Metro Morning

Naloxone 'only a last resort,' deputy fire chief says as front-line workers demand action

Naloxone is “only a last resort” when first responders arrive at a suspected overdose case, the city’s deputy fire chief says, as outreach workers call for more resources to be devoted to what they are calling a “public health emergency.”

Toronto police said more than 20 drug overdoses were reported between Thursday night and Monday

A small bottle of the opiate overdose treatment drug, naloxone, is seen in this Wednesday, Feb. 19, 2014 file photograph. (Mel Evans/Associated Press)

Naloxone is "only a last resort" when first responders arrive at a suspected overdose case, the city's deputy fire chief says, as outreach workers call for more resources to be devoted to what they are calling a "public health emergency."

Earlier this week, the Toronto Fire Service confirmed that this fall, some of its trucks will begin carrying naloxone, a drug administered via injection or nasal spray that is an antidote to an opioid overdose.

The move came as Toronto police announced that officers were dealing with a rash of overdoses, many of which they suspect were linked to heroin laced with fentanyl.

On Wednesday, Deputy Fire Chief Jim Jessop said that despite calls for both firefighters and police officers to carry naloxone to try to curb overdose deaths in the city, the drug is not the first tool first responders turn to, and noted that firefighters largely support paramedics on medical calls. Toronto paramedics all carry naloxone.

"It's really important to realize that naloxone is only a last resort when you come across an opioid overdose," Jessop told CBC Radio's Metro Morning.

Paramedics and firefighters first try to wake-up the patient, and then turn to rescue breathing if that doesn't work.

"Only if vital signs continue to deteriorate after those first two interventions will we at that point administer naloxone," Jessop said.

"It's really important for everyone to realize we've been dealing with overdoses for 30 years. This is nothing new to us."

Jessop confirmed that some trucks will begin carrying naloxone in late September, and the drug will be rolled out across each fire apparatus after that.

Asked why it will take two months for the first naloxone to be rolled out, Jessop noted that while training may only take a matter of hours, health policy for the Toronto Fire Service is set by its medical director at Sunnybrook Health Sciences Centre. While city council determines the types of services that firefighters in Toronto can offer, it's a physician that sets the medical directive. In this case, that will be the dosage of naloxone that firefighters will carry; the type and timing of training in administering the drug; and guidelines for when and to whom they can administer the drug.

"It's not a case where you show up on the street and find somebody unconscious and you reach for naloxone," Jessop said.

'We don't have time'

Community outreach workers and activists have been calling for stepped-up action from the city since Toronto police announced that more than 20 drug overdoses were reported between Thursday night and Monday. Four of them were fatal.

On Tuesday, Zoe Dodd, a harm reduction worker with the South Riverdale Community Health Centre, called for better coordination of targeted resources to curb a growing public health threat.

"We are in a public health emergency so we need to treat it like a public health emergency," she told CBC's Metro Morning.

Dodd suggested that other health crises get more attention and resources, but drug users are ignored and stigmatized. She was concerned that it will take a couple of months for firefighters to begin carrying naloxone.

"We don't have time. We are in a crisis. We are in an emergency situation," she said.

Currently in Toronto, paramedics carry the drug. A spokesperson for Toronto police said there are no plans for officers to carry it and, like Jessop, said paramedics are the best first responders to deal with overdoses.

Jessop noted that Toronto Fire "is not the primary medical lead for the City of Toronto," and described firefighters as a "value-added service" to paramedics.

"I think it's really important for those that are working in the community to realize this: Toronto is unique," Jessop said. "We have the best paramedic care system in the province."

With files from Metro Morning, Lorenda Reddekopp and Trevor Dunn