Ontario Naloxone Program (ONP) Distributing Agencies and First Responders

How do I order more naloxone for my agency or organization?

Qualifying agencies or organizations that have signed a naloxone agreement with the Health Unit can order naloxone kits (nasal spray/injectable) by completing an 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.

Where do I pick up my naloxone order once it has been processed?

Naloxone orders can be picked up at our North Bay's office (345 Oak Street West) shipping and receiving area located at the far side of our building.

If you are picking up your naloxone order at our Parry Sound office (90 Bowes Street, Suite 201), please go to reception.

How many naloxone kits can I give each client?

Feel free to distribute the number of naloxone kits or refills requested by a client. The ONP requests that Public Health Units and qualifying agencies use their discretion when distributing multiple naloxone kits or refills, but also work to prevent both clients stockpiling and acting as distributors.

How do I train someone to use/administer naloxone?

Training someone to use/administer naloxone is easy. Simply complete the train-the-trainer program offered by the Health Unit and use the CarrynaloxONe Training PowerPoint and materials provided to your agency to train new clients to use/administer naloxone. Repeat clients do not need to be re-trained to use/administer naloxone.

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

The ONP has confirmed that the administration of intranasal naloxone is not an aerosol generating medical procedure (AGMP). Performing CPR (chest compressions) alone does not generate aerosols. Clients should be advised to provide CPR (chest compressions) when responding to an overdose, NOT rescue breaths.

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 when administering naloxone during the pandemic. The general public are advised to wear disposable gloves (found in naloxone kit). Individuals responding to an overdose can also:

• Gently and loosely place a mask or cloth to cover the mouth and nose of the person who is overdosing. This will help minimize potential COVID-19 exposure in case the person who is overdosing is positive for COVID-19 and coughs after being given naloxone. The mask or cloth should be removed if the individual responding has to leave the person who has overdosed alone, and/or if the person who has overdosed starts breathing again (i.e., reduce risk of choking if they vomit).
• 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. This will help minimize potential COVID-19 exposure in case the person who is overdosing is positive for COVID-19 and 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.

What materials do I use to train clients picking up naloxone?

The following carrynaloxONe materials have been created to train someone to use/administer naloxone:

• 5 Steps to Responding to an Opioid Overdose (poster)
• Before You Give A Naloxone Kit (poster)
• Before You Give A Naloxone Kit (wallet card)
• carrynaloxONe Training PowerPoint for Clients (presentation)
• carrynaloxONe Train-the-Trainer PowerPoint for Agencies (presentation)
• carrynaloxONe Training Videos

You may also wish to request a naloxone nasal spray kit from the Health Unit for training purposes. This kit includes the components found in a nasal spray naloxone kit as well as an empty nasal spray plunger.

If you are interested in having your staff and/or new staff trained to distribute or use/administer naloxone, email us at harm.reduction@healthunit.ca.

My agency would like to be trained to use/administer naloxone on-site in case of an emergency. Can I train my staff and give a naloxone kit to each staff member?

If you work for a qualifying naloxone distributing agency and have received the train-the-trainer naloxone training from the Health Unit then you can train your own staff to use/administer naloxone. The Health Unit, however, is happy to support you and/or facilitate the training if you prefer.

Please note that if you are a naloxone distributing agency you will not be able to provide your staff with naloxone issued by the Health Unit as the ONP only allows naloxone to be distributed to clients at risk of an opioid overdose and/or family members or friends of someone at risk of an opioid overdose. If you are a naloxone distributing agency and wish to have naloxone on-hand for staff to use/administer in case of an emergency you can:

• Have staff pick-up a kit at a local pharmacy
• Purchase naloxone kits from ADAPT Pharma Canada Ltd.

A pharmacist may also exercise his/her professional judgement on whether or not to provide naloxone kits to eligible persons.

Local businesses and agencies have contacted our agency about being trained to use/administer naloxone in case of an emergency. Can I train them and provide their business with naloxone?

The Health Unit can provide training to local businesses and/or agencies but will not be able to provide these establishments with naloxone as per the ONP guidelines. If a local agency or business wishes to have naloxone on-hand for staff to use/administer in case of emergency they can:

• Check with a local pharmacy*
• Purchase naloxone kits from ADAPT Pharma Canada Ltd.

*Participating pharmacies that distribute naloxone under the Ontario Naloxone Program for Pharmacies (ONPP) can provide training and kits to:

• Someone currently using opioids
• A past opioid user 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 to eligible persons

If a client under the age of 16 requests a naloxone kit, can I train them and provide them with a naloxone kit?

Naloxone kits and/or refills (both nasal spray and injectable) can be provided to anyone who requests them so long as they are someone who uses opioids and/or are a family member or friend of someone at risk of opioid overdose. The Ministry of Health does not have an age restriction on who naloxone can be distributed to.

What other agencies in my area distribute naloxone?

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

Why must we submit naloxone reports?

The Health Unit is responsible to submit all data to the Ministry of Health on behalf of community agencies. These reports are important to understand the need for naloxone in the community, and to generate continued support for the program.

What type of information is collected when distributing or using/administering naloxone? Why is this information collected?

For agencies that distribute naloxone, it is important that you collect the following information:

• Number of individuals trained to administer naloxone
• Number of nasal spray naloxone kits distributed to individuals​
• Number of single nasal spray doses distributed to individuals (aside from what is automatically included in kits)​
• Number of injectable naloxone kits distributed to individuals​
• Number of single injectable doses distributed to individuals (aside from what is automatically included in kits)​

To help track these numbers, you have the option to use this Naloxone Distribution Tracking Sheet. At the end of the quarter, you will add the numbers and include the total in the ONP Reporting Form.

For Fire or Police services, you only report on the number of doses they administered. You report these numbers using the online reporting form.

How often do I provide a naloxone report to the Health Unit?

Naloxone reports are submitted quarterly. Reporting periods are:

• Q1: April 1^st to June 30^th
• Q2: July 1^st to September 30^th
• Q3: October 1^st to December 31^st
• Q4: January 1^st to March 31^st

The Health Unit will reach out to each agency requesting your quarterly report approximately two weeks after the end of each quarter. It is important that reports are completed and submitted on time to ensure accuracy of Ministry of Health reporting.

What is the difference between the Ontario Naloxone Program (ONP) and Ontario Naloxone Program for Pharmacies (ONPP)?

The Ontario Naloxone Program (ONP) and Ontario Naloxone Program for Pharmacies (ONPP) are two of the programs in which publicly funded naloxone can be provided to Ontarians free of charge.

For information on each of these programs including eligibility, visit http://www.health.gov.on.ca/en/pro/programs/drugs/naloxone/naloxone_faq.aspx.

Our naloxone kits and/or refills have 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 and disposal or to the Health Unit office in North Bay and Parry Sound. Should this not be possible, please refer to the following 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 to 25^oC while injectable naloxone should be stored between 15^oC to 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.

It is suggested that naloxone be kept in a safe, secure location at your agency (e.g., locked cabinet). Naloxone should not be stored in direct light.

Is there liability when using naloxone in the workplace?

The liability associated with using or 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 about policies and procedures 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.

Is it recommended that my agency has a workplace policy for distributing and/or using/administering naloxone in the workplace?

Yes, it is recommended that agencies develop a workplace policy for distributing naloxone as well as for using/administering naloxone.

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

Where can I report an overdose?

If an overdose is reported, please complete the online overdose reporting form. This online form allows the Health Unit to collect additional information about overdoses that will help inform work and issue drug alerts in a timely manner, when needed.

If your agency wishes to be added to the weekly Nipissing Parry Sound Overdose Incident Report email list, please contact us at harm.reduction@healthunit.ca.

Where can I find information on local naloxone distribution and opioid related statistics for the Nipissing and Parry Sound Districts?

Local opioid-related and naloxone distribution statistics can be found on the Health Unit’s Nipissing Parry Sound Opioid Related Dashboard.

Please visit the dashboard by clicking here.