Naloxone

What is naloxone?

Naloxone, also known by the brand name Narcan^©, is a safe medication that temporarily reverses the effects of an opioid overdose. Examples of opioids include drugs like heroin, fentanyl, morphine, methadone, codeine, oxycodone, and carfentanil. Naloxone works by knocking the opioid off of the brain’s opioid receptors taking its place temporarily.

What forms does naloxone come in?

Naloxone comes in two forms in Ontario; an injectable form and a nasal spray form. Both types of naloxone are safe and effective in temporarily reversing an opioid overdose.

What is included in a naloxone kit?

Each nasal spray naloxone kit includes:

• 1 hard case
• 2 doses of naloxone nasal spray (4 mg/0.1 ml)
• 1 one-way breathing barrier
• 1 pair of non-latex gloves
• 2 cards that identify the person is trained to give naloxone (English and French)
• 1 insert with instructions (English and French)

Each injectable naloxone kit includes:

• 1 hard case
• 2 (0.4 mg/1 ml) vials or ampoules (a small glass container) of naloxone
• 2 safety-engineered syringes with 25 g, 1” needles attached
• 2 alcohol swabs
• 2 devices (known as “breakers,” “snappers,” or “openers”) for opening ampoules safely
• 1 one-way breathing barrier
• 1 pair of non-latex gloves
• 2 cards that identify the person is trained to give naloxone (English and French)
• 1 insert with instructions (English and French)

Naloxone refills (i.e., medication only) are also available at many participating agencies and/or pharmacies.

What are the signs and symptoms of an opioid overdose?

The main signs and symptoms of an opioid overdose include:

• Person cannot be woken up
• Slow, shallow or no breathing
• Choking, snoring or gurgling sounds
• Blue lips or nails
• Pupils are tiny or eyes are rolled back
• Limp body, cold skin

Who can experience an opioid overdose?

An opioid overdose can happen to anyone. An opioid overdose can be experienced by someone new to taking opioids (including prescription medications) or someone experienced with taking opioids. An opioid overdose can happen in some of these situations:

• Tolerance is low (person has not used an opioid in a while or is new to using opioids)
• Opioids are mixed with other prescription or non-prescription substances, or alcohol
• The opioid is stronger than usual (i.e., different supply or batch)
• The opioid is cut or laced with another substance

What are the steps to responding to an opioid overdose?

There are five key steps to responding to an opioid overdose. These include:

1. Stimulate with touch and sound
2. Call 9-1-1
3. Use/administer naloxone
4. Perform rescue breathing and/or chest compressions
5. Check, is it working?

The five steps to responding to an opioid overdose is available as a printable poster in both English and French.

How should someone respond to an opioid overdose if they do not have naloxone?

Call 9-1-1 immediately and begin rescue breathing and/or chest compressions. Opioid overdose can result in death because the overdose can cause the individual to stop breathing. Rescue breathing can keep an individual alive until an emergency medical service (EMS) arrives.

Are there changes to using/administering naloxone during COVID-19?

The Ontario Naloxone Program (ONP) has confirmed that the use/administration of nasal spray naloxone is not an aerosol generating medical procedure (AGMP). Performing CPR (chest compressions) alone also does not generate aerosols. During COVID-19, it is recommended that individuals provide CPR (chest compressions) when responding to an overdose, NOT rescue breaths, as needed.

Public Health Ontario (PHO) has provided additional recommendations regarding the use of naloxone during COVID-19. If you are a health care worker please consult IPAC Recommendations for Use of Personal Protective Equipment for Care of Individuals with Suspect or Confirmed COVID-19 for recommendations on personal protective equipment (PPE) when using/administering naloxone during the pandemic. The general public are advised to wear disposable gloves (found in the naloxone kit). Individuals responding to an overdose can also:

• Place a mask or cloth over the individual’s face who is overdosing to minimize potential COVID-19 exposure in case the individual coughs after being given naloxone
• Tilt the head of the person who is overdosing to the side to minimize potential COVID-19 exposure in case the individual coughs after being given naloxone
• Step back after giving naloxone to provide physical distance to minimize potential COVID-19 exposure in case the individual coughs after being given naloxone
• Avoid touching your face when responding to an opioid overdose
• Clean hands with soap and water or an alcohol-based hand sanitizer after responding to an opioid overdose

How long does it take for naloxone to start working? How long does naloxone last?

Naloxone usually starts to work in less than 5 minutes (usually 2 to 3 minutes). If an individual does not respond to an initial dose of naloxone they may require additional doses. Naloxone is temporary and usually lasts between 30 to 45 minutes.

Can I give more than one dose of naloxone?

Yes, more than one dose of naloxone can be given, and sometimes more than one dose is needed. You cannot overdose on naloxone.

I have given someone naloxone who experienced an opioid overdose. Why have they not regained consciousness or responded to naloxone after it was used/administered?

Individuals might not respond to naloxone for a variety of reasons. These include (but are not limited to):

• Individual has overdosed from the use of a non-opioid
• More doses of naloxone are needed
• Individual may have a medical condition that has caused them to lose consciousness

What should I do after I use naloxone in an emergency situation?

Check in with a friend, family member and/or co-worker to talk about what happened. Self-care is important! Report the overdose at a local agency or pharmacy that distributes naloxone, and pick-up new naloxone.

If I use/administer naloxone and something goes wrong or the person dies from a substance use overdose, can I be held liable?

The Good Samaritan Act, 2001 protects people who take action to help someone who is in a dangerous or life-threatening situation. If an individual is conscious and refuses your help, call 9-1-1 and stay close in case they lose consciousness. When someone is unconscious you have implied consent to take life-saving measures, such as using/administering naloxone.

What is the Good Samaritan Drug Overdose Act, 2017? Who does it protect?

The Good Samaritan Drug Overdose Act, 2017 provides some legal protection to people involved with, or experiencing, an overdose if 9-1-1 is called. An example of this is protection from simple possession drug charges.

Who can be trained to use/administer naloxone?

Anyone can use/administer naloxone. It is safe and easy to use. A short training is offered the first time naloxone is obtained at a participating agency and/or pharmacy. Refresher training can be requested as needed, and questions can be answered when getting more naloxone.

Persons providing naloxone should have the training necessary to recognize the signs and symptoms of an opioid overdose, and understand what steps to take.

Can I pick-up naloxone if I am under the age of 16?

Yes, naloxone kits and/or refills (both nasal spray and injectable) can be provided to anyone who requests them so long as they meet each agency and/or pharmacy’s eligibility criteria. The Ministry of Health does not have an age restriction on who naloxone can be distributed to.

How long is naloxone training?

One-on-one naloxone training at a participating agency and/or pharmacy ranges from 5-20 minutes. The Health Unit also offers a more in-depth naloxone training, which is 1-1.5 hours in length, for larger groups of individuals (i.e., general community members, businesses, agencies, schools).

Where can I be trained to use/administer naloxone? Where can I pick-up naloxone?

Naloxone is offered by a variety of agencies and pharmacies, and can be picked-up free-of-charge at several locations in the Nipissing and Parry Sound districts.

People At-Risk of an Opioid Overdose or Their Friends and Family Members

Under the Ontario Naloxone Program (ONP) guidelines the following agencies in the Nipissing and Parry Sound districts provide naloxone training and naloxone kits and/or refills to:

• Clients of participating organizations at-risk of opioid overdose
• Family members or friends of someone at risk of an opioid overdose

These include:

Nipissing District
City of North Bay
AIDS Committee of North Bay & Area 269 Main Street West North Bay, ON P1B 2T8 Phone: 705-497-3560	North Bay Indigenous Friendship Centre 980 Cassells Street North Bay, ON P1B 4A6 Phone: 705-472-2811
Children’s Aid Society 457 Main Street West North Bay, ON P1B 2V3 Phone: 705-667-0137	North Bay Parry Sound District Health Unit 345 Oak Street West North Bay, ON P1B 2T2 Phone: 1-800-563-2808
Community Counselling Centre of Nipissing 361 McIntyre Street East North Bay, ON P1B 1C9 Phone: 705-472-6515
West Nipissing
Giyak Moseng - The Right PathCounselling and Prevention Services 316 Ted Commanda Drive Garden Village, ON P2B 3K2 Phone: 705-753-1375	West Nipissing General Hospital -Alliance Centre 172 Ethel Street Sturgeon Falls, ON P2B 1V9 Phone: 705-753-2271
West Nipissing Community Health Centre 68 Michaud Street Sturgeon Falls, ON P2B 1B8 Phone: 705-753-0151
Parry Sound District
East Parry Sound
Argyle Nursing Station 11851 ON-522 Port Loring, ON P0H 1Y0 Phone: 705-757-1717	Rosseau Nursing Station 17 Victoria Street West Rosseau, ON P0C 1J0 Phone: 705-732-1095
Canadian Mental Health Association 87 Main Street Sundridge, ON P0A 1Z0 Phone: 705-384-5392	Whitestone & Area Nursing Station 11 Church Street Dunchurch, ON P0A 1G0 Phone: 705-389-1951
Town of Parry Sound
Canadian Mental Health Association 60 James Street, 2nd floor Parry Sound, ON P2A 1T5 Phone: 705-746-4264	First Nations and Inuit Health Branch 74 Jane Street, Box 302 Parry Sound, ON P2A 2X2 Phone: 705-746-5807
District of Parry Sound Social Services Administration Board 3A Beechwood Drive Parry Sound, ON P2A 1Z1 Phone: 705-746-8886	North Bay Parry Sound District Health Unit 90 Bowes Street, Suite 201 Parry Sound, ON P2A 2L7 Phone: 1-800-563-2808
Esprit Place Family Resource Centre 3A Beechwood Drive Parry Sound, ON P2A 1J2 Phone: 705-746-4800 or 705-746-7777	West Parry Sound Health Centre – Emergency Department 6 Albert Street Parry Sound, ON P2A 3A4 Phone: 705-746-4540
West Parry Sound
Britt Nursing Station 991 Riverside Drive Britt, ON P0G 1A0 Phone: 705-383-2375	Pointe-au-Baril Nursing Station 70 South Shore Road Pointe-au-Baril, ON P0G 1K0 Phone: 705-366-2376

Please note: Other agencies in the Nipissing and Parry Sound districts that train and distribute naloxone to clients ONLY are not included in the list above.

Under the Ontario Naloxone Program for Pharmacies (ONPP) participating pharmacies in the Nipissing and Parry Sound districts provide naloxone training and naloxone training kits and/or refills to:

• Someone currently using opioids;
• A person who used opioids in the past and is at-risk of returning to opioid use;
• A family member or friend of someone who is at-risk of an opioid overdose;
• A pharmacist may also exercise his/her professional judgement on whether or not to provide naloxone kits for eligible persons (i.e., individuals who are in a position to assist someone who is overdosing).

Use the locator map to identify what pharmacies in your area currently distribute naloxone. You can also call 1-866-532-3161 Monday to Friday 8:30 a.m. to 5 p.m. to ask about naloxone distributors in your area.

Other Community Members, Agencies and Businesses

Under the Ontario Naloxone Program for Pharmacies (ONPP) participating pharmacies in the Nipissing and Parry Sound districts provide naloxone training and naloxone kits and/or refills to:

• Someone currently using opioids
• A person who used opioids in the past and is at-risk of returning to opioid use
• A family member or friend of someone who is at-risk of an opioid overdose
• A pharmacist may also exercise his/her professional judgement on whether or not to provide naloxone kits for eligible persons (i.e., individuals who are in a position to assist someone who is overdosing)

Use the locator map to identify what pharmacies in your area currently distribute naloxone. You can also call 1-866-532-3161 Monday to Friday 8:30 a.m. to 5:00 p.m. to ask about naloxone distributors in your area.

Online training is available for community members, agencies and businesses who would like to be trained to use naloxone. Please see the Online Trainings tab below, for more information.

Online Trainings

The Health Unit offers in-depth online naloxone training for general community members, businesses, agencies and/or schools. During each training we will explain where you can pick up naloxone.

If you wish to register for online naloxone training for your local business, agency and/or school please contact us at harm.reduction@healthunit.ca.

How much naloxone can I pick up per visit at a participating agency and/or pharmacy?

The number of naloxone kits and/or refills that can be distributed per person per visit varies by agency and pharmacy. It is best to check with each individual agency and/or pharmacy about quantities distributed.

What type of information do I need to provide if I am picking up naloxone?

The type of information collected depends on where you pick-up naloxone. Some pharmacies may ask that you provide identification such as an Ontario Health Card although most do not. This allows pharmacies to seek reimbursement from the Ministry of Health for some of the costs related to offering naloxone.

Other places that offer naloxone collect contact information so that they can be notified if the product they received is subject to a recall. Demographic information (e.g., age, gender, city/township/community) may also be collected to help identify trends related to naloxone distribution in the Nipissing and Parry Sound districts. All information collected is stored safely, and securely.

Does naloxone enable or encourage people to use substances? Can naloxone be abused?

Naloxone does not lead to increased substance use. Some studies have shown that naloxone results in decreased use of opioids. Naloxone is a non-psychoactive drug. Individuals cannot abuse or get high from naloxone use.

Is naloxone harmful? Are there risks associated with naloxone use?

Naloxone is safe to use. Giving naloxone to someone who is a child, is pregnant or lactating, has a medical condition, or has not taken opioids will not harm them.

The only reason to not give naloxone to someone who is experiencing an overdose is if the individual has a life-threatening allergy to naloxone or any of the ingredients. If allergies are unknown (which is usually the case when responding to medical emergencies), give naloxone.

Does naloxone make people violent and angry?

Naloxone does not directly make people violent or angry. Naloxone does temporarily reverse the effects of the opioid which can cause an individual to experience opioid withdrawal symptoms, leading to pain, distress and/or agitation. Giving the individual and yourself some physical space while they are coming out of an overdose is recommended.

I used/administered naloxone. Where and how do I report its use?

Naloxone use can be reported at any participating agency and/or pharmacy in Ontario. You may be asked to report on the following:

• Type of naloxone used/administered
• Doses of naloxone used/administered
• Number of times 9-1-1 was called

For information on where to report naloxone use refer to the section on: Where can I be trained to use/administer naloxone? Where can I pick up naloxone?

How long is naloxone effective for? Can I use expired naloxone if someone is having an opioid overdose?

Naloxone has a shelf-life of between 18 and 24 months. If only expired naloxone is available, it is safe to use it, but the expired medication might not be as effective.

My naloxone kit and/or refill has expired. How do I dispose of them properly?

For expired nasal spray naloxone, scratch out the expiry date on the naloxone package with a permanent marker and bring the expired medication to a pharmacy that offers medication drop-off or disposal. Should this not be possible, please refer to the fact sheet regarding alternative methods of disposal.

We ask that expired injectable naloxone be brought to a pharmacy that offers medication drop-off for disposal. This will ensure that the glass ampoule and/or syringe are discarded safely.

Where should naloxone be stored?

Naloxone should be stored at room temperature. Nasal spray naloxone should be stored at 15^oC-25^oC while injectable naloxone should be stored between 15^oC-30^oC. Do not store naloxone in your vehicle as it may overheat or freeze. Injectable naloxone and nasal spray naloxone (white plunger) exposed to extreme heat or cold should be replaced.

Nasal spray naloxone that comes in a newly issued red plunger can be thawed by allowing it to sit at room temperature for 15 minutes, and may still be used/administered if it has been thawed after being previously frozen. If nasal spray naloxone is frozen and is needed to respond to an overdose, do not wait for the product to thaw. Seek emergency help right away.

Naloxone should not be stored in direct light.

Where can I find information on local opioid-related overdose statistics for the Nipissing and Parry Sound districts?

Local opioid-related overdose statistics can be found on the Health Unit’s Nipissing Parry Sound Opioid-related Dashboard. Please visit the dashboard by clicking here.

My agency would like to find out if they are eligible to distribute naloxone or use/administer naloxone (as a first responder) under the Ontario Naloxone Program (ONP). Who do I contact to find out if my agency is eligible?

The following organizations can join the ONP:

• Aboriginal health access centres
• AIDS service organizations
• Community health centres
• Outreach programs
• Withdrawal management programs
• Shelters
• Community-based organizations that meet expanded access criteria
• Hospitals with emergency departments and urgent care centres
• St. John Ambulance branches
• Police services
• Fire services
• Other agencies as determined on a case-by-case basis

If your agency is interested in joining the ONP to distribute naloxone or use/administer naloxone (first responders only), please contact us at harm.reduction@healthunit.ca.

My agency, business and/or school would like to train multiple staff to use/administer. Do you offer group trainings?

The Health Unit offers in-depth online naloxone training for general community members, businesses, agencies and/or schools. During each training we will explain where you can pick up naloxone.

If you wish to register for training for your local business, agency and/or school please contact us at harm.reduction@healthunit.ca.

I am a distributing agency. How can I order more naloxone?

You can order more naloxone by completing this online order form. Once an order is placed, you will receive a confirmation message. Someone from the Health Unit will connect with you once your order is ready for pick up.

Is there liability when using naloxone in the workplace?

The liability associated with using/administering naloxone is low as individuals are protected under the Good Samaritan Act, 2001. If using/administering naloxone is part of your job, it is best to check with your agency or business about policies and guidelines for using/administering naloxone. It is suggested that employers wishing to add additional first aid measures, such as naloxone use/administration, into the workplace seek legal counsel, and check with local jurisdictions responsible for health and safety so they are aware of any liability issues.

It is recommended that my agency, business and/or school have a workplace policy and guidelines for using/administering naloxone in the workplace?

Yes, it is recommended that agencies develop a workplace policy and guidelines for using/administering naloxone. Workplace policies and guidelines for using/administering naloxone could include information on (but not limited to):

• Staff permitted to administer naloxone
• Procedures and staff training required to administer naloxone in the workplace (e.g., overview of opioids, how to use/administer naloxone, expired naloxone, records of staff training, frequency of training)
• Personal protective equipment required to administer naloxone safely (i.e., during COVID-19)
• Location and/or links to naloxone training materials and resources as well as key content covered in materials
• Initiation of any workplace codes, where applicable (i.e., code blue – cardiac arrest)
• Procedure to responding to an opioid overdose (i.e., shake and shout, call 9-1-1, administer naloxone, chest compressions and rescue breaths, recovery position, monitoring the individual, number of doses)
• Location and storage of naloxone
• Naloxone reporting (i.e., where to report naloxone use, information to be reported, records retention)
• Other relevant information such as disposal of expired naloxone; changes to training or administration of naloxone during COVID-19; self-care; definitions etc.

For copies of workplace or school sample naloxone policies, please contact us at harm.reduction@healthunit.ca

Below is a listing of additional training materials and/or resources related to naloxone. These include:

• Signs and Symptoms of an Opioid Overdose Poster [Health Unit] – English
• Signs and Symptoms of an Opioid Overdose Poster [Health Unit] – French
• naloxONe Training Video (non-COVID-19 edition) [Ministry of Health] – English
• 5 Steps to Responding to an Opioid Overdose Poster [Ministry of Health] – English
• 5 Steps to Responding to an Opioid Overdose Poster [Ministry of Health] – French
• Before You Give Naloxone Reference Sheet [Ministry of Health] – English
• Before You Give Naloxone Wallet Card [Ministry of Health] – English
• Naloxone Website [Ministry of Health] – English and French
• Where to Get a Free Naloxone Kit – Locator Map [Ministry of Health] – English and French
• Narcan © Nasal Spray [Adapt Pharma Canada Ltd.] – English

The North Bay Parry Sound District Health Unit, in partnership with the AIDS Committee of North Bay & Area will be running a seven week campaign called Naloxone Saves Lives. Get Trained. Get a Kit. The Health Unit region has seen an increase in opioid-related overdose deaths over the years, and throughout the COVID-19 pandemic. This campaign is part of a larger strategy to help reduce the number of opioid-related overdose deaths in our region. This campaign was created to help increase awareness of the following:

• the signs and symptoms of an opioid overdose
• how to help someone who is experiencing an opioid overdose
• that anyone can carry naloxone, and help save a life
• where to get a free naloxone kit
• resources and supports related to mental health and/or addictions

We can all play a role in addressing overdoses in our communities. This campaign encourages individuals, businesses and agencies to be prepared and carry naloxone in case an overdose occurs.

Campaign materials include: posters, social media posts, public service announcements (PSA), digital screens, postcards, cards, stickers, and a variety of other promotional materials. Materials are available in English and French, and can be downloaded below or requested by emailing: harm.reduction@healthunit.ca

Naloxone Saves Lives. Get Trained. Get a Kit. – Poster (8.5 x 11”)

• English
• French

Naloxone Saves Lives. Get Trained. Get a Kit. – Digital Screens

• English
• French

Naloxone Saves Lives. Get Trained. Get a Kit. – Public Service Announcements (English only)

 

 

 

Signs and Symptoms of an Opioid Overdose – Poster (11 x 8.5”)

• English
• French

Signs and Symptoms of an Opioid Overdose – Digital Screens (11 x 8.5”)

• English
• French

Good Samaritan Drug Overdose Act, 2017 – Poster (11 x 8.5”)

• English
• French

Good Samaritan Drug Overdose Act, 2017 – Digital Screens

• English
• French

Good Samaritan Act, 2001 – Poster (11 x 8.5”)

• English
• French

Good Samaritan Act, 2001 – Digital Screens

• English
• French

National Overdose Response Service – Poster (11 x 8.5”)

• English
• French

National Overdose Response Service – Digital Screens

• English
• French

ConnexOntario – Poster (11 x 8.5”)

• English
• French

ConnexOntario – Digital Screens (11 x 8.5”)

• English
• French