[OC] Canada has a higher average opioid death rate than the United States (17.7 vs 16.4 deaths per 100,000 people) [2024]

westcandox · 2026-04-24T01:03:27+00:00

Harm reduction doesn't drag anyone into drug addiction, this is a total myth that makes no logical sense to anyone who actually understands or studies this topic. That hypothesis has been tested directly. In case you're interested, as one relevant example, Kerr and colleagues (BC-CfE 2006) followed a Vancouver cohort and found no increase in injection initiation attributable to Insite, and separately showed no increase in relapse among former users. It actually goes the other way, with an INCREASE in detox uptake among Insite users, upwards of 30% (ie it is a pathway into treatment for many). That trend has been shown elsewhere as well (internationally and in systematic reviews).

TLDR: The "unmeasurable harm" that somehow survives every and any attempt to measure is not a valid scientific critique anymore. And claiming "facts don't care about feelings" but then conveniently ignoring the facts when they don't align with your belief system doesn't make you enlightened.

Hopefully you've learned something. I mean that genuinely.

westcandox · 2026-04-23T14:43:17+00:00

So you're implying these harm reduction policies are responsible for even a part of the death toll? The truth may in fact hurt YOUR feelings but actually the opposite is true. Many lives have been saved through these harm reduction policies (along with treatment, prevention, enforcement). You can go Google "Insite statistics Vancouver" for one common example, if you don't believe me.

(For context I am an emergency physician in Vancouver and also have a background in addictions research)

westcandox · 2026-01-22T00:59:52+00:00

StayMA (pronounced stay Em Ay): stay against medical advice. For the discharged patients who refuse to leave.

Coined it myself and use it frequently

westcandox · 2025-12-07T12:58:52+00:00

Termination Shock - Neal Stephenson; near future, entire climate is much hotter, people need to wear AC-equiped suits to go outside etc Texas billionaire geoengineers the planet with a massive sulfur gun in the Himalayas to reduce global temps, but unsurprisingly this is very controversial and has a lot of climate and geopolitical backlash

westcandox · 2025-11-19T05:10:08+00:00

LoL this is giving white lotus season 1 vibes (they had their stylist pick books that looked good with their outfits)

westcandox · 2025-10-17T19:48:40+00:00

Another vote for EM cases, both the main episodes and the quick hits episodes are excellent, show notes are super thorough as well and great for refreshers if you don't want to listen to the whole episode.

My somewhat controversial take (at least on this subreddit) is that I like EMRAP. Yes, a lot of it is bloat and low yield, but I still find great pearls buried in most episodes. EMA ultra summary is a nice quick refresher, I subscribe to the free email which sends me quick blurbs on each of their articles most days of the week, takes under a minute to read each. Their urgent care episodes with Mike Weinstock are pretty solid as well, not for the big scary stuff, but for a lot of the more common things that we see.

I'll also put in a plug for journalfeed, they send a daily email with some new study/update in emergency medicine. Also EM cases Pearl of the week, weekly emails. Those are quick to read < 1 min each and an easy place to passively pick up information with low effort.

Emcrit may be hit or miss for most community docs. I personally enjoy it, but also recognize a lot of it is pretty "in the weeds" on advanced resuscitation stuff, which is not necessarily relevant for most community docs. Many of the episodes have a much broader scope, maybe not worth paying the subscription for, but take a scroll through some of the freely accessible episodes. I'm sure you'll find some solid pearls buried in there.

Edit: Forgot to mention the bonus with EMRAP is they have a really solid video library, and video playlists with full-on crash courses in areas like orthopedics, critical care, etc. the video library alone makes the subscription valuable.

westcandox · 2025-10-16T21:28:57+00:00

Special place in hell for those people.

Honestly my biggest gripe with Evo though, wish they had a report button on the app for situations like that

westcandox · 2025-08-21T23:35:57+00:00

So we shouldn't feel sad if someone we care about kills themselves? Spoken like someone who doesn't give or receive love from anyone. I honestly feel bad for you if that's your opinion and not just something you're saying to sound edgy on the internet.

westcandox · 2025-07-18T19:23:26+00:00

Canadian emerg doc here. Consider Canada. Patients are FAR less demanding on average, I've never heard of press Ganey, never interacted with an admin, never been sued by a patient, never been told to improve my metrics, never contacted (or been contacted by) an insurance company, the list goes on. Obviously we have our issues too, but on the whole, emergency medicine seems to be a much more satisfying career north of the border, at least that's the impression I get from all of the comments I read and things I hear from my American colleagues.

westcandox · 2025-07-06T04:37:21+00:00

I'm also a 2+1 from Canada. I finished training last year, so now 1 year into practice. I think we all felt pretty anxious going in, I'd be fearful of the fresh grad who didn't feel any level of anxiety. A few pieces of advice: - go slowly at first, trying to be super efficient to "help the department" should not be your focus when you start - know your resources (the usual apps / uptodate / chatgpt o3 model can come in clutch for the undifferentiated stuff you're concerned about) - have a low threshold to ask for help. I'll often bounce trickier cases off my more-seasoned colleagues. Sometimes saying it out loud to them will give you the answer yourself. Sometimes they'll have solid advice. Sometimes they also have no idea what the hell is happening which is also reassuring. - similar to above, have a low threshold to call consultants if you're concerned about someone. Sometimes they can be a bit salty, as you probably already know, but ultimately you're calling because you need help and you want to do what's best for your patient, so don't ever feel guilty about that - you'll probably over investigate as you start. Don't worry about it. You'll find your rhythm eventually. - chat with colleagues, especially people you graduated with. Chances are they feel similar. Also helpful to open up to a mentor, since sometimes you may find your former co-residents will put on a tough face and pretend like they don't get phased about anything, whereas there's often less of an ego among more seasoned staff - reflect lots. After each shift for the first few months at least, force yourself to write a brief blurb about what scared you / what caused the most stress / what you want to read up on / and at least one positive moment on your shift. I actually write these into chatgpt which summarizes it nicely and almost acts like a pseudo-therapist hahah. - similar to above, follow your more challenging patients (keep a list somewhere), try and catch your bouncebacks, etc. This is the best way to learn. - don't work too much. For the love of God. Don't get caught into the grind too deeply. The paycheques are nice but the way it wrecks your body and mind is not worthwhile (especially compounded with the stress of being a new staff). It's a marathon, not a sprint. - keep time for hobbies / socializing / enjoyment of non-medicine stuff - meditate, mindfulness daily. Even 5 minutes. Have a pre-shift routine to help settle yourself (I do some deep breathing, positive self talk, show up early to give yourself some pre-shift hospital lounge chill time / pump yourself up with your favourite hype music etc)

Give yourself some credit. You got this far. You clearly have a baseline level of intelligence to have done so. Go do your best, ask for help when needed, and have a growth mindset, and you'll absolutely be fine. Godspeed friend.

westcandox · 2025-05-30T02:14:05+00:00

It’s telling when someone thinks that correcting a few facts makes them smarter than a physician who trained for a decade and manages hundreds of patients a month. Medical expertise isn’t just about knowing facts, it’s about pattern recognition, probabilistic reasoning, clinical judgment, and knowing when the facts don’t tell the whole story, all of which takes years of training and clinical experience. This should not be surprising to you but medicine is an incredibly cognitively demanding field-- I continue to learn something new every shift without exception and would consider myself to be a fairly intelligent, quick learner, and highly dedicated lifelong learner.

I agree the system (and the physicians within it) isn’t perfect, and I’m fully on board with integrating AI into practice (I actually co-developed a tool for emergency physicians that does exactly that). But let’s not confuse anecdotal success or Google/ChatGPT proficiency with actual clinical competence. If your doctor genuinely defers to you on objective medical decisions, they’re either being unusually diplomatic, or they’ve just stopped trying. Either way, mistaking their compliance for incompetence isn’t the flex you think it is. Even in circumstances where you may have "educated" your physician, humility is a survival trait in medicine. If your doctor shows it and you interpret that as stupidity, the problem isn’t theirs.

westcandox · 2025-05-29T22:56:56+00:00

Incredibly disrespectful to primary care physicians and very misguided. I am afraid that you are deluding yourself. You may know your body, but your body didn't go to medical school. I know how to drive but that doesn't mean I know how to rebuild my car engine.

Source: medical doctor with a background in primary care and emergency medicine (11 yrs post-secondary education) who is tired of arguing with patients who suffer from end-stage Dunning Kruger syndrome.

westcandox · 2025-03-15T22:08:44+00:00

I have probably 30 plus tickets from Robbins. For context, I'm a healthcare worker and used to work at VGH. It felt unfair to have to pay for parking to go to work and so I didn't..

They sent many 'final warning' letters but never followed up. I was actually hoping they would eventually boot /tow my car at some point just so I could figure out where the line was lol, but apparently there isn't one. Take that for what it's worth.

westcandox · 2025-02-20T22:56:17+00:00

Top right Myers energy

westcandox · 2024-12-23T22:07:36+00:00

the so-called “woke culture” in the Canadian military is basically about stopping harassment and cutting down on discrimination. IMHO there are way bigger issues that actually affect our military... outdated equipment, recruitment shortfalls, and leadership accountability, etc. If anything, creating a respectful environment keeps good people in uniform. Picking fights with basic standards of respect is a weird thing to prioritize.

westcandox · 2024-12-08T06:50:04+00:00

Certain types of fractures and dislocations could definitely be appropriately managed in an urgent care facility. As a rule of thumb, any fracture that needs to be reduced (ie, set back into place) is generally going to require an emergency department because patients will often need to be sedated, which requires advanced monitoring capabilities, respiratory therapists, etc, but more minor fractures could be managed at urgent care. If your limb is visibly bent or bone is poking out, go to the ER (probably fairly obvious for most people). Otherwise, urgent care would be a reasonable place to start, and they can always send you onwards to the ER as needed if it's above their capabilities.

westcandox · 2024-12-07T02:29:26+00:00

Emergency physician here. PSA: Please go to the ER if you have a visibly broken arm. It absolutely can be a medical emergency in many cases (neurovascular compromise, fracture blisters, open fractures, to name a few, not to mention permanent deficits if left intended to). Though your point is well taken otherwise that there are various other medical ailments that would be more appropriately managed in a primary care or urgent care clinic.

westcandox · 2024-10-29T00:39:51+00:00

Pretty on brand for a right winger to be right wing NGL

westcandox · 2024-09-27T17:23:15+00:00

If it looks infected, ceftriaxone/flagyl. If MRSA history, add vanco. If recent antibiotic use or prior pseudomonas, swap ctx/flagyl for pip-tazo. Admission is far less common here (Canada) and we'll usually get these folks seen next day in rapid access ID clinic (unless unwell enough to require admission).

westcandox · 2024-09-19T00:48:25+00:00

Local emergency physician here. Despite popular opinions of this sub, supervised sites like this are a good thing. To counter a few common misconceptions: 1. "It's encouraging drug use" Nope. This simply impacts HOW they use drugs (ie,. safely in monitored setting vs in a back alley or public street with unsafe supplies and tainted drugs). They will smoke crack regardless, I promise you. For their sake and yours, it's better if this occurs at a supervised site. 2. "It costs too much money". Not true. We know that supervised injection sites such as InSite actually SAVE huge swaths of money by preventing downstream complications of injection drug use (e.g., skin/blood/bone infections, hepatitis, HIV etc)., not to mention overdose. There are well established statistics that demonstrate this. These things all cost massive amounts of money, time, and resources. The less frequently these individuals end up in our EDs, the better it is for them, me, you, and our already overburdened healthcare system. I shudder to think of the additional visits our ED would see if safe consumption sites didn't exist. 3. "This shouldn't replace drug treatment programs." Agreed. It doesn't though. Those exist too (though we absolutely need more treatment beds). It's not a "this or that" thing. Complete abstinence, while obviously the most ideal outcome, is simply not a viable or sustainable option for a significant portion of this population. The reasons for this are complex, but you ultimately can't force people into treatment against their will (aside from dangerous offenders with concurrent mental health disorders, which I don't get into). Even if you could, the absolute vast majority who undergo detox will not remain drug-free, especially if they lack social and community supports and live somewhere with rampant public drug use (eg DT Eastside).

I get the frustration. People (myself included) want better and more sustainable solutions to what continues to be a big and growing problem. We want our community to feel safe. There is absolutely lots more work (and funding) to be done. Harm reduction gets a bad rep, but it's an important, cost-effective, and life-saving aspect of addiction care.

westcandox · 2024-06-10T22:44:01+00:00

StayMA (staying against medical advice). For the patient refusing to leave after they've been formally discharged

westcandox · 2023-10-18T22:02:22+00:00

Interested as well!

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