Opioids are part of a family of addictive drugs originally prescribed to relieve pain. Oxycodone, morphine, hydromorphone, fentanyl, codeine and methadone are legal opioids that are highly addictive. These medications are relatively safe when taken as prescribed, but become toxic when taken in large amounts or in combination with alcohol or sedatives. Over-prescribing these pain medications set the stage for the opioid epidemic in Canada.
According to the 2014 United Nations World drug report, Canada has the second-highest per capita consumption of prescription opioids in the world. Only the United States ranks higher. In 2011, opioid consumption for medical purposes in morphine equivalence (ME) was 62 mg per person globally. Canada’s ME was 812mg per person.
In 2013, the Centre for Addiction and Mental Health reported that opioids were the third-most common drug used by students in Ontario after alcohol and marijuana. Often the drugs were obtained from family or friends who had legitimate prescriptions.
Illegal opioids including heroin, recreational fentanyl and carfentanil are readily and cheaply available on the streets. Problems arise when the purity and strength of these drugs is unknown.
Opioid overdose is a medical emergency. Signs of an overdose include slow or weak breathing, dizziness, confusion, inability to wake, cold and clammy skin, very small pupils, blue tinged lips or fingertips, collapse and coma.
To prevent opioid overdose deaths the City of Hamilton encourages everyone to become familiar with the 4 C’s of safety:
1. Careful use: don’t use alone, go slow by testing the effect with small amounts first.
2. Carry naloxone. Get a FREE naloxone kit and training to use it.
3. Call 9-1-1 for every overdose.
4. CPR - Push hard, push fast because breathing is severely depressed.
Naloxone is a safe, highly effective medication that reverses the effects of opioids including the new narcotic, "Takeover." Crack laced with fentanyl makes this drug cocktail so strong multiple doses of naloxone are needed.
Naloxone is saving lives, but it’s important to know that it’s only a temporary antidote. The beneficial effects of naloxone last anywhere from 30 minutes to one hour. It buys precious time while waiting for medical help to arrive. In some cases a second dose of naloxone may be needed if the user show overdose symptoms again before medial help has arrived.
Hamilton Public Health Services (HPHS) has been offering take-home naloxone kits to opioid users and former users at risk of relapse through the Harm Reduction Program since May 2014. Friends and family are also able to get these kits. Nasal spray naloxone kits containing two doses have been available since January 2017.
According to Rosemarie Maver, Manager of the Mental Health and Harm Reduction Program, "Generally, whenever staff interact with clients for harm reduction supplies, it is an opportunity to offer a kit if the person is at risk of overdose."
HPHS staff currently provide naloxone training and kits to persons at high risk of opioid overdose through:
- City of Hamilton Public Health Services Harm Reduction Program: 905-546-4276
- Participating local pharmacies by calling the Drug and Alcohol Helpline: 1-800-565-8603
- Van program staff while getting needle supplies
- The Street Health Clinic at Wesley
- The Public Health Nurse at Urban Core Community Health Centre
- Approved staff at The AIDS Network
- Sexual Health clinics
- Home visits
- The Hepatitis C team
- Group training held onsite at locations like methadone clinics
- Hamilton Wentworth Detention Centre upon transfer or release
Overdose deaths from medical and non-medical drug use are now the third leading cause of accidental deaths in Ontario. A substantial number of these deaths involves opioid use.
Naloxone has helped reduce opioid-related deaths. Maver notes, "Clients recognize how important having a kit and training is to their safety with a lot of unknowns with street drugs. Clients appreciate getting a kit and the training. Some have used it multiple times to rescue a friend."
Between January 10 and March 19, 2017, Hamilton Paramedic Services (HPS) responded to 72 emergency calls related to opioid overdoses. Men accounted for 75 per cent of these cases.
The average age of clients was 36 years, but those most affected by opioid use fall into the age range spanning 25 to 44 years.
In 2015 there were 199 emergency department visits and 89 hospitalizations for opioid misuse. However, across all age groups from 15 to 65 plus years, Hamilton rates are consistently higher than provincial rates. Most notably, emergency department visits for opioid poisoning is more than double the provincial average for those 15 to 24 years of age and close to two and a half times greater for individuals 25 to 44 years of age.
During 2016 a total of 460 naloxone kits were distributed by HPHS and 190 lives saved. Acceptance of naloxone kits increased in 2017 when nasal sprays replaced injection kits. From January to March 2017, 365 naloxone kits were distributed by HPHS. At least 69 people were revived during that time using the kits.
Preliminary numbers from the Office of the Chief Coroner indicate that 37 Hamilton residents died from opioid toxicity in 2015. An additional 10 residents died due to toxicity from mixing opioids and alcohol. This is the highest number of deaths in 11 years of data collection.
Hamilton has developed a Comprehensive Approach to Drug and Substance Misuse (CADSM) integrating prevention, harm reduction, treatment, and enforcement. By acknowledging people use drugs, the plan focuses efforts on interventions to decrease negative health impacts while ensuring the safety of individuals, families and the community.
This holistic approach means the city is considering establishing a nurse-staffed safe injection site. The needs assessment and feasibility study to be completed by the end of 2017 will have input from a community advisory committee which may include drug users, their family members, representatives from business and neighbourhood groups, as well as Ward 2 Councillor Jason Farr and Ward 3 Councillor Matthew Green.
The next steps to move ahead with the admirable project will require support from Hamilton City Council. And, that may be the biggest challenge.
Hamilton is doing its best to address the many facets of the opioid crisis. Naloxone kits are readily available to users, their family and friends. First responders including paramedics and firefighters are issued kits. There is reason to hope that the City will approve a safe injection site. That's what makes the stance the police department is taking so puzzling. Police Chief Eric Girt claims he’s 100 per cent on board with the City's harm reduction strategy, yet his actions undermine his words.
The Ontario Association of Chiefs of Police requested provincial funding to cover the cost of providing officers with naloxone kits, but Girt has made it clear that his officers will not be carrying the life-saving antidote.
Girts arguments against providing kits range from not wanting officers to be responsible for naloxone distribution, to having officers focus their efforts solely on law enforcement and the pursuit of those distributing illegal substances. In the case of an overdose, Girt views life-saving as the exclusive domain of paramedics.
Girt also has concerns that officers may wrongfully administer naloxone to an individual with a medical condition mimicking overdose symptoms and that could leave the department open to law suits.
Officers would actually be better served by carrying kits for their own protection as well as for use as first responders in overdose situations. Perhaps naloxone kits should become standard issue under a section of the Workplace Safety and Insurance Act.
As for the argument surrounding liability in the case of naloxone being administered when not required, even Girt has admitted this antidote doesn't have adverse effects. One would hope that officers would at the very least fall under the protection offered by the Principles of the Good Samaritan laws and principles that protect those offering help and first aid.
A realistic solution for the opioid crisis may never be found. To its credit, The City of Hamilton has undertaken an integrated approach to help those chemically dependent on opioids. City Council could take that one step further by approving a nurse-staffed safe injection site in a timely manner.
By empathetically caring for all community members, Hamilton really could live up to its vision of being the best place to raise a child and age successfully.
This article originally appeared in ‘Reefer Madness,’ the April 2017 edition of The Anvil (Vol. 2: 1 of 4). Hamilton’s free topical publication can be found in local coffee shops and art galleries.
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