Why a drug that can reverse fentanyl overdoses should be available over the counter in Canada
Fentanyl deaths have become an epidemic in Canada, with police and health experts from all across the country warning the public of the drug’s devastating and potentially fatal effects. But, a drug that can counter the effects of an overdose of fentanyl—as well as other opiates such as heroin and morphine—is now available over the counter (OTC) in the United States and a Vancouver health expert would like to see Narcan, also known as naloxone, become as readily accessible north of the border to help curb the crisis.
In Canada, the so-called overdose antidote is available by prescription only in a liquid form that’s administered via an intramuscular injection. Narcan works by quickly reversing the respiratory depression caused by opiates in an overdose.
“We would like to see much greater community access to naloxone; it’s a life-saving drug,” says Vancouver Coastal Health medical health officer Dr. Mark Lysyshyn.
“It’s also a very safe drug that has no potential for abuse. It’s not a drug that makes people high. The only thing it does is reverse the effects of opiate analgesics.”
“People addicted to opiates do not want to take it, but they do take or will accept it when they’re dying from an overdose,” he adds. “The only thing it does is the one thing we want it do, and that is to reverse opiate overdose.”
Fentanyl is a synthetic opioid that is far more toxic than morphine and heroin—up to 100 times more toxic than other narcotics, according to the B.C. Centre for Disease Control (BCCDC). It’s used medically for anesthesia and the management of chronic pain, often in cancer patients. Illicit fentanyl may be sold as pills or powders and is often mixed with other substances like heroin or oxycodone. An overdose can reduce breathing, resulting in brain damage or death.
The BCCDC has suggested that naloxone be made available without a prescription. Health Canada is reviewing that option and expects to make a decision in the coming months.
“They [Health Canada] have realized there is a crisis here in Canada around fentanyl and overdose, something needs to happen,” Lysyshyn says. “This [increased availability] is one of things we can do to fight against this problem.”
Research has shown having naloxone available does not increase risk-taking behaviour, according to Toward the Heart, a project of B.C.’s harm-reduction program.
Narcan is available in other parts of the world, such as Italy, where it’s been accessible over-the-counter for about 30 years. Some provinces, including B.C., Ontario, and Alberta, have take-home naloxone programs, which include education on preventing an overdose, identifying symptoms, and responding to an overdose including the administration of naloxone. In B.C., the take-home naloxone program has reversed 373 overdoses since it launched in 2012.
However, the substance still requires a prescription.
Having Narcan available OTC would help save lives and reduce complications like brain injury or brain damage from lack of oxygen during an overdose.
“Before an emergency, we’d like to plan for everyone to have it and use it: we’d like drug users’ partners and family members to have it; we’d like people who work at places like shelters to have it; we’d like all types of first-responders to have it,” Lysyshyn says. “We would like everyone to have it.
“At InSite, which is our supervised injection site, when somebody has an overdose there, that’s what the nurses give to the person,” he says. “Nobody has ever died there.”
