Naloxone, safe injection sites could curb overdoses in Quebec

An antidote to opiate overdose exists and is successfully being used to save lives in a number of North American cities, including Vancouver, Toronto and Edmonton.

Read Part I: Rash of fatal overdoses in Montreal could be linked to fentanyl

However, the drugnaloxoneis not approved by Quebecs prescription drug plan. Currently, it is only available in hospital emergency roomsin Quebec. According toUrgences-Sant, only a small handful of specialized paramedics have been trained to use it.

Unfortunately, in the time it takes for a person who is overdosing to get to a hospital, they could very easily die.

Naloxonehas no negative side effects if accidentally administered to a person who was not really overdosing from opiate consumption. However, the positive effects of the antidote are usually short-lived; people who really have overdosed still need to seek urgent medical attention because they can re-overdose after a time delay of between 30 to 60 minutes.

When people stop breathing, physiologically, its only a few minutes after that the heart stops so theres not a lot of time, and sometimes that few minutes delay is insufficient for an ambulance to go to the bedside and administer the antidote, saidMUHCtoxicologist Dr. SophieGosselin.

In some parts of the world,naloxoneis available as an auto-injector, similar to anEpiPen.

It has shown to save lives,Gosselinsaid. It would be a great public health gesture to have these auto-injectors available.

Nasal spray to come in2015 at earliest

Dr. Marie-ve Goyeris an HIV and addiction specialist. Shesaid its a shame more paramedics and other first responders dont yet have the training required to administer naloxone.

Its very effective. Rapidly, in a couple of minutes, the person is moving from not breathing to being on his feet. Thats something we should have in the community, not just in the hospitals, Goyer said.

A naloxone nasal spray is currently being developed by British pharmaceutical company Reckitt Benckiser. Goyer said Health Canada has told people working in the public health sector that this form of the drug wont even be available until 2015.

She said the Quebec health ministry has taken note of the rise in opiate overdoses in Montreal, and hopes the department will be able to put pressure on Health Canada to make injectable naloxone available in the interim while waiting for the nasal spray.

Pharmacist Flice Saulnier said it would be relatively easy to teach injection drug users how to administer an injectable form of naloxone. Ideally, friends and family members around injection drug users could be taught how to use it as well, in case the users are unable to administer it themselves.

Federal government needs to move on supervised injection sites

The final piece to the harm reduction puzzle in Montreal is, of course, the four supervised injection sites the city was promised in late 2013.

• Montreal to get 4 supervised injection sites

The multi-site model, Goyer said, is to respond to how spread out drug users are in Montreal compared to a city like Vancouver, where most drug users are concentrated in the Downtown Eastside neighbourhood.

With drug overuse, we cant just say, "We dont want, we dont have."- FliceSaulnier, pharmacist

In Montreal, we are ready. We did all our protocols, all our medication, everything is ready. The training that everybody will need, how were going to share the job between social workers, between doctors, nurses, etc., everything is written. But it was sent to the federal agency and now were waiting for an answer, and thats whats taking so long, Goyer said.

If Montreal gets the federal legal exemption its waiting for, it would become the first city in Canada to have supervised injection sites that did not begin as part of a research project.

However, in order to move forward, the government would need to exempt staff and users from the federal law on drugs and other substances. The government denied this exemption to Vancouvers Insite program several years ago, but lost when the Supreme Court ruled in Insites favour.

Saulnier said having supervised injection sites is crucial in helping to save lives and improve the safety conditions in which people consume drugs.

With drug overuse, we cant just say, We dont want, we dont have. Its not the way to treat. We have methadone, we have suboxone, but its the not the right treatment for everyone, Saulnier said.

A supervised injection site can be a really good way to have another way to take care of patients that need help, she said.