Pubdate: Sat, 03 Sep 2016
Source: Observer, The (CN ON)
Copyright: 2016, Sarnia Observer
Contact: http://www.theobserver.ca/letters
Website: http://www.theobserver.ca
Details: http://www.mapinc.org/media/1676
Author: Tyler Kula
Page: A1

NALOXONE ACCESS EXPANDING

More ways for at-risk opioid users to access lifesaving drug

Access to a lifesaving drug for people at risk of overdosing on
opioids is expanding in Sarnia-Lambton.

Naloxone, until recently, has only been available via paramedics and
hospital emerge in the area long awash in drugs like fentanyl - an
opium-like drug similar to, but more powerful than, morphine and heroin.

Now naloxone, an injection drug - like an EpiPen for opioid overdose -
is set to soon be dispersed via public health needle exchange clinics.

"By early fall," said Dr. Sudit Ranade, medical officer of health for
Lambton County.

The idea is to get injection kits into the hands of opioid drug users,
their friends and family members, so when signs of overdose show they
can act, he said.

Pharmacies have been eligible to offer free kits since June, after
Health Canada removed naloxone's prescription status earlier this year.

"However most (in Sarnia) have chosen to have limited access in terms
of doing anything with it," said Marcel Laporte, pharmacist at the
Bluewater Methadone Clinic (BMC).

The clinic, which provides opioid substitution therapy to recovering
addicts, was one of four methadone dispensing clinics set up with
government naloxone kits when the Ontario Naloxone Pharmacy Program
launched, he said.

BMC has given out two or three kits since June, he
said.

"There hasn't been a great demand for it," he said, "simply because
there's not a lot of information about it out there."

Along with offering the drug, pharmacists train people how to use it,
make sure they understand they may be required to perform CPR in an
overdose situation, and offer refills as necessary, he said.

Having greater access to the drug is like having public-access
defibrillators in arenas to guard against potential heart attacks, he
said: it's not a panacea.

"It basically just reduces the risk," he said, noting, "It gives you
that buffer to get patients to the hospital."

Five people died of fentanyl overdose in Sarnia-Lambton in 2013, a
rate per 100,000 that was 4.5 times the provincial average.

The latest data, from 2014, is fewer than five, a spokesperson with
the Ontario Coroner's Office said. Numbers fewer than five aren't
specifically provided in order to protect people's privacy. Concerns
have been raised recently about synthetic versions of fentanyl, which
have caused havoc in western provinces, becoming more prevalent in
Ontario.

Ranade said he's hopeful more pharmacies, which signed on last year to
a patch-for-patch exchange program meant to crack down on illicit
fentanyl patch abuse and diversion, will also get on board with
distributing naloxone.

"They're all aware of the issue and this is an easy next step for them
to participate in the naloxone program," he said.

Proponents of patch-for-patch note it was successful in decreasing 
supply of the drug locally. Meanwhile eight people were given naloxone 
through the emergency department at Bluewater Health between February 
and May of this year, after a Mentoring, Education, and Clinical Tools 
for Addiction: Primary Care-Hospital Integration (META:PHI) program 
launch to help those most at risk from opioid and alcohol overdose, said 
Mental Health and Addiction Services Director Cathy McFarland.

The program also sets up at-risk users with addiction doctors, and is
designed to shorten wait times for addiction interventions.

Access to naloxone is also being provided in jails, along with
methadone and suboxone - another opioid management drug - and inmates
being released are being given cards with information about where to
pick up naloxone, said a Ministry of Community Safety and Correctional
Services spokesperson.

Work is underway with the provincial Health Ministry to see about
providing kits directly to inmates at discharge, said Andrew Morrison,
in an email.

"Enhancing discharge planning is a key part of improving the
reintegration of inmates, which is a pillar of the ministry's
transformation of the correctional system," he wrote.

People who've abstained from opioids for a period of time are at a
higher risk of overdosing if they relapse because their tolerance has
dropped, and they may not pare down their usual dose.

The drug could also be useful for people on methadone, said BMC doctor
Del Donald.

"You could make the argument that anybody who starts on methadone
should get it," said the lead doctor behind the META:PHI program locally.

High-risk groups include people in the first two to three weeks of
starting methadone, and those who take methadone and drink alcohol, he
said.

"I think there's a lot of opportunity there and no doubt it's a
lifesaving medication," Donald said.

There's been no word on making naloxone available to methadone clinic
users specifically, though Ranade said tentative plans are to host
public health needle exchange clinics at BMC once weekly later this
fall.
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