Sandra Smiley (she/her)'s Avatar

Sandra Smiley (she/her)

@sandrasmiley.bsky.social

Smiley by name, smiley by nature | Resident physician @ubcpublichealth.bsky.social | Board @msf.ca | Co-host/producer @justmedicinepod.bsky.social | Posts about public health & social medicine | Opinions mine

112 Followers  |  141 Following  |  47 Posts  |  Joined: 06.12.2024
Posts Following

Posts by Sandra Smiley (she/her) (@sandrasmiley.bsky.social)

As a doctor, I know cutting health care for refugees hurts us all ⋆ The Breach Targeting the most vulnerable is a slippery slope toward weakening public health for all

“The rich & powerful want us to believe there’s never enough to go around. This is a fallacy”

As a doctor, I know cutting health care for refugees hurts us all
via @yipengge.bsky.social #publichealth #healthequity
breachmedia.ca/as-a-doctor-...

05.02.2026 20:14 — 👍 1    🔁 0    💬 0    📌 0
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Measles in an ICE facility is a public health failure A marginalized population, a highly contagious disease, no systemic vaccination safeguards — no wonder there’s measles in an ICE detention facility.

#Measles in an ICE facility is a public health failure.

In my latest for @statnews.com, I argue this outbreak was avoidable and the result of policy choices that concentrate risk without basic prevention. V This is both a health and human rights failure.

www.statnews.com/2026/02/04/m...

04.02.2026 16:42 — 👍 30    🔁 13    💬 1    📌 2
Physicians for Human Rights Call for Protection of Health Care Workers in Iran  - PHR The Islamic Republic of Iran must immediately stop the persecution, physical harm, and detention of all medical professionals who are reportedly being targeted for treating people injured during the r...

"Evidence regarding the massive scale of the crackdown is now trickling out and there must be no impunity for the extreme violence being inflicted upon protesters and the health care workers tending to them across the country.” - Physicians for Human Rights phr.org/news/physici... #Iran

30.01.2026 18:45 — 👍 1    🔁 1    💬 0    📌 0
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'Disturbing' scenes, record overdoses, as powerful sedative hits B.C. drug supply Last weekend, frontline health workers in Trail, B.C., reported "disturbing" scenes to Dr. Karin Goodison, medical health officer with Interior Health.

‘Disturbing’ scenes, record overdoses, as powerful sedative hits B.C. drug supply

via Nono Shen @cdnpress.bsky.social #publichealth #healthequity #medetomidine #toxicdrugs #harmreduction
vancouver.citynews.ca/2026/01/29/b...

30.01.2026 04:47 — 👍 1    🔁 2    💬 0    📌 0
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New single-day record for paramedic calls to drug poisonings in B.C., stats show | CBC News The B.C. Centre for Disease Control (BCCDC) has issued a province-wide drug alert, noting new substances in the unregulated drug supply are putting people at risk province-wide.

Health officials are warning that drug poisonings are on the rise across B.C., with a new single-day record for most drug poisonings attended by paramedics being set last week.

www.cbc.ca/news/canada/...

27.01.2026 03:48 — 👍 5    🔁 8    💬 1    📌 1
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The deafening silence: A diaspora’s grief in the age of internet blackouts - Healthy Debate For the Iranian diaspora, this is not a debate about policy reform; it's about survival. We need our governments and institutions to do more.

The deafening silence: A diaspora’s grief in the age of internet blackouts

via @healthydebate.bsky.social #Iran #SDoH #publichealth #mentalhealth
healthydebate.ca/2026/01/topi...

27.01.2026 02:51 — 👍 4    🔁 1    💬 0    📌 0
BC warns of increase in drug poisonings, shifts in unregulated supply

 

Vancouver - The BC Centre for Disease Control’s (BCCDC) Harm Reduction and Substance Use Services Team is warning the public of a recent increase in drug poisonings across BC. Novel substances in the unregulated drug supply are putting people who use substances at greater risk province-wide.

 

Opioids like fentanyl are now often mixed with medetomidine, a potent sedative used primarily by veterinarians, that can cause low heart rate (bradycardia), changes to blood pressure and prolonged sedation. It can also potentially make people feel very sleepy or go unconscious, increasing the risk of drug poisoning. As a response, BCCDC has issued a province-wide drug alert

 

BC has experienced high and increasing paramedic-attended overdoses in recent months. At the same time, detections of medetomidine have increased in drug checking samples and law enforcement seizures. Medetomidine was detected in 38 per cent of opioid samples tested by the BC Centre on Substance Use (BCCSU) in November 2025.

 

Non-fatal drug poisoning can cause brain injury from lack of oxygen and other harms. Even though the BC Coroners Service data shows that deaths are not increasing, the increase in non-fatal drug poisoning is a cause for serious concern.

BC warns of increase in drug poisonings, shifts in unregulated supply Vancouver - The BC Centre for Disease Control’s (BCCDC) Harm Reduction and Substance Use Services Team is warning the public of a recent increase in drug poisonings across BC. Novel substances in the unregulated drug supply are putting people who use substances at greater risk province-wide. Opioids like fentanyl are now often mixed with medetomidine, a potent sedative used primarily by veterinarians, that can cause low heart rate (bradycardia), changes to blood pressure and prolonged sedation. It can also potentially make people feel very sleepy or go unconscious, increasing the risk of drug poisoning. As a response, BCCDC has issued a province-wide drug alert BC has experienced high and increasing paramedic-attended overdoses in recent months. At the same time, detections of medetomidine have increased in drug checking samples and law enforcement seizures. Medetomidine was detected in 38 per cent of opioid samples tested by the BC Centre on Substance Use (BCCSU) in November 2025. Non-fatal drug poisoning can cause brain injury from lack of oxygen and other harms. Even though the BC Coroners Service data shows that deaths are not increasing, the increase in non-fatal drug poisoning is a cause for serious concern.

Responding to a drug poisoning

If you are responding to a drug poisoning or overdose event:

Call 9-1-1
A drug poisoning or overdose is a medical emergency.
Stay with the person and follow instructions from the 9-1-1 call-taker.
Follow the SAVE ME steps to respond to an opioid poisoning (overdose).
Check for breathing and give breaths if the person is not breathing normally.
Brain injury can happen within minutes without oxygen. Giving breaths provides oxygen until the person can breathe on their own.
Use naloxone
Naloxone only works on opioids but is safe to give even if the overdose is caused by other substances like medetomidine, which is a non-opioid depressant. Since medetomidine is usually found with opioids, giving naloxone can restore breathing and will not cause harm.
If at any time there is no pulse, start CPR with rescue breathing and compressions.
Use an automated external defibrillator (AED) if available.
 

Safer substance use

If you use substances, there are things you can do to be safer:

The safest option is to avoid unregulated opioids, as they may contain medetomidine. Ask a health care provider about opioid agonist therapy (OAT) and use  drug checking services.
Don’t use alone. Visit an overdose prevention site or take turns with a buddy so there is someone who can respond in the event of an emergency.
If you do use alone, consider using the Connect app by Lifeguard. It prompts you to turn off an alarm and sends a notification to BCEHS dispatch if you don’t.
Carry naloxone and know how to use it.
Sign up for drug alerts by texting the word JOIN to 253787 (ALERTS).

Responding to a drug poisoning If you are responding to a drug poisoning or overdose event: Call 9-1-1 A drug poisoning or overdose is a medical emergency. Stay with the person and follow instructions from the 9-1-1 call-taker. Follow the SAVE ME steps to respond to an opioid poisoning (overdose). Check for breathing and give breaths if the person is not breathing normally. Brain injury can happen within minutes without oxygen. Giving breaths provides oxygen until the person can breathe on their own. Use naloxone Naloxone only works on opioids but is safe to give even if the overdose is caused by other substances like medetomidine, which is a non-opioid depressant. Since medetomidine is usually found with opioids, giving naloxone can restore breathing and will not cause harm. If at any time there is no pulse, start CPR with rescue breathing and compressions. Use an automated external defibrillator (AED) if available. Safer substance use If you use substances, there are things you can do to be safer: The safest option is to avoid unregulated opioids, as they may contain medetomidine. Ask a health care provider about opioid agonist therapy (OAT) and use drug checking services. Don’t use alone. Visit an overdose prevention site or take turns with a buddy so there is someone who can respond in the event of an emergency. If you do use alone, consider using the Connect app by Lifeguard. It prompts you to turn off an alarm and sends a notification to BCEHS dispatch if you don’t. Carry naloxone and know how to use it. Sign up for drug alerts by texting the word JOIN to 253787 (ALERTS).

The BC Centre for Disease Control is warning of an increase in drug poisonings across B.C. due to changes in drug supply.

My story from Dec on veterinary sedative medetomidine, detected in 38% opioid samples tested by BCCSU in Nov (gift link)
www.theglobeandmail.com/gift/1ce6625...

26.01.2026 20:31 — 👍 15    🔁 14    💬 1    📌 2
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What is medetomidine and why is it showing up in B.C.'s unregulated drug supply? Health officials say there's been an increase in medetomidine — a powerful sedative used by veterinarians — showing up in unregulated drugs.

What is medetomidine and why is it showing up in B.C.'s unregulated drug supply?

via @tiffycrawford.bsky.social @vancouversun.bsky.social #publichealth #toxicdrugs #harmreduction #bcpoli
vancouversun.com/news/what-is...

23.01.2026 18:56 — 👍 0    🔁 0    💬 0    📌 0
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States are failing to protect civilians and medical care during war | Doctors Without Borders / Médecins Sans Frontières (MSF ... Attacks on medical care reached record levels have reached a record high, according to a new MSF report.

New @msf.ca report says that 81% of incidents of violence against health care in 2024 were attributed to states

#notatarget #humanitarian
www.doctorswithoutborders.ca/record-level...

23.01.2026 04:57 — 👍 0    🔁 0    💬 0    📌 0
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Toronto hospital to double housing program that reduces ER visits | CBC News A Toronto hospital network will double its unique permanent housing program for homeless people who frequently visit emergency departments that has seen great success.

Toronto hospital to double housing program that reduces ER visits

via Liam Casey @cdnpress.bsky.social #publichealth #healthequity #housing
www.cbc.ca/news/canada/...

22.01.2026 20:53 — 👍 1    🔁 1    💬 0    📌 0
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The dire situation of South Sudanese people and how urgent action is needed to prevent a crisis | Doctors Without Borders / Médecins Sans Frontières (MSF ... South Sudan faces its worst crisis since 2018 as conflict, climate events and aid cuts collide. MSF warns urgent action is needed to prevent catastrophe.

"Support from international governments & agencies to the South Sudanese health system has dwindled in recent years. The international community must renew its commitment: donor fatigue cannot define 2026."

via @msf.ca #SouthSudan #cdnpoli
www.doctorswithoutborders.ca/the-dire-sit...

22.01.2026 20:17 — 👍 0    🔁 0    💬 0    📌 0
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How US policies are reshaping global health and humanitarian aid, one year later We are witnessing the human costs of actions upending aid programs around the world

“Global health assistance should be guided by public health need — not political calculations, economic extraction, or ideological coercion”

How US policies are reshaping global health & #humanitarian aid, one year later
via @doctorswithoutborders.org
www.doctorswithoutborders.org/latest/how-u...

21.01.2026 04:44 — 👍 0    🔁 0    💬 0    📌 0
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B.C. health authorities tried to allow purchase of regulated heroin without prescriptions, court hears Effort to reduce toxic-drug deaths was ultimately derailed by political blowback

B.C. health authorities tried to allow purchase of regulated heroin without prescriptions, court hears

via @andreawoo.bsky.social @theglobeandmail.com #publichealth #healthequity #harmreduction #bcpoli #cdnpoli
www.theglobeandmail.com/canada/artic...

20.01.2026 05:38 — 👍 1    🔁 0    💬 0    📌 0
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Opinion: What my sister Ellen taught me about dignity and the importance of being seen As a physician and professor specializing in end-of-life care, I teach the Platinum Rule: Do unto others as they would want done unto themselves

What my sister Ellen taught me about dignity and the importance of being seen
www.theglobeandmail.com/opinion/arti...

18.01.2026 20:10 — 👍 2    🔁 1    💬 0    📌 0
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B.C. First Nations groups say they were shut out of decision to end drug decriminalization pilot Health Minister announced Wednesday that the province is ending its three-year, first-in-Canada pilot program

B.C. First Nations groups say they were shut out of decision to end drug #decriminalization pilot

via @andreawoo.bsky.social @theglobeandmail.com #publichealth #healthequity #harmreduction
www.theglobeandmail.com/canada/artic...

18.01.2026 19:41 — 👍 0    🔁 1    💬 0    📌 0
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Health, human rights, and the Palestine exception In December, 2025, Harvard T H Chan School of Public Health announced that Mary T Bassett would be stepping down as Director of the François-Xavier Bagnoud (FXB) Center for Health and Human Rights. Fr...

If not now, when? (Hillel the Elder) or when does health and human rights as a field become politically inconvenient?

My latest with @eric-reinhart.com on institutional and moral integrity as well as the future of global health.

www.thelancet.com/journals/lan...

17.01.2026 12:26 — 👍 9    🔁 3    💬 0    📌 0
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A young brain at 101? Scientists track 'superagers' to find out how | CBC News People over 80 with memory of those in their 50s show less brain shrinkage and other differences. For a Canadian centenarian, the secret might lie in his passion for sharing a vocation turned hobby.

'Superagers' reveal how to stay sharp as you get older

#publichealth #brainhealth
www.cbc.ca/news/health/...

18.01.2026 19:27 — 👍 0    🔁 0    💬 0    📌 0
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The sudden rise of scabies: ‘I wouldn’t wish it on my worst enemy’ These microscopic mites, which burrow under your skin and cause ferocious itching, are incredibly hard to get rid of – and cases in the UK have soared. What is causing the outbreak, and is there anyth...

"The sudden rise of #scabies: ‘I wouldn’t wish it on my worst enemy’ - These microscopic mites, which burrow under your skin and cause ferocious itching, are incredibly hard to get rid of – and cases in the UK have soared. What is causing the outbreak, and is there anything we can do about it?"

18.01.2026 18:53 — 👍 2    🔁 2    💬 0    📌 0
Alberta to change the way it screens for cervical cancer

Alberta to change the way it screens for cervical cancer

#publichealth #HPV #cervicalcancer
www.cbc.ca/lite/story/9...

17.01.2026 17:34 — 👍 0    🔁 0    💬 0    📌 0
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Many Indigenous Mothers Must Travel Hundreds of Kilometres to Give Birth. Meet the Midwives Changing That | The Walrus A resurgence of traditional midwifery is bringing deliveries back home

Many Indigenous mothers must travel hundreds of kilometres to give birth. Meet the midwives changing that

via @michellecyca.com @thewalrus.ca #publichealth #healthequity #longreads #cdnpoli
thewalrus.ca/indigenous-m...

17.01.2026 01:42 — 👍 9    🔁 4    💬 0    📌 0
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Life expectancy in Canada nearly back to pre-pandemic levels: StatCan - National | Globalnews.ca Life expectancy at birth in Canada increased for the second consecutive year in 2024, with women living longer on average than men, Statistics Canada said.

Life expectancy in #Canada nearly back to pre-pandemic levels: StatCan

via @udayrana.bsky.social @globalnews.ca
#publichealth #COVID #influenza
globalnews.ca/news/1161131...

15.01.2026 00:40 — 👍 0    🔁 1    💬 0    📌 0

What has three years of #decriminalization of drug possession yielded in B.C.?

via @picardonhealth.bsky.social @theglobeandmail.com
#publichealth #healthequity #harmreduction #bcpoli
www.theglobeandmail.com/opinion/arti...

15.01.2026 00:28 — 👍 0    🔁 0    💬 0    📌 0
University of Manchester researchers tracked 25,000 teenagers over three school years.

University of Manchester researchers tracked 25,000 teenagers over three school years.

Study of 25,000 teens says social media time does not increase teenagers' mental health problems https://www.theguardian.com/media/2026/jan/14/social-media-time-does-not-increase-teenagers-mental-health-problems-study

News and analysis ⇢ canadahealthwatch.ca/featured

14.01.2026 20:36 — 👍 10    🔁 7    💬 2    📌 1
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Dossier | Gaz hilarant | Drôle à mourir (3 articles) Le gaz hilarant, perçu comme inoffensif, peut devenir nocif et même mortel. Au moment où cette drogue devient à la mode chez les jeunes consommateurs, les gangs de rue se sont emparés de ce marché cla...

Drôle à mourir: Le gaz hilarant, perçu comme inoffensif, peut devenir nocif et même mortel. Cette drogue devient à la mode chez les jeunes consommateurs, par Mayssa Ferah www.lapresse.ca/actualites/g... via @lapresse.ca

14.01.2026 17:45 — 👍 2    🔁 2    💬 0    📌 0
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B.C. won't extend its drug decriminalization project, health minister announces | CBC News The three-year pilot project, which allowed people to be in possession of small amounts of illicit drugs, began on Jan. 31, 2023, and will expire at the end of this month.

B.C. won't extend its drug #decriminalization project, health minister announces

#publichealth #healthequity #substanceuse #harmreduction #bcpoli
www.cbc.ca/news/canada/...

14.01.2026 22:29 — 👍 0    🔁 0    💬 0    📌 1

A mining town scattered residents, and asbestos, to the wind

via @amandafollett.bsky.social @thetyee.ca #publichealth #occupationalhealth #healthequity #bcpoli
thetyee.ca/News/2026/01...

14.01.2026 18:59 — 👍 0    🔁 0    💬 0    📌 0
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Gaza war leads to 41% fall in births prompting allegations of reproductive violence Israel’s war in Gaza has caused high numbers of maternal and neonatal deaths, say two reports Israel’s war in Gaza has led to a 41% fall in births in the territory, and high numbers of maternal deaths, miscarriages, newborn mortality and premature births, two reports into the impact of the conflict on pregnant women, babies and maternity care reveal. Two reports by Physicians for Human Rights, in collaboration with the Global Human Rights Clinic at the University of Chicago Law School, and Physicians for Human Rights–Israel document how the war has led to high figures for maternal and neonatal mortality and forced births in dangerous conditions and systematically dismantled health services – consequences of “a deliberate intention of preventing births among Palestinians, meeting the legal criteria of the Genocide Convention,” researchers said. Continue reading...

Gaza war leads to 41% fall in births prompting allegations of reproductive violence

14.01.2026 15:36 — 👍 70    🔁 38    💬 13    📌 5
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One Health: Canada’s Missing Link in Global Diplomacy - Open Canada Human activities, coupled with compromised ecosystems, can boost the risk of new human and animal diseases developing and spreading. One Health aims to create new surveillance and disease control meth...

In this Open Canada article, Phaedra Henley explores why Canada should leverage #OneHealth as a strategic asset in global diplomacy, i.e. via stronger Global South partnerships, reciprocal exchange, and institutional investment: opencanada.org/one-health-c...

14.01.2026 14:08 — 👍 3    🔁 2    💬 0    📌 1
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The Town That Asbestos Built. The Cancer It Left Behind | The Tyee Former residents of Cassiar say they weren’t warned about the risks. Now, they struggle to find support.

The town that asbestos built. The cancer it left behind

via @amandafollett.bsky.social @thetyee.ca #publichealth #occupationalhealth #healthequity
thetyee.ca/News/2026/01...

13.01.2026 12:36 — 👍 1    🔁 0    💬 0    📌 1
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Health Canada says it hasn't received application from B.C. to extend decriminalization A federal drug exemption that allows adults to possess small amounts of some drugs is set to end Jan. 31, and Premier David Eby has the province won’t return to its “old policy” of decriminalized public drug use.
11.01.2026 12:48 — 👍 0    🔁 1    💬 0    📌 2