Injection site OD raises resistance concerns
Despite a rescue attempt with naloxone and intervention by paramedics, a drug user who overdosed at a supervised injection site on Murray Street last week later died in hospital.
While no one is yet sure precisely what kind of drug was involved in the death, it has led to speculation about the wider use of naloxone-resistant street drugs that have different overdose effects. These new antidote-resistant drugs have already showed up in drug-testing done at another injection site, this one in nearby Sandy Hill.
“It wasn’t like somebody tottered off and died alone on the street,” said Wendy Muckle, execu- tive director of Ottawa Inner City Health, which operates the Murray Street site with the Shepherds of Good Hope.
“The police were there, the paramedics were there, our staff were there, everybody did everything that was humanly possible. It’s just a very tragic situation.”
Muckle said there were two other drug-related deaths in the past few days — not connected with a supervised injection site — of users well-known in the city’s injection community.
The fatalities are raising fresh concerns about “fentanyl analogs.” These synthetic concoctions mimic the effect of fentanyl — originally a pain reliever — but can have unpredictable effects on the body’s vital systems.
The drug literature lists about a dozen fentanyl analogs, including carfentanil, which is about 100 times more potent than fentanyl and is normally used to sedate large animals like elephants.
“The problem is that all the usual ways, the protocols, you have for dealing with overdoses don’t necessarily work the way they’re supposed to (with the analogs),” Muckle said Saturday.
“That’s the challenge. Us, the paramedics, the police are dealing with these unpredictable situations where you don’t know what’s going to happen next.”
For the past three to six months, said Muckle, officials are dealing with opioids that don’t have the
normal trajectory. Typically, the drugs have a depressive effect on the body’s vital systems, to the point that severe breathing and cardiac problems can result in death.
“People are taking things they think are opioids but instead you get this psychosis, really agitated behaviour.
“So what’s in it? What’s causing that? Nobody really knows,” she explained.
“As soon as we become familiar with how the overdoses play out, the drugs change. It’s like we’re always chasing our tail.”
Not only that, but the political backdrop to publicly funded supervised injection sites is now more fluid. Ontario Premier Doug Ford is not a fan and the Ministry of Health has frozen any new sites while it reviews the existing ones.
Ottawa now has four sites and Mayor Jim Watson, once an opponent, now says he will find money in city coffers if Ontario pulls its financial support and the federal government — which has ultimate authority — doesn’t fill the funding gap. The Shepherds service, operating in a 40-foot trailer for the past year, is already too small and in need of replacement.
The misuse of opioids and their illicit cousins is a scourge across North America. In 2017, there were 3,987 apparent opioid-related deaths in Canada, up sharply from 2,978 the year before.
The number of opioid overdose visits to emergency departments in Ottawa hospitals has been stubbornly high for the past couple of years, averaging about one per day.