#Naloxone 101
Naloxone, or also often referred by the brand name #Narcan, is a fast-acting drug used to temporarily reverse the effects of opioid #overdoses.
Naloxone can restore breathing within 2 to 5 minutes. When you take an #opioid, it affects certain receptors in your brain. Naloxone works by kicking opioids off the receptors in your brain and binding to those receptors.
In Canada, there are two types of kits given out for personal use:
Naloxone nasal spray is sprayed directly into the nose, where it is absorbed. It starts to take effect in 2 to 3 minutes. Learn how to give naloxone spray (video).
Naloxone injectable is injected into any muscle in the body, such as the arm, thigh or buttocks. It starts to take effect in 3 to 5 minutes. Learn how to give a naloxone injection (video).
Naloxone only works if you have opioids in your system, such as:
· heroin
· morphine
· codeine
911 Call Needed After Naloxone:
While naloxone is only active in the body for 20 to 90 minutes (varies by persons and depending on the amount or type of opioid taken, or how the opioids were taken (for example: oral, injection), the effects of most opioids last longer. This means that it is likely for the breathing to stop again if more Naloxone is not administered.
Accessibility:
When fentanyl began to contaminate the drug supply and the public health emergency was declared in 2016, the Take Home Naloxone program boosted. There was a change in policy to remove the requirement to have a prescription to get a kit and the program expanded to community sites and pharmacies, improving access to training and kits throughout the province. People with lived and/or living experience took on a critical role in distributing naloxone. They continue to be on the frontline as first responders saving the lives of friends, loved ones, and community members. Despite improved access to naloxone and its effectiveness in reversing overdose, B.C. is currently experiencing the highest rate of overdoses to date. In 2020, approximately five British Columbians died each day from fatal overdoses.
What’s up with the shortage?
Agencies across different Canadian provinces (e.g., British Columbia and Winnipeg) are reporting a shortage in Naloxone kit. Vancouver is in a state of emergency, and has been for years but we are seeing more deaths related to toxic #drugs rather than a straight-forward overdose. People are buying substances but are not getting purely what they are asking for. For example, there was a recent toxic drug alert from Fort St. John that was warning the public that some meth and heroin suppliers are mixing in antifreeze. In Vancouver, there was an alert where cocaine laced with fentanyl was being sold. People dying every day from an unregulated, contaminated drug supply - these are preventable deaths. To this day, drug testing has indicated further contaminants such as Carfentanil and benzodiazepines (benzos), making it more difficult and complex to reverse overdoses.
When you have opioids laced with #benzos, it is difficult to reverse an overdose with a Naloxone kit. These substances cause very heavy and prolonged sedation affects, so when administering Naloxone to someone overdosing, it may take more Naloxone than compared to if the person was overdosing on pure opioid. If a person does not respond, it is advised to administer more dosages every 2 minutes. It is also important to note that ever since Covid-19 pandemic began, there has been a huge shortage in ambulance staff in BC. This mean it would take longer for paramedics to get to the scene of an overdose. If benzos is keeping an overdosing person unresponsive, then going through more than 1 kit in one incident is possible. While working as an Outreach Worker, my team had to administer Naloxone to a client who we have had to administer Naloxone to before. This client usually would be responsive after 2-3 vials but we started having to use up to 8 vials after her drug supply was laced with benzos. This is perhaps why we are seeing a shortage in Naloxone kits—we are using more-than-usual amounts of Naloxone when responding to overdoses.
Another factor in the shortage of Naloxone is often a forgotten one—How it is stored. Naloxone must be stored at room temperature (between 15 and 25°C), and kept in the box until ready for use. We must consider the fact that homeless people who may be carrying Naloxone are at risk of using an ineffective dosage if they are staying out in the cold or in the summer when it gets too warm.
Another tool to limit potential overdoses is getting your drugs tested. We have been encouraging people to go get their drugs tested, however, Test strips can only check if certain fentanyl or benzos compounds are present in the portion of the drugs tested. They do not detect other drugs or toxic chemicals and do not show the amount of fentanyl or benzos present in the substance.
Naloxone has always been a quick, temporary fix to the overdose crisis but we are at the point where this is no longer viable. If Naloxone and test strips aren’t as effective anymore, then what needs to happen? Public access to safe supply.
#Safe Supply 101
Safe supply services can provide prescribed medications to people who use drugs, and it is often overseen by a health care practitioner, with the goal of preventing overdoses and saving lives. They are provided in a less clinical and more flexible way compared to other care options for substance use, such as opioid agonist treatment (OAT). For example, safe supply services may offer:
a range of medication options
accessible locations (for example, services available at a community health centre)
Leniency on eligibility
flexible dosing conditions and carrying rules (for example, clients may be able to pick up their supply and use as needed)
holistic approach (for example, focusing on improving health and not requiring clients to stop using illegal drugs)
These services are intended to reach people at risk of overdose. At the discretion of health care practitioners, the medications prescribed by safe supply services may include:
Settings where safe supply services operate may include:
medical clinics
supportive housing
community pharmacies
community health centres
The goal of safer supply is to provide prescribed medications as a safer alternative to the toxic illegal drug supply to people who are at high risk of overdose. Safer supply services build on existing approaches that provide medications to treat substance use disorder. However, the safer supply is a holistic approach and do not necessarily focus on stopping drug use. Instead, they focus on meeting people where they are at, reducing the risk of overdose by helping people to be less reliant on the toxic illegal drug supply, and providing connections to health and social services where possible. With the depletion in Naloxone supply and effectiveness, we must continue to work under the principals of #harm #reduction. Safe supply is the next step in preventing overdoses and deaths related to toxic drugs.
Safe Supply in BC
While safer supply is available in B.C, there is definitely not enough accessibility to it. Many people feel like the reality is that safe supply is virtually non-existent. Drug users do not have access, free or otherwise, to a safe supply of opioids that won’t kill them. Back in March 2020, new provincial guidelines were issued that gave physicians the green light to more widely prescribe opiates and other substances to those struggling with addiction. The change was made because of concerns that the pandemic could disrupt the drug supply, along with a desire to have those at risk self-isolate. In order to qualify for the medication, which is covered by B.C's Pharmacare plan, people have to be at risk of developing a COVID-19 infection and at high risk of overdosing or going through withdrawal. However months later, there has been a spike in the number of deadly overdoses and repeated calls for the government to do more to confront the opioid crisis, which was first declared a health emergency in B.C. in 2016. Many people, including B.C.'s premier, John Horgan, and the head of the Canadian Association of Chiefs of Police have been calling for drug decriminalization while others want to see people legally prescribed the same substances they are addicted to.
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