Pubdate: Sat, 22 Oct 2016
Source: Victoria Times-Colonist (CN BC)
Copyright: 2016 Times Colonist
Contact:  http://www.timescolonist.com/
Details: http://www.mapinc.org/media/481
Author: Sarah Petrescu
Page: A1

A GROWING ARMY LEARNS HOW TO HANDLE OVERDOSE CASES

Much of Heather Hobbs's job as a harm reduction co-ordinator involves
showing people how to inject the opioid inhibitor naloxone to reverse
the effects of drug overdoses.

This year alone she has trained nearly 800 people - illicit-drug users
and their parents, shelter staff and support workers - to administer
naloxone and has given out 843 kits.

At least 555 people have died from drug overdoses in B.C. so far this
year. Many of the deaths involve the powerful, cheap opioid fentanyl.
The situation led to a public health crisis being declared in April.
While the death toll has gone down slightly thanks to wider
distribution of naloxone, overdoses are still happening at alarming
rates.

"So what does an overdose look like?" Hobbs asked the half-dozen staff
at Together Against Poverty Society, who help some of the poorest
people in the city with everything from housing to social-assistance
issues.

"They might look blue or grey around their lips, ears and fingernails
from the lack of oxygen," said Hobbs. "People will look dead."

She explained how to stimulate a response by rubbing knuckles on the
sternum or pinching the fingernail beds. If there's nothing, call 911.

She showed how to administer naloxone, breaking a glass vial, loading
a syringe and, using a sponge to demonstrate, stabbing with enough
force to pierce a pair of jeans and a muscle.

"Keep giving injections until you run out or the person wakes up," she
said, adding it takes only a few minutes without oxygen to cause brain
damage and death.

"It's very stressful," Hobbs said later at her AIDS Vancouver Island
office. Since January, her staff has saved more than 40 people. One
staff member crushed a glass vial of naloxone in her hand trying to
save someone.

Kitchen timers beep every five minutes to remind staff to check the
drop-in centre's washrooms, in case someone has gone there to take
drugs and has overdosed.

While no one has died at AIDS Vancouver Island, a client died in Odeon
Alley outside after being turned away when the drop-in centre was
closed briefly to deal with an overdose.

Taylor Teal, a staff member at AIDS Vancouver Island, described an
overdose in a washroom where a young man was revived and taken out to
wait for paramedics.

"I went back to the bathroom to collect his belongings and heard this
ringing. He dropped his phone in the sink and when I looked, the
caller ID showed 'Mom, " she said, choking up. "He was somebody's kid.
If he hadn't overdosed in our bathroom, he might be dead."

It's not only workers at AIDS Vancouver Island who are affected. Staff
at nearly every social-service agency are getting naloxone training,
along with many clients. Police, firefighters and paramedics are
equipped with the nasal spray and injection antidote. They are being
called to twice as many overdoses at social agencies, many of them in
washrooms, according to a recent study from the University of
Victoria's Centre for Addictions Research of B.C.

In August, Our Place communications director Grant McKenzie found a
man in his 50s who overdosed and died in a washroom. McKenzie said the
man was a well-liked regular at the shelter and he had no idea he used
drugs. Hobbs said many service providers are operating as de facto
safe-consumption sites, but without appropriate space and supports.
"We would very much like to run these services with the right
supports," said Hobbs, adding they have approached Island Health with
the idea. The health authority is working on an application for
federal exemption to open safe-consumption sites in the city - but it
could be months or years before one opens.

Before dawn, volunteers from the Society of Living Illicit Drug Users
scour downtown streets for used needles and drug supplies, and provide
clean needles.

"I give out way more needles than I pick up. People are more
responsible [with discarding them] than they get credit for," said
Jack Phillips, 46, a former user.

 From July to September, the organization gave out a monthly average of
11,590 clean needles. They collected 5,037 used ones themselves and
had another 5,993 returned in safe boxes.

In a search for discarded needles, Phillips walked down side streets
to areas users hang out - a tucked-away platform or stairwell. Within
a block he picked up half a dozen syringes and a yellow biohazard
bucket of used needles.

"See, there's an etiquette. People will make an effort to keep this
stuff off the street," he said. It has been about four years since he
used. He lives on a disability pension and is a busy dad. Volunteering
is what he can do to give back.

"It feels useful to be out here. To be doing something, not just
talking about it behind the bureaucracy," he said.

Pandora Avenue is a hub for users and dealers, with Our Place and the
social assistance office on one block. Various empty lots double as
camp sites; hidden Kitchen timers beep every five minutes to remind
AIDS Vancouver Island staff to check washrooms for overdoses.
stairways are places where people can inject themselves without much
notice.

Phillips stood in front of a man passed out on the ground,
chin-to-chest, and then moved on.

"I was counting his breaths," he said. One of the signs of a fentanyl
overdose is slowed breathing, which leads to respiratory shutdown. All
volunteers for the Society of Living Illicit Drug Users are trained to
use naloxone, also known by the brand name Narcan.

He said fentanyl was not nearly as available when he used drugs,
although he did inadvertently try it once.

"Dealers now buff up their drugs, make it more potent," he said. For
users, the appeal is cost saving. One fentanyl-boosted hit can cut the
cost of heroin in half.

"What's in the drugs. That's the scary thing these days. It could be
anything," he said.

He approached a couple cuddled under a tree between a grocery store
and new condo development. They gave him some used gear and asked for
30 needles and a crack pipe.

"That's how it should be. Friendly, ask how they're doing," Phillips
said, recording each interaction on paper.

He stopped at Our Place to check in with regulars and grab
coffee.

Wolf Madge, outreach supervisor for Society of Living Illicit Drug
Users, was there. He said the prevalence of fentanyl and overdosing is
hard on drug users, outreach workers and everyone around them.

"I've Narcanned three people, two in my own building," he said.
Several users live in and frequent his building. When he received the
naloxone training, he put a sign on his apartment door that reads:
"Need Help? I have Narcan."

"It's very stressful. But nobody seems to care. Nobody wants to do
anything, just sweep the problem under the rug."
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MAP posted-by: Matt