Opioid crisis | An antidote more popular than ever

The number of free naloxone kits has increased from 6,000 to more than 78,000 in six years

The popularity of naloxone kits, an antidote to opioid overdoses, has exploded in Quebec since they were distributed free of charge in pharmacies. Despite this enthusiasm, the overdose crisis could have cost the lives of more than 500 Quebecers in the last year.

“In the same week last year, I died seven times,” says the man who nicknames himself Kawich. The homeless man refers to the numerous respiratory arrests he suffered following fentanyl overdoses.

What kept him alive? Naloxone. A medication that his friends and social workers administered to him urgently to allow him to breathe again.

Naloxone temporarily reverses the effects of an opioid overdose, including fentanyl, heroin, morphine and codeine. Since 2017, kits containing the antidote have been offered free of charge in all pharmacies in Quebec and in certain health establishments and community organizations.

The man, who has lived on the streets for 30 years, recently stopped using fentanyl and ensures that his loved ones always have access to naloxone. “I live in a camp and I put a kit on each tent,” he says, adding with pride that he has already saved 10 lives.

A craze for the antidote

The popularity of naloxone in Quebec continues to grow. “Now, it is not uncommon that when a team of paramedics intervenes in a case of opioid poisoning, the patient has already received their dose of naloxone,” says Urgences-santé spokesperson Jean- Pierre Rouleau.

In the last year, more than 78,000 vials and sprays of naloxone were offered free by pharmacies in the province, according to figures from the Régie de l’assurance santé du Québec (RAMQ) coming from a request for access to the information. Six years ago, barely 6,000 doses had been distributed.

In the last year, the Cactus organization also offered nearly 25,000 vials and sprays. “It’s a question of necessity for people who want to keep themselves and their loved ones alive,” says the director of community services at Cactus Montreal, Alexandre Berthelot.

On a daily basis, Urgences-santé paramedics are increasingly called upon to administer naloxone to people who have overdosed. In 2016, fewer than 100 procedures requiring this medication were recorded. This figure will triple in 2023.

Paramedics also expect an increase in overdose cases in the coming weeks. The number of opioid poisonings tends to increase in the summer, around June, July, August and September, says Mr. Rouleau.

“I lost so many of my friends”

Despite the increasing accessibility of naloxone, overdoses have far from slowed. “There are more and more overdoses. We are far from finished,” says Alexandre Berthelot, of Cactus Montréal.

In the last year, Quebec recorded 536 deaths linked to suspected drug intoxication. The last quarter of 2023 was the most disastrous in recent years with 173 deaths recorded. Kawich has witnessed the devastation caused by overdoses firsthand. “I lost so many of my friends this year. This is the worst year, I think. »

Before the pandemic, the Cactus organization recorded two or three overdose interventions per month. “Now, there are four of us a day in the injection room,” says Mr. Berthelot. Since the beginning of May, four users of their services have died from overdoses on the street.

“It’s encouraging to see so many people have naloxone kits,” he said. But it is also worrying to note that despite this, the number of deaths is not decreasing. »

Respiratory arrest which can be fatal

Opioids can cause depression in the respiratory system.

Kawich recalls saving the life of a friend who had overdosed on fentanyl, while they were both camping under the former Montreal strip bar Club 281. “When I turned to him, his lips were purple. I tried to resuscitate him. »

He injected him with a first dose of naloxone intramuscularly. Without success. His friend remained unconscious. “I gave him a second one and I heard him snoring,” he said, remembering the relief he felt knowing he was still alive.

Once administered, naloxone binds to the same receptors in the brain as opioids. The medication can thus dislodge the drug and restore the person’s breathing in two to five minutes.

Naloxone kits available at pharmacies contain the medication either in an injectable vial or in a nasal spray. Those of the Cactus organism include both. “I start with two intramuscular doses. If I see that the person is not coming back, I don’t take a chance and I go with the nasal,” says Kawich.

The intranasal version of naloxone is 10 times more potent than the muscle injection, which can cause withdrawal syndrome in those who receive it. “The person who wakes up, generally, is in tabarnak because they lost $50 of buzz,” explains the user of the Cactus center. To minimize adverse reactions, responders generally begin with intramuscular administration of naloxone, followed by intranasal administration, if necessary.

The effect of the medication usually lasts for a period of 20 to 90 minutes. However, the effects of many opioids can last longer. “If the effect of the naloxone ends and the effect of the drug has not ended, the patient may find himself in respiratory arrest again,” indicates Jean-Pierre Rouleau. Several doses of naloxone are sometimes necessary.

With the collaboration of William Leclerc, The Press