people in black raincoats sort of dotted all the way along the ridge above me. And at one point they had a sort of quite sinister feel to them. And I, yeah. The first time I saw them, I was really confused because you're not allowed to be off trail in that park. And I found it, you know, very odd. But then I subsequently saw them many times in the course of the rest of the race. And by then I sort of assumed they were probably a hallucination.

MG: I mean, as you describe this, I don't know whether you think this, but it sounds insane. It sounds bonkers.

JASMIN PARIS: I mean, it is a bit. Yeah. It is a bit. But then, you know, it's kind of, it's very memorable and, yeah. [MG: Yeah.] So, these moments you look back on and you think that's when, you know, you really, these kind of really stand out in your life when you have times like this, and you push yourself like this.

MG: What were you eating? What kind of food would you fuel yourself with?

JASMIN PARIS: I mean, just kind of pretty normal food. It wasn't any fancy kind of running food for the most part. I mean, I had sandwiches, I had some like omelette type, had pizza with me. This was all to take with me. Trail mix, chocolate bars, sweets. And then in the camp had pasta, porridge, and rice pudding, bananas. Bananas always work very well.

MG: I heard something about pickle sandwiches, too?

JASMIN PARIS: Oh, yeah, yeah. Those are, I had cheese and pickle sandwiches. Yeah. So, very British as well. [MG: Yeah.] It's good to have a bit of kind of umami when you can't bear anything more sweet. So, it's good.

MG: I mean you get invited to do this. Lazarus Lake, who's the creator of the Barkley marathons thought that you could be, you could be specifically the first woman to complete this race, even before you applied to run it. Did that motivate you at all? Knowing that that could be an achievement?

JASMIN PARIS: In terms of whether it, like knowing that I could be the first woman would certainly like, you know, I guess that was added into my kind of thinking about the race, for sure. But my chief kind of ambition when I went and I was just, I just wanted to do it for me. It was kind of proving it to myself that I was capable of it. And the fact that I, you know, did it as the first woman and proved a lot of people wrong, I think they thought a woman could never finish. Yeah, that was really satisfying. I got great pleasure from that.

MG: You have this really busy life, right? You're a mom. You have two young kids. You're working. You're a veterinarian, a senior researcher at the University of Edinburgh. In the midst of all of that, how do you train for a race like this?

JASMIN PARIS: It is pretty challenging. And then I guess the way that I do it is just by doing most of my training early in the morning, kind of before people are awake. And so, I get up at five, I train from 5:30 till about 7:15 when I'm running during the week. And then I do strength work after that. And then it's all kind of a rush to get the kids to, you know, to nursery, my son to nursery and then into work. And we kind of fit all the things, you know, when I'm in the lab I am doing research, I cycle commute to there. And sometimes I swim here in the reservoir, that we live beside a reservoir, do some wild swimming. Basically, fit things in as and when I can. But the majority, the bulk of my training is early in the morning. Even at weekends. And that way I can still get a lot of the time, a lot of the weekend to spend with the kids.

MG: How much of this is about physical preparation versus mental preparation? Because you can be fit and you can be strong, but there has to be something in you that, in the darkest moments, kind of keeps you putting one foot in front of the other.

JASMIN PARIS: Yeah, I personally think that's a huge part of this race, to be honest. Because it's one of these challenges that keeps throwing things at you. And it's almost like you just have to kind of pick yourself up, deal with it and carry on and not let it set you back. So, I think that's at least 50 per cent of it’a sort of in your head. It is about physical preparation, as I did an awful lot of climbing in preparation. And I was kind of doing a maximum, maybe 11, 12,000 metres in the week. So. And that for me is quite a lot of climbing.

MG: I think for anybody that's a lot of climb-- for anybody that's a lot of climbing. But yeah, continue.

JASMIN PARIS: Yeah. But I, yeah. The mental kind of aspect is you know. And that's one of the things, I guess the reason I'm kind of so proud of what I did there. Because I definitely had really quite a tough time, especially kind of loops three and four. And there were lots of times when everything, you know, my body was telling me to stop, and I really wanted it to stop. And at the same time, I knew I was never going to allow myself to do that while I could still carry on. So, yeah. It was a real challenge, and I'm proud that I kind of came through it and carried on.

MG: You know how unusual that is, though, right? I mean, people who do physical acts, your body tells you to stop, and most people stop.

JASMIN PARIS: Yeah, yeah. I guess I'm really stubborn. And I really wanted it, I guess. This year I really felt I could do it going into it. And yeah. I guess I really believed.

MG: There's this amazing story. You competed in The Spine Race in the U.K. This is one of the toughest ultramarathons in the world. And when you did this, your daughter was what, 14 months old?

JASMIN PARIS: Yeah, yeah. Thirteen and a half months old. Yeah. Yeah.

MG: And so, you were stopping in the midst of this race to pump milk for your daughter.

JASMIN PARIS: Yeah, I was expressing, I was expressing milk as I went along because I was still breastfeeding at the time. Yes. I didn't, because I didn't want to get mastitis and so on, you know, obviously if you're used to feeding and regularly. So, she was still, she was still getting milk at home, actually. Most of it was like frozen in the freezer ready for her. So, but yeah, you're right. I was expressing as I went along on that race.

MG: How did you do in that race?

JASMIN PARIS: Yeah, I won it. And yeah, broke the record by quite a bit.

MG: By quite a bit! You broke the record by more than 12 hours.

JASMIN PARIS: Yeah, yeah. I did. Yeah. And I think the next man behind me unfortunately had to drop out because he got hypothermic, I guess, chasing me over the hill. So then, yeah. Then it was about 15 hours, I think back to the next finish at the time.

MG: You're very humble in talking about how you did something extraordinary.

JASMIN PARIS: Thank you. [MG: There's a hashtag.] Yeah.

MG: Well, there's this hashtag that was applied to you during Barkley. The small European woman.

JASMIN PARIS: Yeah. Yeah.

MG: Where did that come from?

JASMIN PARIS: Yeah, I picked it up last year. So, I think there was somebody from what I heard, there was somebody at the fire tower. You know, that's the one place on the course that kind of spectators or, your crew can be allowed to see you. They're not allowed to do anything. Just kind of cheer you on. And I think somebody was reporting back to [unclear] from there and described me as this, they were kind of, gave everybody a new name and called me the small European women. So, that kind of stuck. So yeah, I think I understand that was kind of trending while I was running this year. So, that's quite, I found that quite funny to think of--the small European women--on social media.

MG: What do you think? Just before I let you go, I mean, what do you think you've accomplished tells us about what we are capable of? What you have done is incredible. What do you think that shows about what we can do as people?

JASMIN PARIS: Well, thanks very much for the kind of, your words. And I guess, I mean, I don't really feel like I mean, you know, I don't think I'm anything special. Like, I just think that I kind of believe and when I dream of something I like to give it everything. I like really to follow it. I really throw myself at it with all my heart. And I believe in myself. And I'm willing to go out there and give it everything. So, I think if you want something, if you dream of something, then give it a go and work hard at it and, you know, in my case, it was training hard. But at the same time then, just don't let any kind of preconceptions about what you can achieve or what you're capable of influence you. Just go out there and see. And I honestly think that if you do that, then you'd be surprised what you can achieve. The kind of sky's the limit, really.

MG: What do you do in the wake of this? Do you put your feet up and relax and eat fatty food or something like that? Do you have another race lined up?

JASMIN PARIS: I have eaten a lot of cake in the last three weeks. I'm gonna have to stop doing that, I think. I'm running again now. I'm doing like some fell racing kind of hill racing, local hill racing in the next month or two, and then in September I'm running a long race in the Italian mountains called the Tor des Géants, which is another one of these kind of non-stop, I don't know, it's about 330 kilometres and 24,000 metres of ascent. So, I'll see quite a few people from Barkley there again. So, it'll be a bit like a reunion in there. I'm looking forward to that.

MG: You're amazing. It's a real pleasure to talk to you. So many people were cheering you on from so far away as you were making your way to the finish line. And it's a great pleasure to talk to you. Congratulations and thanks.

JASMIN PARIS: Thank you very much. Okay. Bye bye!

MG: Jasmin Paris is the first woman to ever complete the Barkley Marathons, a race that spans over 160 kilometres. It has to be completed in 60 hours. And she completed it with 99 seconds to spare.

[Music: Instrumental]

MG: This is The Current on CBC radio. My name is Matt Galloway. Last week you might have heard our conversation about the growing number of hospitals that are charging patients extra for staying past their discharge day. Under what is known as Bill 7 in Ontario, hospitals are now able to charge patients up to $400 a day and those hospitals say the beds that the patients are in are desperately needed by other patients. But many of the patients who are in the beds need long term care services, and the waitlist to get into those facilities are often very long. Or the home perhaps is far from family. And so, for some people, staying in hospital and racking up fines can be the only option. We got a lot of mail on this, and The Current's Amanda Grant is here with some of your letters. Amanda, good morning.

AMANDA GRANT: Good morning, Matt. So, I'm going to start with a letter from Jennifer Currie. She writes: "I'm listening to your show on long term care now and my heart is broken. Yesterday I received a call that my father was forced to take a bed almost 80 kilometres away, which is an hour and 15-minute drive. My sisters and I feel this is a death sentence for my father, but who can afford $400 a day? My mother will rarely be able to see my father. They will be married for 63 years on May 6th. With my work schedule, I will be lucky to bring my daughter to see her grandfather once a week. We will now worry what he's eating and if he's getting any attention. My father has dementia, but he was a very social person, so all of our worries are legitimate. Why can't Canada create more long-term care beds? It is not a surprise that our population is ageing."

MG: Kevin Kelly writes from Toronto: "I visited more than 20 long term care homes in and around Toronto six years ago when my mother fell and ended up in hospital. With virtually no support for her to return home, I turned to long term care. I still find myself haunted by some of the things I saw. Many of those homes had appalling conditions. The better ones have long waitlists, so the vast majority of those with open beds are not places we should be sentencing sick and elderly people to. Is there a problem with beds in hospitals? Absolutely. But confusing the issue by going after those who in many cases supported our health system all their lives is cruel."

AMANDA GRANT: Brenda Mccammon from South River, Ontario writes: "Having been an emergency RN and floor nursing in long term care, this is absolutely the right move. These people are elderly but not sick, and when they continue to occupy a bed in the hospital, it prevents those beds being available to patients that need medical care. It is using funding and staff allocated for medical care for long term care. The wait times in the E.R. are not acceptable, and available beds is the main reason why. It is the responsibility of families to create a plan by putting their loved one's name on the waiting list of the long term care facilities, or creating a family care plan for their family member. I personally had to have my mother moved to a facility that was not on the list we had her on, but she eventually ended up in one of the homes on our list."

MG: Katherine Smith writes: "I have significant concerns with these fees, having been a clinical nurse specialist in geriatrics in acute care. I saw the neglect of patients who were listed as alternative level of care by the hospital. I remember one very sad incident of a gentleman with Parkinson's who was unable to get up and go to the bathroom independently. Our service worked with him, adjusted his medications, provided physiotherapy to the point where he could now feed himself and go to the bathroom by himself. He and his family decided he still needed long term care, and the hospital deemed him alternate level of care and transferred units. I decided to pop in and see how he was doing. He was lying in bed, incontinent, his breakfast on a table out of reach, and he was rigid. For hospitals to now charge for care, they had better provide the care these patients require." That letter, just one of many that we received. Another letter came from Kerry Cook. She is one of a number of nurses who wrote in after last week's conversation. Kerry Cook is a registered nurse in Ontario and joins us on the line now. Kerry, good morning.

KERRY COOK: Good morning.

MG: When you wrote in, you said that this situation, the situation of patients being charged because they won't go to a long-term care bed that's not of their choosing, was a nightmare from every perspective. What did you mean by that?

KERRY COOK: It is horrible for the patient. It's horrible for the patient's family. But it's also a major challenge for the hospitals. There's a lot of pressure within the hospital to move patients out of beds so that they are able to decant emergencies. And as everyone knows, emergency departments across the entire province are jammed with patients. And the hospital is in a precarious position trying to free up beds.

MG: And you can imagine, I mean, the stress that would be felt from the families of, and the patients themselves, if they're in the emergency department waiting for a bed further down in the hospital that isn't being freed up.

KERRY COOK: Absolutely, absolutely. So, the hospitals are in the centre of a push and pull situation where there's patients complaining downstairs in emergency that their loved one needs a bed because they are direly ill. And then there are patients that have surpassed their acute care phase and no longer require acute care but are having to remain in beds because there are no long term beds that are available for them.

MG: You said you saw this coming. That you predicted this situation 20 years ago.

KERRY COOK: Absolutely. [MG: What did you see?] I've been in nursing administration for about 20 years, a little over 20 years now. And there was a lot of discussion way back then predicting what our situation would be in that there would be a shortage of nursing staff and health care resources. That we would have an ageing population that we would be needing to deal with the ageing population. And we really did not take any proactive actions to try to rectify the situation before we got here. We knew that by 2020 we were not going to be in a great situation.

MG: What's the root cause of this? Because that's something that you pointed out as well. So, in the last couple of minutes that we have, when you look at this, knowing this was coming, but knowing that this is playing out right now in hospitals across this country, what's the root cause of this?

KERRY COOK: Well, I think the root cause is multifactorial. So, number one, we don't have enough positions in the universities for our nursing students and in the colleges for our PSW students. We're not doing a good job at bringing on some of our internationally trained health care professionals and fast tracking them through. We have a number of physicians that come from other countries that are driving taxis. We also have issues with no family physicians. If you went into an emergency waiting room and pulled the people that are sitting there, I would venture to say that you would probably have about 50 per cent of the people that are there that could be seen through a family physician or family physician group. And we think that we are doing a good job at trying to rectify the situation. The root cause, I think, for the family physician issue is that we don't pay them enough. It sounds like they make a lot of money, but when you look at them as a private business where they're having to hire staff and pay rental fees and pay for equipment, what they're actually taking home is pretty minimal. And the amount of bureaucracy and paperwork and political posturing that happens for hospitals trying to increase their base funding so that they can add nursing staff, increase their hospital beds so that they have additional beds. They can't just open beds willy nilly. It comes out of their base funding.

MG: The heart of it is, as you said, people being charged because they don't want to leave to go to a bed in a long-term care home that is not of their choosing, that it's not close to family, that perhaps is not meeting the standards. And then you have that backlog of people who are back in the emergency department waiting for those beds. If you could make one move to try to solve this, what would that one move be?

KERRY COOK: The one move that I would like to see is more resources for home care. Patients and long-term care patients in particular do much better in their own homes. But the supports that we have available for them in their own home are very, very minimal. I'm dealing with that with my own parents right now. And the only care that they can get is personal care, which means washing and dressing and that sort of thing. But for them to maintain position in their own home, they need, grocery shopping, they need meal preparation, they need house cleaning. They need somebody to help make their beds, someone to help to do their laundry. And unless they pay for that privately, it's not available.

MG: Glad to talk to you about this. You've seen this on the front lines as a nurse in this country. Kerry, thanks for writing. And thanks for talking to us.

KERRY COOK: Thank you so much, Matt. I appreciate the opportunity.

MG: Appreciate speaking with you. Kerry Cook is a registered nurse in Ontario. Amanda Grant is one of the producers here on The Current. Amanda, thank you.

AMANDA GRANT: Thanks, Matt.

MG: If you hear anything on the program that you want to comment on, do get in touch. You can email us: thecurrent@cbc.ca. That is The Current for this Thursday. Q is up next on CBC Radio One. Before we go, you might have heard the story of the 512 Newfoundlanders who randomly ended up on the same cruise. It's not the start of some kind of joke. A celebrity apex cruise to the Caribbean turned into a bit of a kitchen party once word got out about who was on board the boat. CBC St. John's spoke with some of the passengers about how this all happened. Here's Pam Pardy:

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PAM PARDY: For what I understand, it was just a total fluke. Friends of ours and family members booked the trip a year and a half ago, and we were late comers, so we were just going to go along with our friends and family. And then as it started getting around Christmas, I noticed Mark posted, I think it was a Christmas gift to himself and his wife Kelly, that they were going to be going on the cruise. And I'm like, Oh my gosh, we're going, too! And then the post starts: So am I! So am I! And then our travel agent let us know that there were so many Newfoundlanders on the second night of the cruise, we were going to have our own get together, our own special Newfoundland party. So, then we knew that this was just a fluke and that it was going to be a rollicking good time.

MG: A rollicking good time, indeed. The Mark that you heard Pam refer to there is Mark Hiscock. He's also part of the Newfoundland trad band Shanneyganock. And as you do, he played a few tunes for the crowd at that special party. We're going to leave you with one of the songs he performed. This is 'The Islander.' I'm Matt Galloway. Thanks for listening to The Current. We'll see you tomorrow.

[Music: 'The Islander' by Shanneyganock]

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Thursday April 18, 2024 Full Transcript

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