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Naloxone kits in Canada should be readily available in nasal spray and injectable versions: panel

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People administering an overdose-reversing medication should have a choice of both versions of take-home naloxone kits across Canada  — 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 applies to take-home naloxone kits that are distributed at 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. But that formulations is many times more expensive than the intramuscular version.

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 easily accessible 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 option.

“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 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 the nasal spray prevents responders from panicking while they’re trying to inject a needle into someone’s arm or thigh, especially without adequate training.

This report by The Canadian Press was first published Sept. 8, 2023.

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

Camille Bains, The Canadian Press

Note to readers: This is a corrected story. An earlier version said each kit should contain both versions of the drug instead of both versions being readily available.

 

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What’s the greatest holiday gift: lips, hair, skin? Give the gift of great skin this holiday season

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Give the gift of great skin this holiday season

Skinstitut Holiday Gift Kits take the stress out of gifting

Toronto, October 31, 2024 – Beauty gifts are at the top of holiday wish lists this year, and Laser Clinics Canada, a leader in advanced beauty treatments and skincare, is taking the pressure out of seasonal shopping. Today, Laser Clincs Canada announces the arrival of its 2024 Holiday Gift Kits, courtesy of Skinstitut, the exclusive skincare line of Laser Clinics Group.

In time for the busy shopping season, the limited-edition Holiday Gifts Kits are available in Laser Clinics locations in the GTA and Ottawa. Clinics are conveniently located in popular shopping centers, including Hillcrest Mall, Square One, CF Sherway Gardens, Scarborough Town Centre, Rideau Centre, Union Station and CF Markville. These limited-edition Kits are available on a first come, first served basis.

“These kits combine our best-selling products, bundled to address the most relevant skin concerns we’re seeing among our clients,” says Christina Ho, Senior Brand & LAM Manager at Laser Clinics Canada. “With several price points available, the kits offer excellent value and suit a variety of gift-giving needs, from those new to cosmeceuticals to those looking to level up their skincare routine. What’s more, these kits are priced with a savings of up to 33 per cent so gift givers can save during the holiday season.

There are two kits to select from, each designed to address key skin concerns and each with a unique theme — Brightening Basics and Hydration Heroes.

Brightening Basics is a mix of everyday essentials for glowing skin for all skin types. The bundle comes in a sleek pink, reusable case and includes three full-sized products: 200ml gentle cleanser, 50ml Moisture Defence (normal skin) and 30ml1% Hyaluronic Complex Serum. The Brightening Basics kit is available at $129, a saving of 33 per cent.

Hydration Heroes is a mix of hydration essentials and active heroes that cater to a wide variety of clients. A perfect stocking stuffer, this bundle includes four deluxe products: Moisture 15 15 ml Defence for normal skin, 10 ml 1% Hyaluronic Complex Serum, 10 ml Retinol Serum and 50 ml Expert Squalane Cleansing Oil. The kit retails at $59.

In addition to the 2024 Holiday Gifts Kits, gift givers can easily add a Laser Clinic Canada gift card to the mix. Offering flexibility, recipients can choose from a wide range of treatments offered by Laser Clinics Canada, or they can expand their collection of exclusive Skinstitut products.

 

Brightening Basics 2024 Holiday Gift Kit by Skinstitut, available exclusively at Laser Clincs Canada clinics and online at skinstitut.ca.

Hydration Heroes 2024 Holiday Gift Kit by Skinstitut – available exclusively at Laser Clincs Canada clinics and online at skinstitut.ca.

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Here is how to prepare your online accounts for when you die

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LONDON (AP) — Most people have accumulated a pile of data — selfies, emails, videos and more — on their social media and digital accounts over their lifetimes. What happens to it when we die?

It’s wise to draft a will spelling out who inherits your physical assets after you’re gone, but don’t forget to take care of your digital estate too. Friends and family might treasure files and posts you’ve left behind, but they could get lost in digital purgatory after you pass away unless you take some simple steps.

Here’s how you can prepare your digital life for your survivors:

Apple

The iPhone maker lets you nominate a “ legacy contact ” who can access your Apple account’s data after you die. The company says it’s a secure way to give trusted people access to photos, files and messages. To set it up you’ll need an Apple device with a fairly recent operating system — iPhones and iPads need iOS or iPadOS 15.2 and MacBooks needs macOS Monterey 12.1.

For iPhones, go to settings, tap Sign-in & Security and then Legacy Contact. You can name one or more people, and they don’t need an Apple ID or device.

You’ll have to share an access key with your contact. It can be a digital version sent electronically, or you can print a copy or save it as a screenshot or PDF.

Take note that there are some types of files you won’t be able to pass on — including digital rights-protected music, movies and passwords stored in Apple’s password manager. Legacy contacts can only access a deceased user’s account for three years before Apple deletes the account.

Google

Google takes a different approach with its Inactive Account Manager, which allows you to share your data with someone if it notices that you’ve stopped using your account.

When setting it up, you need to decide how long Google should wait — from three to 18 months — before considering your account inactive. Once that time is up, Google can notify up to 10 people.

You can write a message informing them you’ve stopped using the account, and, optionally, include a link to download your data. You can choose what types of data they can access — including emails, photos, calendar entries and YouTube videos.

There’s also an option to automatically delete your account after three months of inactivity, so your contacts will have to download any data before that deadline.

Facebook and Instagram

Some social media platforms can preserve accounts for people who have died so that friends and family can honor their memories.

When users of Facebook or Instagram die, parent company Meta says it can memorialize the account if it gets a “valid request” from a friend or family member. Requests can be submitted through an online form.

The social media company strongly recommends Facebook users add a legacy contact to look after their memorial accounts. Legacy contacts can do things like respond to new friend requests and update pinned posts, but they can’t read private messages or remove or alter previous posts. You can only choose one person, who also has to have a Facebook account.

You can also ask Facebook or Instagram to delete a deceased user’s account if you’re a close family member or an executor. You’ll need to send in documents like a death certificate.

TikTok

The video-sharing platform says that if a user has died, people can submit a request to memorialize the account through the settings menu. Go to the Report a Problem section, then Account and profile, then Manage account, where you can report a deceased user.

Once an account has been memorialized, it will be labeled “Remembering.” No one will be able to log into the account, which prevents anyone from editing the profile or using the account to post new content or send messages.

X

It’s not possible to nominate a legacy contact on Elon Musk’s social media site. But family members or an authorized person can submit a request to deactivate a deceased user’s account.

Passwords

Besides the major online services, you’ll probably have dozens if not hundreds of other digital accounts that your survivors might need to access. You could just write all your login credentials down in a notebook and put it somewhere safe. But making a physical copy presents its own vulnerabilities. What if you lose track of it? What if someone finds it?

Instead, consider a password manager that has an emergency access feature. Password managers are digital vaults that you can use to store all your credentials. Some, like Keeper,Bitwarden and NordPass, allow users to nominate one or more trusted contacts who can access their keys in case of an emergency such as a death.

But there are a few catches: Those contacts also need to use the same password manager and you might have to pay for the service.

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Is there a tech challenge you need help figuring out? Write to us at onetechtip@ap.org with your questions.

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Pediatric group says doctors should regularly screen kids for reading difficulties

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The Canadian Paediatric Society says doctors should regularly screen children for reading difficulties and dyslexia, calling low literacy a “serious public health concern” that can increase the risk of other problems including anxiety, low self-esteem and behavioural issues, with lifelong consequences.

New guidance issued Wednesday says family doctors, nurses, pediatricians and other medical professionals who care for school-aged kids are in a unique position to help struggling readers access educational and specialty supports, noting that identifying problems early couldhelp kids sooner — when it’s more effective — as well as reveal other possible learning or developmental issues.

The 10 recommendations include regular screening for kids aged four to seven, especially if they belong to groups at higher risk of low literacy, including newcomers to Canada, racialized Canadians and Indigenous Peoples. The society says this can be done in a two-to-three-minute office-based assessment.

Other tips encourage doctors to look for conditions often seen among poor readers such as attention-deficit hyperactivity disorder; to advocate for early literacy training for pediatric and family medicine residents; to liaise with schools on behalf of families seeking help; and to push provincial and territorial education ministries to integrate evidence-based phonics instruction into curriculums, starting in kindergarten.

Dr. Scott McLeod, one of the authors and chair of the society’s mental health and developmental disabilities committee, said a key goal is to catch kids who may be falling through the cracks and to better connect families to resources, including quicker targeted help from schools.

“Collaboration in this area is so key because we need to move away from the silos of: everything educational must exist within the educational portfolio,” McLeod said in an interview from Calgary, where he is a developmental pediatrician at Alberta Children’s Hospital.

“Reading, yes, it’s education, but it’s also health because we know that literacy impacts health. So I think that a statement like this opens the window to say: Yes, parents can come to their health-care provider to get advice, get recommendations, hopefully start a collaboration with school teachers.”

McLeod noted that pediatricians already look for signs of low literacy in young children by way of a commonly used tool known as the Rourke Baby Record, which offers a checklist of key topics, such as nutrition and developmental benchmarks, to cover in a well-child appointment.

But he said questions about reading could be “a standing item” in checkups and he hoped the society’s statement to medical professionals who care for children “enhances their confidence in being a strong advocate for the child” while spurring partnerships with others involved in a child’s life such as teachers and psychologists.

The guidance said pediatricians also play a key role in detecting and monitoring conditions that often coexist with difficulty reading such as attention-deficit hyperactivity disorder, but McLeod noted that getting such specific diagnoses typically involves a referral to a specialist, during which time a child continues to struggle.

He also acknowledged that some schools can be slow to act without a specific diagnosis from a specialist, and even then a child may end up on a wait list for school interventions.

“Evidence-based reading instruction shouldn’t have to wait for some of that access to specialized assessments to occur,” he said.

“My hope is that (by) having an existing statement or document written by the Canadian Paediatric Society … we’re able to skip a few steps or have some of the early interventions present,” he said.

McLeod added that obtaining specific assessments from medical specialists is “definitely beneficial and advantageous” to know where a child is at, “but having that sort of clear, thorough assessment shouldn’t be a barrier to intervention starting.”

McLeod said the society was partly spurred to act by 2022’s “Right to Read Inquiry Report” from the Ontario Human Rights Commission, which made 157 recommendations to address inequities related to reading instruction in that province.

He called the new guidelines “a big reminder” to pediatric providers, family doctors, school teachers and psychologists of the importance of literacy.

“Early identification of reading difficulty can truly change the trajectory of a child’s life.”

This report by The Canadian Press was first published Oct. 23, 2024.

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