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Naloxone: What you should know about the opioid overdose-reversing drug, free across Canada

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Health Canada has called the opioid crisis one of the most serious public health threats in recent history, and an addictions specialist says everyone can play a part in helping reduce the death toll. All it takes is access to naloxone, a life-saving medication that temporarily reverses an opioid overdose.

“It’s something that all adult Canadians, and I would hazard to guess teenagers as well, should have access to and be aware of,” said Dr. Sam Hickcox, chief officer of the Nova Scotia government’s Office of Mental Health and Addictions. “If there’s something we could do to save a life, why wouldn’t we?”

He compared administering naloxone to using an EpiPen to treat someone having an anaphylactic allergic reaction.

Hickcox said the country’s ongoing opioid epidemic has been made worse as Canada’s illicit drug supply became “poisoned” in recent years with toxic, highly potent opioid additives like fentanyl and carfentanil. Some users report not knowing what’s in the drugs they’re using.

“It’s been wreaking havoc across the country … starting in the West Coast and heading eastward,” he said in a recent interview.

Since 2016, Health Canada has recorded 38,514 opioid-related overdose deaths. Between January and March this year, there were more than 1,900 apparent opioid overdose deaths in the country, an average of 21 a day.

Widespread access to naloxone is “not just about potentially saving someone’s life — it’s also about all of us playing some part in this and understanding this problem more,” Hickcox said.

Here’s what you should know about naloxone, a life-saving treatment that can be administered by the average Canadian and is free to obtain.

What is naloxone and when is it used?

Naloxone: What to know about the opioid overdose-reversing drug, free across Canada. #Naloxone #OpioidCrisis #OpioidOverdose #OverdoseCrisis

Naloxone is a medication that blocks receptors in the body that take in opioids such as fentanyl, heroin, morphine and oxycodone. The medication does not reverse an overdose caused by stimulants like cocaine, ecstasy or Ritalin.

“Even if you’re not absolutely, 100 per cent sure that someone is having an opioid overdose, it makes sense to administer naloxone,” Hickcox said, because the drug is harmless and won’t interfere with other medications.

“And you might save a life.”

Someone who is experiencing an opioid overdose will likely have trouble walking, talking and staying awake. They will have very small pupils, weak breathing and they may make gurgling or snoring sounds.

Another sign of opioid overdose is someone’s skin turning blue or purple if they have a light complexion, or grey or ashen if their complexion is darker.

If you see someone exhibiting these symptoms, it’s recommended to call 911, administer naloxone, then follow the kit’s guide for chest compressions and CPR.

The vast majority of kits that are distributed for free across the country are injectable naloxone in ampoules that come with syringes, gloves, an alcohol swab and a “barrier shield” to place on someone’s face before mouth-to-mouth resuscitation. The medication is injected into the upper arm or upper leg, and it can be injected through clothing.

Kits typically come with two doses of the drug, allowing for a second dose if the person does not respond after the first.

Some provinces also make a nasal spray naloxone kit available.

How difficult is it to use?

Megan Horochuk, a naloxone take-home kit co-ordinator in Nova Scotia, said it’s “nerve-racking” to administer naloxone to someone experiencing an opioid poisoning, but it’s simple and effective.

“I felt comfortable doing it, though I was nervous. But as long as you’ve had the training, be it official training or not, it’s something most people can do,” she said in a recent interview.

“You just take your time …. 911 was great on the phone, which was reassuring. And the person (suffering a presumed overdose) came to before I even had to do CPR or rescue breathing.”

Across Canada, medical centres, pharmacies and community-based organizations that offer free naloxone kits also provide training, which typically takes 20 minutes. Horochuk said there are also reputable training videos online.

Horochuk speaks regularly with members of the public who have administered the drug.

“Most people I’ve talked to felt quite comfortable. I mean, no one wants to do it, but anyone that I know that has administered it said they felt good and comfortable doing it,” she said.

In British Columbia, a panel of opioid experts that includes people who use drugs has called for take-home naloxone kits across Canada to contain both a nasal spray and an injectable. Those who have used naloxone to save lives have said having nasal spray at hand could ensure a faster response because some people may be uncomfortable with needles.

Naloxone nasal spray comes in a device with two prongs that fit into each nostril to administer the medication. Ontario and Quebec offer free nasal spray naloxone at pharmacies that carry it, or through locations like needle exchange programs, shelters and public health units.

Where can I get one?

Depending on the region, naloxone can be obtained through community organizations, health centres or pharmacies.

In Alberta, British Columbia, Manitoba, Saskatchewan, Prince Edward Island, New Brunswick, Newfoundland and Labrador and Nunavut, kits are available for free to drug users and family and friends of anyone at risk of an overdose.

In Nova Scotia, anyone can obtain a free naloxone kit at more than 400 locations across the province.

Ontario makes both injectable and nasal spray naloxone available to anyone for free at most pharmacies and many community organizations.

Quebec makes both types of kits available for free at pharmacies for health card holders. People who use drugs can obtain free naloxone at many community group sites.

In the Northwest Territories and Yukon, access to naloxone is unrestricted and kits are available at pharmacies and health centres across the regions.

This report by The Canadian Press was first published Dec. 3, 2023.

 

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Health Canada approves updated Moderna COVID-19 vaccine

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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.

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

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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.

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

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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.

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