Health
Was football player Terrance Howard really dead? His parents didn’t think so.

From LifeSiteNews
The Uniform Determination of Death Act (UDDA) states that there must be an irreversible cessation of all functions of the entire brain for a declaration of brain death. The way doctors currently diagnose brain death does not comply with the law under the UDDA.
North Carolina Central University football player Terrance Howard died recently after a car accident reportedly left him “brain dead.” But his family disputed this diagnosis and requested that their son be transferred to another facility for treatment of his brain injury, leading to conflict with Terrance’s doctors and hospital. According to News One, his parents claimed that Atrium Health Carolinas Medical Center wanted to kill their son for his organs, and accused doctors of snickering and laughing while refusing to help him. His father, Anthony Allen, told News One that the hospital removed Terrance from life support against his family’s wishes and forcibly ejected his family from his room. The family posted videos on social media of apparent police officers entering Terrance’s hospital room, and said that the hospital threatened them with criminal action for trespassing.
If these allegations are true, the Howard family has every right to be outraged at the disrespectful treatment they received at Atrium Health. Especially now, as the legitimacy of brain death is coming under increasing scrutiny, it is outrageous that hospitals and doctors continue being so heavy-handed. The National Catholic Bioethics Center (NCBC), formerly a staunch supporter of “brain death,” released a statement in April 2024, saying:
Events in the last several months have revealed a decisive breakdown in a shared understanding of brain death (death by neurological criteria) which has been critical in shaping the ethical practice of organ transplantation. At stake now is whether clinicians, potential organ donors, and society can agree on what it means to be dead before vital organs are procured.
The NCBC statement was prompted by the newest brain death guideline which explicitly allows people with partial brain function to be declared brain dead. But the Uniform Determination of Death Act (UDDA) states that there must be an irreversible cessation of all functions of the entire brain for a declaration of brain death. The way doctors currently diagnose brain death does not comply with the law under the UDDA.
Terrance Howard’s story is reminiscent of the mistreatment of another Black teenager, Jahi McMath. In 2013, Jahi was a quiet, cautious teenager with sleep apnea who underwent a tonsillectomy and palate reconstruction to improve her airflow while sleeping. An hour after the surgery, she started spitting up blood. Her parents requested repeatedly to see a doctor without success. Her mother, Nailah Winkfield, said, “No one was listening to us, and I can’t prove it, but I really feel in my heart: if Jahi was a little white girl, I feel we would have gotten a little more help and attention.”
Jahi continued to bleed until she had a cardiac arrest just after midnight. She was pulseless for ten minutes during her “code blue” resuscitation. Two days later, her electroencephalogram (EEG) was flatline, and it was clear that Jahi had suffered a severe brain injury which was worsening. But rather than treating these findings aggressively, her doctors proceeded toward a diagnosis of brain death. Three days after her surgery, her parents were informed that their daughter was “dead” and that Jahi could now become an organ donor. The family was stunned. How could Jahi be dead? She was warm, she was moving occasionally, and her heart was still beating. As a Christian, Nailah believed her daughter’s spirit remained in her body as long as her heart continued to beat. While the family sought medical and legal assistance, Children’s Hospital Oakland doubled down, refusing to feed Jahi for three weeks. The hospital finally agreed to release Jahi to the county coroner for a death certificate, following which her family would be responsible for her.
On January 3, 2014, Jahi received a death certificate from California, listing her cause of death as “Pending Investigation.” Why was the hospital so adamant about insisting Jahi was dead, even to the point of issuing a death certificate? Possibly because California’s Medical Injury Compensation Reform Act limits noneconomic damages to $250,000. If Jahi was “dead,” the hospital and its malpractice insurer would only be liable for $250,000. But if Jahi was alive, there would be no limit to the amount her family could claim for her ongoing care.
After Jahi was transferred to New Jersey, the only US state with a religious exemption to a diagnosis of brain death, she began to improve. After noticing that Jahi’s heart rate would decrease at the sound of her mother’s voice, the family began asking her to respond to commands, and videoed her correct responses. Jahi went through puberty and began to menstruate — something not seen in corpses! By August 2014 she was stable enough to move into her mother’s apartment for continuing care. Subsequently Jahi was examined by two neurologists (Dr. Calixto Machado and Dr. D. Alan Shewmon) who found that she had definitely improved: she no longer met the criteria for brain death and was in a minimally conscious state. Jahi continued responding to her family in a meaningful way until her death in June 2018 from complications of liver failure.
How could Jahi McMath, who was declared brain dead by three doctors, who failed three apnea tests, and who had four flatline EEGs and a radioisotope scan showing no intracranial blood flow, go on to recover neurologic function? Very likely, due to a condition called Global Ischemic Penumbra, or GIP. Like every other organ, the brain shuts down its function when its blood flow is reduced in order to conserve energy. At 70 percent of normal blood flow, the brain’s neurological functioning is reduced, and at a 50 percent reduction the EEG becomes flatline. But tissue damage doesn’t begin until blood flow to the brain drops below 20 percent of normal for several hours. GIP is a term doctors use to refer to that interval when the brain’s blood flow is between 20 and 50 percent of normal. During GIP the brain will not respond to neurological testing and has no electrical activity on EEG, but still has enough blood flow to maintain tissue viability — meaning that recovery is still possible. During GIP, a person will appear “brain dead” using the current medical guidelines and testing, but with continuing care they could potentially improve.
Dr. D. Alan Shewmon, one of the world’s leading authorities on brain death, describes GIP this way:
This [GIP] is not a hypothesis but a mathematical necessity. The clinically relevant question is therefore not whether GIP occurs but how long it might last. If, in some patients, it could last more than a few hours, then it would be a supreme mimicker of brain death by bedside clinical examination, yet the non-function (or at least some of it) would be in principle reversible.
Dr. Cicero Coimbra first described GIP in 1999, but in the never-ending quest for transplantable organs, his work has been largely ignored. There is absolutely no medical or moral certainty in a brain death diagnosis, and people need to be made aware of this. “Brain dead” people are very ill, and their prognosis may be death, but they deserve to be treated aggressively until they either recover or succumb to natural death. Unfortunately, as the family of Terrance Howard seems to have experienced, doctors are continuing to use a brain death guideline that ignores the reality of GIP and does not comply with brain death law under the UDDA.
Heidi Klessig MD is a retired anesthesiologist and pain management specialist who writes and speaks on the ethics of organ harvesting and transplantation. She is the author of “The Brain Death Fallacy” and her work may be found at respectforhumanlife.com.
2025 Federal Election
Study links B.C.’s drug policies to more overdoses, but researchers urge caution

By Alexandra Keeler
A study links B.C.’s safer supply and decriminalization to more opioid hospitalizations, but experts note its limitations
A new study says B.C.’s safer supply and decriminalization policies may have failed to reduce overdoses. Furthermore, the very policies designed to help drug users may have actually increased hospitalizations.
“Neither the safer opioid supply policy nor the decriminalization of drug possession appeared to mitigate the opioid crisis, and both were associated with an increase in opioid overdose hospitalizations,” the study says.
The study has sparked debate, with some pointing to it as proof that B.C.’s drug policies failed. Others have questioned the study’s methodology and conclusions.
“The question we want to know the answer to [but cannot] is how many opioid hospitalizations would have occurred had the policy not have been implemented,” said Michael Wallace, a biostatistician and associate professor at the University of Waterloo.
“We can never come up with truly definitive conclusions in cases such as this, no matter what data we have, short of being able to magically duplicate B.C.”
Jumping to conclusions
B.C.’s controversial safer supply policies provide drug users with prescription opioids as an alternative to toxic street drugs. Its decriminalization policy permitted drug users to possess otherwise illegal substances for personal use.
The peer-reviewed study was led by health economist Hai Nguyen and conducted by researchers from Memorial University in Newfoundland, the University of Manitoba and Weill Cornell Medicine, a medical school in New York City. It was published in the medical journal JAMA Health Forum on March 21.
The researchers used a statistical method to create a “synthetic” comparison group, since there is no ideal control group. The researchers then compared B.C. to other provinces to assess the impact of certain drug policies.
Examining data from 2016 to 2023, the study links B.C.’s safer supply policies to a 33 per cent rise in opioid hospitalizations.
The study says the province’s decriminalization policies further drove up hospitalizations by 58 per cent.
“Neither the safer supply policy nor the subsequent decriminalization of drug possession appeared to alleviate the opioid crisis,” the study concludes. “Instead, both were associated with an increase in opioid overdose hospitalizations.”
The B.C. government rolled back decriminalization in April 2024 in response to widespread concerns over public drug use. This February, the province also officially acknowledged that diversion of safer supply drugs does occur.
The study did not conclusively determine whether the increase in hospital visits was due to diverted safer supply opioids, the toxic illicit supply, or other factors.
“There was insufficient evidence to conclusively attribute an increase in opioid overdose deaths to these policy changes,” the study says.
Nguyen’s team had published an earlier, 2024 study in JAMA Internal Medicine that also linked safer supply to increased hospitalizations. However, it failed to control for key confounders such as employment rates and naloxone access. Their 2025 study better accounts for these variables using the synthetic comparison group method.
The study’s authors did not respond to Canadian Affairs’ requests for comment.
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Correlation vs. causation
Chris Perlman, a health data and addiction expert at the University of Waterloo, says more studies are needed.
He believes the findings are weak, as they show correlation but not causation.
“The study provides a small signal that the rates of hospitalization have changed, but I wouldn’t conclude that it can be solely attributed to the safer supply and decrim[inalization] policy decisions,” said Perlman.
He also noted the rise in hospitalizations doesn’t necessarily mean more overdoses. Rather, more people may be reaching hospitals in time for treatment.
“Given that the [overdose] rate may have gone down, I wonder if we’re simply seeing an effect where more persons survive an overdose and actually receive treatment in hospital where they would have died in the pre-policy time period,” he said.
The Nguyen study acknowledges this possibility.
“The observed increase in opioid hospitalizations, without a corresponding increase in opioid deaths, may reflect greater willingness to seek medical assistance because decriminalization could reduce the stigma associated with drug use,” it says.
“However, it is also possible that reduced stigma and removal of criminal penalties facilitated the diversion of safer opioids, contributing to increased hospitalizations.”
Karen Urbanoski, an associate professor in the Public Health and Social Policy department at the University of Victoria, is more critical.
“The [study’s] findings do not warrant the conclusion that these policies are causally associated with increased hospitalization or overdose,” said Urbanoski, who also holds the Canada Research Chair in Substance Use, Addictions and Health Services.
Her team published a study in November 2023 that measured safer supply’s impact on mortality and acute care visits. It found safer supply opioids did reduce overdose deaths.
Critics, however, raised concerns that her study misrepresented its underlying data and showed no statistically significant reduction in deaths after accounting for confounding factors.
The Nguyen study differs from Urbanoski’s. While Urbanoski’s team focused on individual-level outcomes, the Nguyen study analyzed broader, population-level effects, including diversion.
Wallace, the biostatistician, agrees more individual-level data could strengthen analysis, but does not believe it undermines the study’s conclusions. Wallace thinks the researchers did their best with the available data they had.
“We do not have a ‘copy’ of B.C. where the policies weren’t implemented to compare with,” said Wallace.
B.C.’s overdose rate of 775 per 100,000 is well above the national average of 533.
Elenore Sturko, a Conservative MLA for Surrey-Cloverdale, has been a vocal critic of B.C.’s decriminalization and safer supply policies.
“If the government doesn’t want to believe this study, well then I invite them to do a similar study,” she told reporters on March 27.
“Show us the evidence that they have failed to show us since 2020,” she added, referring to the year B.C. implemented safer supply.
This article was produced through the Breaking Needles Fellowship Program, which provided a grant to Canadian Affairs, a digital media outlet, to fund journalism exploring addiction and crime in Canada. Articles produced through the Fellowship are co-published by Break The Needle and Canadian Affairs.
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Addictions
Addiction experts demand witnessed dosing guidelines after pharmacy scam exposed

By Alexandra Keeler
The move follows explosive revelations that more than 60 B.C. pharmacies were allegedly participating in a scheme to overbill the government under its safer supply program. The scheme involved pharmacies incentivizing clients to fill prescriptions they did not require by offering them cash or rewards. Some of those clients then sold the drugs on the black market.
An addiction medicine advocacy group is urging B.C. to promptly issue new guidelines for witnessed dosing of drugs dispensed under the province’s controversial safer supply program.
In a March 24 letter to B.C.’s health minister, Addiction Medicine Canada criticized the BC Centre on Substance Use for dragging its feet on delivering the guidelines and downplaying the harms of prescription opioids.
The centre, a government-funded research hub, was tasked by the B.C. government with developing the guidelines after B.C. pledged in February to return to witnessed dosing. The government’s promise followed revelations that many B.C. pharmacies were exploiting rules permitting patients to take safer supply opioids home with them, leading to abuse of the program.
“I think this is just a delay,” said Dr. Jenny Melamed, a Surrey-based family physician and addiction specialist who signed the Addiction Medicine Canada letter. But she urged the centre to act promptly to release new guidelines.
“We’re doing harm and we cannot just leave people where they are.”
Addiction Medicine Canada’s letter also includes recommendations for moving clients off addictive opioids altogether.
“We should go back to evidence-based medicine, where we have medications that work for people in addiction,” said Melamed.
‘Best for patients’
On Feb. 19, the B.C. government said it would return to a witnessed dosing model. This model — which had been in place prior to the pandemic — will require safer supply participants to take prescribed opioids under the supervision of health-care professionals.
The move follows explosive revelations that more than 60 B.C. pharmacies were allegedly participating in a scheme to overbill the government under its safer supply program. The scheme involved pharmacies incentivizing clients to fill prescriptions they did not require by offering them cash or rewards. Some of those clients then sold the drugs on the black market.
In its Feb. 19 announcement, the province said new participants in the safer supply program would immediately be subject to the witnessed dosing requirement. For existing clients of the program, new guidelines would be forthcoming.
“The Ministry will work with the BC Centre on Substance Use to rapidly develop clinical guidelines to support prescribers that also takes into account what’s best for patients and their safety,” Kendra Wong, a spokesperson for B.C.’s health ministry, told Canadian Affairs in an emailed statement on Feb. 27.
More than a month later, addiction specialists are still waiting.
According to Addiction Medicine Canada’s letter, the BC Centre on Substance Use posed “fundamental questions” to the B.C. government, potentially causing the delay.
“We’re stuck in a place where the government publicly has said it’s told BCCSU to make guidance, and BCCSU has said it’s waiting for government to tell them what to do,” Melamed told Canadian Affairs.
This lag has frustrated addiction specialists, who argue the lack of clear guidance is impeding the transition to witnessed dosing and jeopardizing patient care. They warn that permitting take-home drugs leads to more diversion onto the streets, putting individuals at greater risk.
“Diversion of prescribed alternatives expands the number of people using opioids, and dying from hydromorphone and fentanyl use,” reads the letter, which was also co-signed by Dr. Robert Cooper and Dr. Michael Lester. The doctors are founding board members of Addiction Medicine Canada, a nonprofit that advises on addiction medicine and advocates for research-based treatment options.
“We have had people come in [to our clinic] and say they’ve accessed hydromorphone on the street and now they would like us to continue [prescribing] it,” Melamed told Canadian Affairs.
A spokesperson for the BC Centre on Substance Use declined to comment, referring Canadian Affairs to the Ministry of Health. The ministry was unable to provide comment by the publication deadline.
Big challenges
Under the witnessed dosing model, doctors, nurses and pharmacists will oversee consumption of opioids such as hydromorphone, methadone and morphine in clinics or pharmacies.
The shift back to witnessed dosing will place significant demands on pharmacists and patients. In April 2024, an estimated 4,400 people participated in B.C.’s safer supply program.
Chris Chiew, vice president of pharmacy and health-care innovation at the pharmacy chain London Drugs, told Canadian Affairs that the chain’s pharmacists will supervise consumption in semi-private booths.
Nathan Wong, a B.C.-based pharmacist who left the profession in 2024, fears witnessed dosing will overwhelm already overburdened pharmacists, creating new barriers to care.
“One of the biggest challenges of the retail pharmacy model is that there is a tension between making commercial profit, and being able to spend the necessary time with the patient to do a good and thorough job,” he said.
“Pharmacists often feel rushed to check prescriptions, and may not have the time to perform detailed patient counselling.”
Others say the return to witnessed dosing could create serious challenges for individuals who do not live close to health-care providers.
Shelley Singer, a resident of Cowichan Bay, B.C., on Vancouver Island, says it was difficult to make multiple, daily visits to a pharmacy each day when her daughter was placed on witnessed dosing years ago.
“It was ridiculous,” said Singer, whose local pharmacy is a 15-minute drive from her home. As a retiree, she was able to drive her daughter to the pharmacy twice a day for her doses. But she worries about patients who do not have that kind of support.
“I don’t believe witnessed supply is the way to go,” said Singer, who credits safer supply with saving her daughter’s life.
Melamed notes that not all safer supply medications require witnessed dosing.
“Methadone is under witness dosing because you start low and go slow, and then it’s based on a contingency management program,” she said. “When the urine shows evidence of no other drug, when the person is stable, [they can] take it at home.”
She also noted that Suboxone, a daily medication that prevents opioid highs, reduces cravings and alleviates withdrawal, does not require strict supervision.
Kendra Wong, of the B.C. health ministry, told Canadian Affairs that long-acting medications such as methadone and buprenorphine could be reintroduced to help reduce the strain on health-care professionals and patients.
“There are medications available through the [safer supply] program that have to be taken less often than others — some as far apart as every two to three days,” said Wong.
“Clinicians may choose to transition patients to those medications so that they have to come in less regularly.”
Such an approach would align with Addiction Medicine Canada’s recommendations to the ministry.
The group says it supports supervised dosing of hydromorphone as a short-term solution to prevent diversion. But Melamed said the long-term goal of any addiction treatment program should be to reduce users’ reliance on opioids.
The group recommends combining safer supply hydromorphone with opioid agonist therapies. These therapies use controlled medications to reduce withdrawal symptoms, cravings and some of the risks associated with addiction.
They also recommend limiting unsupervised hydromorphone to a maximum of five 8 mg tablets a day — down from the 30 tablets currently permitted with take-home supplies. And they recommend that doses be tapered over time.
“This protocol is being used with success by clinicians in B.C. and elsewhere,” the letter says.
“Please ensure that the administrative delay of the implementation of your new policy is not used to continue to harm the public.”
This article was produced through the Breaking Needles Fellowship Program, which provided a grant to Canadian Affairs, a digital media outlet, to fund journalism exploring addiction and crime in Canada. Articles produced through the Fellowship are co-published by Break The Needle and Canadian Affairs.
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