Naloxone distribution questions need answers amid Canada's opioid crisis

A national network that supports research into misuse of prescription and illegal drugs says several questions need to be addressed about the safety, effectiveness and distribution of a medication that reverses overdoses.

The Canadian Research Initiative in Substance Misuse says the opioid crisis has demanded a quick public health response but has not necessarily allowed for the evaluation of important issues in distributing naloxone.

Every province and territory offers free injectable naloxone, while Ontario, Quebec and the Northwest Territories also provide the nasal form for people at risk of overdosing.

Most jurisdictions also offer naloxone kits to family or friends who could use it to try to save someone's life.

The research initiative says in a report that some areas are limited in their ability to distribute naloxone due to geographic challenges and regulations related to drugs, including that they must be provided by certain health professionals such as pharmacists.

The report involving researchers, service providers, policy-makers and people who use or have used drugs says other considerations include the training needed to effectively respond to an overdose and how to administer naloxone.

There is also a need for evidence regarding the benefit ofdistributing the drug broadly as opposed to only specificpopulations at risk of overdosing, it says.

"There are also ethical considerations including how to collect robust health data while protecting low-barrier access environments and respecting patient anonymity, and whether it is appropriate to provide naloxone kits to minors," the report says.

Equitable outcomes

The federally funded initiative says it's also important to identify the most effective overdose response strategy beyondadministering naloxone, including:

• Chest compressions.
• Rescue breaths.
• Calling 911.

The best order in which those steps should be taken also needs to be determined, the researchers said.

"Consolidating existing evidence, suggesting areas for future research, and building consensus among stakeholders may help improve naloxone access and ensure equitable outcomes in Canada," the report says.

More than 11,500 people fatally overdosed in Canada between January 2016 and December 2018, the Public Health Agency of Canada reported last week.

The data showed 4,460 people died in 2018 alone and many of the deaths were linked to illicit drugs being contaminated with theopioid fentanyl.

The report says a needle exchange program called Streetworks in Edmonton was the first in Canada to start distributing naloxone in 2005, followed by Toronto Public Health and other community groups in 2011.

British Columbia launched its publicly funded take-home naloxone program in 2012, and Ontario began doing the same in 2013, with Alberta and Saskatchewan following in 2015.