In An Ideal World....No Death Wishes

"You'd be foolish to use opioids and not grab a naloxone kit."
“All you can think of is getting your next fix [after two of three times receiving naloxone, feeling 'horrible', as in withdrawal]."
Leon "Pops" Alward, Toronto

"Naloxone can't be seen as this wonder drug, that if we had naloxone in everyone's hands all opioid overdoses would go away."
"Right now, the focus is trying to get naloxone in our community and people using it ... so if there is an overdose there's a naloxone kit there to be used."
"If you think of first aid and CPR classes, nobody really tracks who takes that training and because naloxone can't really be harmful, there's no need to monitor it. It's not unusual. It just makes it more challenging to really understand whether naloxone is working."
Tara Gomes, epidemiologist, St.Michael's Hospital, Toronto

"Naloxone is equipping thousands of people in our community to recognize an emergency and respond in an appropriate way when that emergency happens. That's not just a band aid, that's a community-wide change."
"In an ideal world, 100 percent of people who died would have been given something to help."
"Deaths happen when people are alone. We need to get serious about asking, are people dying from being marginalized more than they're dying from an opioid overdose?"
Dr. Aaron Orkin, emergency department physician, Mount Sinai Hospital, Toronto

"They have to be very vigilant and cognizant of the fact that when the naloxone wears off, the chance of the opioid coming back is still there."
"Other people need to be with them to monitor their well-being so if they overdose again someone can call 911 and they can get more definitive treatment."
Adam Thurston, commander, Toronto Paramedic Services

In an ideal world it is not that people dying of narcotic overdoses being helped to survive them would represent a wonderful benefit, rather in an ideal world people would be bypassing entirely the use of such drugs altogether unless prescribed for a definite purpose and even then both prescribing physician and patient would have to be aware of limiting use as well as ensuring that use is carefully structured for a specific purpose for a limited time-frame.

And then there is the larger issue of non-prescription opioids whose popularity has risen monumentally to include fentanyl and now carfentanil, both most frequently used supplementally, mixed in with heroin  and other opioids for greater profitability, both of which are exponentially more powerful than conventional drugs. Education is said to be the key to ensuring that people know the dangers inherent in their use of such drugs.

Information is widely available, including in screaming headlines, about the dangers of street drugs being laced with fentanyl and its even more knock-out cousin carfentanil, but the allure, despite the now-very-well-known dangers lurking behind their use in soaring rates of overdose and death, appears to knock sense out of users. Who also at the back of their minds may rely on the assurance that naloxone is now so widely available, someone will inject it and save them.

Part of an emergency kit includes several bottles of Naloxone (blue caps)  Bernard Weil/Toronto Star

In Mr. Alward's case, it was his roommate who used naloxone to revive him when he first overdosed in 2017. Out of that experience he's become a devoted naloxone carrier himself, using it to save others from overdose deaths. Between May and October of 2017, 564 people in Ontario died of opioid overdoses. Of that total number, ninety-six had been administered naloxone by hospital staff, emergency responders or bystanders, representing 17 percent of all opioid-related deaths.

One Toronto paramedic, Jason Benaim, speaks of arriving on scene to find someone in cardiac arrest, injection needle in his arm, no longer breathing. Arriving ten minutes after a patient has stopped breathing, he stresses, negates administering naloxone; nothing will bring that person back to life. "It's frustrating because this (death) is something that could be prevented)".

Even when paramedics are certain an injection is too late to reverse an overdose, the province still requires that naloxone be used.

In the first half of 2017, Toronto Paramedic Services administered on average naloxone 32 times monthly; that number leaped to 54 times in the second half of the year. It is an aid, but no cure, viewed by government, cities and public health units, police, firefighters, paramedics, pharmacists and doctors as the only reactive tool at their disposal in dealing with the opioid crisis across the country.

Four British Columbians die every day; over 1,400 people died of opioid overdoses in 2017 in British Columbia, according to the province's coroner's office. Half that number -- still a substantial number of people -- died of the same cause in Alberta last year. Ontario's Ministry of Health and Long-Term Care ordered naloxone administered by needle to be available free of charge in pharmacies across the province.

Leading 333 Toronto pharmacies to hand out over 12,000 kits to anyone who asks for one. Recently, naloxone administered by nasal spray has been added to the province's distribution program. Toronto Public Health itself distributed 9,000 kits to partner agencies and the public. During an overdose with an opioid like fentanyl difficulty breathing can result and breathing can be stopped altogether, causing cardiac arrest, explained Adam Thurston.

Paramedic Jason Benaim holds a syringe using an intravascular method of administering naloxone to a patient. Bernard Weil/Toronto Star

What naloxone does, is reverse the overdose for about 30 minutes, but since opioids remain in the system for a much longer time, the risk of over-dosing after the naloxone has worn off remains. If, explained Mr. Thurston, someone was revived, then used opioids and once again overdosed shortly afterward, naloxone will have failed to succeed.

"People will keep on using their drug even though they've had an overdose and been revived. Naloxone is not enough", explained Dr. Meldon Kahan, substance use director, Women's College Hospital, Toronto. He feels that Suboxone, a prescription drug used to treat opioid addiction, should be more widely available and increased numbers of supervised injection sites established over the four currently in operation in Toronto.