'Everyone' should have a naloxone kit for fentanyl overdoses: Montreal paramedics

Faced with the risk of fentanyl intoxication -- a highly lethal opioid -- in the general population, Urgences-Santé is in favour of “everyone” having the antidote commonly known as naloxone in their possession.

Between the Christmas party and the New Year celebrations, the end-of-year festivities are an ideal time to use substances. These can be cut with fentanyl. As well as marginalized groups, the general population may also be at risk.

“The opioid crisis is a real issue, and we know that festivities can lead to drug use,” said Urgences-sante spokesperson Jean-Pierre Rouleau, who is also a paramedic, in an interview with The Canadian Press. “In the event of intoxication, anyone can administer a dose of naloxone and make a difference.”

In Quebec, a naloxone kit can be obtained directly from a pharmacy -- free of charge and without a prescription. It contains the antidote to be injected nasally into the overdosed person to inhibit the effects of the fentanyl. In the event of intoxication, fentanyl causes respiratory arrest and altered consciousness, which can lead to death.

Naloxone is sprayed directly into the nostril of the intoxicated person. A single dose is normally sufficient, but the person's reaction must be monitored to determine whether another dose is necessary.

“We're going to be in the presence of an inanimate person, and in just a few seconds, that person is going to regain his or her functions,” explained Rouleau.

However, he urges people to keep a safe distance from the person being administered naloxone until help arrives, as it is difficult to predict their condition once they have woken up.

According to the Urgences-sante spokesperson, the majority of their interventions are carried out with more marginalized clienteles, such as homeless people, but cases of accidental intoxication or overdose during festive events are not uncommon.

“It's clear that we sometimes have to administer naloxone to families or private homes,” said Rouleau. “It can happen that someone thinks they are buying substance X, which may contain traces of fentanyl without their knowledge, leading to serious intoxication.”

Fentanyl can also be prescribed by a doctor, as it is a powerful painkiller.

Rouleau is therefore urging the public to be aware of the risk of accidental poisoning by keeping fentanyl out of the reach of children.

“Having a kit (of naloxone) can make the difference between life and death,” said Rouleau.

21 deaths a day on average

According to federal government data, 1,906 deaths apparently linked to opioid poisoning were recorded between January and March 2024, an average of 21 deaths per day across Canada.

Of all accidental deaths apparently linked to opioid poisoning, 81 per cent involved fentanyl.

The number of emergency medical services (EMS) interventions for suspected opioid-related overdoses has reached 8,719 since the beginning of the year, an average of 96 EMS interventions every day across the country.

Urgences-santé, which serves the cities of Montreal and Laval, says it has administered more than 300 doses of naloxone since the start of the year. In almost 50 per cent of cases, the patient had already received a dose of the antidote before their arrival.

Since November 2017, Quebec's Ministry of Health and Social Services (MSSS) has introduced a universal program of free access to naloxone from community pharmacies. To date, Quebec has authorised 1,900 of them to distribute the antidote, as well as 140 community organizations across the province.

The MSSS states that naloxone is supplied on an ongoing basis by various suppliers.

It points out that naloxone is “safe for people of all ages” and that it only takes effect if opioids are present in the body. It will therefore have no harmful effect if administered to someone thought to be intoxicated, but who is not in fact.

The MSSS is of the opinion that people at risk of opioid intoxication and those around them should obtain naloxone in order to be able to act in the event of an incident.

The Quebec public health institute (INSPQ) has posted an interactive map on its website showing where naloxone can be obtained at any time.

This report by The Canadian Press was first published in French on Dec. 9, 2024.