naloxone – Matters of Substance

Drug overdoses get a lot of media attention when a celebrity passes away, be it Cory Monteith, Michael Jackson or Anna-Nicole Smith. However, there is little discussion about how to ensure that people who use drugs live to see another day so that they can seek treatment if and when they choose to. Through the five numbers below, we share with you a harm reduction approach that educates people on how to prevent, recognize and respond to opioid overdoses.

308.

That’s the number of people who died in British Columbia in 2013 because of illicit drug overdoses. Opioids, such as heroin, morphine and codeine, suppress breathing which can result in severe brain damage, and even death, due to lack of oxygen. We can reduce the number of accidental overdoses by educating the public on the factors that increase the risk of overdose, such as mixing drugs and alcohol.

85.

That’s the percent of illicit drug overdoses that happen in the company of other people. Helping others learn to recognize the signs of overdose, and teaching them what to do in the case of an overdose, will increase the likelihood of being able to prevent death from overdoses.

That’s the number of minutes it takes for naloxone to start reversing the effects of an opioid overdose. Naloxone is a safe, prescription-only medication that has been used for decades by paramedics and in emergency departments to reverse the effects of an opioid overdose. Naloxone can restore normal breathing within 1-5 minutes of administration, but the effects may wear off in 30-90 minutes and the overdose may return. Naloxone cannot be abused, does not cause a high, and has no effect on the body if opioids are not present. We can prevent accidental overdose deaths by equipping people with naloxone and training them on how to respond to an overdose.

911.

That’s the number to call as soon as possible. Calling 9-1-1 is the first and most crucial step in overdose response. Medical attention is important even after naloxone is used. The effects of naloxone wear off and overdose may return, especially since some opioids (such as methadone and fentanyl) can last in the body for a long time. Naloxone only works for opioid overdoses and has no effects on other drugs or alcohol that a person may have taken; although removing the effects of the opioids helps in a multi-drug overdose. Medical professionals are trained to handle such situations.

55.

That’s the number of lives that have been saved by take-home-naloxone kits in BC since August 2012. The kits are distributed as part of the BC Take Home Naloxone (BCTHN) program, an initiative of the Harm Reduction program at the BC Centre for Disease Control that aims to prevent unintentional deaths due to opioid use. At participating sites, clients learn how to prevent, recognize and respond to an overdose, and eligible participants are prescribed a take-home-naloxone kit. After 17 months, BCTHN operates in 35 sites across BC, from large urban hubs such as Vancouver and Surrey, to smaller rural centres such as Cranbrook, Campbell River and Fort St. John. Nearly a thousand people have been trained including staff and volunteers at health and social service agencies, as well as friends and family members of someone who uses drugs. Over 600 kits have been dispensed to clients who use opioids and various resource materials are being developed to assist community partners increase the reach of the program.

For more info, visit towardtheheart.com/naloxone

*Please note that the material presented here does not necessarily imply endorsement or agreement by individuals at the Centre for Addictions Research of BC

Authors: Ashraf Amlani (left), Harm Reduction Epidemiologist, BC Centre for Disease Control, and Jane Buxton (right), Harm Reduction Lead, BC Centre for Disease Control

Harm reduction programs need access to the most up-to-date evidence, resources, and well-trained staff if they are to ensure delivery of high-quality services. However, many programs in communities across Canada are often very busy, have limited resources, and struggle to meet demand. Although service providers might desire to know about the newest scientific evidence, realistically how many have the time to search this out and determine the quality and transferability of the evidence to their programs?

We came together as a group of service providers, service users, and researchers from across Canada to make evidence readily available and applicable to the everyday operation of programs that provide service to people who use drugs and are at risk for HIV, hepatitis C (HCV), hepatitis B (HBV), and other harms. In July 2013, we launched the first installment of a comprehensive harm reduction best practices document with a national scope.

This new resource provides a quick overview of best practices and program policies to reduce harms. For example, we know from studies in Canada and internationally that when people who inject drugs have problems accessing clean needles, they are more likely to reuse needles, including those previously used by someone else, which puts them at risk of HIV, HCV, and numerous other harms, such as abscesses and vein problems. Therefore, we recommend that programs distribute needles in the quantities requested by client without limits. To reduce the availability of used equipment, we recommend that programs provide multiple, convenient locations for disposal.

If a new needle and syringe is recommended for each injection, is the same true for safer crack cocaine smoking equipment? After considering the limited availability of scientific evidence about disease transmission and product safety information, our group recommends that crack cocaine smoking equipment be considered unsafe and in need of replacement when: the pipe and/or mouthpiece has been used by someone else; the pipe is scratched, chipped or cracked; the mouthpiece is burnt; and/or the screen has shrunk and become loose in the stem.

Overdose is the most common cause of death among heroin and other opioid users. Significant improvements in overdose prevention are possible if we offer good education and training programs for clients, including how to respond to an overdose. Training should include recognising signs of overdose, knowing when to call 911, how to respond when witnessing someone else overdose, and how to use naloxone, a drug that can reverse the effects of an opioid overdose. We also recommend assessment of the feasibility and acceptability of naloxone distribution programs.

Many more recommendations are contained in the document and we invite readers to check it out and tell us what you think. Our team is midway through development of a second installment, set to release in late 2014, of new best practice recommendations. That installment will focus on recommendations related to program models, testing for HIV, HCV, and HBV, vaccinations, skin and vein care, referrals and counselling, relationships with police, and more. So stay tuned!

*Please note that the material presented here does not necessarily imply endorsement or agreement by individuals at the Centre for Addictions Research of BC

Authors: Dr. Carol Strike (left) and Dr. Tara Marie Watson (right), Dalla Lana School of Public Health, University of Toronto

Tag: naloxone

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