Harold Cook works as a registered nurse with the mobile outreach street team run by North End Community Health Centre. Whether it’s shelters, encampments or on the streets, he meets people where they are to provide primary health care. He’s working on the frontlines of a crisis fueled by opioids. “Historically, Halifax has been predominantly an opioid overdose community. There is a lot of opioid use in HRM, we know how to handle those situations,” says Cook. “Narcan naloxone is a drug that we use regularly to treat and reverse overdoses frequently, but we are seeing concerning signs that there are other drugs that are being cut into the illicit street supply.” Cook explains the trend is alarming, especially here in Halifax. “Doesn’t matter which numbers you are looking at, the trend is upwards. We are doing a great job at getting the word out there, but deaths are increasing year to year,” he says. The team responds to overdoses, a problem they have always seen but as Cook notes is getting worse. “This issue now is that these new drugs that are in the system are not intended for human use, a lot of them are veterinary tranquilizers that are not intended for humans, they are the drugs that are getting cut into opioids into the illicit street supply,” he adds. It’s also a growing concern for Amanda Moore with Direction 180, an addiction treatment program in Halifax. Moore explains one reason for Nova Scotia’s increase in overdose deaths is because of a more potent and toxic drug supply. “Some of the new opioids that are called Nitazene opioids. Some of them are 200 times stronger than fentanyl and if you think about fentanyl which is already a really scary thing to have in our drug supply, that’s 100 times stronger than morphine,” she says. “So, if you can imagine someone who’s never taken an opioid before… even a very small amount of it, like, fentanyl or something stronger, it’s going to be a lethal dose for that person," says Moore. She also explains overdoses are more likely to happen when someone is alone. “We also support here our city’s only supervised consumption site that’s an opportunity to provide vital health care to folks who still do use substances and are not ready to look at abstinence-based model of care for their substance use,” adds Moore. Moore explains naloxone can be given if someone is experiencing an overdose and it can be given intramuscularly or intranasally. “Naloxone is really effective in reversing overdoses that are due to opioids, something like fentanyl. Like I said, because of the new and concerning more potent adulterants that we are seeing we know naloxone is not always going to work and that someone may need multiple doses in order for that overdose to be reversed. So, we believe really strongly in public education,” she adds. Pharmacist Kimberly Hirtle runs naloxone training and educates the public on their use and importance. “What naloxone does is it knocks the opioid off the receptors in the body. So, opioids suppress respiration and breathing,” says Hirtle. Something she often thinks back to is several years ago, her friend lost her child to an opioid overdose that could have been avoided. “If they had had more on hand, if they had called 911 and completed the steps which pharmacists in Nova Scotia are trained to educate the public about, he would still be with us,” says Hirtle. In addition to calling 911, Hirtle says someone may need multiple doses of naloxone. She adds that kits in Nova Scotia went from having two vials of naloxone to three vials. Community distribution sites hand out both nasal and injectable naloxone, but pharmacies only provide injectable kits, Hirtle says pharmacies need the nasal ones as well. “In the event that somebody does come in contact with a drug overdose, the public’s comfort with administering an intramuscular injection is challenging to overcome, and a nasal spray is very simple to administer and people are more comfortable with using that so it would increase our possibility of saving lives,” adds Hirtle. These experts remind residents that if they come in contact with someone who is experiencing an overdose use a naloxone kit if you have one, regardless of what substance someone has consumed. Naloxone doesn’t harm someone when you use it, it’s meant to help. “As soon as you give that first dose, what you are going to do is call EHS, get them on the phone and then they will guide you from there as to whether you should be giving more doses,” says Moore. “It doesn’t work for other drugs that we know are in the Nova Scotia drug supply, like I said the xylazine’s, the medetomidine, those tranquilizers that can also be fatal. It doesn’t work for those drugs but the thing about naloxone is there’s no harm in giving it. So even if they don’t have any opioid on board and the naloxone doesn’t work, it’s still best to give it just in case there is any sort of fentanyl that was laced in that person’s substance that they took,” adds Moore. Naloxone is free and can be found at community distribution sites and pharmacies. For more Nova Scotia news, visit our dedicated provincial page
