A fledgling harm-reduction initiative in British Columbia is being credited with reducing the toll of opioid overdoses – and could play an important role in responding to an increase in illicit use of the dangerously potent drug fentanyl.
The pilot Take Home Naloxone (THN) program – launched on International Overdose Awareness Day in August, 2012 – provides severe opioid addicts ahead of time with an injectable medication that quickly reverses the effects of an overdose of drugs such as heroin and oxycodone. Without it, the user's breathing could slow or stop, leading to brain damage or death.
Since the program began, the province has received at least 162 reports of overdose reversals, although the actual number is believed to be much higher. According to early figures, about 1,300 people have received the take-home kits and 2,700 people have been trained to administer the drug. B.C. has 62 sites where users who have a prescription from a doctor can pick up the kits.
The kits have a shelf life of two years, cost just under $40 and are paid for through the Provincial Health Services Authority.
Jane Buxton, harm-reduction lead at the B.C. Centre for Disease Control, said she is pleased with the program's success to date. However, she would like it expanded into rural areas – where it can take a long time for an ambulance to respond to an overdose – and be more accessible to people such as drug addicts' partners or family members who are not users themselves.
"Right now, it can only be prescribed to people who use opioids who are at risk of an overdose," she said. "But a family member, friend or loved one can get the training, and although the kit is prescribed in the name of the person at risk, obviously we want to train people who are more likely to be the ones to administer."
Naloxone given in the absence of opioids produces no effect, Dr. Buxton said. In B.C., all ambulance crews can carry and administer it, she added. Police officers and firefighters cannot.
Deaths from accidental overdoses of illicit drugs – this includes non-opioids and medications not prescribed to the user – have slowly climbed in B.C., reaching 279 in 2013.
Meanwhile, deaths involving fentanyl – a dangerously potent synthetic narcotic intended to relieve intense pain but often sold on the street as heroin – have increased at such a rate that B.C.'s provincial health officer, the B.C. Coroners Service and municipal police have issued warnings.
Prescribed fentanyl is up to 100 times more potent than morphine, and many times more potent than heroin. Naloxone is an important tool in preventing fentanyl-related overdose deaths. However, fentanyl overdoses are harder to reverse than those of other opioids and can require significantly more naloxone.
B.C. had 15 fentanyl-related deaths in 2012, 51 in 2013 and 49 up to Aug. 31 in 2014.
Last October, Vancouver's supervised injection site, Insite, recorded nearly 40 fentanyl-related overdoses in just a few days.
Constable Brian Montague, a spokesman for the Vancouver police department, said the department is looking into the possibility of having officers carry naloxone. "There are, however, some hurdles we have to overcome," he said in an e-mail. "Unfortunately, it would be premature to go into details about those hurdles, the discussions we are having or our thoughts and ideas regarding any potential naloxone program here."
In 2005, Edmonton became the first Canadian city to introduce a naloxone program. Toronto launched one in 2011; the rest of Ontario followed suit in 2013.
Darwin Fisher, manager of Insite, said the take-home kits have helped foster a sense of community empowerment among users in the Downtown Eastside. He echoed Dr. Buxton's call for the program's expansion.
"My only hope is that this great program will expand beyond needing to be an opiate user to access it," he said.