"Umm... if this stuff has been around in Canada for the past '40 years,' why haven't I heard of it until now," you ask? Damn good question.
"In Canada, Naloxone is controlled as a Prescription Only Medicine (POM) under schedule F of the regulations for Canada's Food and Drug Act. It is prescribed by Doctor's, on a named patient basis only, to those deemed at risk of opiate overdose. The availability of Naloxone is also affected by the provincial legislation governing pharmacies as well as professional bodies such provincial colleges of physicians and surgeons. "
When it comes to Naloxone programs, their respective rules and regulations can vary from place to place, and program to program. Given this variation, I am only going to be describing my personal experience in obtaining Naloxone through the aptly named "Naloxone Program" run by the Middlesex London Health Unit (MLHU) and it's program partners; the Regional HIV/AIDS Connection, London Area Network of Substance Users (LANSU), and London Intercommunity Health Centre (LIHC).
This past Monday June 22nd, Mr. L took a trip down to 'Counterpoint', our local needle/syringe exchange run through the Regional HIV/AIDS Connection, to pick up some sterile syringes and needle tips for his prescribed testosterone injections. Since I happen to be rather experienced in the area of giving injections, I give him the shot at home, as opposed to him having go sit in a walk-in clinic every two weeks for 'X' number of hours. Much easier for me to just poke him in the bum myself! While he was there, he happened to pick up a brochure for their "Naloxone Program," and brought it home for me to check out. I was excited to learn that the MLHU, the Regional HIV/AIDs Connection, LANSU, and LIHC had partnered together to run an open Naloxone training session, for several hours, three days a week; at no cost. The next training session just happened to be the following day; I couldn't help but attend.
As Tuesday afternoon's session time approached, I biked my way downtown, arriving early as usual. I hate being late. It kills me. I wandered into the building, down the hall to the Regional HIV/AIDS Connection entrance, and opened the door. I was greeted by a very friendly gentleman behind the desk, who asked how he could help me. I explained I was there for Naloxone training, and was told to have a seat. Just a minute or so later I was informed someone was being trained at the moment, so I would need to wait about 15-20 minutes until they were done, and then it would be my turn. So I gladly had a seat, and chatted away with the friendly receptionist for a while. A female worker came out from around the corner and gestured for me to come her way, saying me she needed to ask me a question. I wandered over to her, where she said she needed to ask me a question to be sure I qualify for the training. She leaned in and discreetly asked "Do you self-identify as an opiate user?" I answered "yes, I'm a methadone patient," to which she replied "that's all I need to know, love, have a seat." So I did. I ended up waiting almost 45 minutes, but during my wait I was kept company by one of the Connection workers (Greg? For some reason I want to say Greg. But then again, I'm extraordinarily terrible with names. Sorry Greg, if that's even your real name) who told me all about their new Harvoni program for HCV Genotype-1 patients, but that's another story. Finally it was my turn.
The Regional HIV/AIDS Connection worker charged with Naloxone training (I don't remember his name either, terrible I know) lead me into a small room occupied by a round table, two low black leather chairs, and a small desk with a phone. We each had a seat, and he began to empty out the small plastic tray he held in his hand onto the rounded table in front of me. Slouched in the low seated leather chair, I propped myself up to check out all the goodies that were quickly filling up the table. The only thing that looked slightly out of place was what appeared to be a bright orange stress ball. He began with a page or so of questions for me regarding my personal history with drug use and opiates, read through a consent form, and then got into the information booklet about opiate overdose and naloxone.
After he finished reading through the required literature, and teaching me the proper steps to take when encountering an opiate overdose, I found out exactly what that bright orange stress ball was for. The trainer told me that it was now my turn to show him that I'm able to complete the whole process, and am comfortable in doing so. He passed me a 1mL glass vial of water and plastic cap (the exact same type of glass vial in the actual Naloxone kit), a packaged 1cc auto-retract syringe, an alcohol prep pad, the non-latex gloves and that orange stress ball. He proceeded to tell me that I was to crack the vial, draw up the water in the syringe, and then inject it into the orange stress ball (designed to mimic an intramuscular injection). I was somewhat surprised by this, and extremely impressed that it was part of the training process. I am certainly more than comfortable giving an intramuscular injection, but I have personally never used an auto-retract syringe or cracked open a glass vial. Not that it's at all a complicated procedure, but I definitely appreciated having the opportunity to do a practice run to get the feel of things.
The process itself is relatively quick. I went ahead and opened the syringe package, and then grabbed ahold of the little plastic tip on the vial and snapped it off. The vial itself is glass, so when the plastic cap attached to the top of the vial is snapped off, it takes the piece of glass with it, helping to reduce the possibility of cuts or scratches. However, the bottom piece of the vial that contains the liquid is still sharp along the opening, so it's important to be careful when handling it. The process of drawing up the liquid and giving and intramuscular injection with the auto-retract syringe is pretty much the same as it is for your regular old 1cc Insulin Syringe; it certainly isn't hard. I picked up the auto-retract and the glass vial, and drew up every last drop. I grabbed my unresponsive orange stress-ball and syringe, inserted the needle, and slowly pushed down on the plunger until I could feel the syringe itself 'click'. After you've injected all of the liquid in the barrel and felt the click, you remove the syringe like you typically would. However upon doing so, a tiny little spring forces the entire needle to snap backwards, completely encasing itself inside the barrel of the syringe rendering it useless. It can help to reduce unnecessary pokes or pricks in what possibly could be quite a stressful situation. Ta-da! I had successfully given my very first lifesaving intramuscular injection of water to an overdosing orange stress-ball. I'm told it will make a full recovery. I couldn't be happier to hear it.
After a quick little final quiz to ensure I understood everything, he signed my name on the little certification card and handed me my own kit. I was officially trained certified to carry and administer Naloxone. Woo! The whole process took about 35 minutes.
So let's take a look at the kit itself, shall we?
1 Certification Card
1 Information Card
1 "5 Steps to Save a Life" pamphlet
1 Pair of non-latex gloves
1 Rondex CPR mouth shield
2 Alcohol prep pads
2 Glass vials (1 mL) of Naloxone (0.4mg/mL)
I certainly hope I never have to use this kit, but I feel it is very important to trained. Even though I am no longer abusing opiates, I am on Methadone, and regularly encounter active users. Being trained to save someones life can't hurt!
Would you give 25-30 minutes of your time in order to possibly help save a life? Be sure to inquire about the Naloxone program in your area.