Naloxone, which can reverse drug overdoses, is making its way into the hands of drug users, their friends and families across B.C. Police, health authorities and advocates are making sure drug users know about fentanyl’s dangers. But B.C. still struggles to keep up as overdose deaths continue.
Some heroes fly. Douglas Nickerson prefers to ride a bike.
Nickerson, 58, is a fixture on “The Strip,” two blocks in Surrey’s Whalley neighbourhood that have become a tent city and commune for drug users and the homeless.
Last year, as the body count from the fentanyl-overdose crisis surged, Nickerson began carrying a kit containing the overdose-reversing drug naloxone.
Now, he pedals his black-and-flamed cruiser up and down 135A Street, ready to respond to cries of “Narcan!” -- the trade name for naloxone.
He and staff at the nearby Lookout Emergency Aid Society rush into the street to inject the lifesaving drug into users on The Strip, where there are as many as a dozen overdoses each day.
“The blueness is a dead giveaway,” Nickerson said when asked how to tell if someone has overdosed.
“You’ll see people passed out from alcohol or tired from the sun. It’s become habit now to just check on a person.”
Members of the Surrey Area Network of Substance Users said Nickerson has reversed more than 50 overdoses since he began carrying the kit — including six in a single day in January.
But no matter how hard he pedals, he can’t save everyone.
Naloxone plays a vital role in reducing opioid-overdose deaths but won’t stop them all
Since the inception of B.C.’s Take Home Naloxone Program in August 2012, more than 8,200 naloxone kits have been distributed and close to 8,000 people have been trained to use them. More than 600 overdoses have been reversed.
According to data provided by B.C. Emergency Health Services, there were 12,260 emergency 911 calls in 2015 in which overdose or poisoning was suspected based on caller information, up from 10,677 in 2014. But in just the first four months of 2016, there were 5,607 such calls.
Paramedics have been able to administer naloxone for many years, but in January, in response to the rise in overdoses, Health Minister Terry Lake announced that firefighters in Surrey and Vancouver who received special training could carry naloxone, along with an additional 525 community-based paramedics.
In March, Health Canada loosened restrictions on naloxone, making it available without a prescription when used for an opioid overdose emergency outside hospital settings.
But as fentanyl overdoses increase -- with some requiring several vials of naloxone -- health authorities and drug users are looking to expand their tool kit.
And there are concerns about W-18, a toxic research chemical that was detected in one Alberta overdose death and in pills found in Kelowna. Police, doctors and drug users fear naloxone may be ineffective against it.
On June 9, a meeting will be held at the B.C. Centre for Disease Control bringing together some 80 experts dedicated to tackling the overdose crisis. It will include representatives from the Network for Excellence in Substance Dependence and Related Harms, B.C. Coroners Service, WorkSafe B.C., the College of Physicians and Surgeons of B.C., police, parents, researchers and more.
Making it OK to call for help
In 2003, Vancouver Police Department implemented an important policy: If someone calls 911 regarding an overdose in Vancouver, the department won’t automatically send officers. Police attend only if their presence is requested by paramedics, if the overdose scene involves violence, or if the overdose victim dies.
“We actually respond to very few overdoses,” Sgt. Randy Fincham said. “You don’t need to be afraid that the police are going to come seize your drugs, that they’re going to put you in jail. That’s not the reason for the 911 call.”
During the current surge in overdose deaths, this policy has become vital in ensuring drug users don’t hesitate to call for help. Liberal MP Ron McKinnon, who represents Coquitlam-Port Coquitlam, is looking to expand this policy beyond Vancouver.
McKinnon tabled a private member’s bill in February. The “Good Samaritan Drug Overdose Act,” if passed, would protect those who call emergency services for drug overdoses from being charged with possession.
“This bill is about giving people the tools they need to make lifesaving decisions in a time of crisis,” he said in Parliament early May. “It would make it OK to call for help.”
But B.C. Centre for Disease Control research suggests more may need to be done. Researchers have conducted studies around 911 concerns involving drug users and those who have administered naloxone, said Dr. Jane Buxton, the BCCDC’s harm reduction team lead.
“What we see there is that people aren't concerned they're going to be arrested so much for possession,” Buxton said. “(Concern is) more likely when, if the police do arrive, then they may run their names through — whoever's there — and find that they're in breach of probation or they have outstanding warrants."
Increasing access to Suboxone opioid substitution therapy
When opioid users are ready to tackle the addiction, often they’ll replace their drug of abuse with methadone, a long-acting synthetic opioid that doesn’t produce the same high but can prevent withdrawal symptoms such as restlessness, nausea, vomiting and diarrhea.
Methadone is prescribed by physicians who have undergone special training and earned a federal exemption. In B.C., the drug user will visit a pharmacy daily to take liquid methadone orally, typically under the supervision of a pharmacist.
Currently there are more than 16,000 patients accessing the methadone maintenance system in B.C.
But methadone can be abused, diverted to the street, and can even cause overdoses. In recent years, buprenorphine, better known by its trade name Suboxone, has become the preferred treatment for many patients.
Suboxone is more portable in pill form, has a “ceiling effect” on dosage so that taking more has no effect, and has lower risk of fatal overdose. It contains naloxone, so injecting it is pointless.
But accessing Suboxone is tricky. Dr. Ailve McNestry, deputy registrar at the College of Physicians and Surgeons of B.C., said the college has been working to change this.
Last fall, Pharmacare began covering Suboxone as a regular benefit. Demand for it increased, McNestry said.
But the PharmaNet prescription-tracking database was set up so that only a physician with a federal exemption to prescribe methadone for opioid dependence could also prescribe Suboxone. People who wanted to end their opioid dependence complained it was difficult to find a physician who could prescribe Suboxone.
So, the CPSBC is working to change PharmaNet to allow any physician to prescribe Suboxone, McNestry said. She expects this to happen in July.
McNestry said of the current opioid-overdose epidemic: "I think a public health emergency is a very accurate reflection of what the situation is."
Sending a strong message
In March last year, police, health authorities, BCCDC and B.C. Ambulance Service launched the “Know Your Source” campaign in B.C. to spread the message that fentanyl “does not discriminate” and is being cut into drugs of all kinds, killing both new and experienced drug users.
Toward the Heart, a website launched by B.C.’s Provincial Harm Reduction Program, provides important information to drug users about the dangers of fentanyl, how to recognize and survive an overdose, and where to find naloxone.
And those who have endured the nightmare of opioid-overdose deaths are speaking out, too.
Leslie McBain lost her only son Jordan to an opioid overdose in February 2014. Since his death, McBain has devoted herself to learning everything she can about harm reduction and addiction.
The Pender Island resident now belongs to a group of families called “Moms Stop The Harm” whose loved ones were killed by overdoses.
McBain now speaks with B.C. high school students about the dangers of drug use. She said many teens are shocked when she tells them rule No. 1 isn’t, “Don’t do drugs,” but rather, “Don’t do drugs alone.”
Many teens are unaware of the “Russian roulette” aspect of taking a pill that may be laced with fentanyl, she said.
"Parents have to continue the dialogue about the dangers,” McBain said. “The 'don’t do drugs' (message) does not work, because kids are going to do what they're going to do."