Category: Medicine Hat News

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Five Things to Know About Take-Home Naloxone

Antigua (Dr. Noorali Bharwani)
Antigua (Dr. Noorali Bharwani)

“Nothing is impossible; the word itself says, ‘I’m possible!'” -Audrey Hepburn

Naloxone is a life saving medication when used after opioid overdose. In March 2016, the Canadian government made the antidote available without prescription.

There are three kinds of opioid drugs. These are synthetic opioids (example fentanyl), semi-synthetic opioids (oxycodone, heroin), and natural opioids (opium, morphine, codeine). Natural opioids are from a natural source – opium poppy.

Fentanyl is a fully synthetic opioid, originally developed as a powerful anaesthetic for surgery. It is also administered to alleviate severe pain associated with terminal illness like cancer.

Fentanyl is a powerful drug. It is up to 100 times more powerful than morphine. Just a small dose can be deadly. Illicitly produced fentanyl has been responsible in the number of overdose deaths in recent years. It plays a role in the deaths of more than four people on average every day in B.C. and Alberta alone.

Fentanyl poisoning results in respiratory depression, miosis (excessive constriction of the pupils) and altered level of consciousness. These three features should alert physicians to the possibility of fentanyl poisoning.

An article in the Canadian Medical Association Journal (CMAJ September 18, 2017) titled “Five things you should know about take-home naloxone” emphasis the following points:

1. Naloxone is available without prescription in Canada

In 2016, naloxone was removed from the federal Prescription Drug List. Now pharmacists can dispense it without prescription. It is available in commercial formulations, including intranasal preparations, as well as in locally prepared take-home naloxone kits, available from some pharmacies, clinics, emergency departments and community health centres.

2. Most take-home naloxone kits contain similar equipment

Most take-home naloxone kits will contain two ampules of naloxone (0.4 mg per vial), two safety-engineered syringes, two ampule-opening devices, alcohol swabs, nonlatex gloves and a rescue-breathing barrier. The average cost for a take-home naloxone kit is $35. However, many sites offer them free of charge.

3. Multiple doses of naloxone may be required for overdoses related to high-potency opioids

In overdoses related to fentanyl and other synthetic opioids, multiple doses may be required to restore breathing. Most take-home naloxone kits include two doses, and additional doses can safely be administered every two to five minutes if there is no response. Naloxone should be used in conjunction with basic life support principles, such as rescue breathing, cardiopulmonary resuscitation and calling 911.

4. Take-home naloxone kits may reduce overdose-related mortality

Observational studies in North America, Europe and Australia, has found that take-home naloxone programs led to improved survival rates among program participants.

5. Take-home naloxone kits are not only for patients with current opioid abuse

The kit can be used for other at-risk populations include individuals who are on methadone or on high doses of prescription opioids, or who frequently use recreational drugs.

Naloxone can be delivered to the patients in different forms: intravenously, intramuscularly, subcutaneously, through the trachea and nose. The drug is effective in one to eight minutes after administration.

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Understanding Factors that Determine Our Health

A teepee in North Battleford, Saskatchewan, in 1984. (Dr. Noorali Bharwani)
A teepee in North Battleford, Saskatchewan, in 1984. (Dr. Noorali Bharwani)

“The perception that health comes from the health care system is widespread. Yet the health care system accounts only for a small – albeit important – part of the overall health of the population, mainly through treatment. It’s really an illness care system,” says Dr. Trevor Hancock in the Canadian Medical Association Journal (CMAJ December 18, 2017). The title of the article – “Beyond health care: the other determinants of health.”

Hancock is an internationally recognized public health physician. The Canadian Public Health Association recently recognized his outstanding contributions in the broad field of public health with the R.D. Defries Award.

Our health care system is geared towards providing acute care. Most major determinants of health lie outside the acute care system. Health care system should provide major care towards factors that really make us sick, says Hancock.

Hancock says a 2014 policy brief found the health care system to be responsible for just 10 to 20 per cent of broadly defined health outcomes. It does not take into account other factors that affect our health. For example: our behaviour, our social circumstances, physical environment that includes pollution, and genetic factors.

This is hardly a new understanding. The Canadian government’s 1974 landmark Lalonde Report suggested four health fields:

  1. Human biology
  2. Lifestyle
  3. Environment
  4. Health care

Public health care service should attempt to reduce the overall burden of disease, ensuring clean water and air, clean and reliable energy, and quality early child development experiences.

Clearly most of these factors do not lie within the jurisdiction of the Minister of Health or the health authorities, says Hancock.

We need to broaden our concept of health policy and ask ourselves, in what way is current food, housing, transport, or economic policy bad for health, and, conversely, what would a healthy housing and transport policy look like, asks Hancock.

In another article, (CMAJ November 20, 2017) titled “No quality health care without strong public health,” Hancock says public health is in the same business as the rest of the health care system: saving lives and reducing suffering. But it does so by intervening before – rather than after – the onset of disease or injury.

Hancock says the objectives of public health are three:

  1. To focus on improving health in the population as a whole rather than through one-on-one care. It has been found that local and national public health interventions were highly cost-saving.
  2. To improve the patient’s experience of care. Prevention should be seen as the first step in disease management and a key marker for quality health care.
  3. The final aim is to reduce the per-capita cost of health care. This can be approached in four main ways: reduce the burden of disease, improve self-care so fewer people seek care, improve the efficiency and effectiveness of care services, or reduce services.

We have to strike a better balance between prevention and treatment. Let us intervene before the onset of disease or injury. That will save lives and reduce suffering. I will finish with the following words of wisdom:

“Nothing that has value, real value, has no cost. Not freedom, not food, not shelter, not healthcare,” says Dean Kamen, an American inventor and businessman.

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New Year’s Resolution: Drive Safely and Prevent Motor Vehicle Collisions

Sunrise at Haleakala Volcano Summit in Maui. (Dr. Noorali Bharwani)
Sunrise at Haleakala Volcano Summit in Maui. (Dr. Noorali Bharwani)

“Only I can change my life. No one can do it for me.” -Carol Burnett

Most people are good and responsible drivers. They care about their own safety and they care about others. But some drivers are serious threat to safety.

A recent survey done by the Alberta Motor Association and published in their magazine (AMA Insider – Winter 2017) identified the following five actions to be serious threat to safety while on the road:

  1. Drivers texting or emailing
  2. Drivers talking on the phones
  3. People driving after drinking alcohol
  4. Aggressive driving
  5. Speeding on residential streets

It is estimated that traffic collisions would soon become the third major cause of death worldwide. The major victims of these traffic collisions are people between five and 44 years of age. That is tragic.

Let us briefly look at what Transport Canada has to say about road safety.

Although drivers aged 15 to 34 represent only about 30 per cent of the driving population, they accounted for 40 per cent of the fatalities and 45 per cent of the serious injuries, indicating that younger drivers are at greater risk.

The annual social costs of the motor vehicle collisions in terms of loss of life, medical treatment, rehabilitation, lost productivity, and property damage are measured in tens of billions of dollars. We can certainly use that kind of money treating other health issues.

Here are few examples where we can do better:

  1. Seat belts worn correctly can reduce the chances of death and disability. It is estimated about 300 lives could be saved every year if everyone wore seat belts.
  2. Aggressive driving includes speeding, running red lights, tailgating, weaving in and out of traffic, and failing to yield right of way, among other behaviours should be avoided. Forty per cent of speeding drivers involved in fatal crashes were 16 to 24 years of age.
  3. Young drivers, 16 to 24 years of age, continue to be at higher risk of being killed in motor vehicle collisions. One of the reasons being the use of cell phones or other similar devices while driving.
  4. In 2008, coroners’ testing showed almost 40 per cent of fatally injured drivers had been drinking some amount of alcohol prior to the collision.
  5. Drugs, other than alcohol, are also being found in about one-third of tested fatally injured drivers, similar to the prevalence of alcohol.

There are many other reasons why a driver can be distracted: using electronic devices, reading maps, eating, drinking, talking, or impaired by fatigue.

It is estimated about 20 per cent of fatal collisions involve driver fatigue. Everyone is subject to their body’s circadian rhythms such that they are less alert during certain times of the day, usually 2:00-4:00 a.m. and 2:00-4:00 p.m. Therefore, taking breaks from driving during these times could lower the risk of fatigue related collisions.

Let’s make a New Year’s resolution to drive safely and prevent death and disability.

Have a happy and healthy 2018.

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Maternal Age the Most Significant Risk Factor Associated with Down Syndrome

“Attacking people with disabilities is the lowest display of power I can think of.” -Morgan Freeman

Down syndrome is the most frequently occurring chromosomal congenital abnormality in Canada. It is a lifelong condition. It adversely affects infant’s life and mortality.

An English physician John Langdon Down first described Down syndrome in 1862, and helped to differentiate the condition from mental disability. Prior to that for centuries, people with Down syndrome have been alluded to in art, literature and science. Many individuals were killed, abandoned or ostracized from society. Many of these children died during infancy or early adulthood.

Humans usually have 46 chromosomes in every cell, with 23 inherited from each parent. Due to the extra copy of chromosome 21 (trisomy 21), people with Down’s syndrome have 47 chromosomes in their cells. This additional DNA causes the physical characteristics and developmental problems associated with the syndrome.

The cause of the extra full or partial chromosome is still unknown. Maternal age is the only factor that has been linked to an increased chance of having a child with Down syndrome. There is no definitive scientific research that indicates Down syndrome is caused by environmental factors or the parents’ activities before or during pregnancy.

The additional partial or full copy of the 21st chromosome that causes Down syndrome can originate from either the father or the mother. Approximately five per cent of the cases have been traced to the father.

Children with Down syndrome experience intellectual delays and are at an increased risk for several medical conditions.

Congenital heart defects and respiratory infections are the most frequently reported causes of death in children and young adults with Down syndrome. Childhood leukemia is also associated with Down syndrome.

Due to higher birth rates in younger women, 80 per cent of children with Down syndrome are born to women under 35 years of age. Women aged 35-39 years have the highest percentage of babies born with Down syndrome (29 per cent).

According to a report on the Government of Canada website, the birth prevalence of Down syndrome in Canada from 2005 to 2013 has remained stable. Approximately one in 750 live born babies in Canada has Down syndrome. Advanced maternal age is the most significant risk factor, says the website.

Prenatal screening for Down syndrome has advanced in both accuracy and early detection. The number of children born with Down syndrome has remained stable due to increased use of prenatal diagnostic procedures followed by terminations of pregnancies.

The Society of Obstetricians and Gynecologists of Canada’s clinical care guidelines for prenatal testing advise against using maternal age as the only criterion for invasive prenatal diagnosis. They recommend prenatal screening for clinically significant fetal abnormalities be offered to all pregnant women, irrespective of age.

There are 45,000 Canadians with Down syndrome, with a very active organization, Canadian Down Syndrome Society (CDSS). The CDSS is a non-profit organization that provides Down syndrome advocacy in Canada, says their website.

The organization helps people with Down syndrome. People with Down syndrome can go to school, finish university, find careers, and get married. CDSS goal is to ensure all people with Down syndrome live fulfilled lives. It is Canada’s voice for Down syndrome.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!