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The wisdom (or lack of) in prescribing opiates after tooth removal A mother and a dentist team call for an end to routine opioid use for teens after wisdom tooth removal

By Amy Ma and Susan Sutherland Contributors We're writing as a parent and a dentist to spread a message to parents and dental health-care providers across Canada: there are alternatives to prescribing opioids after wisdom teeth removal. Removing wisdom teeth is considered by many as a rite of passage for teenagers. It's one of the most common surgical procedures done in young people aged 16 to 24. Amy Ma Amy's 16-year-old son, Felix recently had his wisdom teeth removed. After surgery, the surgeon's assistant advised that to "stay on top of the pain," Felix should take a Percocet right away. Percocet is a combination of the pain reliever, acetaminophen and an opioid, oxycodone. The assistant provided him with enough Percocet to take every three hours for the next day. Thankfully, Amy knew of the possible harms associated with powerful opioid medications, such as Percocet, especially for young people. Abuse of opioids is a national public health emergency, with growing numbers of opioid overdoses and deaths. So she asked the surgeon's assistant whether there was another pain management option for Felix. Tylenol 3 was suggested (acetaminophen with the opioid codeine), which still seemed too powerful. How did Amy know to question the advice she was given? Susan Sutherland Amy serves as the patient adviser for the national campaign Choosing Wisely Canada, which partners with national clinician societies to develop lists of tests, treatments and procedures that may cause harm. So she knew that the Canadian Association of Hospital Dentists recommends non-opioid based pain medications to be prioritized following dental surgery and to resort to opioids only if the pain can't be managed. Amy asked for Naproxen for Felix - an over-the-counter pain reliever in the same drug class as Aspirin and Ibuprofen. Felix took the Naproxen as directed when the anesthesia wore off and he didn't require anything stronger. In fact, he was quite comfortable. We need to think twice about whether an opioid prescription is needed after wisdom teeth removal. After having her wisdom teeth removed, Lady Gaga posted pictures of her puffy face and tweeted out to her millions of followers: "Wisdom teeth out. P-p-Percocet p-p-Percocet." Percocet after minor oral surgery should not be an expectation of teenaged patients. What's at stake? Persistent opioid use after elective surgery, like wisdom teeth removal, is a risk, especially in young people whose brains are developing and are highly susceptible to the effects of opioids. Leftover opioids are equally dangerous for teens, who might be tempted to experiment or share with friends and family members. Dentists and oral surgeons have a critical role to play here - they're among the leading prescribers of opioids to young people. An American study published recently found that dentists are the leading source of opioid prescriptions for children and adolescents aged 10 to 19 years in the United States. Dental prescriptions account for over 30 per cent of all opioid prescriptions in this age group. This study also found that young people who received opioid prescriptions after wisdom tooth extraction were more likely to be using opioids three months and one year later, as compared to their peers who didn't get an opioid. The evidence is clear: a short prescription for opioids poses a real risk of ongoing opioid use to our teenagers. Many patients experience pain and swelling lasting three to four days and sometimes up to a week after wisdom teeth surgery. The intensity and duration of these symptoms varies considerably depending on the position of the teeth, how deeply they're buried in bone and the surgical difficulty in removing them. While many oral surgeons and dentists prescribe opioids routinely after dental surgery, pain management for all patients should be handled individually. In most cases, post-surgical dental pain can be controlled without opioids and through anti-inflammatory drug such as ibuprofen, in combination with the non-opioid pain relievers such as acetaminophen. For some oral surgery procedures, such as such deeply impacted wisdom teeth or jaw reconstruction, an opioid may be needed for pain control for a short time. It's time oral surgeons and dentists move away from a one-size-fits-all pain management strategy. Avoiding unnecessary opioid prescriptions for teenagers is critical part of staving off the harm of the opioid epidemic. Amy Ma is a parent of three living in Montreal. She is the co-chair of the family adviser forum at the Montreal Children's Hospital and patient adviser to Choosing Wisely Canada. Dr. Susan Sutherland is the chief of dentistry at Sunnybrook Health Sciences in Toronto. She is the president of the Canadian Association of Hospital Dentists.

© Troy Media

Decoding Green Labels 101

A guide for consumers to navigate through all those ‘sustainable’ products

TORONTO, Ont. —From “natural” tea, to “green” cleaning supplies to “eco-friendly” clothing, there are endless products being marketed with claims that attempt to convince consumers that they are making the right decision when shopping.

“Canadians are concerned about the state of our environment and worker conditions, and are opting for more sustainable, conscientious products and services,” says Laurie Simmonds, President and CEO of Green Living Enterprises. “With companies using various ‘green’ claims and labels now more than ever, it can be difficult to distinguish between what looks and sounds ethical and sustainable, and what actually is.” 

Product certifications alleviate this challenge for consumers, as any certified product has undergone a rigorous third party evaluation; examining everything from environmental impact, ingredient procurement, worker conditions and compensation to name few.  Choosing products with the following labels will help you shop smarter and feel more confident about your buying power:  

·         While many may think it’s the most obvious, Fairtrade is often a confusing term. The Fairtrade mark means the ingredients in a product have been produced by small-scale farmer organizations or plantations that meet social, economic and environmental standards. Equifruit for example, is the Canadian market leader of Fairtrade-certified bananas, with a large number of retail partners in Quebec and Ontario.

·         B Certified is to a business what Fairtrade is to fruit or coffee. Launched in 2006, B Certified companies meet the highest standards of verified social and environmental performance, public transparency and legal accountability. Dedicated to offering bee-derived superfoods, Beekeeper’s Naturals is a great example of a B Certified company that has undergone strict analysis and understands their overarching duty to the environment. It is one of 2,048 B Corporations in 50 countries around the world, all demonstrating a desire to make change and be part of something bigger.

·         Eating organic is one of the most popular ways to lead a healthier, more sustainable life. This can be made easy by purchasing products with the Canada Organic label and certification (define what it means – pesticides, antibiotics, etc..). Canada’s organic standards are among the most recognized in the world and Harmony Organic is a Canadian company that wears this label with pride. With 14 family farm producers, Harmony Organic is passionate about the quality of their dairy, their cows and the earth.

·         Sustainable food choices continue to be important to Canadians, changing the way they think about what’s on their plates. With overfishing being the biggest threat our oceans face today, consumers who choose to eat seafood can make a difference by choosing fish that is responsibly sourced or by visiting restaurants, like Hawthorne Food & Drink that use the Oceanwise symbol — an assurance against overfishing, harm to other aquatic creatures and protection of the marine ecosystem.

·         The Leaping Bunny logo is one to look out for when purchasing personal-care products and cosmetics. Companies like Skin Essence Organics that are certified through the Coalition for Consumer Information on Cosmetics, make a voluntary pledge to eliminate animal testing from all stages of product development.

“We are all trying to make better choices for our health and wellbeing that will help build a better world, with a healthy environment and strong communities,” adds Laurie. “Learning about these various labels and certifications is a great step in that direction”.

This April, visit all of these people- and planet-friendly certified companies, plus 400  sustainable companies at the Green Living Show taking place April 7^th to 9^th, 2017, at the Metro Toronto Convention Centre. Please RSVP if you would like to attend as media.

For more info on leading a healthier, greener lifestyle, please visit www.greenlivingshow.ca. ‘Like’ them on Facebook, or follow @GreenLivingPage.

About Green Living Enterprises 

Green Living Enterprises is Canada’s leading cause-marketing agency focused on social and environmental program development. Our team is led by award-winning industry experts in the fields of brand and program development; custom content; advertising, marketing and communications; and event management. Green Living Enterprises also includes Greenlivingonline.com and The Green Living Show, Canada’s largest consumer show, dedicated to simple solutions for leading a healthy and sustainable lifestyle.

Green Living Show

The Green Living Show is Canada’s largest consumer show dedicated to simple solutions for leading a healthy and sustainable lifestyle. This three-day event offers inspiration for all ages and features influential speakers; innovative products; eco home and garden design; local and organic food and wine tastings; health, wellness and yoga pavilions; eco fashion and green beauty makeovers; electric car test drives; nature exhibits and fun activities for the entire family.

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Quebec's health-care privatization a lesson for the whole nation But much still hinges on the outcome of the ongoing court case in B.C.

By Amélie Quesnel-Vallée and Rachel McKay EvidenceNetwork.ca Ask a random Canadian if our health system looks more like that of the United States or the United Kingdom. Chances are, most will respond that our system is nothing like the U.S. - which is largely paid for privately - and every bit like the U.K., which has publicly-funded health care. The reality is more of a cold shower. Amelie Quesnel-Vallee When we look at data from the Organization for Economic Co-operation and Development (OECD), which compares the wealthy countries of the world, we see that Canada is well ahead of most peer countries in terms of private financing, with a whopping 30 per cent of our health expenditures paid for through private health insurance or out-of-pocket spending. This is 50 per cent more than the U.K., where private health spending is at 20 per cent, and three times as much as in France, where it's only 10 per cent. Now, a court case that is ongoing in British Columbia, known widely as the Cambie case, has some worried that we might see an even greater development of the private pay health-care market across Canada. But will we? The Quebec experience suggests that a lot hinges on how forcefully and decisively the B.C. government responds to the court challenge. And, on this count, B.C. has a head start where Quebec faltered. The court decisions matter, of course but, at the end of the day, it will be provincial governments' actions (or lack thereof) that open or shut the door to a two-tier health system. For those with good memories, the Cambie case may be oddly reminiscent of the Chaoulli case that unfolded more than 13 years ago in Quebec. To understand both, it's worthwhile to remind readers of the legal provisions that constrain the private purchase of health care in Canadian provinces. Basically, doctors in Canada are prohibited from extra-billing or double dipping - charging patients for services already covered under our publicly funded medicare. Rachel McKay Doctors are also prohibited from working in both the public pay and the private pay health system at the same time, when providing medicare beneficiaries with publicly insured services. The concern is that such a dual practice could result in a conflict of interest, creating wait times in the public system to funnel patients to the more lucrative private practice. Physicians must choose: either be all in the public system or all out. The Cambie court challenge seeks to break down the all-in or all-out dilemma for physicians, striking at the heart of BC's Medicare Protection Act by targeting all constraints on extra-billing and opted-out practice, dual practice and private insurance that duplicates B.C.'s public plan. The Chaoulli court challenge was far less ambitious, targeting only Quebec's legal prohibition on the purchase of private insurance for services delivered by opted out physicians. Yet, at the time, this was still perceived as significant risk for the development of a two-tier system. Many were concerned when Jacques Chaoulli won his challenge, and Quebec responded with Bill 33, which opened the door to duplicative private insurance for a select number of otherwise publicly-insured health services. While Bill 33 turned out to be fairly innocuous (largely because private insurers didn't deem this a profitable venture and that it only applied to Quebec), it nevertheless responded to the spirit of the court challenge, sending a powerful message that Quebec's elected officials were at least, in principle, supportive of more private health provision and insurance. The Chaoulli case should really be seen as a symptom rather than a cause of the fact that Quebec is home to what is arguably one of the largest private health markets in the country. In fact, the cause stems more from neglect by legislators - whether benign or strategic, and for decades preceding Chaoulli - allowing several hot spots of privatization to flourish. This includes private diagnostic services, which are reimbursable by private insurance in Quebec but not elsewhere in Canada; physicians opting out of the public system in ever increasing numbers, year after year; and extra-billing, which was only been officially banned by the province in 2017 (only after threats of claw backs of the federal health transfer). While B.C. shares similar historical trends with Quebec, we see no such benign neglect by B.C. legislators. Instead, the B.C. government appears to be fighting tooth and nail in the face of Cambie, pulling out all the stops to buttress the Medicare Protection Act. It even resurrected 14-year-old Bill 92, the Medicare Protection Amendment Act, in a deft counterpunch to give the province more powers to crack down on extra-billing. With both sides firmly entrenched in their positions, it's unlikely that we will see a swift resolution to the Cambie conflict. Whichever side loses the court case is likely to bring it to the B.C. Court of Appeal and, from there, to the Supreme Court of Canada, as happened with Chaoulli. In other words, there's still a long battle ahead. Amélie Quesnel-Vallée is the Canada Research Chair in Policies and Health Inequalities and the director of the McGill Observatory on Health and Social Services Reforms at McGill University. She's also a contributor with EvidenceNetwork.ca, which is based at the University of Winnipeg. Rachel McKay is a post-doctoral fellow with the McGill Observatory on Health and Social Services Reforms at McGill University.

© Troy Media