Emergency first responders, hospital physicians and others trying
to revive overdosed drug users are now having to give several doses of
naloxone to counteract increasingly toxic concoctions including heroin,
morphine, and fentanyl, B.C.’s top public health official says.
Chief provincial health officer Dr. Bonnie Henry said even the free, Take Home Naloxone program kits
are now being distributed with three vials since toxic street drugs
require more intense antidotes — as many as six to 10 doses in the most
challenging cases, according to ambulance paramedics.
Henry said
contrary to some perceptions, it’s not that opioid drugs are becoming
“resistant” to naloxone, it’s that many drug users are using not only
more toxic opioids drugs like carfentanil but in multiple combinations
with other drugs. Moreover, the current reality of the overdose crisis
is such that users are taking drugs for which naloxone has no effect to
revive them, she said. That includes cocaine, speed and GHB.
Dr. Bonnie Henry, Provincial Medical Health OfficerJONATHAN HAYWARD /
THE CANADIAN PRESS “It’s a sad state of affairs,” Henry said.
“Some of
the drugs are so toxic, and drug users are also taking opioids with
sedatives like Valium, alcohol or Xanax. So yes, we’re seeing that many
people require several doses,” Henry said, adding that hospital
emergency departments are also requiring higher doses of naloxone in
intravenous drips to save lives.
“What we’re seeing is these
potent toxic drugs, even the smallest amounts cause respiratory
depression, cause people to stop breathing. So we may be getting
naloxone in but we may need more and more, for longer periods of time
because it (naloxone) wears off quickly.”
There are an estimated 55,000 individuals in B.C. who have opioid use disorders.
Joe
Acker, director of clinical practice for B.C. Emergency Health
Services, said in 2017, ambulance paramedics responded to 23,400
overdoses and the number in 2018 will, in all likelihood, exceed that.
(The overall number of overdoses in B.C. would be greater because the
figure provided by Acker does not include overdoses attended by other
emergency personnel or those not attended by such professionals).
Acker
said naloxone was administered in about a quarter of cases and he
acknowledged that some drug users react with anger when they are revived
with naloxone because it not only “ruins their high” but can also cause
nasty withdrawal symptoms.
At times, oxygen may be used instead
of naloxone to prevent those effects. Paramedics are no longer required
to take drug users to a hospital once they have been revived as long as
their assessments show that the client is stable.
Acker
said some drug users seek out the most concentrated drugs like
carfentanil while others are unsuspecting. Paramedics have observed that
welfare cheque days are often the busiest and most lethal.
On the
worst days, ambulances have been dispatched to as many as 135 overdoses
across B.C. in a 24-hour period. Public health experts are expecting
between 1,400 and 1,500 deaths in 2018, similar to 2017.
While
paramedics and health professionals use safety-engineered retractable
needles to avoid contracting infectious diseases from those to whom they
are administering drugs, Henry said public health officials have not
changed their minds about distributing such needles to drug users.
The issue of used needles being discarded on city streets and
parks where unsuspecting children, adults and pets can step on them came
up repeatedly during the civic election campaign.
Needles that retract as soon as they are used are a harm reduction
strategy in some jurisdictions but Henry said they have been ruled out
here because they are harder for injection drug users to handle.
Acker
said BCEHS does respond to citizens reporting accidental needle-pokes
on streets and in parks but he couldn’t provide a number reflecting the
frequency of such calls. Henry said while such cases would be
traumatizing to individuals, in B.C. there has never been a case of
transmission of HIV or other serious infections caused by such
incidents.
Discarded needles seen on Vancouver streets or in parks will be collected if citizens call a hotline at 604-657-6561.
Dr. Patricia Daly, medical health officer, Vancouver Coastal Health In her presentation on the opioid overdose crisis last week
to city council, Vancouver Coastal Health chief medical officer Dr.
Patricia Daly said overdose prevention sites and take-home naloxone kits
were saving lives; the B.C. Centre for Disease Control estimates
thousands of deaths over the last two years have been pre
The issue of used needles being discarded on city streets and
parks where unsuspecting children, adults and pets can step on them came
up repeatedly during the civic election campaign.
Needles that retract as soon as they are used are a harm reduction
strategy in some jurisdictions but Henry said they have been ruled out
here because they are harder for injection drug users to handle.
Daly said more than 300
people have died from overdoses in Vancouver so far this year, similar
to the number at this point last year.
While Canadian life
expectancies are rising, in B.C., they have dropped because of opioid
overdoses. Last year, drug overdoses led to more deaths than suicides,
homicides and motor vehicle accidents combined.
Acker
said some drug users seek out the most concentrated drugs like
carfentanil while others are unsuspecting. Paramedics have observed that
welfare cheque days are often the busiest and most lethal.
