Download February 10, 2017 Neal Roberts, President c/o Ontario Association

February 10, 2017
Neal Roberts, President
c/o Ontario Association of Paramedic Chiefs
1801 - 1 Yonge Street
Toronto, ON M5E 1W7
[email protected]
Re: National Opioid Crisis and Naloxone Availability
President Neal Roberts,
The Ontario Paramedic Association (OPA) is a registered Not for Profit Corporation that has a mandate
to advocate for patients and the profession of paramedicine. We are not a labour union.
We would like to collaborate with the Ontario Association of Paramedic Chiefs (OAPC) in order to
adequately address the presence of emerging synthetic opioids such Fentanyl and Carfentanil. Our goal
is to achieve some alignment with regards to the amount of Naloxone that is carried on paramedic units
across Ontario in order to benefit patients and protect our valued emergency responders.
Using morphine as a baseline comparator, these emerging substances are extremely powerful and are
being mixed in with a variety of other recreational drugs such as Cocaine, Demerol, Ecstasy, Heroin,
MDMA, Morphine and Oxycontin.


Fentanyl - 100x more potent than morphine
Carfentanil – 10,000x more potent than morphine
The OPA respectfully proposes the following recommendations to OAPC:
1) Stock a minimum of 4 BVM ventilators on all Paramedic Units
2) Stock a minimum of 12mg of Naloxone on all Paramedic Units
3) Stock a minimum of 12 Intranasal Atomizers and 12 Syringes on all Paramedic Units
Due to the potency of Fentanyl and Carfentanil, paramedics in BC, Alberta, Manitoba and Ontario have
documented administering recording-breaking doses of Naloxone in order to achieve a therapeutic
effect with patients. This situation introduces a critical juncture for patients and paramedics when most
of the 52 paramedic services in Ontario are only stocking 2 vials of Naloxone per unit.
ONTARIO PARAMEDIC ASSOCIATION
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It is important for paramedics to have enough remaining Naloxone to ensure continuous readiness in
the event that multiple patients require treatment throughout any shift.
Furthermore, the Ontario Paramedic Association is asking our chiefs to ensure there is enough Naloxone
in the event that our paramedic colleagues and/or allied responders become exposed through
accidental inhalation, ingestion or absorption of these extremely potent substances.
We thank you for your leadership with paramedics and for continuing to ensure communities across
Ontario have access to the highest quality healthcare from paramedics.
With respect and sincerity,
Ashleigh Hewer
[email protected]
613-371-7174
Darryl Wilton
[email protected]
613-299-0333
Ontario Paramedic Association
PO BOX 1628
Blind River, ON P0R 1B0
1-888-OPA-LINE
OntarioParamedic.ca
Ontario Paramedic Association
PO BOX 1628
Blind River, ON P0R 1B0
1-888-OPA-LINE
OntarioParamedic.ca
NOTE: Supporting documentation attached
ONTARIO PARAMEDIC ASSOCIATION
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Timeline of Events
o
February 16, 2016 - OPA began pursuing #NoPatchNaloxone through mainstream media and our
social media platforms
o
March 22, 2016 – Naloxone was removed from the Health Canada prescription drug list and
civilian kits were made available in 7 provinces
o
September 01, 2016 - OPA provided a formal recommendation to the Medical Advisory
Committee of the Ontario Base Hospital Group to increase dosing and remove the patch point
for Naloxone for all PCP's and ACP's
o
September 13, 2016 – RCMP to be equipped with Naloxone kits after officers in Kamloops BC
exposed to Fentanyl
o
September 20, 2016 - Paramedic Association of Canada Executive Director Pierre Poirier
provided evidence to the House of Commons Standing Committee on Health
o
Important - MAC states they will remove the BHP Patch point for Naloxone in July 2017
o
Sept 21, 2016 - OPA launches social media awareness campaign from September to December
to compel MAC and the Base Hospitals to do the right thing for the patients and paramedics
o
Important - Paramedic MAC rep states that July 2017 implementation is adequate. OPA
disagrees.
o
November 03, 2016 – Nanaimo, BC Deputy Sheriff exposed to Fentanyl while searching prisoner
o
November 17, 2016 – Winnipeg Paramedic exposed to Fentanyl
o
November 19, 2016 – Federal Minister of Health Jane Philpott declares national crisis at Opioid
Summit in Ottawa
o
December 20, 2016 - OPA contacts MAC regarding BHP Patch Point
o
December 23, 2016 – MAC changes the Medical Directives and removes BHP Patch Point
o
December 26, 2016 – Hamilton Paramedics instructed to wear N-95 masks with additional PPE
o
January 06, 2016 – Hamilton Paramedics now have P-100 masks available with additional PPE
o
February 10, 2017 – OPA submits recommendation to OAPC to increase stock of BVM
Ventilators, Intranasal Atomizers, Syringes and Naloxone on all Paramedic Units
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2017 Naloxone “Treatment Options” across Canada
Province
Public
RCMP
PCP
ACP
BC
AB
SK
MB
ON
QC
NB
PEI
NS
NF
Yes
Yes
Yes
Yes
Yes
Yes
N/A
N/A
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
Yes
Yes (new)
Yes
Yes
Yes
No
No
Yes
Yes
Yes
Yes
Yes
N/A
N/A
Yes
Yes
Yes
Naloxone Medical Directive History in Ontario
2005-06 – No BHP Patch required with a maximum dose of 2mg
2007-06 – BHP Patch required with a maximum dose of 2mg
2011-11 – BHP Patch with a loading dose of 0.4mg IV (0.8mg IM/IN)
2013-11 – BHP Patch with a loading dose of 0.4 mg IV (0.8 mg IM/IN)
2016-02 – BHP Patch with a loading dose of 0.4mg IV (0.8 mg IM/IN) and PCP administration
2016-12 – Sunnybrook advises ACP’s to BHP Patch for repeat doses of 2.0mg – 6.0mg IV, Q 1-2min
2016-12 – No BHP Patch with a loading dose of 0.4 mg IV (0.8 mg IM/IN)
2017-07 – No BHP Patch with a maximum dose of 0.4mg IV (0.8 mg IM/IN) and PCP administration
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Background
1) A Fentanyl and Carfentanil tsunami has taken one year to travel from the west coast towards
the east coast with some police drug seizures in Alberta that had the potential to create 50
million lethal doses. One location had enough volume to kill over 20,000 people.
2) In 2016 there were over 1,760 reported deaths due to accidental overdose with more than half
of those figures related to Fentanyl and or Carfentanil. Many are now calling for a National
Healthcare Crisis as a result of this issue that is evolving at a rapid pace.
3) Fentanyl and Carfentanil are surreptitiously
mixed into other drugs (Cocaine, Demerol,
Ecstasy, Heroin, MDMA, Morphine and
Oxycontin) that can be powdered, diluted,
mixed and then pressed back into a much
higher volume of pills.
4) Significant risk factors exist on scene if
emergency responders come into airborne or
topical contact with powdered Fentanyl or
Carfentanil. Multiple Paramedic Services have instructed their staff to take extra precautions
where airborne Carfentanil could be a possibility.
5) It is apparent that Ontario paramedics are not presently carrying enough Naloxone and their
loading doses under present standing orders (updated Dec 23, 2016) remain not high enough to
have a therapeutic effect with the potency of synthetic opioid overdoses we have seen
escalating throughout 2016 and into 2017. Loading doses required for a therapeutic effect due
to potency of Fentanyl & Carfentanil are starting at 2mg and can go as high as 8mg.
6)
It is crucial to look to where this crisis began for guidance on how we can best prepare. Of
important note is that Vancouver paramedics were initially caught off-guard and ran out of BVM
ventilators and Naloxone for weeks before lab results indicated the potency of these new
clandestine drugs. Vancouver Paramedics reporting increasing their stock and 16 vials of
Naloxone & multiple BVM's per shift (their numbers are also watered down as Naloxone is
readily available on the streets of Vancouver). In addition the Superintendents are carrying
additional stock of BVM ventilators and Naloxone (to ensure continued availability).
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Acknowledgements
We would like to make the following acknowledgements for proactive groups:
1) Peel Region Paramedic Service and the Peel Paramedic Association for being exceptional
patient advocates and for being proactive in protecting their paramedics and allied partners.
 previously stock = 2mg Naloxone
 present stock = 12mg Naloxone (PCP’s) & 16mg Naloxone (ACP’s)
2) County of Renfrew Paramedic Service for being exceptional patient advocates and for being
proactive in protecting their paramedics and allied partners.
 previously stock = 2mg Naloxone
 present stock = 12mg Naloxone (PCP’s & ACP’s)
3) Sunnybrook Centre for Prehospital Medicine for being exceptional patient advocates and for
being proactive in protecting their paramedics and allied partners.
 previously medical directives = 0.1mg – 0.4mg Naloxone IV
 present stock = increased to 12mg Naloxone available in each Paramedic Unit
 present PCP medical directives = 0.8mg Naloxone IV, followed by 2mg IM Q 3-4 min
(maximum 3 doses) until patient responds
 present ACP medical directives = 0.1mg – 0.4mg Naloxone IV, followed by escalating
doses of 2mg IV, 4mg, then 4-6mg IV, Q 1-2min until patient responds
4) Ontario Paramedic Chiefs who have already increased stock to achieve authentic seamlessness
and consistency across Ontario.
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