photos: Naloxone.

Naloxone in hand

The anti-overdose medication should be in every first aid kit, say advocates

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Someone dies from an overdose of fentanyl, heroin, oxycodone or other opiates every 12 hours in B.C. But naloxone can reverse opiate overdoses. Anyone can get the medication and learn how to save a life with it.

Nickerson hands out clean syringes in Surrey.

“I’ve been on both ends of the needle,” says Nickerson, known on the streets as Little Doug. He’s overdosed four times in 2016 and each time was resuscitated with naloxone. But over the past four years, he says he has administered naloxone 92 times, reversing potentially lethal overdoses. “I’m a preacher ’s kid,” Nickerson says, “maybe that’s where I got my big heart.”

Fatalities are spiking along with the spread of potent adulterants like fentanyl. Users buy what they think is their drug of choice, but it turns out to be cut with these cheaper, stronger substances. They get more than they bargained for, and many overdose.

The U.S. approved naloxone in 1971. But until recently, the medication was mostly used by paramedics and in emergency rooms. Beginning in 2012, naloxone was made available by prescription to current or former drug users in B.C. Since the spring anyone can get it at pharmacies—no prescription required.

Accessibility barriers

I stopped by or called a dozen pharmacies in Vancouver, Abbotsford, Victoria, Chilliwack, Prince Rupert, Prince George and Kamloops. For between $25 and $30 all but one was willing to sell me an ampule of Naloxone—a small glass vial containing enough for one injection. Newgen Pharmacy in Abbotsford had naloxone in stock but also suggested two local harm reduction organizations that provide kits and training.

One high-placed source told me of a pharmacy in Kamloops charging $200 during the summer. In the U.S., price gouging is a big problem, with some places seeing a 17-fold increase in price.

A couple of pharmacies offered kits they put together with syringes and gloves for around $50. The BC Centre for Disease Control has kits as part of their Take Home Naloxone program—free for current and former drug users. There are training sessions available online.

Overdoses are striking people in all walks of life—young weekend warriors who are experimenting, seniors on prescribed pain meds, and drug users. Naloxone needs to be in the hands of their family, friends, classmates, and coworkers, according to advocates. Government removed the prescription requirement so that naloxone could be in the first aid kits of schools, universities, workplaces, music festivals, art galleries, government buildings, libraries, and community centres.

Over the years, I’ve had to resuscitate four people, and known dozens who’ve died from overdoses. So in 2014, I got naloxone training at the Drug Users Resource Centre on Vancouver ’s Downtown Eastside. Portland Hotel Society nurse manager Kirsten Locher led the session.

How to administer

First, Locher says, one needs to recognize the signs of opiate overdose. Too much of any opiate leads to slowed breathing and heart rate. The person will become unresponsive, nod out, lose consciousness, and without help, they can die.

Dial 911 if someone is overdosing, Locher advises. She calls on volunteers to perform rescue breathing, and to put each other in the recovery position.

The tricky part is injecting the naloxone. You must crack open the glass ampule containing the naloxone and draw it up into a syringe—a challenge requiring some dexterity under the pressure of an emergency situation. Then, inject the victim—through clothing and in the muscle works fine, she says. Stay with the person. Monitor breathing and after five minutes administer another dose, if necessary. Naloxone lasts for about half an hour, so more than one dose is sometimes needed, especially when strong opiates are onboard.

Locher cautions that naloxone does not work for alcohol or stimulants like crack, speed, and cocaine.

I’ve carried a naloxone kit ever since.

Not everyone is carrying it

Naloxone also comes in a nasal spray, which is simpler than injection.

In the past, Vancouver Police haven’t carried naloxone, due to liability concerns. But police worry about officers overdosing after accidentally coming into contact with fentanyl and other highly potent narcotics. They will start carrying the nasal spray version for officers to use.

Some housing and outreach workers aren’t permitted to carry naloxone. Vancouver Coastal Health’s Tiffany Atkins stated in an email that doctors and nurses are trained to administer naloxone, but the health authority is “working on including social workers, and eventually non-regulated care providers [in naloxone training].”

But drug policy lawyer Adrienne Smith says that isn’t enough.

“The liability risk is really overstated when we consider that a person's life is on the line,” she says. “I'd really like to hear from administrators of Downtown Eastside housing and other services that saving lives comes first, and that they have their workers' backs."

The First Nations Health Authority’s Dr. Evan Adam says he's worried. "First Nations people are going to be overrepresented in overdose injuries and deaths,” he says. He says there are efforts to educate people living on reserve.

"We have staff who travel to communities who train ... social workers or teachers or even laypeople, like family members of a person at risk who are learning how to administer naloxone,” he says.

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