Overdoses on the rise as pandemic shutdown cuts access to life-saving naloxone

Mario Muscato is just as worried about bad drugs right now as the coronavirus.

Not long after the COVID-19 shutdown began in March, a couple of his friends barely survived a bad overdose after injecting what they now suspect to have been a potent mix of fentanyl and sedatives.

Muscato and others frantically applied a nasal spray of naloxone, medication marketed as Narcan that is designed to temporarily reverse an opioid overdose.

They went down hard. We Narcan-ed the hell out of them ... It was scary," said Muscato, who recalled one of his friends managing to stand up, swear - and then pass out yet again. The unconscious couple were eventually taken to hospital and recovered.

But the 46-year-old Muscato, who is himself fighting addiction and living on the streets, said he is troubled by the bad overdoses" he hears about - and occasionally sees - among friends during the pandemic lockdown.

He doesn't think it is a coincidence.

Neither do outreach workers worried the pandemic shutdown is making it more difficult for homeless people to access life-saving naloxone.

What we're hearing on the street is that there are more overdoses and less Narcan in the hands of the people who need it," said outreach doctor Jill Wiwcharuk. There was already an opioid crisis long before COVID-19. This continues to be the crisis within a crisis."

Wiwcharuk blames the street shortage of naloxone on COVID-19 service restrictions or even outright shutdowns of clinics and buildings where harm-reduction materials are usually available. The pandemic problem comes just as public health warns local agencies about reports of a dangerous mix of fentanyl and benzodiazepine, a family of drugs used as sedatives, on the streets.

City statistics show 50 ambulance responses in April to suspected opioid overdoses. That's the highest monthly tally since early last summer, although still far off an alarming spike into the 80s reported over several months in early 2019.

Related hospitalization and death data is still weeks or months behind.

Regardless, those stats show only a fraction" of the problem, said Wiwcharuk, who argued it is far more common for an overdose victim to be revived by friends using naloxone than for paramedics to be called for aid.

Wiwcharuk said she has learned of at least two fatal opioid overdoses so far in late April.

The street outreach doctor was also called on to help save the life of an overdose victim two weeks ago across the street from her methadone clinic. Two friends of the victim ran into the clinic, seeking naloxone.

It took six doses to revive the woman, said Wiwcharuk, who rushed across the street with extra Narcan kits. What struck me was there were six people who use drugs there, but didn't have Narcan on them. That would not have been the case just two months ago."

The public health department is aware of the reported naloxone shortage and looking for creative ways" to increase availability despite pandemic restrictions, said Michelle Baird, director of epidemiology, wellness and communicable disease control for the city.

For example, the downtown AIDS Network office - normally a popular pickup point for harm reduction materials - is temporarily closed due to COVID-19. But the network's mobile outreach van," in partnership with public health, has expanded its hours and is distributing naloxone.

Baird said public health is also lifting normal limits on naloxone kit distribution during the pandemic and will hand out up to four to any client who asks.

We are exploring strategies and talking to our partners," she said. We really don't want to see an increase in overdoses inadvertently as a result of trying to address another public health issue (like COVID-19)."

For now, local pharmacies like Hauser's, Gibson's and Marchese are stepping in to try to fill the gap, said Wiwcharuk.

Marchese Health Care on James Street North is making naloxone kits and plans to distribute both injectable and nasal spray versions to local homeless rest centres as well as street outreach group Keeping Six.

We're happy to try to respond to whatever the need is in the community," said Marchese operations manager Faisal Khawaja, who is working on a first order of 100 kits for each centre and outreach group.

Other city harm reduction agencies are still offering life-saving services, too. That includes Urban Core's overdose prevention site on Rebecca Street, although with pandemic restrictions on hours and distancing. Grenfell Ministries is also running an overdose prevention phone line that people who use drugs alone can call (1-888-853-8542).

Matthew Van Dongen is a Hamilton-based reporter covering transportation for The Spectator. Reach him via email: mvandongen@thespec.com