The province is making a life-saving antidote more readily available, in an effort to combat the public health emergency caused by a spike in fentanyl-related deaths.
The ministerial order extends the scope of practice for registered nurses, paramedics, emergency medical technicians and emergency medical responders and is in effect until July 1, 2016, at which point it can be renewed if necessary.
Under the order, nurses can prescribe naloxone, in addition to administering and distributing it; paramedics can distribute naloxone, in addition to administering; and emergency medical technicians and responders are authorized to administer and distribute naloxone.
According to the latest Alberta Health Services figures, released Monday, from Jan. 1 to Sept. 30, 2015, there were 213 deaths involving fentanyl in Alberta. This is almost double the 120 fatalities seen last year.
Fentanyl is often mistaken for or sold as other drugs, namely OxyContin. It is also being mixed into a number of different substances, usually without the knowledge of the user.
Fentanyl is 10 times more potent than morphine, heroin or oxycodone. The equivalent of two grains of salt is enough to kill a 200-pound person.
As a precaution, AHS recommends that drug users don’t mix drugs or speedball, don’t take drugs alone, do test doses and always carry a Naloxone kit.
However, under current federal legislation naloxone, which reverses the effects of opioids such as fentanyl, is only available with a prescription.
The province is working with the federal government to make naloxone available over the counter so it is more readily available to those who need it, when they need it.
In the summer, Alberta Health introduced a new harm reduction strategy that made take-home naloxone kits available to individuals at risk of overdosing on fentanyl and other opioids by providing a one-time $300,000 grant to the Alberta Community Council on HIV to administer the program. In Edmonton, take-home kits could be accessed through Street Works.
The latest announcement by Alberta’s health minister Sarah Hoffman expands on these efforts.
“This is about putting the right tools in the hands of the people that can best use them. We see this as an opportunity to provide better care to Albertans by expanding the administration of naloxone,” Alberta Health Services’ chief paramedic Darren Sandbeck.
While paramedics have always been able to administer naloxone, emergency medical technicians staff some ambulance services in Alberta, especially in rural and remote communities. The ministerial order makes naloxone more accessible in these areas.
From Jan. 1 to Oct. 31, 2015 there were 392 emergency and urgent care visits in the Edmonton zone due to “poisoning by other opioid.” The data includes, but is not limited to fentanyl.
There were also 91 emergency visits due to “poisoning by heroin” and 68 due to “poisoning by synthetic narcotic.” Both categories include situations of fentanyl overdoses.
Sandbeck said that AHS is still working out the parameters for EMTs distributing the antidote.
From the St. Albert Primary Care Network’s vantage point, the fact that registered nurses can now prescribe the drug won’t make much of a difference, according to clinical manager Heather Newman.
“Usually we use a team approach if we know a person’s at risk. The trouble is identifying those people. Often those people aren’t the people who are seeing their primary care physician,” she said.
Newman said a social worker would more likely be working with clients vulnerable to opioid overdoses than registered nurses.
Both health care professions will continue to talk to the family doctor about the overall health plan, which could include the physician or a pharmacist prescribing the antidote.