Frontline care providers call for Health Canada to look at nasal form of overdose antidote
On Christmas Eve, Sarah Blyth was working as a coordinator at one of the Downtown Eastside’s nonprofit hotels when someone rushed in off the street with a call for help.
“There was a person outside and he was dying,” the former park board commissioner recounted by phone. “So I went running over with the Narcan kit.”
Narcan is a trademark name for naloxone, a drug used to counter the effects of opioids such as heroin. In Canada, the so-called overdose antidote is only available in a liquid form that’s delivered via an intramuscular injection.
With the help of police and staff from Insite, Blyth administered two shots to save the man’s life. But she conceded that the experience rattled her.
“I had never used it before,” Blyth explained. “You’ve got to crack open a little bottle that has jagged edges and then you have to extract it....You can be in the dark and it is quite a few steps.
“With fentanyl going around, this is happening quite a bit,” she continued. “You can see how it can be a difficult thing to do and would be way easier if you had a different method. And there is a different method available.”
Naloxone also comes in the form of an intranasal spray, which Blyth described as easier to administer and less intimidating for people uncomfortable with needles. But the spray is not approved for use in Canada.
In a telephone interview, Health Canada spokesperson Rebecca Gilman said an intranasal form of naloxone would be considered a “major change in formulation” from the injectable type that is approved. She said it would therefore be required to go through a full Health Canada review, a process that, to date, has not been initiated.
“The decision to pursue authorization of a product in Canada rests with the manufacturer,” Gilman explained. “Health Canada has not received a submission for an intranasal formulation of naloxone, and therefore it has not been granted market authorization.”
However, she added Health Canada has received “inquiries” from drug manufacturers about bringing different forms of naloxone to market, and that the federal government has responded with “advice”.
Jane Buxton, harm-reduction lead for the B.C. Centre for Disease Control, told the Straight she would welcome the approval of the drug in the form of a spray.
“If the intranasal was available, then that would be much, much more acceptable, especially for people who do not inject drugs," she said.
In the past, the Vancouver Police Department has expressed reservations about equipping its officers with needles. In a telephone interview, Const. Brian Montague, a spokesperson for the force, said the availability of a nasal spray would help address those concerns.
“We would revisit the thought of having some of our officers trained to carry it if a nasal form was made available here in Canada,” he said.
Calls for greater availability of naloxone have come in response to a synthetic opioid called fentanyl turning up in more drug overdoses in B.C. According to the provincial coroners service, during the first eight months of 2015, fentanyl was detected in 91 overdose deaths in B.C., or more than a third of the total. That’s up from 90 during the whole of 2014, 49 in 2013, and 13 in 2012.
To date, naloxone has been used to reverse 326 potentially fatal overdoses in B.C., according to a provincial harm-reduction program called Toward the Heart, though the actual number is likely much higher, as it is believed the drug's administration is "vastly underreported".
Buxton noted her office has also suggested naloxone be made available without a prescription. Health Canada is reviewing that option and expects to make a decision early this year.