A container of Narcan, a brand name version of the opioid overdose-reversal drug naloxone.Mark Schiefelbein/The Associated Press
In August, 2023, the Canadian Medical Association Journal published evidence-informed guidance on take-home naloxone kits.
The opioid overdose-reversing drug should be widely available to community members in kits that include both injectable and nasal forms, as well as personal protective equipment and instructions for use, the expert committee advised.
British Columbia, which had been under pressure to update its kits to include the nasal form of naloxone, once again rejected the idea, saying it was too costly, would require retraining, and the product was not readily available.
Then, on Jan. 23 of this year, Sidney McIntyre-Starko, an 18-year-old student at the University of Victoria, died of a suspected fentanyl overdose in her dorm. Another student overdosed at the same time, and survived, while a third who took the drug was fine.
The case caused an uproar, in large part because of media coverage, beginning with a heart-wrenching feature story by the Vancouver Sun in mid-May that highlighted the poor emergency response, including long delays in the young student being administered naloxone and CPR.
Every day in Canada, an average of 22 people die of overdoses, another 17 are hospitalized, 80 visit emergency departments, and 121 others are revived by paramedics and firefighters.
There have been a shocking 42,494 overdose deaths in Canada since 2016, when B.C. declared a public-health emergency. We tend to assume that all the ravages of the toxic drug crisis are happening on the streets of big cities, where homelessness is rampant and drug use is visible.
But Ms. McIntyre-Starko’s death served as a brutal (and perhaps unwelcome) reminder that overdoses, deadly or otherwise, also occur routinely in students, construction workers, corporate executives, health workers, retired grandmothers, and more. Drug use, up to and including opioids, is widespread, and so are the ravages.
The other factor spurring extensive media coverage was the fact that Ms. McIntyre-Starko’s parents didn’t mourn silently. They are determined to ensure that their daughter’s death, if nothing else, results in policy change.
The real tragedy in this case is that the 18-year-old student’s death was clearly preventable.
Never mind the moralistic condemnation of drug use. The reality is that teenagers and young adults have always and will always experiment with drugs, from alcohol to cannabis and beyond. We need to equip them with the knowledge to minimize the potential harms of youthful indiscretion, not just serve up “Just say No” bromides.
There are still many unknowns in this case. Did the students know they were taking fentanyl? Likely not, because there are many adulterated drugs circulating. They weren’t using alone, which is smart. But what is shocking is their peers’ seeming lack of knowledge of what an overdose looks like and how to respond.
These are smart, young people and none of them had a naloxone kit, or knew how to administer CPR?
When they called for help, university security came quickly but were slow to act, and delayed calling 911 for help, according to a timeline published by the grieving parents. It was nine minutes before the dying young woman received naloxone – an eternity. (A coroner’s inquest will eventually provide the final word on what went wrong.)
On a website dedicated to Ms. McIntyre-Starko, entitled Sidney Should Be Here, her parents, Dr. Caroline McIntyre and Ken Starko, made seven demands:
1. Make CPR and naloxone training mandatory in high schools. (The ACT Foundation provides this training for free.)
2. Make nasal naloxone available for free in B.C. (It already is in Ontario.)
3. Make naloxone kits (nasal and injectable) easily accessible on all campuses.
4. Make teaching harm reduction mandatory at all high school, college and university orientations.
5. Review the medical response system at colleges and universities to ensure consistent policies.
6. Make it mandatory for all high schools, colleges and universities to report overdoses to public-health authorities.
7. Call a coroner’s inquest into the death of Sidney McIntyre-Starko.
To its credit, the B.C. government has already acted on a number of these issues, including ordering an inquest, introducing harm reduction programs on all postsecondary campuses before the 2025 school year, and reversing its policy and embracing nasal naloxone.
But why did it take a death to spark action? And why is it that a couple of grieving parents are better at articulating sensible public policies than a bevy of bureaucrats and policy advisers?
Teaching someone to use naloxone, nasal or injectable, takes mere minutes.
Surely this is an investment worth making in our kids’ lives.