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Marijuana Legalization, by Dr. Zach, ER Physician

BT Montreal | posted Wednesday, Sep 26th, 2018

For more info, visit www.drzach.ca

 

1. Patients present to ER because of cannabis “poisoning” (bad trip) or cannabis hyperemesis syndrome.

Cannabis poisoning (aka a “bad trip”) — anxiety, paranoia, numbness, dizziness, hallucinations, confusion, psychosis, hallucinations, slurred speech

High heart rate and BP (or orthostatic hypotension), red eyes, dry mouth

Can cause asthma exacerbation.  Rarely angina or heart attack (risk is increased)

No deaths have been reported

Peak concentration levels by route of administration:

Inhalation — 3-10 minutes (smoke vs vape, no smoke with vape)

Oral — 1-5 hours — patients with oral ingestion may take more because they won’t feel intoxicated immediately

Treatment: Largely symptomatic.  Fluids, relaxants if needed, antivomiting medications

 

Cannabinoid Hyperemesis Syndrome:

Most commonly reported cluster of symptoms that brings regular cannabis users to the ER is cannabinoid hyperemesis syndrome.   (even though cannabis decreases nausea in cancer patients)

It consists of intractable nausea, vomiting, and abdominal pain.

Recurrent relapsing disorder.

Vomiting may last 24-48 hours and may lead to dehydration and weight loss.

Symptoms may respond to showering in very hot water.

Treatment: supportive therapy, cannabis cessation.  IV hydration. Metoclopramide, ondasetron. Haloperidol, capsaicin cream to the abdomen chest or back.

Termination of heavy habitual cannabis use may lead to withdrawal symptoms within 48 hours — irritability, anxiety, nervousness, restlessness, sleep difficulty, seizures, and aggression.

2. Legalization results elsewhere:

In colorado ER visits spiked for 6-12 months after legalization but then leveled off.

Experience in places where pot is legalized — In Washington and Colorado:

Rising rates of pot use by minors

Increasing arrest rates of minors, especially

black and Hispanic children

Higher rates of traffic deaths from driving

while high

More marijuana-related poisonings and

hospitalizations

A persistent black market

 

The public health impact of decriminalization or legalization of recreational cannabis use include:

  • Both decriminalization and legalized recreational use have been associated with increased unintentional pediatric ingestions. As an example, after legalization of recreational marijuana use in Colorado, annual calls to the regional poison control center for pediatric marijuana exposure increased 34 percent on average to 6 cases per 100,000 population, which was almost twice the rate for the rest of the United States.  Exposure to recreational marijuana accounted for about half of cases. Rates of hospital visits at a large regional children’s hospital system also increased significantly during the period of the study, although the total number of presenting patients (81) was small.
  • In regions with medical marijuana availability, diversion of drug from registered users may also encourage adolescent abuse.

3. Driving:  

In QC you’ll get a 90 day license suspension if police find any THC in your system.

Not clear how much time before it’s safe but probably at least 4 hours for inhaled and longer for edibles.

Driving stoned is not safe.  One focuses too much on one thing and is too slow to respond to sudden changes.

No clear level that is safe.

Canadian law Bill C-46 states that if you drive with 2-5 nanograms of THC per ml of blood, you’ll face a maximum fine of $1000.  More than 5 nanograms, or having a mix of booze and THC, gets a minimum $1000 fine. Repeat offenders can face up to 10 years in prison

Drivers using cannabis are two to seven times more likely to be responsible for accidents compared to drivers not using any drugs or alcohol. Furthermore, the probability of causing an accident increases with plasma levels of delta-9-tetrahydrocannabinol.

Cannabis use increases reaction time and impairs attention, concentration, short term memory, and risk assessment.  Lasts 12-24 hours

 

Federally approved roadside police tool is Drager DrugTest 5000 — takes a saliva sample but apparently there are false positives and negatives and there are concerns about keeping swabs at the right temperature in Canada.  Other ones are being tested.

Many police forces have not ordered the devices yet.

In the meantime police will rely on a field sobriety test, which can involve standing on one leg or tracking an object with your eye, to screen for impairment.

 

Testing for cannabis in the body:

Urine drug screens are less helpful in adolescents and adults for the diagnosis of acute intoxication. Although testing is usually positive several hours after acute exposure it can also be positive well after symptoms have resolved. As an example, positive results for delta-9 tetrahydrocannabinol metabolites (urine test) have been reported up to 10 days after weekly use and up to 25 days for after daily use

Saliva swab test positive for 6-12 hrs after use

Blood test shows level, positive for 36 hrs after use

Blood samples, which are legally binding, can only be taken if you fail the roadside test, and only at a police station.

 

4. Cannabis seems to unmask predisposition to certain mental illness, especially if used in youth

 

Public health agency of Canada: “One of the things that the research clearly demonstrates is that early access to cannabis can have detrimental affects for brain development and the brain develops up to age 25.”

Several studies have linked marijuana use to increased risk for psychiatric disorders, including psychosis (schizophrenia), depression, anxiety, and substance use disorders. The amount of drug used, the age at first use, and genetic vulnerability have all been shown to influence this relationship. The strongest evidence to date concerns links between marijuana use and substance use disorders and between marijuana use and psychiatric disorders in those with a preexisting genetic or other vulnerability

Teenagers: Prolonged cannabis consumption below age 17 is linked to memory and attention issues later.  Alcohol is not better. Young people struggling with anxiety, depression, or learning problems are more at risk of dependency.

Mental health: people at risk of mental health issues are more likely to suffer adverse effects from cannabis use

Can one get high from second hand marijuana smoke?  No.  Exhaled smoke contains so little THC that you’d have to sit in a room with 16 joints being smoked per hour to show any signs of being high.

Plans for cannabis laws in Canada once legalized:

https://www.canada.ca/en/services/health/campaigns/legalizing-strictly-regulating-cannabis-facts.html

Controlled access

When the Cannabis Act becomes law in October 2018, adults who are 18 years or older would be able to legally:

  • possess up to 30 grams of legal dried cannabis or equivalent in non-dried form
  • share up to 30 grams of legal cannabis with other adults
  • purchase dried or fresh cannabis and cannabis oil from a provincially-licensed retailer
    • In those provinces that have not yet or choose not to put in place a regulated retail framework, individuals would be able to purchase cannabis online from a federally-licensed producer.
  • grow up to 4 cannabis plants per residence for personal use from licensed seed or seedlings
  • make cannabis products, such as food and drinks, at home provided that  organic solvents are not used

The sale of cannabis edible products and concentrates would be authorized no later than 12 months following the coming into force of the proposed legislation.

Strict Regulation

QC law:

Under the new plan, the legal age to buy, possess and consume marijuana in Quebec will be 18 — the same as the drinking age.

Other key points include:

  • No one will be allowed to grow cannabis for personal use. It will also be banned to grow it for commercial use, unless following the laws set out by the government.
  • It must be smoked in the same places as tobacco. Smoking will also be prohibited on university and CEGEP grounds.
  • There will be zero tolerance for drivers — police officers will be able to ask for a saliva sample if they suspect someone is driving while high and will be able to suspend a driver’s licence for 90 days if a sample comes back positive for ANY cannabis.

While saliva testing has yet to be federally regulated, the province says that police officers are being trained to detect signs of marijuana-impaired driving.

 

The Quebec law would set the legal age at 18 and allow individuals to transport up to 30 grams at a time and hold 150 grams at home

 

A government agency, the Société québécoise du cannabis, will have exclusive legal control of recreational use, selling the product through a limited number of storefronts and online. The province will have 15 stores ready by July 1 and up to 150 in two years.

 

Laws re driving high Canada:

Drivers caught with more than five nanograms of THC in their blood would be guilty of impaired driving, while drivers with both alcohol and THC in their system would be considered impaired if they have more than 50 miligrams of alcohol (per 100 mililitres of blood) and greater than 2.5 nanograms of THC in their blood.

The government said the other two proposed offences would be similar to the offences for drunk driving. Drivers with more than five nanograms of THC in their blood would be punished with a mandatory fine of $1,000 for a first offence, 30 days imprisonment for a second offence and 120 days for a third offence.

Laws re driving high Canada:

Drivers caught with more than five nanograms of THC in their blood would be guilty of impaired driving, while drivers with both alcohol and THC in their system would be considered impaired if they have more than 50 miligrams of alcohol (per 100 mililitres of blood) and greater than 2.5 nanograms of THC in their blood.

The government said the other two proposed offences would be similar to the offences for drunk driving. Drivers with more than five nanograms of THC in their blood would be punished with a mandatory fine of $1,000 for a first offence, 30 days imprisonment for a second offence and 120 days for a third offence.

Apple Watch Series 4 review: ‘Guardian on your wrist’ packs a punch

Winston Sih | posted Wednesday, Sep 19th, 2018

At Apple’s annual Sep. event in Cupertino, Calif., the tech giant announced a new Apple Watch that brings hardware and software improvements that doubles down on its commitment to health. With Series 1 only launched three years ago, in just under a week with my review unit of Series 4, you can tell that this is what Series 1 should have been all along.

From a hardware standpoint, Apple Watch Series 4 packs a punch in still a small form factor. It retains its iconic design with some minor updates, featuring 40 and 44mm size options, enabling an over 30 per cent larger display through rounded corners.

watchOS 5 takes advantage of this through enhanced complications on the watch faces, apps have more real estate, and button inputs are easier. This is the first thing you’ll notice when you power it up. While I’m traditionally a silver kind of a guy, I’m a huge fan of the new gold finish, too, aligning with the new iPhone XS offering.

Your bands are still good!

You’ll be relieved to know the bands you’ve spent so much money on are still compatible with Series 4—phew! This was a worry from some tech analysts—that this is a way to force consumers to purchase new bands to be compatible with the new model.

As far as other improvements to the body of Apple Watch itself, a new Digital Crown now has built in haptic feedback. When you scroll through different menu options, subtle vibrations will help guide you through the user interface—a very nice detail.

If you listen to music or interact with Siri on Apple Watch, the speaker is 50 per cent louder—enough to fill a small room with ample feedback. The microphone has been moved to the opposite side of the device to facilitate clearer phone calls.

The ‘guardian on your wrist’

Health is where you see the most improvement, and Apple is very proud of that. Series 3 brought a high heart rhythm alert that became quite popular in notifying users of irregular patterns. Now, Series 4 will do the same with low heart rhythms. 

At launch in the United States, Apple Watch will come with a first-of-its-kind over-the-counter electrocardiogram—or ECG—application, through a new heart sensor built into the back and Digital Crown. This will allow a new way to record information for medical professionals to analyze. However, no word on when this will come to Canada.

Last on the health developments, something that can be great for our aging population (and even clumsy people like me): fall detection. It utilizes the internal gyroscope and accelerometer to detect irregular movements like falls.

In these instances, users will receive a notification to decide whether they want to notify emergency services, and if there’s no response within 60 seconds, Emergency SOS will be activated automatically.  Apple likened these new features as the ‘guardian on your wrist.’

Added cellular support in Canada

New this year is expanded cellular support for Apple Watch in Canada. Rogers has joined the other major wireless carriers to carry the device, meaning active runners can leave their iPhones at home and still be connected to music, podcasts, and loved ones wirelessly.

eSIM technology shares data from your phone plan, while connecting Apple Watch independently to the cellular network. This, combined with the faster dual-core S4 processor and W3 wireless chip brings the future onto your wrist.

How much will this cost, and do I need all this power on my wrist?

Apple Watch Series 4 will start at $519 CAD, with the cellular model starting at $649 CAD. Series 3 will also be available for those who are happy with last year’s model—it is still a great watch. Cellular is good for you if you like to run and be mobile without a phone, however for many (including myself), the standard model suffices. I’m happy to see all three major Canadian carriers—including Rogers—on board with support.

Apple Watch Series 4 is really designed for iPhone users. So if you’re an Android user, you’ll have to look elsewhere.  If you use iPhone and are in the market for a new smart watch, this is a great upgrade. This is the first Apple Watch where I felt it could keep up with my fast fingers.

Rogers Communications is the parent company of Citytv and this website.

7 Days of Fat-Blasting Workouts by Kathleen Trotter

BT Montreal | posted Tuesday, Sep 18th, 2018

 

Intervals are convenient — you can do them anywhere and on any piece of equipment or without equipment — AND they are effective. With intervals, you alternate between bouts of high- and low-intensity training. This places a high metabolic demand on the body, burns lots of calories in a short amount of time, produces a high EPOC (post-workout calorie burn), increases mitochondria growth (mitochondria help to burn fat), and helps to improve one’s fitness level. Plus, they are a fantastic workout regardless of your fitness level; you adapt the interval intensity to fit your current capacity. The intensity of your interval is dependent on your individual fitness level. For some, the “high” interval will be walking quickly. For others, it might be jogging.

Exercise will improve your mood, energy, and overall health, and change your body shape, BUT no amount of fat-blasting workouts will help you shed those extra pounds if you are eating poorly. Be aware of your nutritional choices. Consider journaling — we often overestimate our health choices and underestimate our unhealthy choices.

Always do a proper warm-up and cool-down. The warm-up should be a minimum of 5 minutes; it should promote blood flow and prime your body for motion. Typically, it entails a lower-intensity version of the workout that is to come. For example, jog to warm-up for running or do a low-impact version of high knees before an intense interval of high-impact high knees. The cool-down is 5 or more minutes of stretching, foam rolling, and light cardio that cools the body down.

All exercises can — and should — be progressed or regressed depending on your fitness level. For example, cardio options can be made low or high impact (eg, stepping your feet back into a burpee vs jumping your feet back) and strength exercises can be progressed by adding weight and/or an unstable surface such as a Bosu.

Always listen to your body. Stop if you feel faint, sick, negative pain, etc.

Progress gradually. This week of workouts is an end goal. If you have never worked out before, don’t jump right in. Maybe do 2 of the more intense workouts and on the other days go for a walk. Slowly work your way up. Progress your intensity, choice of exercise, duration, and frequency.

 

Monday Tabata intervals: Cardio based

Tabata is a method of interval training. One cycle of Tabata takes 4 minutes. The 4 minutes is made up of 8 sets of 20 seconds of intense work followed by 10 seconds of complete rest. After 1, 4-minute Tabata set, rest for 1 minute and move on to your next exercise. Literally any exercise can be made into an interval. Both cardio and intense strength exercises can be made into Tabata. For today’s workout, focus on cardio exercises — we will do strength tomorrow! Think mountain climbers, high knees, bum kicks, burpees, or skipping.

Sample Workout

Warm up for 5 minutes by running on the spot or dancing around your living room. Then pick a cardio exercise (such as burpees or jumping jacks). Do the exercise hard for 20 seconds. Rest for 10 seconds. Repeat for 4 minutes. That is 1 Tabata. Do 4 to 6 Tabatas. Cool down.

 

TuesdayAMRAPs

AMRAP stands for “as many rounds as possible.” AMRAP is an example of time-based training. With AMRAP, you aim to fit in as many cycles of a circuit as possible within a set timeframe. The faster you get through the reps of each exercise, the more times you will complete the entire circuit in the given timeframe.

For this workout include strength and cardio exercises — push-ups, squats, and jumping jacks, for example. Beginners should do 2 to 3 sets of a 6-minute round. Intermediate exercisers should aim for 3 sets of 8 minutes. If you’re advanced, 3 sets of 10 minutes. Always warm up and cool down.

Sample Workout

Within your given timeframe (6, 8, or 10 minutes) do as many rounds as you can of 10 push-ups, 10 lunges on each leg, 12 bent-over rows, and 10 jumping jacks. Record how many rounds you get through. Gradually work to increase the number of rounds you can complete in 10 minutes.

 

Wednesday: Extra sleep and recovery day

Both sleep and recovery are KEY for weight and fat loss!!

 

Thursday: Strength and cardio-based minute intervals

With minutes you don’t count reps. You do each exercise as many times as you can within that minute. Pick 4 strength exercises and 2 core exercises. After you warm up, do 1 minute of each exercise, followed by 2 minutes of core and 1 to 3 minutes of intense cardio. Aim to fit in as many good reps as possible for each strength exercise within the 1-minute timeframe. Rest for 1 minute. Beginners repeat the cycle twice. Intermediate exercisers repeat 3 times. Advanced exercisers do 4 sets.

Sample Workout

After you warm up do 1 minute of a “push” exercise such as push-ups, 1 minute of a leg exercise such as squats or lunges, 1 minute of a “pull” exercise such as pull-ups, band reverse flyes, or bent over rows, and finally 1 minute of another leg exercise such as squat pulses, squats jumps, step-ups, or bridges. Then do 2 minutes of core — think planks, V holds, side planks, etc. Finish with 3 minutes of intense cardio such as running, skipping, jumping jacks, stairs, or rowing.

 

Friday: De-stress with yoga and/or pilates!

Stress is the arch nemesis of fat loss — especially abdominal fat. Plus, working your core with Pilates or yoga will help you stand taller. The taller you stand, the better your midsection looks!!

 

Saturday: Cardio-based pyramid intervals

Pick a cardio activity — ie, anything that gets your heart rate up. Any cardio machine, running or walking outside, swimming, dancing, aerobics, etc will all work. Warm-up for 5 minutes with a moderate version of your chosen activity. Then do the following pyramid: 1 minute hard, 1 minute easy, 2 minutes hard, 2 minutes moderate, 3 minutes hard, 3 minutes moderate, 4 minutes hard, 4 minutes moderate, 5 minutes hard, 1 minute easy, and finally 5 minutes hard. Cool down for 5 to 10 minutes.

 

Sunday: Meal prep!

Want to lose weight? EAT BETTER! Instead of exercising on Sunday use the time to rest your body and prep your food for the week!!

 

More info:

What is Tabata?  https://www.flamanfitness.com/blog/stay-fit-this-summer-with-my-do-anywhere-time-efficient-yet-effective-workouts 

What is the Minute Workout? https://www.huffingtonpost.ca/kathleen-trotter/the-minute-workout_b_8296398.html

What is AMRAP?  https://www.huffingtonpost.ca/kathleen-trotter/amrap-training_b_8974816.html

What is Interval Training? (https://www.flamanfitness.com/blog/make-interval-training-your-new-best-friend).

Recovery protocols: https://www.participaction.com/en-ca/blog/lifestyle-culture/4-ways-to-recover-reduce-soreness-and-avoid-injury 

Importance of sleep and how to set up a sleep routine: https://www.theglobeandmail.com/life/health-and-fitness/health/turns-out-sleeping-can-help-you-shed-those-extra-pounds-health/article31415104/

Review: iPhone XS features under-the-hood refinements, but it won’t come cheap

Winston Sih | posted Tuesday, Sep 18th, 2018

Like clockwork, Apple unveiled the latest iteration of their flagship smartphone, iPhone, on Sep. 12 in front of a packed audience at Steve Jobs Theater in Cupertino, Calif. Unlike previous years, however, the tech giant came out with not one, not two, but three smartphones—iPhone XS, iPhone XS Max, and iPhone XR. Tech enthusiasts applauded as CEO Tim Cook and team revealed the tech; but, is it worth the investment?

This review will focus on iPhone XS and iPhone XS Max—the devices Citytv had a chance to review ahead of the Sep. 21 launch in Canada, alongside Apple Watch Series 4. iPhone XR will go on sale later this year.

Hardware

On the exterior, iPhone X and iPhone XS are almost identical. The immersive screen remains at 5.8-inch, no home button, the same top notch you either love or hate, and IP68 water resistance up to two metres for 30 minutes—which Apple is quite proud of boasting through promotional videos. They also come in a new gold finish (in addition to space grey and silver), which I’m quite a fan of. Storage will be available in 64GB, 256GB, and 512GB configurations.

In all three models, you’ll notice Apple has done away with the iconic home button, foreshadowing a slow death of the physical switch. As with iPhone X, there is a slight learning curve, but from personal experience, you get used to the shift in habit.

As for the larger iPhone, it seems the company has nixed the ‘Plus’ naming convention, opting for ‘Max.’ iPhone XS Max comes with a 6.5-inch screen—and it’s gigantic. Both XS and XS Max are great for media consumption, but XS Max is immersive but large for pockets—think watching YouTube videos with the new wide stereo speakers. Or my latest obsession—Ignite TV PVR downloads on the airplane.

Do you need the larger screen? No.  Is it nice to have? Yes.  Can it be a pain to carry in your pocket? Certainly, but having the option is great.

Bionic chip for bionic speeds

When migrating my data from my iPhone X, I could notice speed and power from the get-go. This iPhone houses an A12 Bionic and Neural Engine—what Apple calls ’the smartest and most powerful chip in a smartphone.’ The power is best noticed in resource-intensive applications like video editing, augmented reality, and gaming.

Coupled with iOS 12, it’ll unlock new consumer-friendly functionality, like Memoji and every selfie-taker’s new favourite feature: Smart HDR. Using the two 12-megapixel wide and telephoto lenses, Smart HDR means you can, using a slider, control F-stop or depth-of-field appearance in Portrait mode photos. This puts the power of pro photography in a consumer-grade smartphone—perfect for the ‘gram.

Battery life

In comparison to iPhone X, Apple claims iPhone XS will get you 30 minutes longer than iPhone X. iPhone XS Max will beat iPhone X by 90 minutes, according to Phil Schiller.

In real-life, I got a 12-hour day of consistent use out of iPhone XS Max.

Dual SIM support

New to any iPhone is support for two SIM cards through eSIM technology. It’s reliant on carrier adoption—however, it’s the same technology used for cellular connectivity in Apple Watch Series 4—now on all major carriers in Canada.  Traditional SIM cards will still work, but there is only one slot. The variant to be sold in China which will have two SIM trays.

This means that eventually consumers can still have two phone numbers (say, one for personal use and one for work) and receive calls and texts on one iPhone.

Pricing

In terms of pricing, iPhone XS won’t come cheap. At $1,379 CAD for iPhone XS and $1,519 CAD for the iPhone XS Max variant, these phones aren’t cheap. Carriers will subsidize—for example, Rogers is launching an Ultra tier, where for $10 a month, customers can get up to $250 off the upfront cost of ‘iconic’ devices on a term.

Additionally, later this year, Apple is launching iPhone XR, the third device announced at the Cupertino event. It features a ‘Liquid Retina’ LCD display, 12-megapixel camera, and a wide-array of colours, reminiscent of the iPhone 5C. iPhone XR rings in at just over $1,000.

Bottom line

So why would you want this device? You’re likely using an older iPhone—perhaps a 7—and it’s time for an upgrade. As a former iPhone 7 Plus user, iPhone XS Max is a nice option—albeit the hefty price tag.

If you’re an iPhone X user, there’s plenty to love about it still. iPhone XS brings a lot of new under the hood, but might not be worth $1,379.

Lastly, there’s a lot to be intrigued about iPhone XR, from the colour options to battery life. For the average consumer, it may be worth considering it when it comes out later this year. Let the games begin.

Rogers Communications is the parent company of Citytv and this website.

World Suicide Prevention Day, by Dr. Zach, ER Physician

BT Montreal | posted Monday, Sep 10th, 2018

by Dr. Zach, MUHC (more info: www.drzach.ca)

WHO: Close to 800 000 people die due to suicide every year, which is one person every 40 seconds. Many more attempt suicide. Suicide occurs throughout the lifespan and is the second leading cause of death among 15-29 year olds globally (after unintentional trauma such as car accidents).

Quebec still has the highest suicide rate of any province in Canada, and men and Indigenous people are afflicted disproportionately.  Over 1,000 people die by suicide per year, at an average of just under 100 per month. Indeed,

Men make up around 80 per cent of suicide victims in Quebec. French-Canadian men living in small towns and rural areas have particularly high-rates of suicide.  Risk factors include being unemployed or underemployed, and divorced.

Suicide rates very high in native communities.  Risk  factors including poverty, unemployment and hopelessness, and the long-term impact of assimilationist policy and the residential school system. Many Indigenous people were taught to be ashamed of their culture, and others were sexually or physically abused at residential schools. Such abuse is a strong predictor of suicide and alcohol use.

Quebec has the highest suicide rate of any province in Canada, about 15 per 100,000 (the territories have higher rates, esp Nunavut).

Women make suicide attempts more often than man, and are hospitalized more frequently for them, but men have a higher rate of committing suicide (often they use more violent methods).

The main risk factors for suicide are:

  • A prior suicide attempt
  • Mental health disorders
  • Substance abuse disorder
  • Family history of a mental health or substance abuse disorder
  • Family history of suicide
  • Family violence, including physical or sexual abuse
  • Having guns or other firearms in the home
  • Being in prison or jail
  • Being exposed to others’ suicidal behavior, such as a family member, peer, or media figure
  • Medical illness
  • Being between the ages of 15 and 24 years or over age 60

The behaviors listed below may be signs that someone is thinking about suicide:

  • Talking about wanting to die or wanting to kill themselves
  • Talking about feeling empty, hopeless, or having no reason to live
  • Planning or looking for a way to kill themselves, such as searching online, stockpiling pills, or newly acquiring potentially lethal items (e.g., firearms, ropes)
  • Talking about great guilt or shame
  • Talking about feeling trapped or feeling that there are no solutions
  • Feeling unbearable pain, both physical or emotional
  • Talking about being a burden to others
  • Using alcohol or drugs more often
  • Acting anxious or agitated
  • Withdrawing from family and friends
  • Changing eating and/or sleeping habits
  • Showing rage or talking about seeking revenge
  • Taking risks that could lead to death, such as reckless driving
  • Talking or thinking about death often
  • Displaying extreme mood swings, suddenly changing from very sad to very calm or happy
  • Giving away important possessions
  • Saying goodbye to friends and family
  • Putting affairs in order, making a will

Protective factors:

  • Strong connections to family and community support
  • Skills in problem solving, conflict resolution, and non-violent handling of disputes
  • Personal, social, cultural and religious beliefs that discourage suicide and support self preservation
  • Restricted access to means of suicide — gun control
  • Seeking help and easy access to quality care for mental and physical illness

What can we (individuals) do to help prevent suicide:

  • Remove the stigma from mental illness
  • Learn and recognize the signs of warning signs for suicidality
  • Reach out and connect — engage the person, explore their situation
  • Know resources available (there is a list of QC resources here — https://amiquebec.org/suicide/)

 What people who interact with the public need to do:

  • People who interact with the public need to know how to recognize risk factors and address them:  primary healthcare providers, mental healthcare providers, emergency healthcare providers, teachers and school staff, community leaders, police officers and other first responders, social workers, spiritual and religious leaders, traditional healers

What government can do:

  • We need to restrict access to means of self-harm/suicide
  • Government needs to support crisis centres and workers and community programs — mental disorders need to be identified and treated

Suicide rates in Quebec have declined by almost 50 per cent since the year 2000. This may be directly linked to the publication in 1998 of Help for Life: the Quebec Strategy for Preventing Suicide. This strategy was written by the Ministry of Health and Social Services.

References:

https://montrealgazette.com/opinion/opinion-more-can-be-done-to-reduce-suicide-rates-in-quebec

http://www.who.int/mental_health/prevention/suicide/suicideprevent/en/

https://iasp.info/wspd2018/