Pubdate: Thu, 16 Oct 2014
Source: Globe and Mail (Canada)
Page: S1
Copyright: 2014 The Globe and Mail Company
Contact:  http://www.theglobeandmail.com/
Details: http://www.mapinc.org/media/168
Author: Mark Hume
Bookmark: http://www.mapinc.org/heroin.htm (Heroin)
Bookmark: http://www.mapinc.org/topic/Insite (Insite)
Bookmark: http://www.mapinc.org/find?142 (Supervised Injection Sites)

OVERDOSES UNDERSCORE NEED FOR OUTREACH

A flood of drug overdoses at Vancouver's supervised injection site is
being blamed on fentanyl, a highly dangerous substance that looks like
heroin and which is increasingly being sold on the streets.

The flurry of nearly 40 incidents since Sunday is underscoring for
health officials the need not only for controlled injection sites such
as Insite, but also for outreach programs that can deliver naloxone to
users, wherever they are. Naloxone is a rapidly acting antidote for
opioid drug overdose that users and other volunteers are being trained
to administer in a pilot program run by the BC Centre for Disease
Control (BCCDC).

Officials at first didn't know what was causing the recent overdose
spike, but the Vancouver Police Department said Wednesday Health
Canada lab tests of some samples showed it was fentanyl.

"It is being sold as heroin," Jane Buxton, head of harm reduction at
the BCCDC, said.

"One of the problems with an unregulated drug is that we don't know
what people are using - and they don't know either," she said.
"Sometimes, the white powder people are using may be heroin mixed with
fentanyl or it may be just fentanyl, and fentanyl is about 100 times
stronger than morphine."

Dr. Buxton said even experienced drug users can't easily tell if
heroin has been mixed with other substances.

"You can't tell by looking at it. The standard advice is if you are
going to use, do it in a safe way," she said. "Don't use alone. Use a
small amount to start with just to see the effect. And when you are
with people, make sure somebody has naloxone with them."

Naloxone is a medication that within two to five minutes will counter
the effects of an overdose of an opioid such as heroin, fentanyl,
morphine or oxycodone.

"It seems miraculous because it works so quickly," she said of the
drug.

Long used in hospital emergency rooms, naloxone is increasingly being
used by drug users, their friends and family members and by service
providers trained in the BCCDC pilot project. Similar projects have
been developed in Edmonton and Toronto.

Dr. Buxton said that in the past two years 2,500 people in B.C. -
about half of them drug users - have been trained to administer
naloxone by jabbing a hypodermic needle into someone who has overdosed.

The BCCDC has given out about 1,340 small kits that contain two doses
of the drug.

"And from that we have had reports of 130 overdoses reversed," she
said. "So this is potentially lives saved, potentially brain damage
avoided."

Dr. Buxton said the flurry of drug overdoses this week re-enforces for
her the importance of having Insite, where trained staff can deliver
the antidote to any user in distress, but it also makes it clear more
people need to be trained to use naloxone outside such sites.

Steve Mathias, medical manager of the Inner City Youth Program at St.
Paul's Hospital, says about 30 naloxone kits have been given to young
drug users in the city in the past year.

"We've seen youth helping each other in situations that are actually
quite stunning in terms of the risk to the person who has overdosed,"
said Dr. Mathias. "My information is that one youth has used a kit
over 7 or 8 times [to save others]."

Like Dr. Buxton, he raised concerns about the growing use of
fentanyl.

"We know people are using fentanyl. It's not pharmaceutical grade,
it's almost the crystal-meth version of an opiate. It's short acting,
it's highly potent," he said. "In terms of what happened this weekend,
I don't know that it's a blip on the scale. Certainly we've seen an
emerging trend in the last three to six months, in our youth
population, that the overdoses are on the rise."

Gavin Wilson, a spokesman for Vancouver Coastal Health, said there
have been 36 overdoses at Insite in three days. The clinic usually
averages 10 to 12 overdoses a week, but there were 16 cases on Sunday,
15 Monday and five on Tuesday.

"Even five is still higher than you'd expect to see on a single day,"
said Mr. Wilson.

He said none of the overdoses at Insite has resulted in a fatality.
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MAP posted-by: Richard