‘People are going to die’
Shelter Health Network cut off from giving out opioid antidote
The Shelter Health Network says “people are going to die” because the organization that serves Hamilton’s most vulnerable populations can no longer get naloxone kits in bulk to reverse opioid overdoses.
“We give out a huge number of kits every week,” said Dr. Kerry Beal, lead physician of the network comprised of 35 health professionals. “Somebody is going to die for lack of Narcan.”
In the past, the network was able to get the opioid antidote from pharmacies. That access ended on Feb. 9 when the province changed how pharmacies submit claims for distributing naloxone — the brand name is Narcan. But the network didn’t find out about the new rules until Feb. 22.
It has left the organization, caring for the highest-risk populations with no stable housing and complex health problems, scrambling for kits at the worst possible time as benefit cheques went out at the end of the month.
“This all happened last minute without anybody telling us about it,” said Beal. “When cheques come out, overdoses happen.”
The change could have a significant effect considering pharmacies gave out nearly 31,000 doses of naloxone in the first six months of 2023 alone, according to figures from Hamilton Public Health Services. It’s not clear how many of those doses were given to organizations like the network that have been cut off from the supply.
The city’s medical officer of health, Dr. Elizabeth Richardson, said she is “absolutely” concerned about the potential consequences of the network running out of kits.
“The population that they serve is a group that we want to make sure has naloxone,” said Richardson. “We know naloxone is really critical.”
The Ministry of Health called the network’s claims a “misunderstanding” in a statement. The ministry said that a clarification was made to the Ontario Naloxone Program for Pharmacies on Feb. 9, but that it still allowed claims for kits distributed at “Canadian Addiction Treatment Centres.”
“This clarification was not intended to reduce access to naloxone kits for Ontarians,” stated the ministry.
However, the network is not an addiction treatment centre. As a result, Beal says the organization can now only get two kits at a time — the same as any individual getting the opioid antidote from a pharmacy.
“The bottom line is they stopped being able to provide them to agencies like ourselves,” said Beal. “They cannot give us a quantity of naloxone kits to hand out at our own discretion.”
The ministry refused to answer questions about what was being misunderstood or why groups like the network could no longer get kits in large quantities from pharmacies.
Beal says the new rules that would require the vulnerable individuals they serve to go the pharmacies themselves is not workable and doesn’t provide enough kits.
“I’ve got a guy in a tent and he’s asking me if I can give him 10 or 12 kits so that he’s got them for the tents around him,” said Beal. “What will happen, is somebody will overdose and it takes a while for the paramedics to get there, so as a community they treat each other. They all know how to use this stuff. They’re better at it than I am. I always have Narcan with me and I will happily hand over kits whenever anybody asks me for them or whenever I identify that somebody really does need them.”
The network tried to turn to a different provincial program that allows public health to give out the kits to organizations. But Beal says the network doesn’t meet the eligibility requirements for the Ontario Naloxone Program.
“That’s a provincial decision as to what organizations meet the criteria and which ones don’t,” said Richardson. “We have to work within the criteria that the province sets up and the province has to ultimately approve the organization.”
Public health has been working with organizations to get them approved and says it has the supply to ramp up the program, which handed out just over 15,000 doses in the first six months of 2023 — roughly half of what was given out through pharmacies.
“We have lots of supply. Supply is not an issue at all,” said Richardson. “We’re trying to work with any of those organizations … to make sure that process of getting on board and being approved by the province is expedited as much as possible.”
For organizations that aren’t eligible, public health is looking for a way to still get them kits.
“Are there other ways that we can make this work,” said Richardson. “How can we look at the problem and find a solution and make sure the supply is there. That’s the process we’re going through right now.”
It’s a life-and-death question considering Hamilton’s opioid-related death rate was 63 per cent higher than the provincial average in 2022.
Beal says it’s not uncommon for it to take three kits to resuscitate one person.
“It’s become ridiculous the amount of Narcan that you need to resuscitate somebody,” said Beal. “There is all sorts of horse tranquilizers and stuff like that now in the drug supply. There’s a lot of benzodiazepines, instead of just opioids. Narcan will reverse a strictly opioid overdose quite readily, but you start getting into the carfentanil and the horse fentanyl and it’s causing so much more respiratory depression that it needs larger quantities of Narcan to reverse it — and it does nothing against the benzodiazepines.”
As a result, Beal says the network often runs out of kits in the middle of night or on weekends, so 24-hour pharmacies were a good place for the organization to get naloxone. Public health provides kits up until 11 p.m.
“I’ve lost so many people to overdose that I went into a little bit of a panic when this all happened,” Beal said about the province cutting off access. “People are going to die and I’m going to feel like I didn’t do enough to make sure that there was enough Narcan out there. I feel like I’m banging my head against the wall. Why would they not give it to a clinic of doctors that serves the population that they claim to be interested in serving?”