Pubdate: Mon, 02 Jun 2014
Source: Vancouver Sun (CN BC)
Copyright: 2014 Postmedia Network Inc.
Contact:  http://www.canada.com/vancouversun/
Details: http://www.mapinc.org/media/477
Author: Denise Ryan
Page: A5
Cited: VANDU: http://www.vandu.org/
Bookmark: http://mapinc.org/topic/naloxone

BACK FROM THE BRINK OF DEATH

Naloxone Is Saving Lives by Quickly Reversing an Opioid Overdose. but 
It Is Not Readily Accessible

Outside the glass doors of VANDU, the Vancouver Area Network of Drug 
Users, a welcoming, if rag tag, band of community members mills on 
the sidewalk, exchanging jocular asides, faces crinkling with warm 
smiles. Anyone who comes through these doors, with few exceptions, is 
going to be treated as family.

The storefront on East Hastings has been part community centre, part 
health resource and part home to drug users in Vancouver since 1998. 
As people bustle in and out the front door, pull chairs into rooms 
for meetings, check in at the front counter and gather in the lobby, 
only a few things make this space look different than any other 
community centre: a bulletin board with a notice for a pot luck, for 
example, also has a notice warning about fentanyl-laced heroin.

Upstairs at VANDU, Lorna Bird settles into a chair and places a small 
blue zip pouch on the table in front of her. In it is a take-home 
overdose kit that contains two ampoules of Naloxone, the drug that 
not so long ago saved her life.

"Last year I did OD," she says. "I guess the dope was really strong 
and I ended up ODing."

She touches a crudely tattooed heart on her arm. "That's where they 
put the needle."

Bird, a heroin addict and former board member at VANDU, had been in 
Victoria for a conference. A chronic user, Bird shoots up at least 
seven times a day. Like many addicts, Bird habitually injected alone, 
increasing her risk of death.

She has her reasons for not using Insite, Vancouver's supervised 
injection site, when she is in the city. On that day in Victoria, she 
got lucky - she wasn't alone.

"I got my rig ready and everything, then I went to do it and next 
thing you know I was just sitting there and it was like I was 
finishing the same sentence I was saying before."

Bird had no idea she had nearly died. Someone else in the room had to 
tell her she had OD'd, and that Naloxone had been used to save her life.

Bird felt fine. The only thing that could convince her was a tiny 
pinprick in her arm at the tip of her tattoo.

She knows how lucky she is. "It scared me. I will not use alone anymore."

She carries her own overdose kit in case it happens again.

"I was really lucky. I had three angels with me that day."

She unzips the small blue fanny pack, ruffles through it to remove a 
small glass ampoule. "I'm very fortunate I had this. Without it, I 
wouldn't be alive."

Take-home program

Naloxone, an opioid "antagonist," quickly and efficiently reverses an 
opioid overdose, and many users at VANDU are participating in a 
take-home Naloxone program that is drawing international attention as 
rates of opiate addiction soar in communities across North America.

Revival from overdose is possible, and lives can be saved. Near death 
one moment, bolt upright the next: it's almost as fantastic as the 
scene in Pulp Fiction, when a woman overdoses and is brought back to 
life with epinephrine administered through one needle-stab to the 
heart. Although Naloxone is not the drug portrayed in that movie, its 
effects are equally dramatic, and the case for increasing its 
availability is compelling.

Naloxone is an almost instant antidote to opioid overdose: it takes 
just one minute to start working. It is easy to administer, is not 
addictive and has no effect on the body if administered incorrectly. 
In B.C. it is available to paramedics and emergency room physicians. 
Through the take-home Naloxone program, an initiative of the Harm 
Reduction program at the BC Centre for Disease Control, the drug has 
also been made available to addicts and other participants since its 
inception in 2012.

Advocates argue that it should also be widely and easily available to 
anyone who may be in contact with someone using opioids - family 
members, mothers, brothers, roommates of users - and be reclassified 
for over-the-counter availability. Because prescription opioids, 
especially when mixed with alcohol, have such high fatality rates, 
some experts believe if there are opioids in the medicine cabinet, 
there should be Naloxone too. (Overdose is the most common cause of 
death among heroin and other opioid users.)

"We are very proud of our program," said Dr. Jane Buxton, head of 
harm reduction at the BCCDC.

In Italy, says Buxton, you can buy the drug over the counter.

"If someone has taken opioids, and has too many on board, and that 
could be heroin, or it could be a prescribed opioid like Fentanyl or 
methadone or morphine, the opioids act on a centre in the brain that 
depresses respiration. Breathing becomes shallow, people can turn 
blue because of lack of oxygen and die. Naloxone actually pushes the 
opioid off those receptors on the brain to restore the breathing."

The drug will be effective for about 30 minutes, after which it wears 
off and another dose might be necessary.

Other opioids, like methadone, are long-acting.

Buxton says for this reason, they advise people to call for an 
ambulance even if the Naloxone appears to have successfully reversed 
an overdose.

Addicts saving addicts

B.C.'s take-home Naloxone program includes an education component, 
including 40 sites throughout the province educating drug users and 
distributing the kits.

Only opiate users can get a prescription for the take-home kit, but 
the program is designed to train people close to the user how to 
administer the drug.

"They're the ones that are going to be using the kit," says Buxton.

Naloxone has been available in Canada for 40 years, but until 2012 
the drug was only available to paramedics and emergency departments. 
But because of stigma and fear, Naloxone may not be saving enough lives.

One of the greatest barriers to access is that opioid users must 
declare themselves to a doctor in order to get Naloxone. Many users, 
particularly young people and teenagers, are reluctant to do so, and 
because the drug can only be prescribed to a user, a parent or friend 
can't get a kit, even if they know a loved one is using.

"Illicit drug users, particularly teens, might be afraid of 
criminalization, or afraid of getting arrested if they called for 
help," said Rob McGirr, a youth addiction counsellor.

However, Buxton says, "If your child is an opiate user, you can go 
with your child and have the training, and they would receive the 
kit. You can hang on to the kit, you can have it at home, you can use 
it on your child."

In 2013, 308 people died of illicit drug overdoses in B.C.

In 2009, 60 per cent of those who died of drug overdoses were 
opioid-related, and an additional 74 deaths were related to legally 
prescribed opioids.

Many of them could have been saved if someone nearby had a Naloxone 
kit. Eighty-five per cent of overdoses happen in the presence of other people.

Among participants in the take-home Naloxone program, often it is 
addicts who are saving addicts.

Laura Shaver is one of the 800 British Columbians who has been 
prescribed a take-home kit, and she has reversed nine overdoses already.

Shaver has been on methadone for 12 years after struggling and 
relapsing on heroin on and off for years.

She calls herself a "functioning drug user."

Shaver has never had Naloxone used on her, but she knows the most 
important thing. "It saves lives."

She is critical of the B.C. health authorities that make the drug so 
difficult to attain.

"If somebody has OD'd, you can't use too much on them; you can't hurt 
them. The only thing Naloxone does is counteract with the opiate," 
she says. "You can't get high from it, you can't die from it but it 
will stop you from dying."

She happened to have the kit while on a camping trip with friends. 
One of them accidentally overdosed on methadone. They were 45 minutes 
from help. "If I hadn't been prescribed the Naloxone or had it with 
me, that man would have died."

Anne McNabb, Director Inner City Mental Health and Addiction Services 
for Vancouver Coastal Health said, "Morally and ethically it would be 
appropriate to have friends, relatives or close companions of someone 
who uses having access and being trained to use Naloxone. It may be a 
question of resource in terms of supplying the drug, or expanding the program."

Shaver wants wider availability. "You have to be an opiate user to be 
prescribed it. You can't just go to a doctor and say, 'Hey, I'm 
around a lot of opiate users and I've been around people that OD, can 
I get some?' No, you can't."

She said VANDU staff members, who want to be able to save lives, have 
been refused kits because they are not active drug users.

"It should be as easy to get as Tylenol or at a walk-in clinic," said 
Shaver. "Using heroin doesn't have a face. It doesn't choose a blond, 
a native, a white person ... it could be your sister, your mother, 
your brother, your son."

The difficulty in accessing Naloxone, Shaver says, is "embarrassing. 
They know how it saves lives."
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MAP posted-by: Jay Bergstrom