Opioids blamed for at least 12 deaths in Nova Scotia in first 4 months of 2017

Health officials are bracing for stronger opioids to hit Nova Scotia streets that could potentially outsmart life-saving antidotes.

According to the province's Health Department, 12 people died from opioid overdoses in Nova Scotia between January and April of this year. An additional seven cases were deemed "probable opioid toxicity deaths." None involved illicit fentanyl.

Dr. Robert Strang, Nova Scotia's chief medical officer of health, said the numbers are on track with last year's rate of 60 fatal opioid overdoses.

"What it tells me is that the problem is not increasing — at least in the number of overdose deaths — but it's not getting any better either," he said.

Strang said opioids contribute to approximately two-thirds of all acute drug toxicity deaths in the province. 

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He expects that number to climb based on the information coming out of B.C. and Alberta where the fentanyl crisis has spiralled out of control. 

Dangerous evolution

What's more is how opioids are changing.

"It's a constant evolution of different types of opioids of increasing strength and the concern is that some of the new strains have some resistance to naloxone," said Strang.

"It's really important that as part of this, we actually understand what substances we're actually dealing with."

Naloxone is the antidote used to reverse the effects of an opioid overdose. 

Last year, naloxone was used in approximately 30 overdose reversals. Strang said there were another 50 requests to replace naloxone kits from members of the public, which suggests the kits had been used to help people.

"We know from police there is more and more illicit fentanyl on the streets," said Strang.

"We also know from our naloxone pilot programs that we've had a number of overdose reversals, so it's entirely possible — if not likely — that numbers could have been worse if we hadn't done the work we've begun in terms of increasing access to naloxone."

Strang could not say how many naloxone kits have been used so far this year in Nova Scotia.

Stronger monitoring

A long-awaited opioid response plan is currently being developed by the Health Department. It's expected to be completed by the end of next month.

"Part of what we'll be putting in place is stronger monitoring so we can have a better handle on the number of naloxone kits distributed and how they've been used," Strang said.

"In an ideal world, we'd have almost real-time reporting so we would know overdoses and not only overdose deaths, and also have it by local community."

As it stands in Nova Scotia, lab tests following an overdose death take at least one month to determine what drugs were involved.

"That's one of the challenges that we face nationally and there's national discussions looking at this," said Strang.

"What is the lab capacity we need to have on the forensic labs side to actually have more timely identification of the exact substances that are involved in an overdose?"

Strang said he would like to see a central system that identifies "hotspots" across the province. It would bring together first responder calls and emergency room reports in one database. 

"If we had a cluster of overdoses, we'd want to work rapidly with the health system and with our policing colleagues to say 'What's going on? What's out there on the streets?'" he said.

"We've built very stand-alone information systems, and now we have the challenge of taking all of that different information from different sources and making sense of it, and then being able to report that on a regular basis."