Pubdate: Fri, 28 Apr 2017
Source: Kingston Whig-Standard (CN ON)
Copyright: 2017 Sun Media
Author: Steph Crosier
Page: A1


Naloxone kits are flying off the shelves at local pharmacies and the
Street Health Centre, as fentanyl continues its disastrous wave across
eastern Ontario.

Dr. Meredith Mackenzie, a physician at the centre, said on Wednesday
that its clients are listening to their advice and reading news
reports and are making an effort to curb their use, but it's not working.

"People are much more aware of the drug contamination problem,"
Mackenzie said. "That means people are using more safely, they're
using less, but they are still overdosing, even though they have a big
tolerance. We're seeing people with high-opioid tolerance overdosing
on smaller amounts of drugs."

Fentanyl is 50 to 100 times stronger than morphine, says the Kingston,
Frontenac and Lennox and Addington Public Health website. It can be
cut into any drug but is most commonly found in crystal
methamphetamine, morphine, cocaine, crack and marijuana or pressed
into speed or ecstasy tablets.

At the Street Health Centre, Mackenzie said fentanyl is mostly showing
up in urine tests of those who thought they were using heroin.

"[Fentanyl] is a universal contaminant," Mackenzie said. "It's mostly
heroin, but the riskier piece is when it's found in something that's
not an opioid. That's the biggest risk because that would typically be
a person who doesn't have any tolerance to opioid and is at really
high risk of overdosing."

Naloxone is an opioid antagonist, and its injections, or the
five-times-stronger Narcan nasal spray, put an individual who has
overdosed into almost instant withdrawal. It only lasts a short
period, but usually enough time to get a person to the hospital. All
Frontenac Paramedic Services crews carry naloxone kits. Kingston Fire
and Rescue crews do not, but were willing to work with their community
partners to see if it is worth also carrying kits.

Kingston Police Deputy Chief Antje McNeely told the WhigStandard on
Thursday that the force is taking a measured approach. After
consulting with a workplace safety specialist, local emergency
services partners and KFL&A Public Health, Kingston Police's main
concern is the safety of their officers. "We do have Narcan
[naloxone], but it's going to be available to the specialty units such
as the drug unit and the emergency response unit," McNeely said. "Our
frontline supervisors will have it available so that if it's required,
they'll have access to it.

"But we're really focusing on the prevention end of things. So, of
course, that would be personal protective equipment that would be on
hand for officers to utilize. Those are things such as double gloving,
in terms of the nitrile gloves, and having available an N95 mask,
approved safety glasses, first aid kits, that kind of thing."

Mackenzie said that in the past eight weeks there have been 16
overdoses reported and 23 people picked up naloxone refills. During
that same time frame, Mackenzie said the centre has given out 135
kits. Compare that to London, Ont., a population more than twice the
size of Kingston, where local organizations have distributed only 71
kits for all of 2017 so far.

"I'm not surprised by the number of kits that we're handing out, and
the overdoses that are occurring," Mackenzie said. "It's an opioid
crisis. … It's really an emergency."

Despite the number of individuals coming in for naloxone kits,
Mackenzie knows the Street Health Centre isn't hearing about all of
the overdoses. Numbers from Frontenac Paramedic Services supports
that. Marco Smits, communications officer for the service, says that
in 2016 paramedics responded to 270 overdoses and administered Narcan
nasal spray 22 times. So far in 2017, they've responded to 125
overdoses, using Narcan 15 times. Smits said the numbers are for all
overdoses, not just from opioids, and they don't include any cardiac
arrests that may have been caused by an overdose.

McNeely said if police officers arrive at an overdose before
paramedics do, officers would assess the situation, relay any
information to paramedics and request their expected time of arrival.

"We would make some decisions at that point in time whether we call
for a supervisor to attend the scene. They would have the appropriate
Narcan there," McNeely said. "So it'd be in consultation with the
supervisor and with the paramedics that are en route."

Last week was particularly dangerous in the nation's capital, writes
the Ottawa Citizen. Over the weekend, The Ottawa Hospital reported
emergency staff dealt with six overdose cases during a 24-hour period
on Saturday, and paramedics there responded to another on Sunday. In
the three days prior, there were 15 potentially life-threatening
overdose-related emergency room visits. No deaths have been reported.

"This is certainly a concerning event for the community at large,"
McNeely said. "I think the best thing is that we work together in
this, and that's what we're doing. The paramedics are the first
responders to any kind of medical emergency and any way we can help,
we're there to assist. That's by communicating with them, and if we
can get extra resources there we'll do that as well."

Signs of an overdose can include slow breathing, blue lips and nails,
choking or gurgling noises, or cold and clammy skin.

A list of locations naloxone can be picked up is on the Ontario
government's website:

Mackenzie recommends calling the pharmacy ahead of time as clients
have reported arriving and the pharmacy has run out.
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