Naloxone & Epinephrine Emergency Kits - FAQ

Frequently asked questions about our emergency kits:

When did epinephrine become publicly available?

We were able to place publicly available epinephrine in 28 sites during a pilot project in the community of Sussex, New Brunswick in 2014 and with the overwhelming response and requests for help and assistance we initiated our small business in hopes that we could grow this idea everywhere. In fact, since we began 6 lives have been saved. We believe this was the first project of its kind in the world.

When did naloxone become publicly available?

Public naloxone and take home kit availability has become increasingly available over the past several years and varies in countries and communities. We developed alarmed cabinets initially for Corrections New Brunswick in 2016 and have had several sites request and purchase them since that time.

Why is publicly available epinephrine important?

Anaphylaxis is the most serious type of allergic reaction. It is life-threatening, severe, happens quickly and requires immediate attention. A severe allergic reaction can develop in minutes to hours. Many people with severe allergies do not carry their own epinephrine as they forget it at home or maybe never fill their prescription. There are also many people who do not know they have an allergy. People can die before an ambulance ever arrives. Having publicly available epinephrine centrally located and highly visible is essential during a severe allergic reaction. It also provides the opportunity for an entire community to be educated regarding response to severe allergic reactions. This is analogous to having Automated External Defibrillators (AED’s) in public places.

Why is publicly available naloxone important?

The opioid crisis (drug overdoses) started in the late 1990’s in Canada and the United States and has continued throughout the 2000’s. It continues to grow with a rapid increase in the use of prescription and non-prescription opioid drugs with hundreds of lives lost to this growing crisis everyday.

When someone takes an opioid like heroin, morphine, oxycodone, or methadone, their breathing can slow and they can be difficult to awaken from this drugged state. Naloxone (known by the trademarked name Narcan) reverses the overdose by blocking the opioids. It is not possible to get high off of naloxone because it is designed to only work on people who have taken opioids. Without opioids in the body, the drug does not have anything to affect.

The medication is easy to administer. There are two methods. One is similar to that of an epinephrine shot, where it is injected into the thigh muscle or arm or buttocks. It can also be given in a spray form through the nose. The nasal spray is a quicker, more efficient and safer method to administer naloxone. It only takes about five minutes for the drug to work, but some people do require a follow-up dose if the first one does not help with the overdose.

What types of sites would have publicly available epinephrine or naloxone?

To date we have over 20 communities that have started to embrace our concept and there are over 600 sites in most provinces of Canada and North Dakota and California in the US that have installed our alarmed cabinets for epinephrine auto injectors (EAI) or naloxone.

Publicly available epinephrine cabinets have been placed in several venues such as schools, restaurants, churches, hotels, sports/recreation facilities (rinks, curling clubs, golf courses, ski hills, near ball fields, YMCA’s), daycare centres, funeral homes, dental offices, medical clinics, community centres, correctional/jail services.

It is appropriate to have EAI’s wherever there is food, medications, insects that can sting and where exercise occurs or latex exists.

Naloxone cabinets have been placed in venues such as corrections, university residences, opioid overdose response centres, community response centres, and private businesses. It is appropriate to have naloxone wherever there is a potential for an opioid overdose.

What are the cabinets made of?

The cabinets are made of a highly durable polycarbonate material and are lightweight for easy attachment to any wall. They are brightly coloured to stand out with a clear window to view the Epinephrine and Naloxone auto injectors and they are alarmed to raise attention to the emergency.

Where are the cabinets manufactured?

The cabinets are manufactured in New Brunswick, Canada and will hold up to 4 EpiPens or 1 naloxone kit or 2 naloxone nasal sprays.

Are the epinephrine auto-injectors or naloxone included with the cabinet?

No. Epinephrine auto-injectors (EAI’s) or naloxone are available separately from any local pharmacy behind the counter. The cost varies between pharmacies. They can be included with the cabinet for “at company cost”

What brands of epinephrine auto-injectors and naloxone are available?

Currently in Canada there are two brands of EAI available – EpiPen and Allerject. In the United States there is EpiPen, Auvi-Q.

Naloxone is available via a kit for injection or nasal spray (Evzio, Narcan)

What are the laws regarding administration of Publicly Available Epinephrine?

Publicly available epinephrine is protected under the Good Samaritan Law. Is it more a question of what will happen if you do not provide the treatment for anaphylaxis or opioid overdose. Epinephrine Auto-Injectors or Naloxone (injectable or nasal spray) May be purchased by the public. Any person who has been educated and trained can give themselves or another person an epinephrine auto-injector.

In the United States, the laws vary from state to state regarding the purchase of an EAI’s.

There are multiple states that have passed legislation permitting, but not requiring various public venues (entities), to stock undesignated epinephrine for use in cases of anaphylaxis response.

The definition of venues (entities) does vary from state to state and may include recreation facilities, restaurants, daycare centres, theme parks, day camps and college campuses.

A small number of states have passed laws specific to colleges and universities that allow, but do not require, post-secondary education venues to stock undesignated epinephrine.

These laws may provide exemption from civil liability and outline specific requirements for educating and training personnel, as well as how to obtain, maintain, store and administer epinephrine. The following is an outline of the current situation for each state.

https://www.networkforphl.org/_asset/8483ms/Issue-Brief-Epi-Entity-Stockin.pdf

A document outlining the current states with specific laws for each state can be found on the Food Allergy Research and Education (FARE) website.

https://www.foodallergy.org

The following website provides very specific stories about deaths in relation to anaphylaxis.

Any litigations in the US are because epinephrine was NOT administered.

http://nonutsmomsgroup.weebly.com/blog/remembering-those-we-have-lost-to-food-allergies

Is it safe to administer epinephrine if I am not a professional?

It is safe to administer an epinephrine auto-injector. It has become mainstream first-aid to have epinephrine available in public places. If a person is dying from anaphylaxis it is better to give epinephrine than the consequences a severe allergic reaction. A person who has received an epinephrine auto-injector should always be sent to the hospital and stay near a hospital for 48-72 hours. You can assist the person in trouble and save a life.

Typically, how are epinephrine auto-injectors acquired to stock the alarmed cabinets since they are not prescribed to a particular person?

Epinephrine auto-injectors are available behind the counter at any pharmacy in Canada. In the United States and other countries, the laws vary. The reason that a person requires a prescription in Canada is for it to be covered by their health insurance plan. We have some schools/sites where parents/private donors or businesses purchase the epinephrine auto-injectors and/or the alarmed cabinet as a donation. If there is a pharmacist associated with the school, that is always helpful and some pharmacies have donated to communities, schools or organizations. Many Parent committees or home and school associations have also contributed schools. Local foundations have provided grants within communities as well.

Typically, how is naloxone acquired to stock the alarmed cabinets since they are not prescribed to a particular person?

In March 2016, Health Canada changed the prescription status of naloxone to increase public access. Instead of requiring a prescription for each individual in need of naloxone, pharmacies are now able to proactively give out naloxone to those who might experience or witness an opioid overdose. Additionally, switching naloxone to non-prescription enabled emergency responders to administer naloxone without having to wait for a prescription to be ordered for each individual in need. https://www.canada.ca/en/health-canada/services/drugs-health-products/drug-products/announcements/narcan-nasal-spray-frequently-asked-questions.html

Narcan Is Now Available Over the Counter in 46 States. Walgreens announced that they are now dispensing naloxone, the drug that can reverse an opioid overdose, over the counter in 46 states. (If you have a prescription, you can buy it in any state.) CVS offers it over the counter in 43 states.Oct 27, 2017

Since you are in Eastern Canada and will not be able to physically visit a site or location wanting to have publicly available epinephrine, how do you decide where the alarmed cabinet (s) should be located?

The cabinet should be located in an easily accessible, centrally located area of the site. Many have chosen to place them next to the AED if there is one on site. In schools, they can be placed close to administration office/cafeteria/gym. Some schools have purchased up to 3 cabinets depending on the size of the school. We are happy to consult with any site and discuss options. What we do know is that they should NOT be placed in a locked area.

If school staff already receive education/training regarding administration of epinephrine auto-injectors is there additional education/training regarding the use of the alarmed cabinet?

The cabinet is very easy to use. You just pull off the front and it automatically alarms. Then you take the front to the person in trouble. The epinephrine auto-injectors or Naloxone are encased behind the front cover of the cabinet. Installation instructions and battery replacement type come with the cabinet. Teleconferencing or videoconferencing are also available if a site is interested.

Do the sites with these alarmed cabinets typically have information alerting and stating the presence and location of the alarmed cabinets? I have seen these when sites have AED’s.

There is a cling sticker that will come with the cabinet that says EpiPen on site. It can be placed on the entrance (s)of the site that has the alarmed cabinets and EAI’s.

Is there typically information also posted with the cabinets on recognizing symptoms of anaphylaxis?

There are instruction posters available and can be included with the cabinet as well as a small square card that inserts in the cabinet easily. Some areas have chosen to Velcro the poster beside the cabinet.