Ask the Pharmacist

Q: I am worried about a friend of mine and his potential to overdose. What can you tell me about naloxone?

A: With just about every national news source quoting the epidemic of overdoses occurring all over Canada, it is high time we discussed a simple intervention that could well save a life. The statistics are simply shocking and are causing the medical community and our various levels of government to rethink health care policy and practices.

In 2016, illicit drug overdoses claimed 914 people in British Columbia, alone, and the numbers for 2017 look as if they may very well be even worse. People are unknowingly consuming extremely-potent narcotics, such as fentanyl and carfentanil, when they take other drugs, such as oxycodone, ecstasy, heroin, MDMA and cocaine.

These “other” drugs, while not endorsed as either safe or smart choices to begin with, have nowhere near the same potential to kill you as fentanyl and carfentanil do. And before you write this off as a “junkie” problem only, a medical office out of Vancouver has stated that many of the overdose victims are not the hard-core addicts but recreational drug users holding down careers who neither look like, nor live, the lifestyle of the stereotype we associate with this sort of activity.

Unfortunately, many of the actions we have taken as a society, so far, seem to be more for show than any real solution. As an example, at the pharmacy level, identification from the individual picking up the prescription is required for any narcotic or controlled drug. Another is that the government has stopped covering the higher strengths of some narcotics in the hope of reducing their intake.

Any impact that measures such as these have had, has so far eluded our detection as the response we see is people simply taking more of the lower-strength pills or having to go home to grab their driver’s licence.

However, one effective reaction has been the change in status of the opioid antagonist naloxone by Health Canada, making it more accessible to the public for use in emergency situations.

In Ontario, pharmacies and community organizations can give you a free kit of injectable naloxone (there is also a nasal spray version which is not being given out currently by pharmacies but is available from a limited number of other organizations to those who qualify) without the need of a prescription. All that is required is a valid Ontario health card and perhaps a little patience as the kit may need to be ordered (usually arriving a day later). You do not need to divulge information that may be considered quite sensitive.

All current opioid users, as well as friends, family members or other people able to, and likely to be required to, help people at risk of an overdose, are encouraged to at least consider picking one up.

Naloxone works by competing and displacing opioids in the region of the brain where the narcotics slow down the central nervous system. It works within three to five minutes, and is very effective at reversing an acute overdose. One of its limitations is that its effect last for only about 30 minutes, meaning that it can wear off while a victim still has potentially-lethal amounts of narcotics circulating around in the body. As such, it is important to get the victim to a hospital as soon as possible after the successful use of the injection.

Not only is naloxone effective, it is a safe drug as well. It has no abuse potential of its own and if you use it on someone who has overdosed on another type of chemical (e.g. alcohol, sedatives, cocaine), it will not harm him/her although, unfortunately, it will be of no help either.

Recognizing an overdose situation is not always obvious. The victims may simply look as if they are in a deep sleep but if they cannot be awakened by noise or physical stimulation, they are likely in imminent danger of brain injury or death from the reduced breathing rate that high doses of narcotics can cause.

As such, using a dose of naloxone should at least be considered. The free kit comes with two vials of naloxone, two syringes with needles attached, a device that can safely open the vial, and a pair of non-latex gloves. To give the injection, draw one millilitre (mL) from the vial into the syringe and inject the needle straight into a large muscle such as the gluteus (buttock), quadriceps (thigh) or deltoid (just below the shoulder).

Do not take the time to remove clothing as seconds count and the needle will easily pierce tough fabrics such as blue jeans. Naloxone should continue to be administered every three to five minutes until the overdose is reversed (at which point the victim will literally wake up) or emergency help arrives.

Chest compressions should be administered between injections, using the standard technique (i.e. one hand over the other centred in the middle of the person’s chest, arms straight, push hard and fast with no interruptions other than to give another dose). Pharmacies that carry naloxone will train whoever requests help to ease any confusion or apprehension you might have over your ability to administer this drug in an emergency setting.

For more information about this or any other health-related questions, contact the pharmacists at Gordon Pharmasave, Your Health and Wellness Destination. Also check the website at www.gordon-pharmasave.com/ and the Facebook page at www.facebook.com/GordonPharmasave/?fref=ts