Overdose and Substance Misuse Prevention

Learn how to prevent, recognize and respond to an overdose. Anyone who uses drugs can be at risk for overdose.

You may not know that someone you love is using drugs. By learning more, you could save their life.

What is an overdose?
An overdose happens when a person uses more of a drug, or a combination of drugs, than the body can handle. As a result, the brain is not able to control basic life functions. The person may:
  • Pass out,
  • Stop breathing,
  • Have a heart attack, or
  • Experience seizures depending on what drugs they have used.

Learn the signs and symptoms of different types of drug overdoses below!   

Anyone can overdose: first time users, people who have been using for a long time, people who use regularly, people who only use once and a while, seniors, young people, overdose doesn't discriminate.

  • There is no exact formula for figuring out how much of a certain drug, or combination of drugs, will lead to an overdose. How strong a drug is (potency), how a drug is taken- whether swallowed, snorted of injected, how much of a drug, and how often a drug is used all are factors.
  • Factors like weight, health, and tolerance for a drug at that particular time all play a role.
  • Overdose risk is higher when you haven't used in a while (whether you took a break, or were in treatment, hospital, or jail).
Ottawa Overdose Statistics

Figure 1: Emergency Department Visits for Drug Overdoses in Ottawa

This report provides available monthly trend data on drug overdose-related emergency department visits. It provides information on the overdose-related emergency department visit trends relating to overdoses in the last 6 months.

The data used in this report is from:

  • Drug overdose-related emergency department data
  • Ottawa Paramedic Service response data
  • Ottawa Paramedic Service naloxone administration data

Emergency department visits for drug overdoses in Ottawa

Data
Figure 1 Data: What are the emergency department (ED) overdose trends in the last 6 months?
Week Ending Week Count
2016-10-15 18
2016-10-22 30
2016-10-29 16
2016-11-05 18
2016-11-12 21
2016-11-19 18
2016-11-26 22
2016-12-03 20
2016-12-10 25
2016-12-17 23
2016-12-24 18
2016-12-31 20
2017-01-07 19
2017-01-14 20
2017-01-21 26
2017-01-28 21
2017-02-04 28
2017-02-11 25
2017-02-18 33
2017-02-25 26
2017-03-04 22
2017-03-11 33
2017-03-18 23
2017-03-25 22
2017-04-01 18
2017-04-08 25
2017-04-15 18
2017-04-22 28
2017-04-29 30

In 2015, 48 Ottawa residents died from unintentional drug overdose:

  • 29 of these, or almost 2 in 3 deaths were due to opioids
  • Fentanyl was involved in 14 of these deaths, more than 1 in 4

Figure 2: Unintentional drug overdose deaths in Ottawa by type of drug involved, 2015

Unintentional drug overdose deaths in Ottawa by type of drug involved, 2015

Data source: Office of the Chief Coroner for Ontario, extracted December 2, 2016. Analyzed by Epidemiology Team, Ottawa Public Health.

Age: These 48 overdose deaths were not distributed evenly across ages; some age groups were more impacted than others. One third of those who died, 15 people, were under 40 years old. See chart below.

Figure 3: Age distribution of Ottawa unintentional drug overdose deaths, 2015 (48 deaths total)

Age distribution of Ottawa unintentional drug overdose deaths, 2015 (48 deaths total)

Data source: Office of the Chief Coroner for Ontario, extracted December 2, 2016. Analyzed by Epidemiology Team, Ottawa Public Health. (Data table below)

Data
Age distribution of Ottawa unintentional drug overdose deaths, 2015 (48 deaths total)
Age group Percentage of deaths
10 to 19 years 2%
20 to 29 years 12%
30 to 39 years 19%
40 to 49 years 15%
50 to 59 years 37%
60 years and older 15%

The rate of drug overdose deaths increased 32% in Ottawa between 2014 and 2015 and only 6% in the rest of Ontario.

The increase in unintentional overdose deaths in Ottawa and in the rest of Ontario has been due to increased unintentional opioid overdose deaths, and since 2014, fentanyl has been involved in the largest proportion of drug overdose deaths in Ottawa. For more information see "Drug-related death in Ottawa, 2000-2015".

Overdose prevention- Reduce Your Risk

If you are going to use:

Don't Use Alone

  • If you overdose when you are alone there will be no one there to help you.
  • When using with someone else, don't use at the same time. Be sure your friend is willing to call for help, and make a plan for what to do if an overdose happens.  
  • If you do use alone, tell someone before you use. Leave the door unlocked and have someone come check on you.

Don't Mix Drugs

  • Don't mix drugs with other drugs or alcohol.
  • Mixing with other drugs puts you at higher risk of overdose.
  • If you are going to mix, use one drug at a time or use less of each drug.  

Go Slow

  • The quality of street drugs is unpredictable. Fentanyl is being cut (mixed) into both opioid and non opioid drugs:
    • Made as a powder and mixed into cocaine, heroin, and crack.
    • Made as pills and being sold as 'oxycodone' (eighties, oxys) or other pills including ecstasy/MDMA.
  • You may not be able to taste, smell or see it. Even very small amounts can cause an overdose.
  • Start using in small amounts and do "testers" (or test doses) to check the strength of what you are using.

Carry Naloxone

  • Naloxone is a medication that can temporarily reverse an opioid overdose.
  • Naloxone is available free to people who use drugs and their family and friends!
  • Learn more about Naloxone and where to get a kit.

Know your tolerance 

  • Tolerance is the body's ability to 'handle' the effects of the drug being used. Tolerance to a drug develops over time.
  • Drug tolerance will decrease when somebody has taken a break from using - whether intentionally or unintentionally (like while in treatment, hospital or jail).
  • Your tolerance will also change depending on: 
    • Weight,
    • Illness,
    • Stress,
    • Lower immune system (from hepatitis for example),
    • Lack of sleep,
    • Other drugs/medications being used, and
    • General health. 
  • Use less drugs when your tolerance may be lower.
  • Your risk of overdose increases if you are a new user or haven't used in 3+ days!

Be aware

  • Drugs can be tampered with at any point. People buying or selling drugs may not be aware if it has been cut with anything before they sell it to you.

A paramedic speaks about overdose prevention and calling 911.

Signs and symptoms of an overdose
 An overdose may look different from one person to the next and depending on the drugs involved.  An overdose is a medical emergency and the first step is always to call 911.

Type of drug

Common signs and symptoms of an overdose

Opioids 

(like heroin, morphine, fentanyl, methadone, oxycontin)

Opioid overdose signs and symptoms

Download: Signs and Symptoms of an   opioid oversdose [PDF 1.8 MB]

Breathing is very slow, or irregular, or they may not be   breathing at all

Fingernails and/or lips are blue

Body is limp

Deep snoring or gurgling sounds

Loss of consciousness/passed out (can't wake the person   up)

Unresponsive  (not answering when you talk to them or   shake them)

Pinpoint (tiny) pupils

Vomiting

Stimulants

(like cocaine, speed, crystal meth, MDMA/ecstasy)

Seizures

Pressure and tightness in chest

Foaming at the mouth

Racing pulse

Excessive sweating

Vomitting

Headaches/dizziness/ringing in the ears

Hard time breathing

Sudden collapse

Loss of consciousness/passed out (can't wake the person   up)

Hallucinogens

(like acid, LSD, ketamine, magic mushrooms)

Catatonic syndrome (person will be in a trance like state)

Psychosis (their reality is altered may be having   hallucinations or delusions)

Nausea/vomiting

Seizures

Information for Parents

You are your child's best defense against drug use.

The top two things that a parent or guardian can do is to be informed about drug issues and talk to your kids about drugs.  For more information, including  tips for talking to your kids about drugs, information on opioids including  fentanyl, how to spot an overdose,  what to do in an overdose,  and where to get naloxone go toYouth and Opioids: What Parents Need to Know (link is external)on Ottawa Public Health's Parenting in Ottawa website.  

Information for Pharmacists

Naloxone Distribution

Pharmacists are highly respected as the medication management experts of the health care team. By becoming a participant in the Ontario Naloxone Program for Pharmacies (ONPP), your pharmacy can increase access to naloxone and be part of the enhanced response to overdose prevention in our community.  For more information on how to participate in the ONPP, please see this notice from the Ministry of Health and Long Term Care 

Used Medication Disposal at Pharmacies

Pharmacies play a fundamental role in raising awareness about the importance of properly disposing of unused or expired medications by providing a drop-off locations for such medications as over-the-counter, prescription and natural health products through Health Products Stewardship Associations' (HPSA) Medications Return Program (OMRP), and for sharps materials and devices through its Sharps Collection Program (OSCP).

  • Ottawa Public Health (OPH) is working in partnership with the Health Products Stewardship Association (HPSA) to raise public awareness of the importance of safe disposal of unused or expired medications. Success depends on participating pharmacies being informed about the procedures, guidelines and regulations of the Ontario Medications Return program (OMRP),  and actively offering the collection and management of unused or expired medications returned by the public. 
  • You can call the HPSA to register your location at 613-723-7282 or send an email to info@healthsteward.ca. The OMRP covers the costs associated with the responsible disposal of health products returned by the public. There is no cost to you.
  • If you would like to receive FREE copies of the Take it Back! public rack cards, pictured below, you may use the order form, or call or email the Health Products Stewardship Association to receive copies.  They will be happy to send you English and /or French copies, free of charge, to your pharmacy location(s).
  • Please find a list of products that are accepted and not accepted through the Ontario Medications Return Program. Your  pharmacy clients will be able to find the closest participating pharmacies to their  location through the HPSA website homepage by typing in their postal  code or address.

Ottawa Public Health Opioid Email Updates

You can also join the distribution list for Ottawa Public Health Opioid Updates for communications regarding overdose prevention and naloxone programming.  To register for the list please email jackie.kay-lepors@ottawa.ca

For all other inquiries please contact  the Ottawa Public Health Information Line athealthsante@ottawa.ca or call  613-580-6744 ( TTY: 613-580-9656, Toll free: 1-866-426-8885) Monday to Friday from 8:30 am to 4:30 pm (closed on statutory holidays).

Local Resources

Fentanyl Facts [PDF 103 KB]

Treatment Information

Detox

Support Services and Treatment

Methadone Services

If you are feeling sadness or experiencing any other negative emotional reactions here are some links to resources that might help:

What is Fentanyl and Carfentanyl?

What is fentanyl?

Fentanyl is an opioid that is much more toxic than most other opioids. Opioids include drugs like heroin, morphine, fentanyl, methadone and codeine. Fentanyl is usually prescribed in a patch form as a painkiller. It is around 50 to 100 times more toxic than morphine. This makes the risk of accidental overdose much higher.

There are also different Fentanyls being made illegally and sold on the streets. This illicit fentanyl is often made as a powder and mixed with other drugs (like heroin, cocaine or crack). It is also being pressed into pills made to look like other prescription pills (like oxycontin, eighties or percocet) or other pills including speed. It may be in drugs that are in powder, liquid or pill form.

What's the risk with fentanyl?

When fentanyl is mixed with other opioids, alcohol, benzodiazepines, or stimulants like cocaine, it increases the risk of accidental overdose.

Illicit fentanyl is much more toxic than other pharmaceutical opioids. There is no easy way to know if fentanyl is in your drugs. You can't see it, smell it or taste it. Any drug can be cut (mixed) with fentanyl. Even a very small amount can cause an overdose.

When you are getting drugs from anywhere other than from a pharmacy or medical professional, like from a friend, ordering online, or a dealer, there is no way to be sure exactly what is in them or how toxic they may be.  

It's important to know that drugs other than fentanyl can also cause an overdose! 

Check out our tips on overdose prevention and naloxone to reduce your risk! 

Carfentanil

Carfentanil is an opioid that is used by veterinarians for very large animals like elephants. It is not for human use. It is approximately 100 times more toxic than fentanyl and 10,000 times more toxic than morphine. This means carfentanil can be deadly in extremely small amounts.

Ottawa Police are warning that carfentanil has been found in Ottawa. 

Carfentanil is being cut in to other illicit drugs like heroin and counterfeit pills made to look like prescription opiods (including green pills stamped 'CDN' on one side and '80' on the other). There is no easy way to know if carfentanil is in your drugs, you can't see it, smell it or taste it. It is extremely toxic and a very small amount can cause an overdose, or even death.

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What is Naloxone?

Naloxone is a medication that can temporarily reverse the effects of an opioid overdose. Opioids include drugs like heroin, morphine, fentanyl, methadone, codeine, etc.

In Ontario, naloxone is available for free through programs like POPP, at local pharmacies, community agencies, shelters, outreach programs, and withdrawal management programs. It is available to people who could be at risk of an overdose and to people who could help someone who is overdosing.

How does Naloxone work?

In an opioid overdose a person's breathing slows down or stops. Naloxone blocks the effect of opioids on the brain. It temporarily reverses these effects on a person's breathing. Giving naloxone can prevent death or brain damage from lack of oxygen.

Naloxone will only work on opioid-related overdoses. It is important to remember that a lot of other drugs are being cut with fentanyl. If the person has used any drugs and is showing signs of an opioid overdose call 911 and give naloxone.

How long does Naloxone take to work?

Once given, naloxone will start to work in approximately 2-3 minutes.

Naloxone stays active in the body for up to 2 hours but it is important to know that most opioids stay active in the body longer than 2 hours! If the opioid is still in the body after the naloxone wears off, the overdose can return!

This is why it is so important to call 911 in every overdose situation!

Are there age restrictions for administering naloxone? Is it safe to give to teens?

Naloxone is a very safe drug that is used across ages. An opioid overdose is a life-threatening situation, which can be temporarily reversed by naloxone, and for that reason If your teen is overdosing you would give naloxone regardless of age.  For this same reason, you would also give naloxone if your child was pregnant or lactating, and if they have medical conditions such as heart, respiratory, liver or kidney disease.

The only reason to NOT give naloxone would be if there was a known history of allergy to naloxone or its ingredients. If allergies are unknown (which is the likely the case when responding to medical emergencies), give naloxone.

Always call 911 for any overdose or suspected overdose, even when naloxone has been given.

Will it "harm" my child if I give them naloxone and it turns out they were NOT overdosing?
No. The main "risk" of giving naloxone to someone who is dependent on opioids is that it will cause them to suddenly go into withdrawal, these symptoms are temporary and not life threatening, though they can be unpleasant, and will stop once the naloxone wears off.

The only reason to NOT give naloxone would be if there was history of allergy to naloxone or its ingredients -which you likely wouldn't know. 

 Naloxone Facts

Learn more about Naloxone from the following University of Waterloo video:

Take-Home Naloxone Kits

Naloxone kit 

Being able to recognize the signs of an overdose quickly and having a naloxone kit can save a life. Naloxone can buy time while paramedics are en route. Take-home naloxone kits do not replace the need for emergency care or minimize the importance of calling 911. 

You can get a take-home naloxone kit for free from pharmacies and other agencies in Ottawa. When you get your kit you will also receive training on overdose prevention, recognizing an overdose and how to respond. Below is a list of places where you can get a free Naloxone kit in Ottawa

  • Ottawa Public Health's Site Needle & Syringe Program provides free kits and training for clients and their family or friends.  Visit our 
    • Site Office @ 179 Clarence St (in the Byward Market) from 9 am to 9 pm 7 days a week
    • Mobile Site Van (provides service throughout the City of Ottawa): 5 to 11:30 pm 7 days a week, phone 613-232-3232
    • For more information on these services visit our Harm Reduction Services in Ottawa section.
  • Many local Ottawa Pharmacies: To  find a participating pharmacy near you:
    • Call the Drug and Alcohol Helpline @ 1-800-565-8603.  
    • Check this list of pharmacies that have naloxone. This list is managed by the Ministry of Health and Longterm Care. Should a pharmacy be missing from the list, please contact the Ministry
    • Once you have located a pharmacy, Ottawa Public Health suggests you call ahead to make sure that they currently have naloxone available.
  • The Ottawa Hospital- offers training and naloxone kits for registered patients at risk of overdose.  
  • Sandy Hill Community Health Centre's Oasis Overdose Prevention Service (221 Nelson Street 1st floor, 613 569-3488) 
    • available through walk-in services Monday-Friday
How to respond to an opioid Overdose

5 Steps to Save a Life

What to do in case of overdose?

Shake and shout to check responsivenessCall 9-1-1 if not responsiveGive naloxone at anytimeGive chest compressions or CPR with no interruptions, except to administer naloxone.Is it working? Continue chest compressions or CPR until the person responds or EMS arrives. If they are not awake after 3 minutes, administer second dose of naloxone.

  1. Shake and shout to check responsiveness
  2. Call 9-1-1 if not responsive
  3. Give naloxone
  4. Perform Rescue Breathing, and/or Chest Compression or CPR as trained
  5. Is it working? If the person still does not start breathing normally on their own and additional doses of naloxone are available, more doses of naloxone can be administered every 2-3 minutes until first responders arrive.

If you have to leave the person at any time put them in the recovery position.  The recovery position helps keep a person's airway open so they can breathe and can prevent them from choking on vomit or spit.

Recovery Position

 recovery position

  1. Responder extending victims closest arm above the victims head
  2. Responder positions other arm across the victims chest and bends furthest leg at the knee.  Victim is rolled towards responder and placed on side
  3. Victim laying on side with head stabilized on extended arm. Knee is bent and stabilized

It is important to stay with a person after giving them naloxone: 

  • The person may be confused and frightened when they wake up. You will need to tell them what happened.
  • A lot of opioids can last longer in the body than naloxone, so an overdose could return. It is important to make sure that the person knows not to take any more drugs!
  • It is important to tell paramedics everything you know about the situation so they can provide the best care.
  • Naloxone may cause people who have used opioids to go into withdrawal. This may make the person want to use again.  Using more will increase the risk of overdose as the naloxone wears off. 
  • This can be very uncomfortable for the person but is not life threatening.  Withdrawal symptoms may include:
    • Muscle aches,
    • Sweating,
    • Nausea/vomiting,
    • Agitation,
    • Irritability. 

For full training on how to give naloxone, visit the locations listed above.

Learn about tips on how to respond to overdoses of a stimulant (PDF) like cocaine, crystal meth, speed, MDMA, or Ritalin. 

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