Pubdate: Fri, 21 Nov 2008
Source: Edmonton Journal (CN AB)
Copyright: 2008 The Edmonton Journal
Contact: http://www.canada.com/edmontonjournal/letters.html
Website: http://www.canada.com/edmonton/edmontonjournal/
Details: http://www.mapinc.org/media/134
Author: Jodie Sinnema
Bookmark: http://www.mapinc.org/rehab.htm (Treatment)
Bookmark: http://www.mapinc.org/find?132 (Heroin Overdose)
Bookmark: http://www.mapinc.org/topic/Naloxone

ADDICTS TAUGHT TO SAVE LIVES WITH ANTI-OVERDOSE KITS

EDMONTON - James Gush knows the deal if a buddy overdoses on morphine 
or heroin: Take out his vial of Naloxone, fill a clean syringe with 
the anti-opiate, and jab his friend in the arm or leg.

Gush hasn't had to use his Naloxone kit, but he knows it and a 
first-in-Canada training program for street people in Edmonton could 
save the lives of drug users who overdose.

Gush, who quit morphine three years ago in exchange for methadone 
treatment, is a regular at Streetworks, Edmonton's needle-exchange 
office. Streetworks launched an overdose prevention program three years ago.

Back then, Gush was overdosing every week, sometimes every day, 
passing out for 48 hours, only to wake up in hospital having his 
stomach pumped.

"I was a pig and I ate as many (pills) as I could every day, and I 
would be in the hospital every day," said Gush, 49.

"I used to live in the Remand (centre) in my drug days. And I used to 
see quite a few doctors and I was tired of it, getting pumped out. 
Geez, an awful feeling."

That changed in 2005, when he was trained by Streetworks staff on how 
to inject himself and others with Naloxone, a drug that revives 
people who have overdosed on Tylenol 3s, codeine, Demerol, morphine 
or heroin by blocking opiates from binding to receptor sites.

Gush learned to give Naloxone to addicts when their mouths have 
turned blue, eyes have rolled up and breathing has slowed or stopped, 
causing unconsciousness. The treatment stops the drug high, revives 
the person by restoring proper breathing and gives a 30-minute window 
to seek medical help before the treatment wears off.

Learning those skills empowered Gush to quit his habit and live 
healthier, said Andrea Allen, the overdose program's manager and 
nurse educator.

Gush now has his own downtown apartment, was able to be by his 
father's side when he died six weeks ago and has become closer to his 
mother and six siblings.

"I'm cautious of the drugs I take," he said. He limits himself to 
marijuana and only a few pills instead of handfuls.

"It saves lives," Allen said of the overdose prevention program.

"It empowers people who are trained by giving them a whole wealth of 
knowledge they never thought they could have. People in this 
community are often pushed down so low that they don't think they 
deserve to know anything."

Edmonton's program, which mimics similar ones in such cities as San 
Francisco, New York, Chicago, Baltimore and New Mexico, began as a 
demonstration project with $150,600 in funding over three years from 
the Canadian Drug Strategy. It was sparked by a one-week period in 
which three street people overdosed and died in Edmonton.

In the program's first year, when 50 street people were trained 
locally, 18 per cent of drug overdoses were reversed. That's a better 
result than in U.S. cities, which see an average 10-per-cent reversal 
rate in their first years.

"People had probably given up on (James) at one point," Allen said. 
"Now, he felt acknowledged and part of something."

Opponents say Naloxone programs legitimize drug use and encourage 
people to continue hard with their habit, since they have an escape 
valve that will save their lives.

But Marliss Taylor, Streetworks' program manager, said studies have 
found overdose prevention programs reduce drug use, since people take 
on more responsibility to save themselves and their friends.

"They're more aware, they're more careful," Taylor said. "If someone 
feels that they have to keep an eye on everybody, they're much 
healthier in a whole lot of ways."

Drug overdoses kill approximately one person in Alberta each day, 
Taylor said. Most are accidental, as frantic, high and careless 
people sneak behind garbage cans and hurriedly shoot up for fear of 
being seen or caught.

Friends or family who witness an overdose don't want to phone police 
or paramedics for help. Allen said she trained one woman six months 
ago who was shooting drugs with her partner when he overdosed. 
Because the woman had misplaced her Naloxone kit, she called an 
ambulance. When police showed up alongside the paramedics, officers 
found drugs on the woman and charged her with attempted murder, even 
though she hadn't injected her partner, Allen said.

Even so, Allen tells everyone they must call for help, even after 
injecting Naloxone, because it only works for 30 minutes, whereas 
methadone can stay in the bloodstream for 24 hours.

Allen knows one man who has used his Naloxone kit five times to save 
five different people.

"These are valuable people, really neat people, people who contribute 
to society one way or another," Taylor said.

She isn't currently looking for an agency to fund the program, even 
though the original money has run out and Streetworks now spends 
about $400 each year to purchase Naloxone through a partnership with Chicago.

Each vial contains 10 doses and costs $2.50 when purchased from the 
United States. Those vials cost $79 if bought in Canada, Taylor said.

Instead, she wants to raise awareness of the human cost of overdoses.

"I don't know how to convey how tragic it is when this is so 
preventable," she said.

"Right now, I'm concerned with the lack of concern of society with 
overdose. I think that sometimes people think: 'Well, they've done it 
to themselves. They're just a bunch of drug addicts anyway,' without 
thinking that could be someone's niece or nephew."

OTHER CITIES

Toronto, Montreal and Windsor are all trying to set up overdose 
prevention programs, says Marliss Taylor, program manager at 
Edmonton's Streetworks. But because the programs will likely be 
delivered by the health regions in those cities rather than by an 
independent agency such as Streetworks, the wheels are turning 
slowly, she said.

The health regions have to worry about possible liability and other 
bureaucratic hiccups, even though Taylor said she has fielded no 
negative feedback about her program.

People can't overdose on Naloxone, the generic form of the brand-name 
drug, Narcan. If it's injected into someone who hasn't taken any 
opiates, it runs through the body as harmlessly as saline solution.

Naloxone works to block the effects of morphine, codeine, heroin, 
methadone, oxycontin, percocet, hydrocodone, fentanyl and hydromorphone.

Naloxone doesn't work for alcohol, benzodiazepines, tricyclics, 
ketamine, cocaine, amphetamines, methamphetamine or ecstasy.

According to a study published in the Harm Reduction Journal in 2007, 
an estimated 900 opiate users die from overdoses each year in New 
York City. Since its overdose prevention program was set up in 2005, 
1,485 people were trained and 104 had overdoses reversed.

The Chicago Recovery Alliance reported that 3,500 people were 
equipped with Naloxone since 2001, resulting in 319 overdose reversals.
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MAP posted-by: Jay Bergstrom