City of Edmonton policy forbids most employees from administering naloxone during work hours

A health and safety consultant who teaches people how to administer naloxone is calling a recently updated City of Edmonton policy on the life-saving medicine "an absolute failure."

According to Cyndil Taylor, branch manager of workforce safety and employee health at the City of Edmonton, only adequately trained employees who have city-provided personal protective equipment and naloxone are allowed to administer the drug during work hours. The updated policy was implemented earlier this month.

Taylor said approximately 170 employees have approval to administer naloxone to the public. That's less than two per cent of the city's roughly 12,000 employees.

"I've never seen a policy that so clearly robs the workers of their autonomy," said Catherine Jevic, who owns the consulting firm All-Safe Health, Safety and Environment. Jevic is also the president of the Sherbrooke Community League and teaches naloxone administration with the Water Warriors charity.

Jevic said city employees have expressed concerns to her about the policy and they are worried about repercussions if they try to help someone experiencing opioid poisoning. 

Per Health Canada, naloxone is a drug used to temporarily reverse the effects of an opioid overdose and "it cannot be improperly used."

Jevic said many Edmontonians, including some city councillors, have taken advantage of free naloxone training in the community — and they should be able to put it to use. 

A city website on drug poisoning prevention promotes free naloxone kits through Alberta Health Services and says "know the signs of opioid poisoning," "know how to respond," and "use a naloxone kit if you have one."

Taylor said in an email that the city must strike a balance between supporting people with addiction and the safety of employees.

She said the city has occupational health and safety obligations to identify and control workplace hazards — and implement measures to eliminate or reduce exposure to those hazards.

She said opioid-related hazards can include potential exposure to opioid drugs or paraphernalia or responding to a suspected opioid poisoning.

"The city has taken a risk-based approach to opioid-related hazards and naloxone administration to ensure that protections are in place for employees' physical and psychological safety when carrying out their duties," she said.

City employees who are not approved to carry and administer naloxone are asked to call 911 if they encounter someone on public property who needs medical assistance.

Legal liability

Sarah Coderre, a labour and employment lawyer at Bow River Law in Calgary, said cities could be liable if their employees administer naloxone incorrectly or if employees are harmed in the process.

"I would hate to see somebody do something and think they're being a Good Samaritan and then they're getting sued over it or losing their job over it," she said.

Coderre said she would not recommend employers create policies that allow non-medical employees to administer naloxone.

Chris Randall, an associate lawyer with MacDonald and Associates in Toronto, said there is a risk of financial liability for the employer but there is also the risk that an employee may suffer emotional harm if they are not able to help someone struggling.

Randall said there is a role for employers to play in preventing opioid-related deaths and that there is some employee liability protection under the Emergency Medical Aid Act in Alberta.

"Certainly there are checks and balances and policies that have to be enacted to ensure that any training is carried out appropriately and that you have employees that want to and are willing to take on the responsibility that comes with that training," he said.

Other approaches

The City of Calgary's naloxone policy resembles Edmonton's in that only city staff who have completed first aid and naloxone training may intervene.

Those staff members are in occupations with a higher likelihood of encountering people who may need naloxone, a spokesperson said.

The Edmonton Public Library has naloxone at every branch and training on how to administer it is available to all staff. The library also has designated people, who are trained in both naloxone and first aid.

"Staff can administer this nasal spray in an emergency at the direction of 911, and it's only administered if staff feel safe and comfortable to do so and should be done as part of an emergency response to a customer in medical distress," said Chrissy Hodgins, director of branch services and community engagement.

Only staff who have been trained by EPL are permitted to administer the naloxone nasal spray.

Explore Edmonton, which has a corporate office in the World Trade Centre and operates the Edmonton Convention Centre and the Edmonton Expo Centre, offered two optional naloxone training sessions to employees this year. 

Daniel St. Pierre, Explore Edmonton's director of strategic communications and partnerships, said employees asked for the training.

Reception desks now have naloxone kits on standby, but they are only for staff members who have completed the training, he said.

"We wanted to equip our staff to be in a position to help if they were comfortable doing so," he said.

Some businesses don't have formal policies but have stocked up on kits and trained employees how to use them.

"You're risking someone's life by not doing it," said Darren McGeown, who owns Arcadia Brewing Co.

Who's administering naloxone at work?

Though most City of Edmonton employees are not allowed to administer naloxone during work hours, transit peace officers may do so. The city says they had administered naloxone 251 times this year as of Dec. 19.

Edmonton Fire Rescue Services employees administered it 851 times as of the same date.

The Edmonton Police Service initially told CBC that police have administered naloxone 50 times so far this year, but a spokesperson later revised the number to "at least 200."

"Unfortunately, we struggle to track this number as it is administered so often by all different areas of our service," the spokesperson said in an email.

Jevic, meanwhile, is calling for the city to rewrite its policy.

She believes workers will disregard the rules and help people whose lives are at risk.

"Whether they're going to be fired or disciplined, they'll do it anyway," she said.