Opioids

Opioids are drugs whose effects can include pain relief, euphoria (a high), sedation, and slowed breathing. Some people use opioids prescribed by their doctor, and some people use opioids illegally. Illegal opioids can come from illegal manufacturers or from prescriptions that have been diverted to the illegal market. People who use drugs illegally may do so for many reasons to sleep, self-treat pain, stop withdrawal symptoms, or to get high.

Some commonly used opioids include fentanyl, morphine, heroin, methadone, and oxycodone. Buying opioids on the illegal market (whether from a friend, drug dealer or the internet) is very risky and potentially life-threatening. Opioids sold on the illegal market vary considerably in terms of their purity, potency and composition, which puts people at high risk of overdose. Drugs should only be bought or obtained from a pharmacy or through a registered healthcare provider.

Signs and Symptoms of an Opioid Addiction

Needing to take more of the drug to get the same effect
Persistently wanting to quit, or trying unsuccessfully to quit
Spending a lot of time and effort to get, use and recover from opioids
Continuing to use opioids, despite negative consequences
Escalating use
Buying opioids on the illegal market
Feeling ill (withdrawal) when use of opioids suddenly stops
Showing signs of opioid intoxication (e.g., nodding off, pinpoint pupils, slowed breathing, confusion, and significant drowsiness)

Signs and Symptoms of Opioid Overdose (video)

Reduce your Risk of an Overdose

Never use alone. It is good to have someone with you in case something goes wrong or if you need help.
If you must use alone, let someone know when you plan on using substances, where to find you and how to reach you:

Call a friend or family member to stay on the phone, download the Brave app (Canada & US) or call the National Overdose Response Service 1-888-688-6677 (Canada only)
How to Spot Someone so They Never Use Alone (video)

Never mix opioids with other drugs like alcohol or benzodiazepines as this increases overdose risk.
Go slow if you are using a new substance; always take a small test dose first to see how it is going to affect you. Drugs purchased on the illegal market may be much stronger or have a different effect that you're expecting.
Know your tolerance. Your tolerance will change if you have taken a break, whether intentionally (e.g., while in treatment) or unintentionally (e.g. while in hospital). Even if you know your tolerance, go slow: illegal opioids may be stronger than you are expecting.
Carry naloxone - it is a medication that can temporarily reverse an opioid overdose.
Call 9-1-1, even if naloxone has been given. An overdose is a medical emergency and the effects of naloxone wear off after approximately 30-90 minutes.

Naloxone

What is Naloxone?

Naloxone is a medication given to reverse an opioid overdose
Naloxone displaces or "kicks out" the opioids from the receptors in your brain, and then blocks those receptors and the effects of the opiate for approximately 30 - 90 minutes
Naloxone comes in two formulations: a nasal spray, sometimes referred to by the brand name Narcan, and a formulation that is delivered via injection.
Naloxone can restore breathing within 2 - 3 (nasal) and 3 - 5 (injectable) minutes.

Who Can Get a Free Naloxone Kit?

Through BCHU and community organizations who participate in the Ontario Naloxone Program (ONP):

People at risk of opioid overdose (i.e. people who are actively using opioids)
Family and friends of people who are at risk of opioid overdose

Through pharmacies who participate in the Ontario Naloxone Program for Pharmacies (ONPP):

Current and past opioid users at risk of returning to opioid use
Family and friends of the above
Other individuals in a position to assist a person experiencing an opioid overdose

You can request up to 2 naloxone kits if you meet the eligibility criteria for a pharmacy. Call your pharmacy ahead of time to make sure they have kits on hand before you visit.

Naloxone Kits and Training

Individuals, organizations and businesses can call the Health Unit at 519-753-4937 ext. 460 to book a training session. Naloxone kits and training are also available from other community organizations and at many pharmacies in Brantford and Brant County.

Community Organizations (walk-in, no health card required):

St. Leonard's Community Services (133 Elgin St. and 225 Fairview Dr., Unit 1)
Brantford Downtown Outreach Team (12 Market St.)
Haldimand Norfolk Brant Van Program (289-440-4912)
Brantford Region Indigenous Support Centre (BRISC) (325 West St Unit B110)
The Salvation Army Housing Resource Centre (255 Colborne St.)
The Salvation Army Booth Centre (187 Dalhousie St.)
Grand River Community Health Centre (363 Colborne St.)
The Crisis Hub (1546 Chiefswood Rd.)
Six Nations Mental Health and Addictions (1769 Chiefswood Rd.)

For pharmacy locations near you where you can get naloxone kits and training, click HERE.

For more information on naloxone click HERE.

Signs and Symptoms of an Opioid Overdose

Breathing is very slow, or irregular, or they may not be breathing at all
Fingernails and/or lips are blue for those with lighter skin, and grey or ashen for those with darker skin
Body is limp
Deep snoring or gurgling sounds
Loss of consciousness
Unresponsive (not answering when you talk to them or shake them)
Pinpoint (tiny) pupils
Vomiting
Skin feels cold and clammy

How to Respond to an Opioid Overdose

Shout their name and shake their shoulders
Call 9-1-1 if they are unresponsive
Give naloxone (1 spray into nostril or inject 1 vial into arm or leg)
Perform rescue breathing and/or chest compressions
Assess. If no improvement after 2-3 minutes, repeat steps 3 & 4

Always stay with the person. Staying at the scene of an overdose is important to help save the life of the person experiencing an overdose. The Good Samaritan Drug Overdose Act gives some legal protection for individuals who witness an overdose and call 911 or their local emergency number for help. It also protects a person from simple drug possession charges if they've taken drugs or have some on them.

Always give naloxone, even if you think non-opioid drugs are involved. Giving naloxone to someone who has taken non-opioid drugs will not cause any harm, and it may save their life.

Naloxone Training Videos

Naloxone Made Easy (video)
How to use Naloxone Nasal Spray in a Few Simple Steps (video)

High Potency Opioids

Since the early 2010's, the potency of Canada's illegal opioid supply has been increasing and the composition has become more unpredictable. The introduction and expansion of illegal fentanyl was a primary driver of this trend. Recently, the addition of benzodiazepines to many illegal drugs has contributed to an increase in Ontario's overdose deaths.

Fentanyl

Fentanyl is around 50 to 100 times stronger than morphine. This makes the risk of accidental overdose much higher. Other, even more potent opioids such as carfentanil, may also be present. High potency opioids have been found in non-opioid drugs such as cocaine, methamphetamine and MDMA.

Remember that even if you are buying drugs from someone you know and trust, you cannot be sure what is in the drug. It is impossible to see, smell or taste whether the drugs you are buying contain what you think they do.

Benzodiazepines

Benzodiazepines are drugs that are used to treat anxiety, seizures and insomnia, but are also found in the illegal drug market. They are not opioids but have increasingly been found in the illegal opioid supply. Because benzodiazepines and opioids both cause sedation, using them together can increase the risk of overdose.

Although naloxone does not reverse the effects of benzodiazepines, it does reverse the effect of an opioid overdose and can be safely given to people who have taken both opioid and non-opioid drugs. If a person has overdosed on a mixture of benzodiazepines and opioids, naloxone may re-start their breathing even if they remain sedated.

For more information:

Additional Links and Resources

Community Addictions Peer Support Association - CAPSA

Brant/Brantford Opioid Information System

Toronto's Drug Checking Service

Reports