1. Harm Reduction and Overdose in Hamilton
Kathy Guffroy
Public Health Nurse
Harm Reduction Program
City of Hamilton Public Health Services

2. Overview: Harm Reduction The Opioid Crisis Hamilton’s approach
Opioid overdose – symptoms and response
Fentanyl and Carfentanil
Questions

3. Harm reduction is a respectful nonjudgmental approach to reducing harms of substance use that meets people “where they are at”
What harm reduction isn’t- a new thing, or way to try and get someone to stop using drugs.
Image source: harmreductioncafe.com

4. Four Pillars Drug Strategy
ENFORCEMENT
PREVENTION
HARM REDUCTION
TREATMENT
The City of Hamilton engages in all 4 pillars. Public Health specifically in 3
Prevention – comprehensive Mental Health Strategy
Harm Reduction – that’s us
Treatment – Alcohol, Drug and Gambling Services
Four Pillars Drug Strategy

5. Harm Reduction are the strategies we put in place to keep folks safe
Mount Recovery
Ideal!!!
Harm Reduction are the strategies we put in place to keep folks safe
Reality
Substance use is cyclical – not a smooth road to ‘mount recovery’ but with relapse and with different areas of need.
Help folks stay as healthy as possible – for example avoid contracting HCV, which can be silent for a very long period of time.
Although people who inject drugs account for only 0.2–0.5% of the world’s population, they make up approximately 5–10% of all people living with HIV. However, globally, less than 1% of people who use drugs have access to HIV treatment.
(UNAIDS, March 2014)

6. Harm Reduction in Hamilton
Public Health began to offer needle exchange services in 1992 (on the street outreach with backpacks!)
The VAN as a mobile outreach and in clinics and other sites where people get unused injection supplies and can return used supplies

7. Harm Reduction – the VAN
Operates Monday to Saturday, 8 pm to 12 am
Will meet with people anywhere in Hamilton
Accepts text messages
Confidential, focused on developing relationships and trust
New injection equipment, safer sex supplies, information, connection with community supports
Disposal of used supplies
Naloxone
Connection with the Cold Alert Response in winter, cold supplies
Expansion hopes: testing and wound care

8. Harm Reduction – Needle Syringe Program Sites
The Wesley Centre, 195 Ferguson Ave N
The AIDS Network, 140 King St E, Lower Level
Hamilton Urban Core Community Health Centre, 71 Rebecca St
Sexual Health Clinics

9. Harm Reduction - IDU Outreach Worker
1:1 Practical Assistance – reducing barriers to housing, food, access to health care
Harm Reduction Approach
Peer Engagement

10. Safer Inhalation Kits
Image source: Ontario Harm Reduction Program

11. Safer Injection The Kit: Needles Ties Spoons/cookers Alcohol swabs
Filters
Matches
Vitamin C
Water
Condoms

12. Popcorn, Fentanyl, Carfentanil and Overdose

13. Popcorn Heroin + Fentanyl Inconsistent dosing of both substances
People who are used to heroin OD’ing with smaller amount

14. Fentanyl
Previously mostly available by patch or in hospital settings by IV
Used patches cut up, melted and injected or smoked
Inconsistent dosing and availability

15. Fentanyl Change from OxyContin to OxyNeo 2012
OxyNeo made harder to dissolve and inject
Bootleg fentanyl developed – chemical make-up continually changed slightly to avoid detection
Overseas suppliers

16. Carfentanil Analog of Fentanyl
more potent than morphine, 100 x stronger than fentanyl
General anesthetic for large animals, such as elephants
No safe amount for human consumption
Naloxone may be ineffective
Occupational exposure concerns

17. The Opioid Crisis Locally
Between January 10, 2017 and Sept 24, 2017, Hamilton Paramedics responded to 296 calls related to opioid overdoses.
52 deaths in Hamilton were caused by opioids or a combination of opioids and alcohol in Hamilton’s death rate was 48% higher than Ontario’s provincial average.
There have been more opioid-related deaths in the Hamilton LHIN over a five-year period than anywhere else in the province
In well over half of overdoses in which Naloxone was used from the HOPE program, 911 was not called.
Rates of death not accurate due to only coroner cases

18. Hamilton’s Response so far….
HOPE Naloxone Program 2014
Opioid Summit January 2017 – EMS, Hospitals, Methadone Clinics, Public Health, Police
Opioid Surveillance and Monitoring
Community Consultation re: Supervised Injection Services

19. Hamilton’s surveillance and monitoring system:

20. What does an overdose look like?
Opioid Overdose
Stimulant Overdose
Slow or no breathing
Blue lips and/or fingertips
Pinpoint pupils
Not able to wake up
Snoring or gurgling sounds
Cold and clammy skin
Unconscious
Rapid breathing
Chest pain and/or racing heart
Shaking or seizures
Confusion, anxiety and/or psychosis
Sweating

21. Overdose: How to reduce the risk
Who will overdose? Anyone can, there is no magic formula.
How you take the drug (Route of administration)
Avoid mixing- or use less of each substance
Change in tolerance – start low and go slow
Inconsistent drug quality/strength – do testers
Using alone – Fix with a friend or let someone know
Stronger drugs (examples: Fentanyl, carfentanil)

22. How to respond to an overdose
Know what an overdose looks like (Signs and symptoms)
Know what to do
(911! Naloxone! First aid care!)
Know what to avoid

23. Naloxone (aka Narcan) Naloxone reverses an overdose.
Works for minutes.
When it wears off, the overdose could return.
~2000 kits dispensed*
Around 550 overdoses have been reversed by the Naloxone in the kits*
* From May 2014-Sept 2017

24. How does Naloxone work? Kicks Opioid off Brain
Keeps Opioids off for mins
When Naloxone wears off, leftover opioid can take effect again

25. What don’t you need to get a Naloxone kit?ID
An appointment
Lots of time
What do you need to get a Naloxone kit?
1. To currently be using opioids, or a history of opioid use OR
2. To be a friend or family member of someone who uses opioids
3. To not have an allergy to Naloxone.
4. To be willing to participate in a training session on Naloxone.

26. Where can you get Naloxone kits? Contact numbers for more information:
Wesley Street Health Centre
The AIDS Network
Notre Dame House
Urban Core Community Health Centre
City of Hamilton’s Sexual Health Clinics
Home visits and group training available
Various pharmacies throughout the City
The VAN
Contact numbers for more information:
Public Health Program:
(injectable & nasal)
Pharmacy Program:
(injectable only currently)

27. Public Health Response
Improve reporting systems for OD’s and deaths in the city
Improve communication with stakeholders i.e. weekly report
Recently received approval for funding for more staff and Van hours for naloxone response
Planning started for input regarding supervised injection sites

28. Lived experience suggestions:
“be real, don’t be phoney”
“don’t judge if someone asks for help”
“make someone feel at ease”
“work with me”
“meet me halfway”