Naloxone’s limits laid bare in fight against toxic drugs
Stronger drugs and combinations make reviving users more difficult
Emergency 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.
The 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 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.
“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.
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 prevented because of the measures.
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.
It’s a sad state of affairs. Some of the drugs are so toxic, and drug users are also taking opioids with sedatives like Valium, alcohol or Xanax.