The debate over whether naloxone should be as common as defibrillators

The man at the helm of the company that makes the life-saving opioid antidote naloxone says he wants to make the drug as common as defibrillators by stocking Narcan nasal spray in schools, community centres and arenas.

David Renwick says drug should be stocked alongside emergency automated defibrillators in public venues

When sprayed up a person's nose, Narcan nasal spray can quickly deliver a life-saving dose of the opioid antidote nalaxone through nasal membranes. (Adapt Pharma Canada)

The man at the helm of the company that makes the life-saving opioid antidote naloxone says he wants to make the drug as common as defibrillators by stocking Narcan nasal spray with the devices in schools, community centres and arenas.

Opioid-related overdoses killed 1,460 Canadians in the first half of last year and while more recent statistics aren't yet available, the Public Health Agency of Canada was predicting in December that the country was on pace to surpass 4,000 opioid overdose deaths by the end of 2017. 

It's why David Renwick, the general manager of Adapt Pharma Canada, the manufacturer of naloxone, told CBC News that the life-saving drug should, like a fire extinguisher, be readily available in most public places.

'There's a problem right across the country'

David Renwick is the general manager of Adapt Pharma Canada. He's looking to make Narcan nasal spray as common as defibrillators.

"There's a problem right across the country," he said. "It doesn't seem to be limited to a stigma that we might have of people who are addicted to drugs, or perhaps living on the street or battling mental health issues, the reality is it's affecting all socio-economic profiles."

"It really needs to be tackled holistically," he said. "I think the one idea that stimulates that discussion is having these available in places where we have first aid kits, fire extinguishers or [with automated emergency defibrillators.]"

"The main driver here is 'how do we save lives?' I think the way we're trying to do that is looking for ways to make sure that Narcan is as broadly available as possible." 

Kingston city council voted to do exactly that, making Narcan nasal spray kits available at 14 public venues across the city as of Feb. 1, including swimming pools, museums, parks, a theatre and even the city airport. 

'I think in theory it's a good idea'

Paramedics in London, Ont. say combining drugs such as naloxone with an AED, or automated emergency defibrillator (above) might confuse the public, who often don't know where they are and hardly use them in an actual emergency. (Darren Bernhardt/CBC)

Public schools in Lambton County and Chatham-Kent will also start carrying the drug, which reports say came after school officials took the advice of local health authorities to make it more readily available. 

Paramedics in London, Ont., however, a city that hands out needles at a rate second only to Vancouver, think Kingston city officials and Lambton-Kent education officials might not be making the most pragmatic choice, especially when it comes to pairing the drug with an AED, or automated emergency defibrillator in a public venue. 

"I think in theory it's a good idea," Jay Looslie, the superintendent of education for Middlesex-London Emergency Medical Services said. 

"We have a hard enough time having people find the AEDs and having them registered and being used, to add other things into it, I think would just confuse the public." 

Another layer of difficulty

Narcan nasal spray comes in two, 4 mg doses that are packaged together and, unlike the intramuscular nalaxone injection kit that's free at any Ontario pharmacy, you would have to pay about $145 dollars for two doses, according to Adapt Pharma Canada. (Adapt Pharma Canada)

"We've been working for 20 plus years with the public to recognize where AEDs are, how to use them, how to even get them off the wall and not to be afraid of them and it's been really difficult," he said. 

​"We're not doing a lot of calls at high schools for narcotic overdoses," he said, noting most regular people wouldn't know the first thing about administering the opioid antidote.

"It's a drug and there are side-effects to drugs and giving to the wrong person, it does have its side effects," he said.

"I don't think having public access Narcan in a school or a mall, in places I don't think it will really be used, just adds another layer of difficulty."

Paramedics say people at the scene of an opioid overdose can save a life without Narcan, by keeping the victim's airways open until paramedics arrive. 

"No one would ever associate an AED for cardiac arrest with a narcotic overdose," Looslie said. "I just don't think you'll get best the bang for your buck."

Nalaxone injection kits free in Ontario

Paramedics say stocking Narcan nasal spray with automated emergency defibrillators risks confusing the public in an emergency. (Andrew Lupton/CBC)

Nalaxone kits are currently available for free to anyone who asks for one from an Ontario pharmacist. The kit can deliver an inter-muscular injection of a life-saving dose of naloxone to anyone suffering from an opioid overdose. 

If however, you were to ask for the same drug in its less intimidating nasal spray form, it would cost you more. Likely over $145 for a box of two doses, but the price is highly variable, according to Adapt Pharma GM David Renwick. 

"It depends on the purchaser," Renwick said. "Depending upon which province you live, depending upon what's been worked out with governments. We do work with a purchaser to find a way to lower the cost."

"My hope is in the future we'll be able to provide a little more clarity of where the pricing is going to land."

About the Author

Colin Butler

Video Journalist

Colin Butler is a veteran CBC reporter who's worked in Moncton, Saint John, Fredericton, Toronto, Kitchener-Waterloo, Hamilton and London, Ont. Email: colin.butler@cbc.ca