Specialist in critical care, palliative care, ethics and the English Premier League. State-sanctioned Physician.
Ottawa, Ontario
Joined September 2013
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Our latest: Microdose psilocybin improves symptoms of depression, anxiety and demoralization in a palliative setting in phase 2 study. Phase 3 RCT now enrolling!
@bruyerehealth @uOttawaMed @PCPCRCollab @GovCanHealth @cancersociety
journals.sagepub.com/doi/10.…
Important and detailed explanation from @raghu_venugopal to the ranting nonsense from @brianlilley
🚨 Warning- data alert 🚨
Mercifully tabloidist Brian Lilley won't have a duty to care for the public. His lunatic right-wing populist ideas (safe consumption sites cause opioid deaths and closing them saves people) are laughable. He can't cogently respond to my 2024 post to him or anything below. 👇👇👇
Why are there now less opioid deaths.
1-Less opioid deaths isn't just in Ontario. It's across Canada and the US. Ontario's obtuse abstinence-only approach can't explain why opioid deaths are significantly down in for example, British Columbia or the states of Washington or Oklahoma.
Ontario's abstinence-only approach can't explain the 14% reduction in opioid deaths in the majority of American states in 2025 (and in 2024 and 2023).
2-Opioid deaths sharply declined in Ontario from Dec 2024 to Feb 2025, long before Ontario started shutting down safe use sites in March 2025. In fact, death rates declined while safe consumption sites were open and in place.
3-The drug supply has changed. A factor behind less deaths is what is cut into street fentanyl. Less benzodiazepenes in the drug supply means less respiratory depression which naloxone can't reverse. This is a moving target, but is an important factor. What's tragic is that when Ontario Conservatives ended safe consumption sites, a lot of drug-checking was lost with it. Drug checking is really important for people using drugs and for ER doctors like me, to know what to expect with overdoses and withdrawal.
4-Naloxone has flooded the zone. This is crucial reason we see less opioid deaths. Naloxone is widely available compared to ever before.
5-More community and public awareness. The community using drugs is more aware of life-saving naloxone. Pharmacies and ERs give it out for free. This is crucial.
6-Treatment and recovery does play a key role. There's more awareness of the importance of this approach, and here, Ontario Conservatives deserve praise for adding new funding for HART hubs - at the unfortunate expense of slashing safe use sites. It was never supposed to be either/or - it was supposed to be harm reduction and treatment/recovery.
7-Many of the most vulnerable are now dead. This includes patients I've cared for. I remember who they were. This is a tragic truth. 56,631 Canadians have died from opioid toxicity between 2016-2025.
8-Those still alive are using street drugs more carefully and are better supported across North America. For example, a lot of healthcare workers - ER doctors like me - know that the overdose patient in the ER - is probably the sickest patient and the most soon to die - compared to all the rest of the patients in the ER that day.
9-Harm reduction has been effective. In 10 years, Canada had 6 million visits to safe consumption sites. There were 70,000 overdoses. None died.
Brian - try to frame an intelligent argument using facts, professional experience and without a political axe to grind and even despite your paycheque coming from American MAGAs.
@brianlilley @MooreintheAM
James Downar retweeted
Meet finalist Dr. Sarina Isenberg, from Bruyere Health Research Institute, who will present "The Art of a Good Death: Transforming public engagement with end-of-life research." Catch Dr. Isenberg's live pitch at Virtual Hospice's 2026 Innovation Challenge. @caremcgill
James Downar retweeted
In the US, roughly 400,000 to 500,000 families a year make a decision to withdraw or withhold life-sustaining treatment for a dying relative in an ICU. If you count every family member meaningfully involved in those decisions, that's about 1 to 2 million people annually.
I don’t think @NightShiftMD needs me to defend him, but stupidity of what is being thrown at him is painful to read.
Brian is a mensch.
@MakisMedicine and @DeanAllisonMP need to put a tent on their circus.
James Downar retweeted
"You pray for the hungry . . . then you feed them. This is how prayer works."
Pope Francis
James Downar retweeted
So AI is going to kill us before Microsoft 365 understands that I have more than one profile.
James Downar retweeted
Hi, I'm a psychiatrist. I assess peoples thoughts for a living. It has been well established that asking adults (even children!) about things they already know about does not introduce an "increase" in those thoughts, nor does it "offer" it to them as a new thing.
"Have you thought about harming others?"
Is not an offer to harm others
"Do you use ketamine?"
Is not an offer to use ketamine.
"Have you thought about leaving your husband?"
Is not an offer to leave your husband
"Have you thought about suicide?"
Is not an offer for suicde
"Have you thought about calling your ex-boyfriend?"
Is not an offer to call your ex-boyfriend
"Did you think about using cocaine last week?"
Is not an offer to use cocaine
"Did you worry last night?"
Is not an offer to continue worrying.
so... now that we 've established that
"Have you thought about Medical Assistance in Dying?"
Is not an offer for MAiD
James Downar retweeted
As US Ambassador to NATO on 9/11, the first to call me to suggest we invoke Article 5 was Canadian Ambassador David Wright. Our allies came to our rescue that terrible day. I’ll call David this morning 25 years later to thank him and our great neighbor Canada once again!
James Downar retweeted
“As long as the problems of the poor are not radically resolved by rejecting the absolute autonomy of markets and financial speculation and by attacking the structural causes of inequality, no solution will be found for the world’s problems — or, for that matter, to any problems.
“Inequality is the root of social ills.” — Pope Leo XIV
James Downar retweeted
Major release!
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I have compiled the worlds largest database of pediatric suicide information, consisting of 137 countries, from 1952-2025. In total, 27.64 BILLION person-years of data are represented.
/1
James Downar retweeted
Harvard study by my psychology department colleague Matt Nock predicts most suicide attempts a week in advance - quite a feat. Agitation, not depression, is the most common trigger. current.fas.harvard.edu/stor…
James Downar retweeted
Pope Leo XIV says that the Catholic Church’s teaching on sexual ethics must be less prioritized over “greater, more important issues.”
“We tend to think that when the Church is talking about morality, that the only issue of morality is sexual.
“And in reality, I believe there are much greater, more important issues, such as justice, equality, freedom of men and women, freedom of religion, that would all take priority before that particular issue.”
James Downar retweeted
A conspiracy theory linking medical assistance in dying, white Canadians, and immigration has moved from the fringes of online discussion to one of the world’s largest political platforms.
Read our analysis of how this disturbing argument against MAiD was presented on The Tucker Carlson Show.
maidincanada.substack.com/p/…
James Downar retweeted
Dr. Zivot and his 'drowning' claim about MAiD just won't go away, so we decided to take close look at the evidence and logic behind this claim.
The evidence doesn't hold up at all (his logic doesn't fare well either).
Read our latest article to learn why we can dismiss this claim once and for all, and to learn how you can respond when you hear it in the future.
We've made two versions; one long, and one short. Find them both here:
maidincanada.substack.com/p/…
James Downar retweeted
Lack of affordable housing is bad for our health, as individuals and as a country. On the housing front we need fewer calls to action and more action, by @picardonhealth
theglobeandmail.com/gift/0fc… via @GlobeDebate
James Downar retweeted
Hindsight is 2020: Did Canada get the early response to the COVID-19 pandemic right? The short answer is: More or less. Taking precautious is not the same as overreacting, by @picardonhealth theglobeandmail.com/opinion/… via @GlobeDebate
James Downar retweeted
Much of Tucker Carlson’s two-hour interview with Kelsi Sheren was devoted to repeating the same misleading claims about MAiD that we have heard many times before.
However, a few notably different claims caught our attention—and we thought they warranted a closer look.
maidincanada.substack.com/p/…
James Downar retweeted
It took only one sentence to misrepresent the position of the American Association of Suicidology. Correcting that sentence took more than six months.
In January, Gordon Friesen claimed that the AAS denied any meaningful distinction between MAiD and suicide. His source did not establish that. It showed only that the organization had temporarily retired an earlier position statement while reviewing its past positions.
We contacted the AAS directly. Six months later, it republished its statement—and its actual position could hardly be further from the way Friesen characterized it.
The AAS explicitly recognizes MAiD as distinct from what is traditionally understood as suicide. It even argues that the word “suicide” should not be used to describe legally authorized assisted dying.
Our latest article looks at what the AAS actually says—and why a false claim can take seconds to make but months of careful work to correct.
maidincanada.substack.com/p/…
James Downar retweeted
We have become exceptionally good at extending lifespan. Now we must focus on extending healthspan. We can do a lot more to prevent chronic illnesses and painful conditions, by @picardonhealth theglobeandmail.com/opinion/… via @GlobeDebate
