City lagging on overdose prevention kit implementation

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Dr. Norm Buckley on opioid addiction 35:22

A lifesaving kit that prevents heroin and oxycodone overdoses will soon be rolled out in Hamilton, the city's public health department says.

But the kits are coming months later than expected, in a less efficient method than is being used in the U.S. and they won't be as widely available as some addiction experts say is necessary to save lives.

These overdose prevention kits contain a drug called Naloxone — an opioid antagonist first developed in the 1960s. When injected into a person who is overdosing, it can reverse the effects of prescription opiates like oxycodone, fentanyl and percocet for about 10 minutes, which is long enough to get them to hospital.

With opioid abuse and addictions increasing in Hamilton, distribution of overdose prevention kits was flagged as a "high priority" of the Ministry of Health and Long Term Care in a report to the city's board of health from October. That same report states distribution of these kits was expected to begin in Hamilton in the fall of 2013 — but almost five months into 2014, the city doesn't have a firm answer as to when the program will be launched.

"It has taken us until now to get the program in place," said Dr. Julie Emili, associate medical officer of health. "We ended up getting a bit distracted by measles." Public health announced a Hamilton woman had been infected with measles in late March.

Emili could not give a specific date when the program would be launched, but said it should be implemented in the "next couple of months."

But getting Naloxone to the people who need it most needs to happen soon, says Dr. Norm Buckley, director of Hamilton Health Science's pain clinics. "It could almost certainly save lives," he said.

Doctor Norm Buckley is the professor and chair of the Department of Anaesthesia at McMaster's DeGroote School of Medicine. (Adam Carter/CBC)

Buckley is spearheading a task force of health officials working together to fight a growing prescription painkiller problem in Hamilton. He wants to see the kits distributed as widely as possible, a position that puts it in conflict with the tight distribution controls being imposed by the province on the city.

Buckley's task force is searching for answers in the face of some disturbing statistics: according to the Drug and Alcohol Treatment Information System, admission rates for local opioid withdrawal programs are now the second highest in the province, behind only northern Ontario.

As well, opiate deaths make up over half of all acute drug-related deaths in the city, according to the coroner's office.

Naloxone is front and centre in the group's "template for action," which was finalized earlier this month. Buckley says getting it into the hands of more first responders and health officials is essential to curbing unnecessary deaths.

Some first responders in Hamilton already have access to Naloxone. There are about 50 advanced life skills paramedics who are trained to administer the drug out of the 300 or so paramedics in the city, EMS Manager Carmen D'Angelo says. Doctors in the city can also prescribe the drug to their own patients.

Police officials told CBC Hamilton there aren't any ongoing plans to get overdose prevention kits into the hands of frontline officers.

U.S. version not available in Canada

That's a marked difference from the approach being taken in some U.S. cities. Earlier this month, U.S. regulators approved an auto-injector version of the device to treat painkiller overdoses, in a move to combat the rise of opioid-related deaths and abuse of the painkillers.

According to the New York Times, the attorney general's office is pushing for a kit that includes Naloxone and training to use it that would be given to every state and local police officer in New York. A nasal inhaler version also exists.

An auto-injector version of Naloxone would be useful in Canada too, Emili says. Instead of the drug coming in a standard syringe like most other injections, it would be packaged like an Epipen is for people with allergies. "It would be easier to train people and administer it," she said.

An auto-injector version of the drug isn't currently available in Canada. Health Canada officials would not say if one is coming, citing "confidential business information."

Buckley says an auto-injector version would be much easier for addicts and patients to use — but not all first responders say it would be for them. D'Angelo says paramedics wouldn't want it because they need to be careful and give very small, measured doses of Naloxone to people who are overdosing. If a paramedic gives a full dose to someone who is unconscious, then they'll wake up — and they usually wake up angry. "Oftentimes, they get angry that you took away their buzz," D'Angelo said.

Instead, paramedics use small doses and keep the person's airway open long enough to get them to hospital, where they're given a full dose. "For people without training [an auto-injector version] would be useful," he said. "But not for paramedics. You want to control the dose."

Funded by tax dollars

The municipality and the province fund naloxone for paramedics equally, while funding for public health's overdose prevention kit program comes solely from the province. "This was approved at the board of health in the context of not only helping individuals with addictions but also those in the community who are dealing with the consequences of it," Emili said. Oftentimes programs like this one and needle exchanges are met with some public outcry, but "we hope that the community would support our efforts in decreasing overdoses in Hamilton," Emili said.

Part of the city's deal with the ministry includes a tight distribution method. "The agreement with the ministry is we can't distribute it to others," Emili said. "The ministry does limit us to being the ones doing it."

That means the kits will only be provided at clinic sites to be administered by public health nurses, not distributed widely to the public. That gives people with addictions two options to get Naloxone: either get a prescription from a doctor (which costs money) or obtain one for free from a public health nurse (which isn't terribly efficient when the person next to you has stopped breathing).

Buckley's group is calling for a wider distribution net than that. He admits that free flowing Naloxone would no doubt end up trafficked among addicts as a kind of safeguard to abusing opiates — but he says that beats the alternative.

"If the goal is to keep people from dying, that's not unreasonable."

Should the city be providing overdose prevention kits to people at risk of overdosing on opiates?

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