On this episode of the CMAJ Podcast, Dr. Mojola Omole and Dr. Blair Bigham examine the issues raised in a recent CMAJ commentary on Alberta’s Compassionate Intervention Act, which explores the ethical and clinical implications of this approach to involuntary treatment. As governments across Canada turn to coercive measures in response to the overdose crisis, the episode considers what these policies mean for patient autonomy, clinical practice, and the role of physicians in enforcing care.

Dr. Bonnie Larson, a family physician and addictions medicine specialist at the University of Calgary, joins the conversation to unpack the legislation. She explains how the Act allows individuals to be detained and treated even when they are deemed capable of making their own medical decisions. Dr. Larson describes how this represents a substantial departure from established principles of consent and autonomy, placing physicians in ethically complex positions and reshaping their role in care.

The discussion then turns to Massachusetts, where involuntary treatment for substance use has existed for decades under Section 35. Dr. Keren Ladin, a bioethicist and health services researcher at Tufts University, reveals the experiences of clinicians working within this framework. Drawing on her research, she describes how Section 35 has shaped clinical practice, contributed to moral distress among healthcare providers, and often resulted in people being treated in carceral rather than therapeutic settings.

Together, the guests reflect on what these policies reveal about how societies respond to addiction, the limits of coercive care, and the risks of prioritizing control over evidence-based, patient-centred treatment.

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On this ENCORE of our most popular episode of 2025, hosts Dr. Mojola Omole and Dr. Blair Bigham speak with two authors of the latest “Hypertension Canada guideline for the diagnosis and treatment of hypertension in adults in primary care”

The discussion reflects a shared urgency: despite past successes, Canada’s hypertension control rates are declining. The new guidelines aim to reverse this trend by simplifying diagnosis and treatment for frontline clinicians.

Dr. Rémi Goupil, a nephrologist and clinician researcher at Sacré-Cœur Hospital in Montreal, and Dr. Greg Hundemer, a nephrologist and clinician scientist at The Ottawa Hospital, explain that the updated guideline is deliberately designed for primary care providers. They highlight key shifts: lowering the diagnostic threshold for hypertension to ≥ 130/80 mm Hg, simplifying blood pressure targets, and emphasizing accurate, standardized measurement techniques both in clinic and at home. The guidelines were created with input from a majority-primary care committee—including family physicians, nurses, pharmacists, and patient partners—to ensure clinical applicability.

Together, the panel outlines a streamlined nine-step treatment algorithm, emphasizing combination therapy as first-line pharmacologic management. They explain the evidence supporting ARB–thiazide combinations, discuss cost considerations for drug selection, and address adherence challenges. They also explore red flags for secondary hypertension and how the algorithm supports—but does not replace—clinical judgment.

For physicians, this guideline offers a clear and practical roadmap: measure blood pressure correctly, aim for systolic pressure below 130 mm Hg, and use the simplified treatment sequence to improve adherence and outcomes. Designed to be easy to implement, the new approach aims to empower primary care providers to act with confidence

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Join us as we explore medical solutions that address the urgent need to change healthcare. Reach out to us about this or any episode you hear. Or tell us about something you'd like to hear on the leading Canadian medical podcast.

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The CMAJ Podcast is produced by PodCraft Productions

Despite a range of effective prevention tools, HIV incidence continues to rise in Canada, with stark disparities across ethnicity, gender, Indigeneity and geography. Updated Canadian guidelines on HIV pre- and post-exposure prophylaxis reflect scientific advances since 2017 and address both new formulations and persistent barriers to equitable access.

Dr. Darrell Tan, lead author and clinician scientist at St. Michael’s Hospital, outlines several prophylaxis options now available. Daily oral tenofovir disoproxil fumarate with emtricitabine is close to 100 per cent effective with perfect adherence and remains forgiving of occasional missed doses. Long-acting injectable cabotegravir, administered every two months, shows even greater effectiveness in trials largely because it reduces the adherence challenges associated with daily pills, though cost and availability continue to limit uptake.

Natasha Lawrence, a community health worker at Women’s Health in Women’s Hands Community Health Centre in Toronto, reports that most women she serves have never heard of pre-exposure prophylaxis. Many people perceive their HIV risk as low until discussions explore relationship dynamics, including uncertainty about partner fidelity or difficulty negotiating condom use. She highlights how power imbalances and gender-based violence shape women’s risk and may limit the practicality of daily pills. Long-acting injectables can offer greater privacy and autonomy for some women, reducing the risk of partner detection. Public health messaging, she stresses, must be co-designed with communities to ensure cultural relevance and avoid stigma.

Clinicians should initiate sexual health conversations routinely, not only when patients raise concerns. Pre-exposure prophylaxis can be discussed during visits for contraception, mental health or other routine care. When patients express interest, access should not be limited by rigid criteria. Long-acting options may be especially helpful for women who face safety or privacy concerns in their relationships.

For more information from our sponsor, go to medicuspensionplan.com

Comments or questions? Text us.

Join us as we explore medical solutions that address the urgent need to change healthcare. Reach out to us about this or any episode you hear. Or tell us about something you'd like to hear on the leading Canadian medical podcast.

You can find Blair and Mojola on X @BlairBigham and @Drmojolaomole

X (in English): @CMAJ
X (en français): @JAMC
Facebook
Instagram: @CMAJ.ca

The CMAJ Podcast is produced by PodCraft Productions