Expansion of naloxone program among changes coming to Barton Street jail

Dayroom at the Barton Street jail. Ontario Coroner's inquest

The jury at a coroner’s inquest has heard testimony that the Hamilton-Wentworth Detention centre is ready to expand its naloxone program this month.

READ MORE: Calls for inmate admissions to be examined at Barton Street jail inquest

Linda Ogilvie, the head of the corporate health-care division with the Ministry of Community Safety and Correctional Services, testified on Thursday that an opioid awareness training program has almost reached all staff.

It includes information, she says, about the signs and symptoms of opioid-related withdrawal and overdose. It also provides instructions on how to use the opioid overdose-reversing drug naloxone.

It’s a tool that the jury at this coroner’s inquest has heard much about through an examination of eight inmate deaths at the jail between 2012 and 2016.

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In a matter of weeks, all correctional officers will be permitted to use the nasal spray during an emergency.

Up until this point, naloxone has been made available to nursing staff at the jail and more recently, to sergeants as part of a “code white” kit.

According to Ogilvie, once the expanded program is fully operational, the spray will be “strategically” placed throughout the jail so that it can be accessed quickly.

It’s part of ongoing efforts to combat the opioid crisis across the province. The synthetic opioid fentanyl was detected in toxicology reports for some of the inmate deaths being examined in this inquest, including 20-year-old Julien Walton in 2015 and Peter McNelis in 2016.

READ MORE: Barton Street jail to add 4 ‘addictions nurses’ to help manage opioid crisis, inquest told

Ogilvie testified that the Ministry of Community Safety and Correctional Services is working closely with the Ministry of Health and Long-term Care to develop educational materials for inmates about the risks associated with opioid intoxication and overdose.

The challenge, she says, is that often, there is “poster fatigue” within the institution. Part of their strategy, she told the inquest, has been to offer wallet cards at discharge with those details. Naloxone kits are also available when an inmate is discharged, she says, but if they don’t take it, they can still find information about community providers on the card.

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Tracking naloxone use

The jury has heard from numerous witnesses who work within the jail that they are responding to an increasing number of overdose incidents but the exact number remains unknown.

Ogilvie gave evidence on Thursday that she is actively working to implement an emergency response form that requires staff to document when naloxone is used.

Eventually, she told the jury, it will be part of orientation for incoming nursing staff. On the ministry side, Ogilvie testified more staff have been hired to ensure compliance, because they too want to review the data.

Addressing addictions

Dr. Mikhail Eplebaum, the psychiatrist on contract at the Barton Street jail has given evidence that the Ministry of Community Safety and Correctional Services is altering the eligibility requirements for the methadone maintenance program that is used to help manage opioid addiction.

Previous policy set out that an inmate had to be pregnant, on the program when they entered the institution, or a month away from release.

As of April 17, the policy has changed to allow for the assessment of any inmate expressing interest in opioid addiction therapies such as methadone or Suboxone (a combination of buprenorphine and naloxone.)

It’s a critical change before the jury because they have heard evidence that Marty Tykoliz was denied access to the program at the Barton Street jail just months before his death.

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From outside the inquest, Kevin Egan, counsel to Tykoliz’ sister, April Tykoliz, said the ministry appears to be heading in the right direction. “In Marty’s case, he wanted to be on a methadone program and there was no good reason not to put him on it other than the policy said ‘no.'”

Eplebaum and the jail’s healthcare services manager Angela DiMarco have both cautioned that the policy change doesn’t mean that it’s immediately operational.

Providing the prescription is the easiest part, Eplebaum explained. DiMarco testified that resources are “scarce” and that this will require more staff to roll out.

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