Out in the Open

'I don't give naloxone very often,' paramedic says of handling opioid overdoses

Jason Benaim, a paramedic in Toronto, says naloxone is only meant to “buy you time to get to the hospital” in the event of a fentanyl overdose.
Toronto paramedic Jason Benaim pulls a vial of naloxone out of a drug kit in the back of an ambulance. (Sam Colbert/CBC)

As the fentanyl crisis makes its way across Canada, cities are preparing to see an increase in overdoses. 

Toronto, for example, set up its first safe injection site this summer, so that harm-reduction workers could respond if someone overdoses at the site. And the Ontario government has made naloxone kits available for free to the public.

Naloxone is a drug that can reverse the effects of an opioid overdose. 

But Jason Benaim, an advanced care paramedic in Toronto, says naloxone isn't always the best option for treating an overdose. 
Naloxone temporarily blocks the effects of an opioid overdose, but can cause symptoms of withdrawal. (Sam Colbert/CBC)

"I don't give naloxone very often," he says. If he can, he'll try other methods of restoring a patient's breathing before resorting to the drug.

He explained that fentanyl, heroin and other opioids stay in a patient's system longer than naloxone. That's puts the patient at risk for a second overdose.

"They're probably going to go and shoot up" again if they're a chronic user, compounding the opioid dosage, "because we gave them naloxone and temporarily ruined that high."

Naloxone is really only meant to "buy you time to get to the hospital," says Benaim.

Frequently, he sees patients who resist being taken to the hospital, or decide to leave soon after arriving there. Benaim sometimes then has to go back and treat that same patient for another overdose. He calls it a "revolving door."

Though he points out that drug overdoses are affecting all kinds of people, not just addicts.

"I don't like using the term 'junkie,' but it's not your typical junkie any more," he says. "We get kids. When I say kids, I'm talking 12, 13 year olds, all the way up to cancer patients who are on long-term opioids."

He's in favour of harm-reduction techniques, and believes addiction needs to be treated primarily as a mental health issue, rather than strictly a criminal one. He tries to help patients help themselves, so they don't end up back in his ambulance.

"When they're on my stretcher, when they're alert and they can understand what I'm saying, I want to hear their story. … I try my best to get that human contact and say, listen, I'm here for you," Benaim says. "And you go ahead and overdose another time; I'm still going to be here for you.

"But you've got to be here for yourself as well."