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 the Downtown 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.
The Key Role of Trustworthy Babysitters in Balancing Work and Family Life
Are you a busy parent in constant pursuit of the elusive work-life balance? We know firsthand how overwhelming and challenging it can be to juggle professional commitments while still having quality time with your children.
That’s why we’re here to discuss an essential ingredient that unlocks the secret to harmony: trustworthy babysitters.
What Characteristics Parents Should Look for When Choosing a Babysitter?
Parents should look for a few key characteristics when choosing a babysitter. A good babysitter should be patient, responsible, and reliable. They should also be comfortable with children and have prior experience caring for them.
Besides, the babysitter must be able to communicate effectively and follow directions well. The babysitter should be someone the parents can trust to care for their children in their absence.
Strategies for Parents to Establish Reasonable Anticipations
As a parent, finding babysitters you can trust to care for your children is vital. However, it is also important to establish reasonable expectations for your babysitters.
Some tips for establishing reasonable expectations for babysitters include:
- Set clear expectations: Sit down with your babysitter to discuss bedtime routines, dietary preferences, and any necessary medications.
- Allow flexibility: While clarity is vital, also provide room for your babysitter to use their judgment and feel comfortable in their role.
- Trust their expertise: Once expectations are set, trust your babysitter’s judgment as a professional caregiver to avoid undermining their authority and creating discomfort in their role.
Determining a Fair Payment Plan
Determine your babysitting budget, factoring in your income and family size, while researching local rates. Account for the babysitter’s experience and qualifications, giving preference to those recommended by trusted sources.
Engage in open negotiations with your chosen babysitter. This aims to find a mutually agreeable arrangement that accommodates both your budget and their needs.
Tips on Finding Trustworthy and Compassionate Caregivers
When seeking a caregiver for your child, to ensure you find the right fit:
- Seek recommendations from trusted sources such as friends, family, and neighbours who may have suggestions for caregivers in your area.
- Conduct online research to review feedback and check references to gauge candidates’ qualifications and experience.
- Request references and contact details from the caregivers’ previous employers or families they have worked with.
- Trust your instincts and ensure you feel at ease with the caregiver, ensuring they are someone you can entrust with your child’s well-being.
Being able to trust your babysitter means you can have peace of mind knowing your child is safe and cared for.
Spending some time researching online reviews or asking friends and family for recommendations will help you find the perfect fit so you can feel more at ease while juggling work commitments in today’s hectic world.
Facility-wide COVID-19 outbreak at Bethammi Nursing Home
THUNDER BAY — St. Joseph’s Care Group and the Thunder Bay District Health Unit have declared a facility-wide COVID-19 outbreak at Bethammi Nursing Home, part of the St. Joseph’s Heritage complex on Carrie Street near Red River Road.
The respiratory outbreak at the 112-bed facility was declared effective Sept. 15 but only announced publicly on Monday.
No details were provided with regard to the number of people affected to date.
Restrictions are now in place for admissions, transfers, discharges, social activities and visitation until further notice.
Alberta COVID hospitalizations up 73% since July: health minister
Three weeks after the start of the school year, Alberta’s health minister provided an update on the spread of airborne viruses in the province.
Adriana LaGrange also said more information about flu and next-generation COVID-19 vaccines will soon be released.
“Now that we will be spending more time indoors, we need to make doubly sure we are following proper hygiene protocols like handwashing and staying home when sick,” LaGrange said. “It also means respecting those who choose to wear a mask.”
Global News previously reported that influenza vaccines will be available on Oct. 16 with the new Moderna vaccine formulated to target the XBB.1.5 variant likely to be available at around the same time. On Sept. 12, Health Canada approved the use of the Moderna vaccine.
“More information on immunizations against respiratory viruses including influenza and COVID-19 will be available shortly,” the health minister said.
LaGrange said there have been 28 cases of influenza and five lab-confirmed cases of respiratory syncytial virus (RSV) since Aug. 28.
“This is consistent activity for this time of the year,” the health minister said in a statement.
The end of August or the beginning of September has typically marked the beginning of flu season for provincial health authorities.
LaGrange also provided an update on the ongoing COVID-19 pandemic in the province.
From Aug. 28 to Sept. 8, there were a total 92 new hospitalizations and three ICU admissions, bringing the total to 417 in hospital and seven in ICU, a 73 per cent increase of COVID hospitalizations from the last reported info.
On July 24 – the last update to the province’s COVID data dashboard – there were only 242 in hospital.
“Sadly, five Albertans died during that period due to COVID-19,” LaGrange said.
LaGrange said the reporting dashboard is being refreshed to include RSV, influenza and COVID-19 data, work that was originally expected to be completed on Aug. 30. The latest data on the province’s influenza statistics dashboard is dated July 22.
“This work is currently underway and will be available in the coming weeks,” LaGrange said.
She said data for the dates between July 24 and Aug. 27 will be available when the new dashboard goes online.
Amid more hospitals continent-wide reinstating masking requirements in the face of increased hospitalizations, the health minister made no mention of any such moves for Alberta hospitals. Acute care COVID-19 outbreaks in Alberta jumped from Sept. 5 to 12, with 146 per cent more healthcare workers and 55 per cent more patients testing positive for COVID.
LaGrange stressed the “collective responsibility” to prevent the spread of airborne viruses like COVID and influenza.
“As a mother and grandmother, I understand the anxiety that comes with sending your children back to school. I want to reassure you that Alberta’s government has the health and well-being of all young Albertans top of mind,” the health minister said.
–with files from Meghan Cobb, Global News
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