Pubdate: Wed, 19 Feb 2014
Source: Hamilton Spectator (CN ON)
Copyright: 2014 The Hamilton Spectator
Author: Sheryl Ubelacker


Addicts Are Packing Naloxone to Help Fellow Drug Users Who Have 'Gone Down'

TORONTO - David Wheeler deftly snaps off the top of a tiny vial of 
naloxone, draws the drug up into a syringe and gives it several sharp 
raps with his fingernail to make sure it contains no air. The next 
step would be to plunge the needle into a drug user who has "gone down."

This is a demonstration, but Wheeler has been through this process 
for real 19 times - six of those for one person - reversing heroin or 
other opiate overdoses in fellow drug users, most of them living in 
his downtown Toronto apartment building.

"They pound on the door. I know right away. I grab the kit and off I 
go," he says. "One time, I had to go three blocks down the street."

The kit Wheeler snatches up is provided by Toronto Public Health as 
part of a harm-reduction program called Preventing Overdose in 
Toronto, or POINT, which trains volunteers on how to administer 
naloxone when a drug user is in danger of dying from taking too big of a hit.

POINT is one of several naloxone programs in Canada, including the 
country's first at the Street Works in Edmonton.

Participants are current or former drug users, who must meet certain 
criteria to join. Since the program began in August 2011, the unit 
has given out about 1,000 kits that have been successfully used in 
120 opioid overdose cases in the city. Only one overdose victim could 
not be saved.

The kit, a zippered hardcover eyeglass case, contains two doses of 
naloxone, two safety needles that automatically retract, packaged 
alcohol wipes and step-bystep directions. The cost to the city is 
less than $30 per kit.

"The process that we train them on is fairly simple - five steps," 
says Shaun Hopkins, manager of Toronto Public Health's needle exchange program.

"Normally, they'll be using with someone, so the person will go down 
right there." Naloxone, also known as Narcan, works by attaching to 
the same central nervous system cell receptors as drugs like heroin, 
morphine and oxycodone latch onto. "It targets the same receptors 
that the opiates would target, so it basically displaces them," 
explains Dr. Rita Shahin, an associate medical officer of health for Toronto.

"It reverses the effect of an opiate," she says. "And it's 
short-acting, so the effect only lasts up to 45 minutes. That's why 
we give a second dose and we also strongly encourage people in the 
training to call 911 and get emergency help."

Naloxone works only to reverse an overdose caused by an opiate - 
there's no antidote yet for taking too much cocaine, a stimulant that 
acts on different brain receptors.

That's a concern, says Hopkins, as crack cocaine is probably the most 
popular drug among Toronto addicts, although there's been a recent 
upsurge in heroin use.

When the maker of the prescription painkiller OxyContin rejigged its 
formulation in 2012 to make a more tamper-proof version called 
OxyNEO, she says many of those who previously crushed the pill for an 
injected high moved to opiates that were more readily available on 
the street, like heroin and another narcotic painkiller, 
hydromorphone (Dilaudid).

"So we really ramped up that naloxone program at that time and did a 
lot of training and reaching out to different agencies to have our 
staff go into their space and dispense the kits to people who used 
opiates there," Hopkins says.

A buddy once did it for Wheeler, now 47, bringing him back from the 
brink of death when he injected too big a dose of morphine, his drug 
of choice for about six years before he went on a methadone program 
18 months ago.

The guy, Wheeler says, knew where he kept his naloxone kit and 
immediately gave him an injection. "You don't have time to think 
about it. You've just got to do what you've got to do - or one more 
person is gone."
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