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Bringing them back from the brink

Nasal spray antidote another tool in combating opioid overdose deaths in Squamish
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After a squirt or two in the nose, the person in the midst of an overdose sits bolt upright, moving from being on the edge of death, to fully alive — in seconds.

Many first responders in B.C., including Squamish RCMP, carry this antidote to an opioid overdose — the Narcan Nasal Spray.

Narcan is a brand name of Naloxone with a different method of delivery — nasal spray versus injection.

The Squamish RCMP tell The Chief they are trained to use and carry the nasal spray version. They carry it not only for themselves, in case there is any contamination, but in case they come across someone overdosing.

Detachments across Canada also carry the spray.

They do not carry the needle version.

Squamish Fire Rescue carries Naloxone in needle form in its first responder kits as does BC Ambulance Service, whose members trained the firefighters.

The Provincial government has passed legislation that allows anyone to administer Naloxone in either form.

Just last week, Canada's chief public health officer, Dr. Theresa Tam, called for the country to "double down" on ways to address the crisis, with more than 9,000 people dying in Canada from January 2018 to June of this year from a toxic drug supply.

The nasal spray is another tool in the arsenal to combat the wave of death from — primarily — fentanyl that is sweeping the nation.

Most have heard of Naloxone administered by needle that can reverse the effects of opioid overdose from heroin, methadone, fentanyl, and morphine, but few have likely heard of the nasal spray form.

While a take-home naloxone needle kit is provided free in B.C. through some pharmacists (at London Drugs in Squamish), Narcan nasal spray isn't freely available.

The nasal spray version has some distinct advantages, though.

 

"Anyone who has overdosed — whether they are breathing or not breathing — this is such an easy thing and simple thing. There is no needle involved. It is just up the nose, and a squirt," said Craig Plain, pharmacy manager at Clinical Pharmacy in the Pier health Resource Centre in Vancouver's Downtown Eastside.

His pharmacy was the first in the province to distribute free naloxone kits and training. In part for his work combating opioid deaths, he was named the Canadian Pharmacist of 2017.

Narcan takes about one minute to work, he said.

The opioids are so strong that he uses two doses to the nose, he said.

"Fentanyl is so strong and so powerful," he explained.

The tricky thing is that the antidote wears off quickly, so the person being treated also needs medical attention. Call 911 if an overdose is suspected.

Bringing someone back from an overdose is an incredible thing to see, said Plain.

 "Most of mine have been at least breathing a little bit... When you stop breathing, oxygen levels start to go down, and you start to go blue. People turn blue — is quite shocking," he said. "You give the dose, and it is wild. Within about 30 seconds... from a laying position, they just sit straight up. Their eyes are wide open."

People brought back from an OD are often confused and can be violent as they go into a bit of withdrawal, but Plain said most of the people he has brought back have been discombobulated, but thankful.

Plain said on the Downtown Eastside, while overdoses are still very common, dying from them seems to be decreasing, thanks to education and the availability of antidotes like Naloxone and Narcan.

"Harm reduction and educating on how to use safely," he said, have reduced death rates there.

There is a network of people helping each other and aware in the city, whereas people outside the core are not as tuned in, perhaps, he said.

"It is happening to people who are working; it is happening to people with children — it may be their children's friends coming into the home and finding opioids in the house and taking them — there are so many other scenarios now."

Plain said more supervised consumption sites in communities around B.C. — not just in Vancouver — might be the way out of the opioid death epidemic.

"It works," he said, noting that he has seen heavy substance users become stabilized on a supervised dose, who then turn away from crime to get money for drugs and live more healthy lives thanks to such sites. "Better access to these drugs... in controlled settings, prescribed by physicians and administered by nurses and pharmacists. To me, it is such a simple solution."

In September — the month the most recent death data is available — 128 people died from an overdose across B.C., including 37 people in the Vancouver Coastal Health region, which includes Squamish, according to the BC Coroners Service.

In October, 587 overdoses were seen at nine VCH emergency rooms.

For more information on overdose and harm reduction, to go www.vch.ca/public-health/harm-reduction/overdose-prevention-response/drug-checking.

For more information on how to obtain the Health Canada-approved Narcan Nasal Spray, contact the manufacturer at adaptcanada@customer-support.ca or 1-877-870-2726.

 

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