Following a rash of fentanyl overdoses in southern Alberta, the provincial government has announced plans to spend $300,000 on a province-wide program combatting the potentially deadly affects of the popular street drug.
When the funding is approved, the program will be administered in the region by HIV West Yellowhead, which serves Jasper, Hinton, Edson and Whitecourt, as well as their surrounding communities.
Through the program, the organization will help opioid drug users obtain a prescription for naloxone—a medication that can counteract an opioid overdose—and teach them how to both identify an overdose and treat it using the medication and assisted breathing.
Opioid refers to a large family of painkillers—some prescription, some not—including, fentanyl, heroine, dilaudid, morphine, oxycodone and Tylenol 3 with codeine.
The new program will fund the purchase of thousands of naloxone kits that will be distributed through harm prevention organizations across the province.
Each kit includes two doses of naloxone, syringes, alcohol swabs and a CPR mask, as well as instructions.
To receive one, opioid drug users must first obtain a prescription from a doctor or pharmacist.
HIV West Yellowhead’s support and outreach worker in Edson, Sarah McNicoll, will assist people in getting their prescriptions, as well as dispense the kits and instruct people on how to use them. McNicoll is able to fulfill that role because she is a licensed practical nurse.
During an overdose prevention training session, May 14, she said she already has clients in mind that would benefit from the kits.
“I think of where I was yesterday, they were both opioid users and they’re in the middle of nowhere, so an ambulance couldn’t get there in time to save them. So those are two perfect people for this,” she said.
Fentanyl overdoses have increased dramatically in the province over the past few years.
In 2011, there were just six, compared to 120 in 2014.
“The numbers are huge,” said Mat Wong, a registered nurse with Edmonton’s Street Works. “Just for the first two months of this year, we have 50 fentanyl overdose stats already, so it’s a huge issue, but it’s very hidden.”
Until the provincial government’s recent funding announcement, Street Works was the only harm reduction agency in Alberta with a naloxone program. It launched in 2005, training 300 users over the past decade. Of those, 30 have returned to say they’ve successfully used the kit to prevent an overdose.
This spring, the provincial government was compelled to take action to address fentanyl overdoses after 16 people lost their lives to the drug on the Blood reserve outside of Lethbridge.
The reason for these deaths, said Wong, isn’t because people are purposefully taking too much fentanyl, but rather because the fentanyl being sold on the streets is often tampered with or passed off as the less potent painkiller oxycodone.
“We sadly have this societal belief that it’s sort of your fault if you use drugs,” said Wong. “[The mindset is] ‘you chose to use those drugs and then you died from it, so it’s kind of on you.’
“But we never apply that logic to any other risky things, like driving a car. It’s inherently risky to drive a car, but when someone dies from driving a car, we don’t blame them for it—we mourn them.”
Wong has been working with Street Works for three years, and has been tasked with travelling to communities in the province to teach harm reduction workers about the naloxone program.
While in Jasper last week, he taught HIV West Yellowhead’s staff how to detect an opioid overdose, as well as how to prevent it using naloxone and assisted breathing.
McNicoll will be tasked with passing that knowledge along to any opioid users in the region who are interested in obtaining their own naloxone kits.
“Pretty much the universal statistic is for every 10 people you hand a kit to one to two of them will come back and let you know that, ‘yeah, I used the kit and reversed someone’s overdose,’” said Wong, noting that the training can take as little as 10 minutes and has the potential to save lives.
An opioid overdose causes a person to stop breathing.
“So,” explained Wong, “when someone is overdosing on opioids their heart is still pumping, but what kills them is not getting any oxygen in their body because they’re not breathing anymore.”
To counteract that response, Wong taught the group to follow a method dubbed SAVE ME. Like an acrostic poem, each letter in SAVE ME represents a step in the recovery process.
The first step is “stimulation”—the application of negative stimuli to elicit a response.
“If the person does not respond to painful stimuli then that person is in an opioid overdose,” said Wong. To test that, he suggested rubbing your knuckles over the person’s chest or over their upper lip.
“What you want is any reaction,” he said, noting that if the person flinches or vocalizes they haven’t overdosed. “If they’re not reacting, immediately call 911.”
The next step is “airway”—tilting the person’s head back and lifting their chin, then checking for signs of breathing. If they aren’t breathing, that leads to the third step: “ventilate.”
Using the CPR mask in the naloxone kit, seal your mouth over theirs and gently provide one breath every five seconds while pinching their nose.
After helping the person breath, it’s time to “evaluate”—looking at the situation to determine if anything has changed: has the person’s lips regained their normal pink colour or have they woken up?
“If they’re still not up then it’s time to move onto the muscular injections,” the “M” in ME.
Naloxone injections are given in the shoulder muscle or thigh and rescue breathing is continued throughout the entire process.
“Naloxone is the antidote to opioid overdose,” said Wong. “It is honestly a magical drug in that it really has no harmful effects.
“Unless you have opioids in your system, it does absolutely nothing to you.”
After the injection, people tend to wake up within five minutes, although in some cases they will remain unconscious and require a second dose.
“The dose we give is a fraction of the amount they might give you in the hospital, so if you ended up in the hospital, they’d pump you full of a lot more naloxone.
“With the dose that’s given in the kits right now, it’s ideally to wake someone up more gradually, not a sort of Pulp Fiction thing where you wake up screaming, it’s more of a gradual one-minute to five-minute getting up.”
Reflecting on the training, Karly Savoy, HIV West Yellowhead’s acting executive director, said she’s glad to be able to offer the program and to have McNicoll as a resource for people in the region.
“To go through overdose prevention—recognizing signs and things to think about—is valuable for anybody who lives in a community of people who are using,” she said. “And we’ll have that service available to all the communities that we work in.”
To learn more about HIV West Yellowhead and the services it provides, visit www.hivwestyellowhead.com.
Nicole Veerman
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