Saturday 20 October 2018

Antidote action plan to tackle drug more deadly than heroin

Fentanyl overdose victims have just minutes to live ­- and the killer drug is on its way here, writes Niamh Horan

Singer Tom Petty was using the drug for pain medication when he died from an overdose.
Singer Tom Petty was using the drug for pain medication when he died from an overdose.
Niamh Horan

Niamh Horan

Fentanyl, an opioid drug thousands of times more dangerous than street heroin which has left more than 70,000 people dead in Canada and the US, is creeping into Ireland, according to one of the country's leading drugs experts, Dr Chris Luke.

The synthetic heroin has made headlines around the world for reaching epidemic proportions in the States and has been named as a factor in a number of celebrity deaths including Prince and Tom Petty.

Speaking to the Sunday Independent Dr Luke, a consultant in emergency medicine at both the Mercy Hospital and at Cork University Hospital for more than 25 years, said the drug has come to Ireland over the past five years - in particular, due to the rise of people gaining access to online mail order drugs.

Now Dr Luke is calling for the roll-out of naloxone - a medication used to block and reverse the effects of an opioid overdose - in key locations around Ireland, which he says would save hundreds of lives.

Following the introduction of community defibrillators which have saved scores of lives from heart attack and cardiac arrest, an injection of naloxone (though it is also available in the form of a nasal spray) could help save the life of someone who has stopped breathing after overdosing - on anything from over-the-counter codeine painkillers and cough mixtures to morphine and street heroin.

Dr Luke explains: "Everyone has a natural thermostat in their brain, which enables breathing.

"But opiates turn that thermostat right down, and if you take too much of it you eventually turn blue, stop breathing and are found dead, typically on the side of the street, in a toilet, in a back alley, or in a hostel.

"You only have three or four minutes to live - so if someone suspects that one of their buddies has had an opiate overdose, they can raise the alarm and get the antidote to the victim.

"Therefore, it is important to make the injection as freely available as possible to those parts of society where overdose is likely - in hostels, homeless shelters and addiction centres, but also in pharmacies in areas where overdoses are more likely."

Much of the naloxone currently available is sold under the brand name Narcan and is made by Irish firm Adapt Pharma.

Narcan is being shipped in massive amounts to the US, where 640,000 doses of its nasal spray, worth some $30m, were bought in 2016.

Naloxone has also been used in Northern Ireland.

Statistics released last year revealed that it had been administered 112 times in Northern Ireland over the previous five years, saving 98 lives.

In the Republic, there is an HSE-run project which has trained 600 people in how to administer the drug - and these frontline trainees have reportedly prevented five overdoses in the Dublin and Limerick areas. (The project was also rolled out in Cork and Waterford.)

But still, one person dies from an opiate overdose every day in Ireland.

Dr Luke says the slow action to roll out the life-saving antidote is down to one key reason: "It is called stigma. But people need to realise, on a very, very pragmatic level, if you can save these peoples' lives quickly with a squirt of this drug, you can save a vast amount of expenditure on guards, ambulances, fire crews, first responders, forensics, autopsy and above all the health service.

"Because if somebody only half survives, or is brain damaged, they will end up spending days, weeks, months or years in the health service, which is phenomenally expensive.

"So even if you look at it in incredibly black and white terms, saving lives with a squirt of naloxone can save society huge amounts of money."

Injections could save 200 lives

The medical uses of fentanyl are typically pain management after surgery or for chronic pain.

Singer Tom Petty was using the drug for pain medication when he died from an overdose.

He had been prescribed the drug for knee problems and a fractured hip. He was also taking an anti-anxiety drug and a sleep aid.

Fentanyl was also implicated in the fatal overdose of Prince in 2016.

Figures released last month show that, here in Ireland, 42pc of people who died where heroin (injecting or smoking) was implicated were not alone at the time they took the drug. As one person dies from an opiate overdose every day in Ireland, this suggests that there may have been an opportunity to prevent almost 200 deaths through the administration of naloxone.

Sunday Independent

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