Between Life and Death The Barriers to Calling 9-1-1 During an Overdose Emerencgy
click on image to download full report
In Ontario, accidental poisoning, of which unintentional drug overdoses are the leading component, are the third leading cause of accidental death (Ontario Mortality Data, 2007). In Ontario, opioid-related deaths doubled from 1991 to 2004 from 13.7 per million to 27.2 per million
Fatal and non-fatal overdoses have significant social, health and economic impacts, including loss of productivity and direct costs to health care and law enforcement. The societal burden of opioid-related mortality and morbidity in Canada is substantial.
Overdose deaths, and related harms, can be prevented through interventions such as prompt emergency medical attention, but for people who use drugs there are barriers to calling 9-1-1 during these emergencies. In most of Canada, a 9-1-1 emergency call triggers a response from police, fire and ambulance.
Fear of the criminal justice system is the number one reason people would not call. The research also revealed that populations more likely to witness an overdose are less likely to call 9-1-1 than others in the survey sample. For example, younger individuals are significantly less likely to call 9-1-1 and wait for help to arrive. They are also significantly more likely to cite fearing arrest as a reason they would not make the call.
Prescription for Life Report
click on image to download full report
Massive increasesin opioid prescribing have made Canada a world leader in per-capita prescription opioid consumptionand Ontario a leading province in opioid prescribingand high dose opioid dispensing.Ontario has witnessed 13 years of increasing and record-setting opioid overdose fatalities,which now rank as the third leading cause of accidental death,and more than double the number of drivers killed in motor vehicle collisions.More than 5000 Ontarians have died of an opioid overdose since 2000, the vast majority unintentionally.Non-fatal opioid overdoses have been estimated at 20-25 times the number of fatal overdoses and can be a significant contributor to morbidityhowever, data on prevalence and injury burden are limited.Opioid-related hospital emergency department (ED) visits in Ontario have increased significantly,and hospital stays across Canada are up 23%.
It is critical to understand that people who are at-risk of an accidental overdoseinclude individuals who are taking opioids as prescribed,in addition to people using opioids non-medically.Effective opioid overdose prevention and intervention targets both opioid-using populations- and potential witnesses.
Naloxone is the opioid antagonist that has been used to effectively revive victims of opioid overdose for decades, in hospital emergency rooms and by select paramedics. A limited “take-home” naloxone program was recently launched in Ontario,however, barriers prevent dispensing to most Ontarians at risk of experiencing or witnessing an opioid overdose; an opioid overdose victim cannot save themselves. Considered as an essential part of the First Aid toolbox, expanded low-barrier naloxone access will reduce injuries, save lives,and begin to provide similar levels of care that are dedicated to reducing other preventable deaths.
We can do much better at responding to the thousands of opioid-related medical emergencies that are certain to occur. As Peterborough Police Chief Murray Rodd noted when speaking of opioid overdoses and naloxone, “It could be anybody's mother or father, anybody's brother or sister - we have to respond appropriately”.
Brief of the Canadian Drug Policy Coalition
It’s easy and it saves lives: Opioid overdose prevention & response in Canada In 2013, 308 people lost their lives due to illicit drug overdoses in BC alone. The worst part? Drug-related deaths from opiate overdose are entirely preventable.
And not in the sense that “well if people didn’t use drugs… there wouldn’t be overdoses.” Because while that’s essentially true, we know that people will use drugs. One hundred years of prohibiting drugs and arresting and incarcerating people who sell and use drugs hasn’t stopped that.
We need to be realistic and practical. Drug use does happen and it will happen. So let’s get on with preventing deaths and injuries from drug overdose. Here at the Canadian Drug Policy Coalition, we’ve worked with experts across the country to come up with set of policy changes that can save lives and make Canada safer for all.
While putting together this brief, we met many dedicated, compassionate people who work in frontline overdose prevention programs across Canada. One of the most pragmatic and effective interventions to prevent overdose injury and death is the “take-away naloxone program.” Based on 180 similar initiatives in the US, the program involves distributing overdose response kits – dubbed take-home-naloxone kits – to people who have been trained to prevent, recognize and respond to an overdose. Naloxone is a 40-year old medication that when administered during an opiate overdose reverses the effects of the drug. It has no narcotic effect and people cannot become dependent on this drug.
Streetworks in Edmonton pioneered this initiative in Canada and similar programs have spread throughout Canada. The country’s most robust overdose program – “take-home naloxone” (THN) – can be found at British Columbia’s Centre for Disease Control’s (BCCDC) harm reduction resource Toward the Heart.
Through a series of participating organizations throughout BC, the naloxone program operates in 35 sites, from large urban hubs such as Vancouver and Surrey, to smaller rural centres such as Cranbrook, Campbell River and Fort St. John. Nearly 1000 people have been trained including staff and volunteers at health and social service agencies, as well as friends and family members of people who use drugs. Over 600 kits have been dispensed to clients who use opioids and various resource materials are being developed to assist community partners to increase the reach of the program. Since its origins in 2012, 55 overdoses have been reversed.
While these simple yet effective initiatives are demonstrably preventing overdoses, significant challenges prevent these programs from being scaled up. Naloxone remains a prescription-only medication, and it’s costly and not covered by provincial drug plans. An even more significant challenge is the lack of a national Good Samaritan law, one that prevents people from being arrested and charged with drug possession if they call for help during an emergency. Eleven US states have passed Good Samaritan laws, often with bipartisan support from legislators.
Our hope is that this policy brief will help support efforts to clear away the barriers blocking overdose programs. That’s the most realistic way to prevent drug-related deaths from opiate overdose.
Brief of the Canadian Public Health Association
click on image to download brief
May 26, 2014
(Toronto) – Canada needs a public
health approach to managing illegal psychoactive substances that de-emphasizes
criminalization and stigma in favour of evidence-based strategies to reduce
harm, according to a new policy report from the Canadian Public Health
In a report to be
released Tuesday, May 27, 2014 during
Health 2014, Canada’s largest annual gathering of public health
professionals, CPHA argues that drug policies based on prohibition have failed
to prevent the use of illegal psychoactive substances. Instead, they have
caused serious harm, often for the most vulnerable Canadians.
has engendered an environment that fuels the growth of illegal markets,
organized crime, violent injuries, and the deaths of users, dealers, and
police,” said Ian Culbert, CPHA’s Executive Director. “It also has adverse
public health consequences such as accelerating the spread of HIV and hepatitis
C, and increasing overdose deaths from concentrated and contaminated products.”
provincial and territorial governments are at the forefront of delivering
public health services to address illegal psychoactive substances issues, while
municipalities such as Vancouver, Toronto, and others have incorporated public
health principles into local strategies. Internationally, countries such as
Switzerland, Norway, Australia, Portugal and Uruguay have developed innovative
approaches that ensure that public health is central to their illegal
psychoactive substance strategies. Their focus is on reducing harms and
providing access to health services to all individuals who require them.
to prohibition and criminalization exists,” said Culbert, “a public health
approach that is based on the principles of social justice, attention to human
rights and equity, evidence-informed policy and practice, and addressing the
underlying determinants of health.”