Street mural of man saying 'shoot it into my vein'
Health

Tips For Saving A Life From A Former Manager of Vancouver’s Overdose Prevention Society

By Amy Romer, Megaphone Magazine, Local Journalism Initiative Reporter

For anyone who spends any time in the Downtown Eastside, or sadly any community in B.C. these days, you’ve likely walked past someone in public who looks unconscious, as though they might need your help. But as each step brings you closer to this person in need, you soon find yourself looking back at them, already convinced they’re just sleeping something off, that this person surely isn’t overdosing. Before long, something distracts you, your phone probably, and your day carries on. Until the next person. And so it continues. 

Every few months, members of 312 Main in the Downtown Eastsie are privileged to receive naloxone training from Trey Helten, former manager at the Overdose Prevention Society (OPS). Naloxone (brand name Narcan) is a fast-acting medication that temporarily reverses the effects of an opioid overdose.

Helten is better qualified than most on how to spot the signs of a drug overdose. He’s helped reverse hundreds of overdoses over the years, and as a former drug user himself, the level of intimacy to which he understands the overdose crisis is largely incomprehensible, even to him. 

After recently taking this training, Megaphone wanted to provide a refresher (vetted by Helten, who is informed by his considerable lived experience) on how to spot the signs of an overdose, and just as importantly, what to do. 

[Note: This information has not been provided by an official health care expert. For further guidance, seek out a medical professional].

Narcan 101 

Firstly, it’s important to note that the number-one thing that kills people in an opioid overdose is a lack of oxygen — they stop breathing. If you suspect a person is overdosing, call 911. 

  1. Stay slow and observe. If you’re approaching a person who looks unconscious, take 30 seconds to watch them — can you see their chest rising up and down? If you think you can see them breathing, you can walk away.
  2. Opioid overdose symptoms. If you can’t tell whether a person is breathing, try to wake them up. You can shout at them, “Hey, buddy!” If they’re still unresponsive, you can try shaking their foot. Finally, if they look blue, clammy, or you see by opening an eyelid that their pupils are tiny, call 911 and prepare to give breaths.
  3. Call 911. If you suspect the person is unconscious, call 911 before giving breaths. When calling 911 for an overdose in Vancouver, police will only ever be dispatched if they hear violence on a call.
  4. Breaths and oxygen are the most important thing. Breaths given every five seconds can keep a person alive during an opioid overdose. Before giving breaths, call 911. Tilt their head to a 45-degree angle and give breaths until a first responder arrives.
  5. Always carry naloxone kits. It’s better to have it and not need it, than need it and not have it. You can pick one up from any overdose prevention site — no training required (though it certainly helps) or pharmacies in B.C. If you’re in the DTES, head to OPS or Insite. They’ll also give you a refresher on what to do, if you ask. And if you need one and don’t have one on you, someone else might. Ask around.  
  6. Snoring or gurgling is a very bad sign. Snoring should not be seen as the person sleeping as it can indicate a person’s airway is obstructed. You should attempt to wake them immediately. If they wake up, the snoring or gurgling should resolve. If they don’t wake up, call 911.
  7. Rigidity. One in 50 people go rigid on fentanyl, but this is also a sign of stimulant use, like crystal meth, cocaine or MDMA. Try to ask them what they’ve taken. Naloxone will not reverse a stimulant overdose, but it can help if they’ve taken a mixture of stimulants and opioids. If in doubt, call 911 and use naloxone.
  8. Opioids and alcohol — a deathly concoction. If you know a person has been taking opioids and drinking alcohol, they will likely overdose and may also vomit or choke. Do not give breaths to a person vomiting or choking.
  9. Administering naloxone. When you open up your kit, you’ll find gloves, a mouthpiece to give breaths through, three syringes and three 1-ml vials of the injectable life-saving naloxone hydrochloride. Follow the “Save Me” steps stuck on the inside of the pack. Put on the gloves, and get the person onto their backs if they’re not vomiting. Tilt their head to a 45-degree angle and give breaths through the mouthpiece, making sure they don’t have any drug paraphernalia or false teeth that might obstruct their airways. Give breaths every five seconds. (This alone could save their life.) Prepare the naloxone while continuing to give breaths as frequently as you can. It’s helpful if there’s a second person helping to prepare the vials while another gives breaths. Start by giving a double shot (two vials) of naloxone and wait for five minutes while continuing with breaths every five seconds and preparing the third vial. This is called the “5 x 5 rule.” If the person is still unconscious after five minutes, administer the third injection. The maximum number of successfully administered naloxone shots you should need to give a person is five. If they need more, it could be a benzo-dope coma. Benzodiazepines or “benzos” are not opioids and cannot be reversed using naloxone. Continue giving breaths until a first responder arrives.
  10.  Finding a muscle. Pinch the flesh, and inject at an angle into a shoulder or thigh muscle. Don’t worry about undressing someone to find a muscle. If necessary, you can inject through clothing.
  11.  Recovery position. Anytime you’re not giving breaths, place the person overdosing into the recovery position in case they vomit. Do not give breaths to a person vomiting.
  12.  Naloxone wears off after two hours. After regaining consciousness from naloxone, it’s possible a person will continue to overdose after the naloxone wears off. It’s important they’re monitored at a hospital — not by a friend, who may themselves be an overdose risk — to ensure this doesn’t happen.
  13.  Expired naloxone. A recent study showed that naloxone that is five years out of date, only loses 10 per cent of its effectiveness. Expired naloxone is better than no naloxone.
  14.  Light and heat sensitive. Naloxone loses potency when exposed to light or frozen. Keep it in its orange bottle inside the pack, and out of places like the car where it could freeze.
  15.  Walk the alleyways. If you’re looking to save some lives, walk the alleyways. Using alone is deadly, and folks in the allies are more likely to be alone. There’s a stigma about using a supervised drug consumption site, because now you’re one of “those people.”
  16.  Veterans and status cards. Any veteran or Indigenous person with a status number and Personal Health Number can access free naloxone nasal spray — considered much easier to administer, especially for the elderly and youth. 


All the following overdose and drug testing sites offer free naloxone kits and five-minute refreshers

  • Insite, 139 E. Hastings St., Vancouver – Low-barrier supervised drug consumption site that doubles as a walk-in clinic. Open 9 a.m. to 2 a.m., seven days a week.
  • Overdose Prevention Society (OPS), 141 E. Hastings St., Vancouver  – No-barrier supervised drug consumption site. Open Tuesday through Sunday, 8 a.m. to 9 p.m. and Monday from 12-9 p.m.
  • Molson Overdose Prevention Site (MOPS), 166 E. Hastings St. (alleyway), Vancouver – Open 1-11 p.m., seven days a week and 24 hours Tuesday to Thursday of welfare cheque week.
  • Harm Reduction Window, 177 E. Hastings St. (alleyway), Vancouver – Open 24 hours. This is somewhere to ask for help when Insite is closed.
  • Get Your Drugs Tested, 880 E Hastings St., Vancouver – A free drug testing site for anyone to use. Open 12-9 p.m., seven days a week.
  • For emergency help – Call 911
  • For non-emergency help – Call the Overdose Outreach Team at Vancouver Coastal Health 604-360-3874. Provides advice for people who have recently experienced an opioid overdose, or who are at high risk for opioid overdose.
  • Lifeguard App – An app for people using drugs alone. When activated, an alarm will sound after a 50-second countdown. If the user doesn’t respond after 75 seconds, a call goes out to 911 on the user’s behalf.

Top image credit: In Vancouver’s Downtown Eastside, street artist Smokey Devil is turning alleyways into powerful messages on the opioid crisis, using spray paint to highlight harm reduction measures and spark dialogue in one of Canada’s hardest-hit neighbourhoods. – Photo by Amy Romer

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