Preventing and responding to an overdose and naloxone

Last revised: February 29, 2023

Anything can be cut with fentanyl or carfentanil. There is no way to be sure of what is exactly in drugs obtained from anywhere other than a pharmacy or government retailer (such as an OCS). If you get them from a friend, order them online, buy them from a dealer, or anywhere similar, you don’t know how toxic they may be.

Counterfeit pills can be made to look almost identical to prescription opioids and other medications. Illicit fentanyl is often made as a powder and mixed with other drugs (like heroincocaine or crack). It can also be pressed into pills and sold as 'oxycodone' (OxyContin, oxys, Percocet, percs, 80s) or other pills, including speed and ecstasy/MDMA.

There is no easy way to know if fentanyl is in the drugs you are using. You can't see it, smell it or taste it. A very small amount of the powder can cause an overdose.

Lower Risk Use

Individuals who use drugs are reminded to:

  • Avoid using alone - If you use alone and experience an overdose, nobody will be there to respond. If you are using with someone else, don’t use at the exact same time. 
  • If you do use alone -
  • Carry naloxone - Naloxone is a medication that can temporarily reverse the effects of an opioid overdose. Naloxone kits are available at no cost in Ontario. Please visit our Stop Overdose Ottawa webpage to find out how to get a naloxone kit at no-cost. 
  • Don’t mix drugs - Using more than one drug at a time puts you at a higher risk of overdose. 
  • Know your tolerance - Your risk of overdose increases if you are a new user or haven't used in more than three days. 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. 
  • Start low and Go slow - The quality of unregulated drugs is unpredictable. Anything can be cut with Fentanyl or Carfentanil. 
  • Seek medical care for unusual skin lesions

If you have a friend or family member who uses drugs, you are encouraged to: 

  • Know the signs of an overdose and call 9-1-1 immediately if you witness an overdose. 
  • Carry naloxone – a medication that can temporarily reverse an opioid overdose. 
  • Take the online no-cost Party Safer course and get a certificate. Learn about commonly used substances, how to ID an OD and access naloxone, and get information on mental health, addictions, and substance use health supports and services.
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. Always call 911.

Signs and symptoms of an overdose
Type of drug Common signs and symptoms of an overdose
Opioids 
(Examples like heroin, morphine, fentanyl, methadone, OxyContin)
  • 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
Stimulants
(Examples like cocaine, speed, crystal meth, MDMA/ecstasy)
  • Seizures
  • Pressure and tightness in chest
  • Foaming at the mouth
  • Racing pulse
  • Excessive sweating
  • Vomiting
  • Headaches/dizziness/ringing in the ears
  • Hard time breathing
  • Sudden collapse
  • Loss of consciousness/passed out (can't wake the person up)
Hallucinogens
(Examples like acid, LSD, ketamine, magic mushrooms)
  • Catatonic syndrome (person will be in a trancelike state)
  • Psychosis (their reality is altered and may be having hallucinations or delusions)
  • Nausea/vomiting
  • Seizures

 

How to respond to an opioid overdose 

5 Steps to Save a Life and the Good Samaritan Drug Overdose Act

Shout and ShakeCall 911Give naloxonePerform rescue breathing and/or chest compressionsChecking breathing

What to do in case of overdose

COVID-19 Pandemic recommendations when responding to an overdose.

Remember to put on the non-latex gloves that come in your naloxone kit before you respond.

1. Shout the person’s name and shake their shoulders.

2. Call 9-1-1 right away if unresponsive.

3. Give naloxone:

  • Spray: insert nozzle into nostril, then press plunger down firmly to give the dose (only spray once plunger is in the nostril)

Or

  • Injectable: inject 1 vial or ampoule into arm or leg

4. Perform chest compressions only (not rescue breaths).

5. Is it working? If no improvement after 2-3 minutes, repeat steps 3 and 4.

6. Stay with them. 

If the person begins breathing on their own, or 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.

For more services and resources, visit the Mental Health, Addictions and Substance Use Health Services and Resources webpage. 

Visit the COVID-19 Main Page for more information and current situation.

Recovery Position

Recovery Position

  1. Responder extending victims closest arm above the victim’s head
  2. Responder positions other arm across the victim's 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 for the following reasons: 

  • 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. 
  • Withdrawal can be very uncomfortable for the person but is not life threatening. Withdrawal symptoms may include:
    • Muscle aches,
    • Sweating,
    • Nausea/vomiting,
    • Agitation,
    • Irritability. 

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

Naloxone 

An overdose is a life-threatening medical emergency. Naloxone is a medication that can temporarily reverse the effects of an opioid overdose, but it does not cure an overdose. If anyone suspects or witnesses a person experiencing a drug overdose, call 911 and administer naloxone, even if the drug consumed is unknown. Example of opioids include heroin, morphine, codeine, Percocet, methadone, fentanyl, carfentanil, etc.

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

Naloxone: Save a Life (fact sheet) - Government of Canada

 Effects of naloxone
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 mixed with fentanyl and carfentanil. 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!

 Limitations
Giving naloxone to someone that is unconscious because of a non-opioid overdose is unlikely to cause more harm. Overdoses are life-threatening. Giving naloxone is better than not administering it.

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

Naloxone is safe for all ages. An opioid overdose is a life-threatening situation, which can be temporarily reversed by naloxone, and for that reason, naloxone can be given regardless of age, if the person is pregnant or lactating and if they have medical conditions such as heart, respiratory, liver or kidney disease.

For more information about using naloxone, see below:

Where to get a Naloxone kit

Naloxone kit

In Ontario, naloxone is available for free through various programs. It is available to persons who could be at risk of an overdose and to people who could help someone who is overdosing. 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 or visit the Ontario website for information on where they can find the nearest naloxone distribution partner near you:

Ottawa Public Health's Harm Reduction Program

Free kits and training available for clients and their family or friends.

  • Site Office
    • Located on 179 Clarence St (in the Byward Market)
    • Available 9 am to 5 pm, Monday to Friday
  • Mobile Site Van provides service throughout the City of Ottawa
    • Available 5 to 11:30 pm, 7 days a week
    • Telephone number: 613-232-3232
  • For more information on these services visit Harm Reduction Services in Ottawa.

Local Ottawa Pharmacies

Get a free kit and training at a participating pharmacy near you by:

  • Calling the Drug and Alcohol Helpline @ 1-800-565-8603.  
  • Checking 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.

Local Ottawa Community Harm Reduction Partners

Get a free kit and training at a participating Harm Reduction Partner near you by checking this map of community agencies that have naloxone.

Online Training

Our online Overdose Prevention and Response Training is now available! Learn about types of drugs, drug intoxication and overdose prevention, naloxone, the 5 steps to respond to an opioid overdose, and available supports. Take it at your own pace.

St John's Ambulance and Sobeys Pharmacy Orleans

Free monthly opioid awareness and naloxone training sessions.

  • Available the 1st Wednesday of each month from 12 noon to 1 pm
  • Located on St John Ambulance (1050 Morrison Drive)
  • To register, send an email to info.ottawa@sja.ca.
Good Samaritan Drug Overdose Act 
The Good Samaritan Drug Overdose Act protects you, the person who is overdosing, and anyone at the scene from being charged with:
  • Possession of controlled substances (example, drugs)
  • Breaches in pre-trial release, probation orders, conditional sentences, or parole related to simple possession

The Good Samaritan Drug Overdose Act does not provide protection against charges for:

  • Outstanding arrest warrants
  • Making and selling of controlled substances (example, drugs)
  • All other crimes not outlined within the Act

For more information, visit the Government of Canada website.

StopOverdoseOttawa.ca
Prevention Harm Reduction Services Health Services and Supports Statistics Ottawa's Strategy Naloxone Online Training
StopOverdoseOttawa.ca

News and trainings 

a honeycomb bulletComplete our Stigma: How You Can Impact Change online training.
Learn about stigma and how we can all work together to support our community through the language we choose.

a honeycomb bulletOur online Overdose Prevention and Response Training is now available! 
Learn about types of drugsdrug intoxication and overdose prevention, naloxone, the 5 steps to respond to an opioid overdose, and available supportsTake it at your own pace. 

a honeycomb bulletOur online Party Safer training is now available! 
Learn about how and where to access Naloxone, reduce health risks using party safer tips, how to identify and respond to an overdose and find information on local supports. Take it at your own pace and get a certificate of completion.

a honeycomb bullet

Growing concerns around the toxicity of the unregulated drug supply - February 9 2024
Ottawa Public Health (OPH), Ottawa Police Service, Ottawa Paramedic Service and the Overdose Prevention and Response Taskforce are issuing an alert to warn residents about the risk of overdose related to the toxicity of the unregulated drug supply.

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