Fentanyl: The Drug Deadlier than Heroin

[Hondaracer]

Gregor: Things are all going to plan, at this rate we will meet the homelessness goal!

[Mr.Money]

there is beds for overnight freezing weather but crazy people gonna crazy people..."I don't like it there".

[adambomb]

What about the people who choose to get high? Those who know they're addicted, know that there is help available to get clean, yet choose to get a $10 bag despite the consequences. How do you handle those people and the continuing drain they have on first responders?

For those that don't know, the next income assistance day in BC is Wednesday Dec 21, 2016. Those who want to do drugs, will get their drugs. Most likely at midnight on Tuesday when the funds go into their accounts, some will most likely get revived 2-3 times that night. fix after fix after fix.

[GabAlmighty]

Not much sympathy from me here. Everyone at some point made a choice. A lot of my friends are casual/somewhat habitual users and I'm scared for the day when I have to deal with it. I'll be sad and upset they're gone, but I'm going to find it hard to be sympathetic.

Agreed on the entire "need more paramedics" statement.

[meme405]

Originally Posted by Shorn

So basically what you're suggesting is involuntary rehab. I think this is done in some places in the US, and I'm not sure how well it works. I mean you can broadly divide repeat overdose victims into 2 groups, the people who want to stop but can't, and the people who have some sort of mental illness and does not want to stop at all. I think that involuntary rehab would work only for the first group, since the second group would be much more likely to relapse.

Now is it morally correct? Some would say that yes, these people lost their right to freedom when they started incurring costs for society. Others would argue that basic liberties such as being free from imprisonment should be guaranteed unless you've been convicted/charged of a crime.

Now legally, police can apprehend anybody that is acting in a manner that endangers their own or other's safety under the Mental Health Act section 28 (commonly known as being sectioned). Generally this is used for forcing mentally ill patients to go to the hospital with us, but I could foresee it being used for involuntary rehab as well.

So would it work? I think it would definitely cause a decrease in general of overdoses, but morally, I'm not so sure about. It would be a better use of funds than a shiny new fire truck though.

I agree morally you are approaching a line which is continuously getting thinner and thinner; however, I think the greater good is still the winning factor here, and the greater good is the fact that you would be saving many of these people's lives.

You describe the two groups, well it sounds the second group has made a conscious decision, they are going to do this until it takes their life. In that case just let them do it. I'm sorry but it's tough to continue defending someone who doesn't seem to want your defense. Someone who has put themselves to the brink of self destruction and death, been saved, put through an entire rehabilitation program, and then decided; "yeah fuck it, gimme drugs". That person is damaged beyond the help that we as a society can provide for them.

It comes back to a similar moral dilemma as assisted suicide; someone is suffering immensely, and yet we as a society continue to revive and save them, when in reality maybe they have just come to terms with it, and would rather it just be done.

[68style]

^ usually these people have some sort of mental trauma man, they don't see the world the same as the rest of us or are able to control their thoughts like us.

You could easily switch your whole middle paragraph out, take out "repeated drug user" and insert "physically and mentally disabled" person there too and with that sort of mentality they should all be killed and left to die too since they're, theoretically, unable to contribute to society, are a continuous drain financially to the system and nothing will ever change.

There no halfway point for human life, you're either for saving everyone or you're for an elitist system where someone arbitrarily decides that certain groups of people aren't worth it. Where do you draw the line? Is it the same as the next person or the person after that? Hitler also thought the line was drawn somewhere too and believed fervently in it... Slippery slope.

[mikemhg]

Originally Posted by Mr.Money

there is beds for overnight freezing weather but crazy people gonna crazy people..."I don't like it there".

LOL, have you ever been to one of these overnight shelters before? If not, you probably wouldn't want to sleep there either. To many of those on the streets our shelters are more dangerous and nasty than sleeping in the alley.

[Mr.Money]

Originally Posted by mikemhg

LOL, have you ever been to one of these overnight shelters before? If not, you probably wouldn't want to sleep there either. To many of those on the streets our shelters are more dangerous and nasty than sleeping in the alley.

100% of the people with colds or illness coughing 24 hours ,Pissing,spitting on the floor...It's a pool of sickness.

[ZN6]

Originally Posted by Hondaracer

Gregor: Things are all going to plan, at this rate we will meet the homelessness goal!

Actually, by his facial expression, he's probably thinking: "I wonder if your wife will be happier banging a man who actually had hair. Like me for example."

[ZN6]

Any way, back on topic. As I grow older, I find I have less and less empathy which I know is a bad thing. At the same time, how do you help addicts who don't want to get clean. There comes a point when a guy OD's multiple times and the paramedic has to be thinking: What's the damn point? The guy on the next shift's gotta do the same thing to this guy a couple of hours away.

I'll do my part to help those in need who can't help themselves out of circumstance, but I now refuse to help those who can't help themselves by their own choice.

[Gnomes]

A St Paul hospital ER nurse says there are addicts who hang around at the hospital getting high on fentanyl knowing they will be resuscitated. One druggie was admitted 3 times in a 24 hour period.

[godwin]

The fall out of this will affect disproportionately the sick and the elderly. Since ambulance care is first come first serve, if all ambulances are attending to drug overdoses, the resources will be stretched thin for things like heart attacks.. Good luck if you or any of your family members have a cardiac event at home this Christmas..

Either way we have to treat them.. do we use the Emergency services which cost several magnitude than out patient services operationally? or build facilities which cost money up front, but lessen the blight. It is not "bleeding" heart but the latter is more cost effective. Heck if you count up each service call by Ambulance, Fire Truck, ER visit.. just one call can easily be close to 10k all said and done (that's a lot of rent!).. I rather have them at a facility with supervision than splurging on trucks running around the city.

Honestly there is an elephant in the room here, for people out of province we should bill the province of origin for the care.

Originally Posted by GabAlmighty

Not much sympathy from me here. Everyone at some point made a choice. A lot of my friends are casual/somewhat habitual users and I'm scared for the day when I have to deal with it. I'll be sad and upset they're gone, but I'm going to find it hard to be sympathetic.

Agreed on the entire "need more paramedics" statement.

[k2_alpha]

Originally Posted by godwin

The fall out of this will affect disproportionately the sick and the elderly. Since ambulance care is first come first serve, if all ambulances are attending to drug overdoses, the resources will be stretched thin for things like heart attacks.. Good luck if you or any of your family members have a cardiac event at home this Christmas..

As mentioned by Shorn before, ambulances or AKA cars are being pulled in from other districts. The ambulance system is provincial system. Hence cars from as far away as Pemberton are doing calls in Vancouver. Cars from Mission are being pulled into Surrey for calls. The "back fill" are cars from areas further areas. Chiliwack cars in Langley - Hope cars in Chiliwack and so forth.

An overdose call in the current DTES typically goes like this:

Patient administers the drug
Drug affects begin
The desired "high" begins
The undesired effects begins - Respiratory system begins to be affected -Breathing Rates decrease/Respiratory arrest begins - Hypoxia begins (oxygen starvation)
OD is noticed by bystanders or shelter staff or community support workers
911 is called on behalf the patient
If Naloxone AKA Narcan is present, 0.4mg is administered intramuscularly doses are in 0.4mg. More than one dose may be administered.
Depending if equipped personnel are present, oxygen may be given to the patient by Bag Valve Mask (BVM)

Vancouver Fire Department (VFD) arrive. Usually in a team of 4.
If patient is still in respiratory arrest VFD will take over scene and begin to provide assisted ventilations with BVM and oxygen. VFD may choose to admin more Narcan Intramuscularly

Primary Care Paramedics (PCP) usually a team of 2 from BC Ambulance Service (BCAS) arrive and take over scene
Additional dose of Naloxone is typically given intramuscularly. Intravenous (IV) line maybe started. Narcan may be given via IV
Advance Life Care Paramedics (ACP) arrive and receive report from PCP about care
ACP will decide if patient needs more Naloxone is needed, if patient needs to be attached to Life Pack 12 for cardiac monitoring, if advanced airway is needed

Patients typically rouse from OD
VFD is cleared by BCAS
ACP clears from call
Patient decides if he wants to be taken to the hospital - PCP transport patient to hospital
PCP provides report to ER Triage Nurse
Patient care is now handed over to ER Department

[Shorn]

Originally Posted by godwin

The fall out of this will affect disproportionately the sick and the elderly. Since ambulance care is first come first serve, if all ambulances are attending to drug overdoses, the resources will be stretched thin for things like heart attacks.. Good luck if you or any of your family members have a cardiac event at home this Christmas..

just wanted to say it's not quite first come first serve - all 911 calls are triaged using an internationally recognized triage system. an unconscious not breathing overdose will receive the highest priority, which trumps anything else. so if there is an ambulance responding to a chest pain call, and an overdose comes in that's close by, that ambulance will get diverted there instead.

[Presto]

Shorn, what are your thoughts on decriminalizing and regulating all drugs?

If we can learn anything from history, it's that prohibition doesn't work. If they can't get it legally, people will get they need from illicit sources. In the case of the alcohol prohibition, consumers risked blindness, paralysis, or even death. Yet, they still wanted it.

Pumping more funds into emergency services is just dealing with the symptoms, and doing nothing to address the problem.

[k2_alpha]

Overdose calls are considered highly advanced calls. However, with the recent "epidemic" these calls are now routine for most Metro Vancouver paramedics. Just the sheer number of attending these calls.

There are lots to consider during these calls.

Things such as scene safety - Are there used needles around? Are there any people that do not like Emergency Responders?

Managing the people present on scene -If the patient OD in a shelter, there are the people that use the shelter, typically 2 shelter staff, 4 VFD, 2 PCP, 2 ACP and of course the patient.

Managing the oxygen levels and ventilations - the person providing assisted ventilations are essentially breathing for the patient.

Managing the temporary reversal of the narcotic overdose. Narcan dislodges opiates in the opiate receptors in the brain. Also, continues to occupy the receptors temporarily. Narcan half life is typically lasts 30-80 mins in most patients. However, most opiate half life is much longer. For example, Fentanyl half life is around 220 mins. Thus, the patient may OD again after the initial OD reversal.

While Narcan is touted at the miracle drug, it has some very bad effects as well. As explained above, Narcan dislodges opiates in the receptors. If a large dose is administered, too much opiate may be dislodged. Pushing the patient into withdrawal.

Also, OD in the DTES are typically in an enclosed small space with lots of people. Narcotic OD patients typically hypoxic at some time during the OD. This may lead to violent awakenings. Punching and kicking while not present in all OD calls, are quite common. More prevalent in patients who suffer longer hypoxia time and those who have not OD as often.



Trying to demystify OD calls in DTES. Tried to explain the best I can with out using medical jargon. Hope it helps!

[Shorn]

Originally Posted by Presto

Shorn, what are your thoughts on decriminalizing and regulating all drugs?

If we can learn anything from history, it's that prohibition doesn't work. If they can't get it legally, people will get they need from illicit sources. In the case of the alcohol prohibition, consumers risked blindness, paralysis, or even death. Yet, they still wanted it.

Pumping more funds into emergency services is just dealing with the symptoms, and doing nothing to address the problem.

i support decriminalization of all drugs. i think drug use is a public health issue, not a criminal one. for instance, portugal did it in 2000, and it worked great for them. overdose deaths down, overall drug use down.

i think it would take a lot of work for it to be implemented here though, with public opinion and all that. but if anywhere in canada, vancouver is the most likely to happen.. with the fentanyl crisis maybe people will start realizing that what we're doing now isn't working.

[Soundy]

Originally Posted by adambomb

Those who want to do drugs, will get their drugs. Most likely at midnight on Tuesday when the funds go into their accounts, some will most likely get revived 2-3 times that night. fix after fix after fix.

It's all good bro, the good taxpayers of the CoV will be picking up the costs from here on out.

Glad I live in Abby.

[godwin]

That's what I was trying to say. It is NOT just the taxpayer of CoV.. it is the whole province.. then it is the whole country. Resources are pulled all over the province.

A ER doc get paid 200k ~ a year.. now say it goes to 300k for overtime etc.. where does that 100k comes from? Not from CoV. Province will just work with what they have.. now something will have to get chopped.. certainly not in Vancouver.. Maybe Abby?

On the long run it is cheaper to house them properly.. rather than to let the addicts use emerg services.

Yes we need addiction treatment spaces but we can't pull them out of thin air. WE already hired a lot of specialist from the south to cover.

Originally Posted by Soundy

It's all good bro, the good taxpayers of the CoV will be picking up the costs from here on out.

Glad I live in Abby.

[CivicBlues]

Originally Posted by Soundy

Glad I live in Abby.

Said no one ever?

[Soundy]

Originally Posted by godwin

That's what I was trying to say. It is NOT just the taxpayer of CoV.. it is the whole province.. then it is the whole country. Resources are pulled all over the province.

Did you miss the part where CoV homeowners are getting smacked with a property tax increase to cover the additional EMS costs for the spike in overdoses? Better them than me.

Sent from my SM-N900W8 using Tapatalk

[6o4__boi]

Addicts now using needles from naloxone kits to shoot drugs, say paramedics | Globalnews.ca

[Traum]

Originally Posted by 6o4__boi

Addicts now using needles from naloxone kits to shoot drugs, say paramedics | Globalnews.ca

Upsetting. Makes you wonder why we should continue spending our tax dollars to save their sorry OD a$$es.

[i-vtecyo]

Dw, the nalaxone kits are only approx. $15 each and its coming from tax payers money.

Like i said before, throwing narcan at this situation is actually giving them a sense of false security. it actually encourages them to inject more frequently thinking that they're safe, in fact, according to that article, they even resort to using 1cc vanish points from the antidote kit to inject when there are lots of free needles at safe injection sites....

A new medic truck staffed with 3 firemen is also a horrible hasty decision because it doesnt benefit ANYONE in any OTHER medical emergency besides drug overdose related (even more specifically, narcotic drug overdoses). Gregor tried to pull the "What if ur family had a medical emergency but first responders were delayed as they were too busy dealing with OD's?" Well first of all, im glad no one in my family or any of my friends are addicted to opiods.. Secondly, fire lacks medical equipment and training such as different type of drugs to intervene with other types of emergencies and in addition, an EMR course is only 2 weeks in duration or a FR course is only 1 week. Finally, a new medic truck continues to lack the ability to transport as they are STILL required to wait for paramedics to arrive..

Only a small % of these guys want help and the rest of them would rather die before they seek change. Maybe instead of throwing all our hard earned tax money on this whole population, they should find a better place to start.. Maybe by focusing on the group that actually wants help whether its opening more rehabs centers as the wait list is approximately 6 months and most of them die before they even get in to the program.

[corollagtSr5]

British Columbians open to legalizing hard drugs, survey says - British Columbia - CBC News