adplus-dvertising
Connect with us

Health

Naloxone kits across Canada should have both nasal spray and injection options: panel

Published

 on

Take-home naloxone kits across Canada should contain both versions of the opioid overdose-reversing drug — a nasal spray and an injectable that goes into a muscle — says a panel of experts that includes people who use drugs.

The new guidance, led by the BC Centre for Disease Control, aims to standardize take-home naloxone kits that are distributed through various sites, including pharmacies, community groups and emergency departments, to anyone who could respond to an overdose.

Those who have used naloxone to save lives say having the nasal spray at hand could ensure a faster response because some people may be uncomfortable with needles.

Authors of the guidance, published recently in the Canadian Medical Association Journal, strongly recommend federal, provincial and territorial programs be adapted so people have a choice of methods when a fast response is needed after someone has overdosed on an illicit substance.

First responders also carry naloxone, which blocks the effects of opioids such as fentanyl, heroin, morphine and oxycodone. The medication will not work on someone who has overdosed on stimulants including cocaine, MDMA (ecstasy) and Ritalin, but will not cause harm either.

The vast majority of kits that are distributed for free across the country include injectable naloxone in ampoules or vials along with syringes, gloves, an alcohol swab and a “barrier shield”to place on someone’s face before they’re given mouth-to-mouth resuscitation. An overdose can be temporarily reversed in about three to five minutes but responders should call 911 first in case the person stops breathing again.

Three one-milligram ampoules of naloxone, also known as Narcan, are in the kits distributed in B.C., where life-saving training is provided at various sites through the BCCDC.

Dr. Jane Buxton, an epidemiologist and a senior author of the guidance, said take-home naloxone programs differ among provinces and territories, with some collecting data on distribution from pharmacies while others rely on organizations that may not be providing complete information.

“The intranasal (formulation) is available in some provinces to anybody and in others it’s more limited,” said Buxton, who recently retired as the medical lead for harm reduction at the BCCDC.

“In B.C., we don’t have the intranasal (formulation) as available as it is in Ontario.”

Naloxone nasal spray comes in a device with two prongs that fit into each nostril to administer the medication to someone who has overdosed.

It is available at no cost through a federal program to First Nations and Inuit when prescribed or recommended by a pharmacist. But, as the authors note, the high cost for provinces and territories is generally the biggest hurdle in accessing that formulation, and it varies across the country.

Ontario and Quebec offer free nasal spray naloxone at pharmacies that carry it, or through locations such as needle exchange programs, shelters and public health units.

At one pharmacy in Vancouver, about a 10-minute walk from theDowntown Eastside, the intranasal naloxone costs $75, but it is not stocked and must be ordered. Unlike the injectable version, other supplies are not included.

Buxton said having both formulations of naloxone in every kit would be ideal because someone who is not accustomed to needles could feel more confident using the nasal spray while others may prefer the intramuscular version.

“What we heard from people with lived experience is that many feel that the injectable (formulation) can be titrated better,” Buxton said.

That prevents withdrawal symptoms brought on by too much naloxone, which wears off within an hour.

“It may mean people immediately start searching for substances to get rid of that withdrawal.”

About 80 per cent of people who carry a naloxone kit use opioids themselves and may administer the medication to someone who overdoses on a toxic illicit substance, said Buxton, noting people are encouraged to not use drugs alone.

“We know we’ve had at least 150,000 overdose reversals but that’s a vast underestimate because people don’t always report,” she said.

In B.C., each intramuscular naloxone kit comes in a hard black case with a silver cross and a belt hook. Besides items such as three retractable syringes, it includes a form with a dozen questions regarding when and where the overdose occurred. But many responders may not email or fax it to the BCCDC as requested so the true number of reversed overdoses is not being counted.

The new guidance, which included input from experts across Canada, as well as the United Kingdom and Australia, also calls for responders to prioritize rescue breaths, or mouth-to-mouth resuscitation, to get oxygen into a person’s blood over massaging their heart.

“It’s part of the training in B.C., but it isn’t necessarily consistent throughout the country,” Buxton said. “Interestingly, there’s not a lot of evidence in the literature. And that’s why it was so important for us to have the insights from people who have been administering take-home naloxone, who have done thousands and thousands of reversals.”

More than 1.9 million naloxone kits have been distributed in B.C. since 2015 through 2,200 locations, according to the BCCDC, which started the country’s longest-running provincewide take-home naloxone program in 2012. A community group called Streetworks began Canada’s first naloxone program in Edmonton in 2005, based on a Chicago model, which also helped inform B.C.’s effort.

More than 37,000 people in Canada have died of a toxic drug overdose since 2016, prompting some jurisdictions to introduce safer alternatives, though Buxton said greater access to such programs is crucial as part of a comprehensive response to the overdose crisis.

In B.C., 1,455 people fatally overdosed between January and July this year, a record number of deaths in that time period since overdose deaths started climbing rapidly in 2016, when the province declared an ongoing public health emergency.

Cheryl Guardiero, a retired nurse, said she injected her son, Brett Colton Mercer, with naloxone 10 separate timesbefore he fatally overdosed alone in 2017 at age 29.

She agreed with the guidance, saying many people would be too anxious to load a syringe with naloxone from an ampoule while trying to help an extremely drowsy or unconscious person.

“If you’re rushing with adrenalin and you’re trying to clip that little glass thing apart and draw (the naloxone) up, that takes a few seconds. But for somebody that’s not used to that, it’s pretty traumatizing whereas if it’s just the nasal spray, they can just pop it up their nostrils and spray it.”

Guardiero, who recently moved from Nanaimo, B.C., to the Alberta hamlet of Wabamun, walked the streets of Vancouver’s Downtown Eastside with naloxone kits after her son died. She said shereversed four overdoses.

“Reversing overdoses down there is a different world. You go from one to the other to the other,” said Guardiero, a member of the advocacy group Moms Stop the Harm.

Marliss Taylor, program manager for Edmonton’s Streetworks harm reduction program, said the cost of a naloxonedose shipped from Chicago back in 2005 was 25 cents.

Now, a hard-shell kit with three doses of the drug and supplies costs about $30, though it’s distributed for free, and the intranasal formulation, uncommon in Alberta, sells for about $100, she said.

While the intramuscular injection kits offer more precise dosing, Taylor said including the nasal spray would prevent responders from panicking while they’re trying to inject a needle into someone’s arm or thigh, especially without adequate training.

 

728x90x4

Source link

Continue Reading

Health

Health Canada approves updated Moderna COVID-19 vaccine

Published

 on

 

TORONTO – Health Canada has authorized Moderna’s updated COVID-19 vaccine that protects against currently circulating variants of the virus.

The mRNA vaccine, called Spikevax, has been reformulated to target the KP.2 subvariant of Omicron.

It will replace the previous version of the vaccine that was released a year ago, which targeted the XBB.1.5 subvariant of Omicron.

Health Canada recently asked provinces and territories to get rid of their older COVID-19 vaccines to ensure the most current vaccine will be used during this fall’s respiratory virus season.

Health Canada is also reviewing two other updated COVID-19 vaccines but has not yet authorized them.

They are Pfizer’s Comirnaty, which is also an mRNA vaccine, as well as Novavax’s protein-based vaccine.

This report by The Canadian Press was first published Sept. 17, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

The Canadian Press. All rights reserved.

Source link

Continue Reading

Health

These people say they got listeria after drinking recalled plant-based milks

Published

 on

 

TORONTO – Sanniah Jabeen holds a sonogram of the unborn baby she lost after contracting listeria last December. Beneath, it says “love at first sight.”

Jabeen says she believes she and her baby were poisoned by a listeria outbreak linked to some plant-based milks and wants answers. An investigation continues into the recall declared July 8 of several Silk and Great Value plant-based beverages.

“I don’t even have the words. I’m still processing that,” Jabeen says of her loss. She was 18 weeks pregnant when she went into preterm labour.

The first infection linked to the recall was traced back to August 2023. One year later on Aug. 12, 2024, the Public Health Agency of Canada said three people had died and 20 were infected.

The number of cases is likely much higher, says Lawrence Goodridge, Canada Research Chair in foodborne pathogen dynamics at the University of Guelph: “For every person known, generally speaking, there’s typically 20 to 25 or maybe 30 people that are unknown.”

The case count has remained unchanged over the last month, but the Public Health Agency of Canada says it won’t declare the outbreak over until early October because of listeria’s 70-day incubation period and the reporting delays that accompany it.

Danone Canada’s head of communications said in an email Wednesday that the company is still investigating the “root cause” of the outbreak, which has been linked to a production line at a Pickering, Ont., packaging facility.

Pregnant people, adults over 60, and those with weakened immune systems are most at risk of becoming sick with severe listeriosis. If the infection spreads to an unborn baby, Health Canada says it can cause miscarriage, stillbirth, premature birth or life-threatening illness in a newborn.

The Canadian Press spoke to 10 people, from the parents of a toddler to an 89-year-old senior, who say they became sick with listeria after drinking from cartons of plant-based milk stamped with the recalled product code. Here’s a look at some of their experiences.

Sanniah Jabeen, 32, Toronto

Jabeen says she regularly drank Silk oat and almond milk in smoothies while pregnant, and began vomiting seven times a day and shivering at night in December 2023. She had “the worst headache of (her) life” when she went to the emergency room on Dec. 15.

“I just wasn’t functioning like a normal human being,” Jabeen says.

Told she was dehydrated, Jabeen was given fluids and a blood test and sent home. Four days later, she returned to hospital.

“They told me that since you’re 18 weeks, there’s nothing you can do to save your baby,” says Jabeen, who moved to Toronto from Pakistan five years ago.

Jabeen later learned she had listeriosis and an autopsy revealed her baby was infected, too.

“It broke my heart to read that report because I was just imagining my baby drinking poisoned amniotic fluid inside of me. The womb is a place where your baby is supposed to be the safest,” Jabeen said.

Jabeen’s case is likely not included in PHAC’s count. Jabeen says she was called by Health Canada and asked what dairy and fresh produce she ate – foods more commonly associated with listeria – but not asked about plant-based beverages.

She’s pregnant again, and is due in several months. At first, she was scared to eat, not knowing what caused the infection during her last pregnancy.

“Ever since I learned about the almond, oat milk situation, I’ve been feeling a bit better knowing that it wasn’t something that I did. It was something else that caused it. It wasn’t my fault,” Jabeen said.

She’s since joined a proposed class action lawsuit launched by LPC Avocates against the manufacturers and sellers of Silk and Great Value plant-based beverages. The lawsuit has not yet been certified by a judge.

Natalie Grant and her seven year-old daughter, Bowmanville, Ont.

Natalie Grant says she was in a hospital waiting room when she saw a television news report about the recall. She wondered if the dark chocolate almond milk her daughter drank daily was contaminated.

She had brought the girl to hospital because she was vomiting every half hour, constantly on the toilet with diarrhea, and had severe pain in her abdomen.

“I’m definitely thinking that this is a pretty solid chance that she’s got listeria at this point because I knew she had all the symptoms,” Grant says of seeing the news report.

Once her daughter could hold fluids, they went home and Grant cross-checked the recalled product code – 7825 – with the one on her carton. They matched.

“I called the emerg and I said I’m pretty confident she’s been exposed,” Grant said. She was told to return to the hospital if her daughter’s symptoms worsened. An hour and a half later, her fever spiked, the vomiting returned, her face flushed and her energy plummeted.

Grant says they were sent to a hospital in Ajax, Ont. and stayed two weeks while her daughter received antibiotics four times a day until she was discharged July 23.

“Knowing that my little one was just so affected and how it affected us as a family alone, there’s a bitterness left behind,” Grant said. She’s also joined the proposed class action.

Thelma Feldman, 89, Toronto

Thelma Feldman says she regularly taught yoga to friends in her condo building before getting sickened by listeria on July 2. Now, she has a walker and her body aches. She has headaches and digestive problems.

“I’m kind of depressed,” she says.

“It’s caused me a lot of physical and emotional pain.”

Much of the early days of her illness are a blur. She knows she boarded an ambulance with profuse diarrhea on July 2 and spent five days at North York General Hospital. Afterwards, she remembers Health Canada officials entering her apartment and removing Silk almond milk from her fridge, and volunteers from a community organization giving her sponge baths.

“At my age, 89, I’m not a kid anymore and healing takes longer,” Feldman says.

“I don’t even feel like being with people. I just sit at home.”

Jasmine Jiles and three-year-old Max, Kahnawake Mohawk Territory, Que.

Jasmine Jiles says her three-year-old son Max came down with flu-like symptoms and cradled his ears in what she interpreted as a sign of pain, like the one pounding in her own head, around early July.

When Jiles heard about the recall soon after, she called Danone Canada, the plant-based milk manufacturer, to find out if their Silk coconut milk was in the contaminated batch. It was, she says.

“My son is very small, he’s very young, so I asked what we do in terms of overall monitoring and she said someone from the company would get in touch within 24 to 48 hours,” Jiles says from a First Nations reserve near Montreal.

“I never got a call back. I never got an email”

At home, her son’s fever broke after three days, but gas pains stuck with him, she says. It took a couple weeks for him to get back to normal.

“In hindsight, I should have taken him (to the hospital) but we just tried to see if we could nurse him at home because wait times are pretty extreme,” Jiles says, “and I don’t have child care at the moment.”

Joseph Desmond, 50, Sydney, N.S.

Joseph Desmond says he suffered a seizure and fell off his sofa on July 9. He went to the emergency room, where they ran an electroencephalogram (EEG) test, and then returned home. Within hours, he had a second seizure and went back to hospital.

His third seizure happened the next morning while walking to the nurse’s station.

In severe cases of listeriosis, bacteria can spread to the central nervous system and cause seizures, according to Health Canada.

“The last two months have really been a nightmare,” says Desmond, who has joined the proposed lawsuit.

When he returned home from the hospital, his daughter took a carton of Silk dark chocolate almond milk out of the fridge and asked if he had heard about the recall. By that point, Desmond says he was on his second two-litre carton after finishing the first in June.

“It was pretty scary. Terrifying. I honestly thought I was going to die.”

Cheryl McCombe, 63, Haliburton, Ont.

The morning after suffering a second episode of vomiting, feverish sweats and diarrhea in the middle of the night in early July, Cheryl McCombe scrolled through the news on her phone and came across the recall.

A few years earlier, McCombe says she started drinking plant-based milks because it seemed like a healthier choice to splash in her morning coffee. On June 30, she bought two cartons of Silk cashew almond milk.

“It was on the (recall) list. I thought, ‘Oh my God, I got listeria,’” McCombe says. She called her doctor’s office and visited an urgent care clinic hoping to get tested and confirm her suspicion, but she says, “I was basically shut down at the door.”

Public Health Ontario does not recommend listeria testing for infected individuals with mild symptoms unless they are at risk of developing severe illness, such as people who are immunocompromised, elderly, pregnant or newborn.

“No wonder they couldn’t connect the dots,” she adds, referencing that it took close to a year for public health officials to find the source of the outbreak.

“I am a woman in my 60s and sometimes these signs are of, you know, when you’re vomiting and things like that, it can be a sign in women of a bigger issue,” McCombe says. She was seeking confirmation that wasn’t the case.

Disappointed, with her stomach still feeling off, she says she decided to boost her gut health with probiotics. After a couple weeks she started to feel like herself.

But since then, McCombe says, “I’m back on Kawartha Dairy cream in my coffee.”

This report by The Canadian Press was first published Sept. 16, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

Source link

Continue Reading

Health

B.C. mayors seek ‘immediate action’ from federal government on mental health crisis

Published

 on

 

VANCOUVER – Mayors and other leaders from several British Columbia communities say the provincial and federal governments need to take “immediate action” to tackle mental health and public safety issues that have reached crisis levels.

Vancouver Mayor Ken Sim says it’s become “abundantly clear” that mental health and addiction issues and public safety have caused crises that are “gripping” Vancouver, and he and other politicians, First Nations leaders and law enforcement officials are pleading for federal and provincial help.

In a letter to Prime Minister Justin Trudeau and Premier David Eby, mayors say there are “three critical fronts” that require action including “mandatory care” for people with severe mental health and addiction issues.

The letter says senior governments also need to bring in “meaningful bail reform” for repeat offenders, and the federal government must improve policing at Metro Vancouver ports to stop illicit drugs from coming in and stolen vehicles from being exported.

Sim says the “current system” has failed British Columbians, and the number of people dealing with severe mental health and addiction issues due to lack of proper care has “reached a critical point.”

Vancouver Police Chief Adam Palmer says repeat violent offenders are too often released on bail due to a “revolving door of justice,” and a new approach is needed to deal with mentally ill people who “pose a serious and immediate danger to themselves and others.”

This report by The Canadian Press was first published Sept. 16, 2024

The Canadian Press. All rights reserved.

Source link

Continue Reading

Trending