Wider use of overdose kits encouraged
Expert on drug safety wants broader adoption of naloxone for people on high doses of prescription opioids
People dependent on highdose prescription opioids should consider having another drug on hand at all times — a naloxone kit in case of overdose, according to a prominent drug-safety expert.
Dr. David Juurlink, head of clinical pharmacology and toxicology at Sunnybrook Health Sciences Centre in Toronto, wants to see broader adoption of the life-saving antidote more commonly associated with the fentanyl crisis.
“The idea that naloxone is purely for people with addiction, I think, is a seriously misguided one. If somebody is on fentanyl patches for chronic pain, most of those people you can make an argument that they should have naloxone in the household, even if they seem to be functioning well,” Juurlink said.
Even those who follow their doctor’s orders are at risk of being harmed by their medication, he said, especially when the drug is combined with sedatives, sleeping pills or anxiety medication.
“For a patient who’s ever had anything resembling an overdose, or who is falling asleep on their opioids or is on high-dose opioids, I think it’s a very good idea for that patient and their family to be aware of the potential utility of naloxone and to know how to use it,” Juurlink said.
“There’s no downside to having naloxone in the home.”
Longtime users of narcotics are typically on high doses because they’ve become tolerant over time. The higher the dose, the bigger the risk, Juurlink said, adding that someone prescribed just eight pills of Percocet after dental surgery probably doesn’t need a naloxone kit.
The life-saving drug is available as a nasal spray or in injectable form without a prescription. But Juurlink said most pharmacies do not carry naloxone and access varies across Canada, with concentrated availability in areas known for illicit intravenous drug use.
It is targeted at people at risk of an opioid overdose and people likely to witness and respond to an overdose, such as family and friends.
British Columbia remains most affected by Canada’s opioid epidemic, with the coroners service recording 640 illicit-drug overdose deaths during the first five months of the year.
Provincial health officer Dr. Perry Kendall said B.C. sees about 75 prescription overdose deaths a year — mostly in people using other substances, such as alcohol and antidepressants. But patients often die in their sleep and it can be difficult to determine whether overdose was a factor, Kendall said.
He was cautious in calling for expanded distribution of naloxone. “These people are more at risk from [taking several prescription drugs] or sometimes themselves getting diverted to additional drugs or alcohol. Or they’re more at risk if they’re being withdrawn too quickly,” Kendall said. “The answer there is to look to better prescribing.”
Guidelines published in the Canadian Medical Association Journal in May say clinicians may provide naloxone to those at risk of overdose, but that current “low quality” evidence doesn’t back suggestions it would reduce deaths.
Still, the guidelines say naloxone could be considered when rotating opioids, since patients may take more than their prescribed dose. They also say the mere suggestion of naloxone would highlight potential risks and could lead to increased vigilance.
Despite encouraging broader deployment, Juurlink said it wouldn’t make sense to make naloxone as easily found as defibrillators.
“It does cost some money to put naloxone in every McDonald’s and every Burger King and every Tim Hortons,” he said.
“But anywhere in Vancouver’s Downtown East Side, or anywhere there’s lots of drug use, I think you can make a case that naloxone should be available in every nightclub and in restaurants and public washrooms.”
He warned against reading too much into reports suggesting it is possible to inadvertently overdose on fentanyl. The case of a 10-yearold Miami boy who died after mysteriously coming into contact with fentanyl during a trip to his neighbourhood pool is extremely rare, Juurlink said.
And Juurlink cast doubt on an Ohio police officer’s claim that he overdosed on fentanyl after touching it at a crime scene.
“There’s a lot of hysteria about this,” he said. “Getting a bit of fentanyl on your skin and washing it off is not generally going to be a concern.”