How artificial intelligence could guide drug discovery

Prediction tools can rein in the risks of finding new medications

How artificial intelligence could guide drug discovery

Drug discovery is traditionally a high-risk and resource-intensive process — so much so that it has drawn comparisons to gambling.

Brendan Frey, a U of T professor, put it bluntly: “It’s like the Big Pharma companies come into a casino, put a million-dollar coin into a slot machine, and with some probability like 10 per cent or something, they get a win.”

But recently, a growing trend in the field is reducing uncertainty around drug discovery by using artificial intelligence (AI) as a prediction tool. Dr. Christine Allen, a professor at the Leslie Dan Faculty of Pharmacy, together with post-doctoral researcher Pauric Bannigan, recently published a review paper on the subject in the Journal of Controlled Release.

How AI can be used to reduce risks in drug discovery

“Let’s say that in our lab… we have a drug, and [it’s] really hydrophobic [repellent of water],” said Allen in an interview with The Varsity. To give such a drug orally, which would expose it to water, researchers must decide on the components that they will need to use in order to make the tablet or capsule ready for delivery. They must also decide on the ratio between those components and the active drug.

Researchers normally conduct a high number of experiments to find these solutions, Allen explained. However, the emergence of prediction tools based on AI can significantly change the process of experimentation.

As Bannigan describes, AI prediction tools have the potential to narrow the starting point from which researchers have to begin experimenting from. By eliminating incompatible solutions, AI can guide scientists toward potential avenues for success, thus saving both time and money.

Guided by these tools, pharmaceutical researchers may hypothetically only need 10 experiments to test promising solutions with AI, as opposed to 100 experiments to test most possibilities, he explained.

Case studies of AI used in drug discovery

Real-life examples of the applications of AI were drawn from the book Prediction Machines: The Simple Economics of Artificial Intelligence, which was cited multiple times in the review paper.

Dr. Avi Goldfarb, a professor at the Rotman School of Management, is a co-author of the book. He wrote to The Varsity that AI prediction tools can have significant and specialized meaning to the pharmaceutical industry.

For example, Atomwise, a company that predicts the binding of molecules with proteins, can “increase the success [rate] of early stage experiments in the drug discovery process and increase the number of successful drugs that come to market.”

BenchSci is another company that makes it easier for scientists to search the relevant literature by predicting which content is relevant to a particular need.

“[BenchSci] is also aimed at improving the drug discovery process,” wrote Goldfarb.

Current applications

There is a growing trend of Big Pharma companies partnering with those specializing in AI, according to the review paper.

As an example, Allen recalled Novartis, which “dealt with Intel to try and reduce the amount of time required to analyze microscopic images.”

Allen’s research group has now started collaborating with U of T professor Alán Aspuru-Guzik, who has significant expertise in applying AI to chemistry. The teams have been working together to use algorithms that could help predict which materials could be best used for drug discovery.

The impact of AI on human involvement

As for the impact of AI on researchers, Allen noted that as AI tools get more involved in industries, human judgement remains highly valued,  and is one of the main ideas of Prediction Machines.

“You might predict the likelihood of rain, but without judgment on how much you mind getting wet and how much you mind carrying an umbrella then the prediction alone won’t tell you what to do,” wrote Goldfarb.

While AI could guide researchers by providing predictions, Goldfarb noted that their human judgement would still be valuable in deciding what to do with the predictions once they have them.

Drug therapy and frailty among older adults: which causes which?

In conversation with Dr. Paula Rochon on optimizing the use of prescription drugs

Drug therapy and frailty among older adults: which causes which?

Frailty among older adults has been a common cause for concern for decades. The arrival of modern medicine has, to an extent, eased this worry and improved physical weaknesses among senior citizens. However, could there be something exacerbating this infirmity?

According to a recent editorial co-authored by Dr. Paula Rochon, a professor at U of T’s Department of Medicine and Institute of Health policy, Management and Evaluation, the answer may be yes, due to the relationship between the intake of a cocktail of prescription drugs and frailty among older adults.

The Varsity spoke to Rochon, who also serves as the vice-president of research at Women’s College Hospital, a geriatrician, and as the The Retired Teachers of Ontario/Les enseignantes et enseignants retraités de l’Ontario chair in geriatric medicine at the U of T. She has a longstanding interest in improving the health and wellness of older adults, particularly women, who make up most of this demographic.

One area which she has studied extensively is the optimization of drug therapies for older adults in order to maximize their benefits and minimize harm.

What came first, the chicken or the egg?

Frailty is a geriatric syndrome characterized by “age-related decreases in physiologic reserves, resulting in vulnerability to health declines following even minor stressor events,” according to the co-authors. Polypharmacy is a situation in which patients take a combination of prescription drugs — or a drug cocktail, as it’s commonly called.

While both frailty and polypharmacy are known to be linked and have co-existed for quite some time, little is known about the extent of their relationship. Scientists are unable to discern whether drug therapies manage frailty and accompanying chronic medical illnesses, or whether they prompt health declines characterized as frailty.

Similar to the philosophical question of the chicken and the egg, we are unsure which factor causes what.

Unravelling the mystery of the relationship

To determine the type of association between frailty and polypharmacy, two longitudinal studies were published in Journal of the American Geriatrics Society, in order to further explore the question.

Shahar Shmuel, a researcher at the University of North Carolina, and colleagues conducted a longitudinal study of older adults. Their study notes the high prevalence of frailty and polypharmacy in older adults, and suggests that there is a relationship between polypharmacy and frailty.

The researchers note that further research can be conducted to see whether lowering the number of prescriptions would reduce frailty.

Dr. Andrew Bergen at the Oregon Research Institute and his colleagues conducted a longitudinal analysis of more than 1,400 community-dwelling older adults. Their study found that the prescription of drugs for sleep and pain was associated with increased frailty.

In both studies, a relationship was found between prescription drugs and frailty, even though one was looking at polypharmacy and the other was looking at specific drug classes for pain and sleep. However, while both studies established a relationship, the chicken-and-egg scenario still remains.

For this reason, Rochon believes that the association between frailty and polypharmacy is extremely difficult to entangle. Scientists need to be able to study the sequence of events in order to determine if polypharmacy causes frailty, or whether it is the frailty that leads to polypharmacy, she noted.

Future steps of research

Rochon suggested that researchers investigate and conduct medication reviews on all pre-frail and older adults to identify the possibility of ‘deprescription’ — decreasing the dose of the prescription or even possibly discontinuing the prescription. She wrote that identifying drugs that could make frailty worse should be the first step.

Identifying cascades is also an important priority, she added. In other words, drug therapies that lead to the growth of medical conditions and additional drug cocktails to treat these conditions also make frailty worse.

Lastly, in the usage of drug therapy for an individual, course of life must also be considered. In many cases frailty is associated with death and this association or connotation must be accounted for when making prescriptions. A patient’s life expectancy and a drug’s lag time should also be accounted for, she further noted.

While both Shmuel and Bergen’s studies provide useful information, none are able to completely solve the puzzle. The current conclusion is that polypharmacy and frailty have an effect on each other, but this relationship remains ambiguous.

It is possible that we may never know the answer to the chicken-and-egg question. But in the meantime, there are steps that we can take to answer this one — one of them being to focus on optimizing drug therapy for frail or pre-frail adults.

Alternatives to Canada’s policies against criminalized drugs

Expert panelists advocate for decriminalization, among other policies for treating substance use disorder

Alternatives to Canada’s policies against criminalized drugs

An expert panel hosted by the Canadian Students for Sensible Drug Policy (CSSDP) chapters at U of T and Ryerson University discussed the impact and alternatives to Canada’s prohibitory drug policies on October 9.

The speakers debated the effects of what they dubbed Canada’s “war on drugs” on its vulnerable populations, key events in its history, the shortfalls of its current drug policy, and alternatives to treating substance use disorder.

The opioid crisis

Susan Shepherd, Strategic Support Director at Toronto Public Health, discussed the need to treat the opioid crisis as a public health problem, as opposed to a criminal justice approach, and to consult people in the community.

Toronto Public Health conducted two community sessions and 20 interviews with people asking how well they thought the current system was working and whether the federal government should decriminalize personal use of opioids.

The responses were generally in favour of decriminalization and respondents agreed that the system is “broken,” though they also stressed action beyond decriminalization. Respondents also generally agreed that the government should continue to prosecute those involved in producing and selling illicit drugs.

The history of Canada’s drug policies

Matt Johnson, a Harm Reduction Outreach Program Coordinator at Parkdale Queen West Community Health Centre, spoke about the history of Canada’s drug policy, starting with the Opium Act of 1908, which he saw as the beginning of Canada’s harsh drug policies.

A turning point in Canada’s approach to drugs was the formation of LeDain Commission in 1969, which published four reports on the role that the government should play in drug regulation. Its 1972 report suggested the decriminalization and eventual legalization of cannabis would be the best course of action — a proposal that then-Prime Minister Pierre Trudeau refused to implement.

In the present day, Johnson said that the future of drug policy reform in Canada does not look optimistic, as the two main party leaders support the status quo of criminalizing opioids.

He further stressed that the criminalization of drugs does not exist in a vacuum, as racism, colonization, homophobia, transphobia, and other systems of oppression are deeply intertwined  and need to be addressed alongside drug policies.

The impact on Indigenous peoples

Michelle Sault — Indigenous consultant, lead facilitator, and project strategist for the Toronto Indigenous Overdose Strategy — focused her talk on Indigenous issues. She spoke about her own experience developing the Overdose Strategy and some of the experiences that she heard from Indigenous people.

“[The Overdose Strategy] was more comprehensive, research based, and the strategy itself that I engaged in was more of a facilitated process which is both a session, and an invitation to share advice on what it is that Indigenous people need or want,” said Sault.

A 2002 study at the University of Washington showed that personal health is determined by a balance between trauma and buffers. When trauma outweighs one’s buffers, it is expected that they will experience worse health outcomes, and experience harmful substance use. Cultivating buffers, including cultural identity, community, and family connection can help mitigate the effects of trauma. 

This especially applies to Indigenous peoples in Canada, many of whom have experienced intergenerational trauma as a result of forced assimilation through residential schools. A 2018 survey showed that survivors of residential schools and their descendants face poorer health outcomes. They were more likely to have considered suicide at some point in their lives, and had higher rates of binge drinking and opioid use. 

Sault described many of the testimonials from these sessions and said that many people started using drugs because of personal trauma, poverty, homelessness, or sexual abuse. Sault added that many of the people making decisions related to drugs are disconnected with whom it is they are making the policy for, especially Indigenous peoples.

She further stressed the importance of challenging colonial constructs when discussing conditions such as addiction. 

Editor’s Note (November 9, 4:01 pm): Due to space constraint, the print version of this article omitted several concluding paragraphs and indicated that the full text would be available in the online version of this article. This article has now been updated to include these concluding paragraphs. The Varsity regrets the delay.

The promise of ketamine in overcoming treatment-resistant depression

Therapeutic potential of ketamine discussed in review by U of T medical researchers

The promise of ketamine in overcoming treatment-resistant depression

Content warning: Discussions of suicide in the context of treating major depressive disorder.

Ketamine is a promising medication that brings hope to patients struggling with severe depression, offering potential therapeutic effects for those who are non-responsive to standard antidepressants.

The dissociative anesthetic is currently used by physicians and veterinarians to cause fast-acting insensitivity to pain during medical procedures. It is also used illicitly as a recreational drug, causing feelings of disconnection and relaxation among users.

Yet in controlled settings, ketamine also shows potential as a medication to help patients who are suffering from major depressive disorder. In April, a research review by U of T researchers found that ketamine offers significant effects as an antidepressant.

The lead author of the paper, Dr. Joshua Rosenblat, discussed the review’s findings with The Varsity. As a clinician-scientist in the Department of Psychiatry, Rosenblat is currently studying the antidepressant effects of ketamine.

He explained three major effects that differentiate ketamine from standard antidepressants: a different mechanism of action, a rapid onset of effects, and a response in patients who are not positively affected by commonly prescribed antidepressants.

Ketamine affects depression via a novel mechanism of action

For the past several decades, standard antidepressants have worked by affecting levels of serotonin, norepinephrine, and dopamine, explained Rosenblat.

In generalized terms, serotonin is a chemical messenger thought to regulate mood, while norepinephrine controls alertness and arousal. Dopamine affects attention and emotion.

But ketamine affects the brain differently. Rather than targeting these neurotransmitters, it instead changes levels of glutamate – the main excitatory messenger in the brain.

Ketamine’s unique mechanism of action could therefore explain why it may positively affect patients suffering from treatment-resistant depression, who do not respond to standard antidepressants.

Ketamine could provide a more rapid onset of affects, versus standard antidepressants

Ketamine also provides a rapid onset of effects. Standard antidepressants, said Rosenblat, usually take two months of prescribed usage to take effect.

He explained that with ketamine, alleviation of depressive symptoms can appear within two hours of consumption. This is especially promising as an option for patients suffering from suicidal thoughts.

A decrease in suicidal thoughts can plausibly reduce the number of suicidal attempts; however, Rosenblat noted that the evidence is currently too limited to make a conclusion. He explained that studies are lacking, as only a small percentage of patients affected by such thoughts attempt to commit suicide.

Ketamine could also be used for special applications. Depression is very common among patients facing terminal cancer, explained Rosenblat.

“If you were to start them on an antidepressant and they only have one month left to live, for example, [the patients may] only experience the side effects, and never get the benefits.”

Rosenblat is currently leading a clinical trial at Princess Margaret Hospital to research the use of ketamine for improving the final months of life for patients affected by terminal cancer.

The risks and drawbacks of ketamine as an antidepressant

While the prospect of applying ketamine for treating depression is promising, there are several discouraging factors to its application.

To start, ketamine carries the risk of substance abuse. While ketamine is not strongly addictive, said Rosenblat, recreational users of the drug can develop a dependence.

Ketamine may also be prohibitively expensive for potential patients, as it is not covered by OHIP. Furthermore, as a medicine that is only available for research study or private use, it cannot currently be prescribed by most physicians.

There are also limited studies on the rare side effects of ketamine. In the short-term, the main known side effects are disassociation, a daydream-like state, and nausea which may occur during the administration of ketamine.

“We don’t know what we don’t know,” said Rosenblat. It is unclear whether ketamine may cause rare, adverse reactions in some patients. Long-term side effects of ketamine are also unclear.

Rosenblat therefore does not encourage self-medication for U of T students suffering from mental health challenges, as ketamine is not sufficiently studied.

Only a “very small percentage” would likely positively benefit from ketamine, explained Rosenblat, compared to standard treatment options supported by a much wider body of research.

The future of ketamine research

Although ketamine is not fully studied and is currently only used in special situations, it still brings “a message of hope,” said Rosenblat.

While ketamine is still not approved as an antidepressant, the U.S. Food and Drug Administration has approved esketamine, a structurally similar compound, as a nasal spray antidepressant. This became the first antidepressant of its kind to be used in the United States.

While Rosenblat notes that much more future research needs to be done with ketamine, he agrees that preliminary results are “very promising.” With a new avenue of research in treating severe depression, the future of research in the field seems optimistic.

There’s major dough in dope — how should the government use it?

To effectively combat substance abuse, marijuana tax funds should primarily be invested in prevention and education

There’s major dough in dope — how should the government use it?

On November 10, the Canadian federal government announced an excise tax plan that will be implemented when marijuana is legalized next summer. The plan proposed an excise tax of $1 per gram, or 10 per cent of the producer’s sale price, with the higher amount of the two being charged.

The plan is still in its consultation stage, and there are sure to be many changes over the next few months. Hopefully the fact that education and prevention tactics provide better long-term solutions to addressing substance abuse than punitive mechanisms will guide future discussions about the tax plan. Moving forward, marijuana legalization should be approached mainly as an issue of public health — the revenue from legalization can play a major role in ensuring appropriate solutions to substance abuse are implemented.

In a November 2016 report entitled “Legalized Cannabis: Fiscal Considerations,” the Parliamentary Budget Officer estimated that sales tax revenue for legal marijuana could be as high as $959 million in its first year. While it is unlikely that this figure will be reached due to initial legalization costs, it doesn’t include potential revenue from an excise tax. Sales and excise taxes combined could make the almost $1 billion goal an achievable reality.

Meanwhile, substance abuse continues to be a costly problem for the government and citizens alike. The Canadian Centre on Substance Abuse (CCSA) claims that substance abuse and addiction isn’t an isolated problem — it burdens our health care, law enforcement, and criminal justice systems, as well as our overall productivity as a society. This doesn’t even begin to cover the unquantifiable human costs of substance abuse either, such as decreased life expectancy or disruption of family life.

In 2006, the CCSA released a report titled “The Costs of Substance Abuse in Canada 2002.” The results were harrowing: the total annual societal costs of substance abuses was $39.8 billion. Our flailing health care system has struggled to keep up with substance abuse issues for years. A 2014 CCSA study, “The Impact of Substance Use Disorders on Hospital Use,” showed a 22 per cent increase in hospital costs for substance abuse-related issues from $219 million in 2006 to $267 million in 2011. This included $14 million in hospital costs along with a 39 per cent increase in days spent in the hospital for marijuana users.

These reports speak to a need for a more effective and efficient system to combat substance abuse and addiction problems. While it would be misleading to equivocate the repercussions of marijuana abuse and those associated with hard drugs, the sheer amount of revenue the government will be bringing in from marijuana legalization can be redirected to alleviating the problems associated with substance abuse in general.

The current tax plan calls for a 50-50 split of the revenue between the federal and provincial governments. Provinces spoke out against this plan immediately, stating that they deserve a bigger portion of the revenue given that they are responsible for most of the work and costs associated with implementing legalization. Municipal governments have also argued that, because they cover almost 60 per cent of Canada’s policing costs, the revenue should be directed to cities to help offset them.

Both of these claims mention the enforcement aspect of legalization, which remains a part of the government’s marijuana regulation strategy. Yet if there is one thing the ‘War on Drugs’ has taught us, it is that cracking down on drug use via highly punitive enforcement measures is an inadequate solution. This approach has proven ineffective at reducing substance abuse and has burdened the criminal justice system, incarcerating people at alarming rates while failing to confront and deal with the root causes of drug use.

Punitive measures can also be extremely costly. A 2005 report by the Health Officers Council of British Columbia found that for every $5 spent on treatment, the federal government spent $95 on enforcement. There are substantial costs, financial and otherwise, associated with incarceration in particular.

In contrast, education and prevention programs deal with reducing harm by destigmatizing substance abuse so that people can get the help they need. This approach can be highly beneficial, particularly when it supersedes harsher measures. An example of this is Vancouver’s Four Pillars drug strategy, which has been successful in preventing the spread of infectious diseases, overdose deaths, and public drug use by focusing on the combined principles of harm reduction, prevention, treatment, and enforcement. This strategy recognizes the need for policing while emphasizing a preference for non-punitive measures where possible. In this model, police officers connect non-violent offenders with health services instead of incarcerating them, a method that has been commended by the city’s Drug Treatment Courts.

Accordingly, the federal government should devise a tax plan that prioritizes funding education and prevention programs over law enforcement strategies — not just for marijuana, but for all substances. Adopting this approach to countering substance abuse and addiction and using marijuana tax revenue to finance it has the potential to increase public awareness about marijuana and how to use it safely. It could also lower the need for extensive policing and other enforcement costs. Legal substances, which will soon include marijuana, are the most abused in Canada — almost four times as much as their illegal counterparts — and it makes sense to use the money reaped from legalization to prevent harmful misuse.

If the federal government wishes to make the best use of marijuana tax revenues, they must prioritize investing those funds in the fight against substance abuse and addiction. Diverting more funding to law enforcement is unlikely to achieve this goal. Fortunately, the consultations for the excise tax framework are ongoing, and I would encourage students to get involved in the process. Individuals and groups who wish to present their own ideas about the framework can review the relevant documents at the Department of Finance website and send written comments by email until December 7.

Ramsha Naveed is a third-year student at Trinity College studying Political Science.






There’s no dope in team

The effects of the first four of the NCAA’s banned substance list

There’s no <em>dope</em> in <em>team</em>

The National Collegiate Athletic Association (NCAA) forbids its athletes from consuming several psychoactive substances. These substances have a variety of physical and psychological effects on athletes; most of which, over the long-term, can lead to serious health complications. Here’s a quick list of some of these banned substances.   

Drug class: Stimulants 

Examples: Caffeine, amphetamines, and cocaine 

What they do: Stimulants increase activity in the central nervous system, which is composed of the brain and the spinal cord. They cause feelings similar to an adrenaline rush, which will make the user more energetic; this has obvious implications for athletes. Of course, there are significant differences in the potency per milligram of each stimulant: a cup of coffee is, by the milligram, definitely a more moderate pick-me-up than a line of cocaine. Nevertheless, crashes, or a sudden drain in energy, follow the high one experiences from all stimulants.

Drug class: Anabolic agents 

Example: Steroids 

What they do: Steroids, among the most well-known anabolic agents, promote muscle growth and weight gain. According to the Centre for Addiction and Mental Health (CAMH), steroids are generally used to encourage speedy growth of farm animals; however, they may also be prescribed for various medical reasons, including to counteract body deterioration symptoms of individuals suffering from AIDS or other diseases. Obviously, the muscle growth effects can be and, in many cases, are abused by athletes to improve their performance. Yet, consistent use of steroids is discouraged for reasons other than being unsportsmanlike. Increased feelings of aggression, depression, and nausea, as well as reduced fertility in both men and women are but a few of many symptoms that accompany long-term use of anabolic agents. 

Drug class: Alcohol and beta blockers 

Example: Propranolol

What they do: Beta blockers are commonly used to treat ailments such as hypertension. They are also used to treat of generalized anxiety disorder. The term ‘beta’ refers to a class of brain cell receptors (adrenoreceptors) responsible for producing cyclic adenosine monophosphate (cAMP). These promote brain cell activation by inhibiting the beta receptor. Beta blockers also inhibit cAMP production, which leads to inhibiting of a given brain cell from firing. This can have a variety of effects, depending on the cell being inhibited.

Used as heart medication, beta blockers slow one’s heart rate and lower blood pressure, making them especially dangerous for athletes to consume. The effects of alcohol require no explanation. 

Drug class: Diuretics

Example: Water pills

What they do: Diuretics encourage the excretion of water and sodium from the body. They cause an increased intake of sodium to the kidneys, which, along with water, exits the body in urine. Like beta blockers, diuretics are commonly used to lower blood pressure. Athletes may also use them to hide bodily evidence of previous substance use — these drugs are often refered to as masking agents — that would normally be obtained via urine testing. Athletes may also benefit from the increased urination consequent to diuretic ingestion to lose ‘water weight’ for competitions. 

The new war on drugs

Students advocate for drug reform in Canada

The new war on drugs

From April 19–20, the United Nations will be holding a General Assembly Special Session (UNGASS) to discuss global drug policy for the first time since 1998. U of T students from the Canadian chapter of Students for Sensible Drug Policy (CSSDP) hope to be in attendance.

Canadian Students for Sensible Drug Policy (CSSDP)

The Canadian chapter of the CSSDP focuses on harm reduction and a scientific approach to drug policy, say Daniel Grieg, a leader within the organization, and Kyle Lumsden, a dedicated member.

In an email exchange with The Varsity, Greig emphasized that restrictions of scientific inquiry into psychedelics hinder medicinal development.

“Drugs are inappropriately classified in present policy.  For example, psychedelics are currently being explored… for their therapeutic properties and are also contributing to research in how we think about consciousness and the brain.  If it does turn out that psychedelics are useful and safe medicines, then we will be effectively withholding treatment from people suffering from mental illness,” he said.   

Greig emphasized the importance of lifting barriers to research. “Ultimately, we need to not only minimize the negative impacts of drug policy, we also need to maximize the possible benefits. Harms are things such as the disproportionate criminalization of the poor and people of colour, as well as the unnecessary deaths caused by lack of available knowledge. The benefits are such things as useful research tools, the development of more effective mental health treatments and tax revenue.”

Lumsden outlined the focus of his interest in drug policy reform: “The widespread harm of alcohol and violence associated with black markets for illegal drugs pose the greatest threat to society and can be improved with evidence based public policy. Multiple studies show that when police have a successful takedown of a drug network, there is a spike in violence afterwards due to a vacuum of power; other criminal groups compete for their share of the market indefinitely.” 

Nazlee Maghsoudi is the strategic advisor for the CSSDP, the knowledge translation manager for the International Centre for Science in Drug Policy (ICSDP), and a U of T graduate. She said that the reality is that “prohibition has endangered young people” despite the war on drugs rhetoric, which claims to be aimed at “keeping children safe.” 

Maghsoudi believes that UNGASS is “drug policy’s moment in the sun, in terms of approach.” According to Maghsoudi, the UN’s drug policy approach has grown outside of the UN because “the global drug policy regime is divorced from human rights” even though non-progressive countries execute their inhabitants for possession or consumption. 

She also believes that there are many barriers to reaching the consensus needed for the construction of an international framework through the UN.

Canada’s opioid problem

According to an article in the Globe and Mail article, “Canada is the world’s second-largest per capita consumer of opioids and the fallout is being felt across the country. The article indicates that between 2009 to 2014, at least 655 Canadians died as a result of fentanyl, a powerful opioid that is available by prescription and is also manufactured in clandestine labs and sold on the street.” 

Tara Gomes, a scientist working for the Ontario Drug Policy Research Network (ODPRN) describes pain as “difficult to manage” and that there “isn’t a lot of training for it in medical school.”

It’s not that opioids should not be used, but once someone shows addictive tendencies doctors should be able to refer patients to a case-dependent addiction treatment. Tara Gomes emphasized “there is a place for these drugs in clinical practice,” Gomes said.


The Triplicate Prescription Program (TPP) and Prescription Review Program (PRP) were created in part to address the opioid prescription problem facing Canada. 

Wende Wood, a pharmacist and a graduate from the Ontario Institute for Studies in Education, recently moved to Alberta, where the TPP is currently in effect. According to the College of Physicians and Surgeons’ website, “TPP collects prescribing and dispensing data for listed drugs. When the data meet certain criteria, physicians and others involved in the care of the patient are alerted, provided with information and directed to resources to support them in providing safe care.” 

Saskatchewan has a PRP that performs a similar function. 

Wood said that these prescription monitoring programs have not caught on because providing three copies of the same prescription is tedious for doctors to fill out. 

Marijuana and Toronto’s dispensaries

Under the current framework, marijuana is legal as a prescribed medication. To obtain this prescription, one must register for a mail order from a licensed producer, or obtain a doctor’s prescription for a health-related issue, whioch must be taken to a local dispensary. 

The dispensaries are not authorized by Health Canada.

Don’t be a dope

Part two of a series explaining the significance of doping and drug testing in sport

Don’t be a dope

For many North American athletes, whether Olympic hopefuls or professionals, collegiate athletics is the first step to a professional contract or gold medal. Shifting from amateur athletes requires an increased amount of time dedicated to more intense training regimes, and it also brings with it stricter rules: especially when it comes to doping.

Any athlete who is a member of either of the two major collegiate sporting bodies in North America, Canadian Interuniversity Sport (CIS) or the National Collegiate Athletic Association (NCAA), is required to follow the world anti-doping code, established in 2004 by the World Anti-Doping Agency (WADA).

This code covers many different classes of substances, and perhaps most importantly, emphasizes the fact that it is the athletes themselves who are ultimately responsible to ensure that they are not violating any of its policies. If an athlete is found to have violated any part of the code, whether intentionally or not, they may face serious consequences.

So what exactly do the CIS and NCAA do in order to help educate and protect their athletes? The CIS, in conjunction with the Canadian Centre for Ethics in Sport (CCES), have created an anti-doping program for all its athletes. The program consists of courses the athletes must take in order to be cleared to play. Each athlete’s CCES account also gives them access to further educational resources, including the Canadian Anti-Doping Program (CADP), a quick reference card on the policies in place, and the ‘prohibited list,’ taken directly from WADA’s website.

Blood doping paraphernalia. Nathan Chan/THE VARSITY

Blood doping paraphernalia. Nathan Chan/THE VARSITY

The NCAA has a similar practice in place. Each athlete must sign a consent form at the beginning of the year indicating that they understand the rules, and that they give their consent to be tested at any time. If they do not sign this form, then they are not able to play. Finally, NCAA athletes must submit a student athlete statement, which provides the NCAA with more drug use information.   

Both organizations also warn against taking any nutritional supplements due to the fact that they are poorly regulated and may contain banned substances, which could lead to violating the code for an athlete. On their websites, the CCES and NCAA provide additional resources which athletes can consult in order to determine whether or not something they are taking is classified as a banned substance or not.

Closer to home, and in addition to completing the online courses through the CCES, many Varsity Blues athletes attend anti-doping seminars during orientation week each year. This seminar is organized and run by members of the David L. MacIntosh Sport Medicine Clinic, and it serves to further inform the athletes about anti-doping policies and the potential dangers of doping. If an athlete is caught, they can face a number of consequences, including but not limited to being suspended, being stripped of their title, or being banned from competition.

In a 2013 TEDx talk at U of T Doug Richards, medical director of the David L. MacIntosh Sport Medicine Clinic, and an assistant professor in the department of kinesiology and physical education, mentioned that the culture of risk that is associated with the ‘winning at all costs’ mentality in sports can lead to using performance enhancing agents. “Look at the behaviour of athletes in respect to doping” said Richards, “they’re willing to take dangerous substances, subject themselves to potential bodily harm, they’re willing to cheat and potentially get caught and kicked out all in the name of increasing their probability that they might win.” Doping is not only a choice an athlete makes in order to increase their chances of winning, but it is also an extreme reaction to the culture within sport where winning has traditionally been the only predicator of success. 

So why do athletes dope in the first place? Well, the short answer is to increase their chances of winning. With over 284 purported doping cases in professional sport in 2014 and the recent state-sponsored Russian doping scandal, it doesn’t look like anti-doping education is as effective as it can be. It is clear that doping is a very complex issue in collegiate-level and professional sport, but the system could potentially benefit from an overhaul by changing the emphasis on the individual to focusing on the sports community to take the pressure off of winning.

Until that point, we will have to rely on information sessions and tests to commit athletes to ‘playing true.’