Opioids and Overdose Prevention

Counterfeit drugs may look like prescription medications but do not come from a pharmacy. 

These pills are made to look like real prescription medication but are not made under regulated standards and/or in legal environments. They can be mixed with unknown chemicals and/or unknown amounts of opioids such as fentanyl or carfentanil, which can be deadly.

Opioids can suppress the sensation of pain. Other effects of opioids can include:

• Euphoria.
• Slow heart rate.
• Shallow, slow breathing.
• Fatigue.
• Difficulty concentrating.
• Feeling that you may pass out.

Higher doses of opioids can cause more intense and longer lasting effects. An overdose can occur if someone takes more opioids than their body can handle.

Opioids and pregnancy

Taking opioids during pregnancy can be harmful to your baby.

Learn more about pregnancy and opioids.

Fentanyl is a type of opioid. It is 50 to 100 times stronger than morphine. Even a small amount of fentanyl can cause an overdose. This amount can be as small as two grains of salt.

What is carfentanil?

Carfentanil, is an even stronger opioid, approximately 100 times stronger than fentanyl and 10,000 times stronger than morphine.

Fentanyl and carfentanil are often mixed with other street drugs such as cocaine, cannabis, heroin and ecstasy.

All types of opioids have a risk of overdose, which can lead to respiratory distress (having trouble breathing).

An overdose on opioids can include any of these signs or symptoms:

• Not waking up
• Limp body
• Slow or no breathing
• Blue lips and nails
• Cold skin
• Very small pupils
• Choking or throwing up
• Snoring or gurgling

An overdose is a medical emergency.

If you think someone has overdosed on opioids, call 911 immediately. Even if naloxone was given, call 911 as naloxone may wear off and overdose symptoms can return.

If you or someone you know has an opioid use disorder, consider using the following overdose prevention tips:

• Always use in the company of friend or around other people.
• Use less at first, especially if you are using a new product.
• Make an overdose plan with friends or drug partners.
• Use one drug at a time.
• Use less after any period of abstinence or decreased use – even a few days away can lower your tolerance.
• Test the strength of the drug before you use the whole amount.
• Use a less risky method (for example, snort instead of inject).
• Age and physical health matter; stay hydrated, eat regularly and get enough sleep and rest when you feel worn down.

Additional tips on preventing overdoses.

Where to get help for addiction or mental health issues.

Naloxone is a medication that can briefly block the effects of an opioid overdose until medical help arrives.

Here is what you need to know about naloxone:

• Naloxone is given when someone is having a suspected overdose on opioids. Naloxone can help the person start breathing and wake up again.
• More than one dose of naloxone may be required depending on the amount of opioid the person has overdosed on.
• Naloxone is given by nasal spray or needle.
• Naloxone is free without a prescription.
• Naloxone kits and training on how to use them are available at some drug stores and community agencies including John Howard Society of Durham and Carea Community Health Centre.

You are eligible for a free kit if you are:

• at risk of an opioid overdose.
• a family member, friend or other person able to help someone at risk of an opioid overdose.
• a client of a needle syringe/exchange program or hepatitis C program.
• newly released from a correctional facility.

The Good Samaritan Drug Overdose Act provides some legal protection for people who experience or witness an overdose and call 9-1-1 for help.

The act can protect you from:

• Charges for possession of a controlled substance (i.e. drugs)
• Breach of conditions regarding simple possession of controlled substances (i.e. drugs) in:
  • pre-trial release
  • probation orders
  • conditional sentences
  • parole

The act does not provide legal protection against more serious offences, such as:

• outstanding warrants
• production and trafficking of controlled substances
• all other crimes not outlined within the act 

Expired and unused medications are often left in medicine cabinets and cupboards. These medications can pose safety risks for you and your family.

In 2017

• One-quarter (24 per cent) of Durham Region students (grade 7 to 12) reported that it was very easy or fairly easy to get prescription pain-relief pills if they wanted them.
• 9 per cent reported getting them most often from a parent or sibling.
• 14 per cent of Durham Region students felt that taking them when not prescribed posed slight to no risk of harming themselves.

Keep your family safe and return your expired/unused prescriptions to any pharmacy. Do not flush prescriptions down the sink or toilet.

Patch for Patch Program (P4P)

People with opioid patch prescriptions must return their used patches to their pharmacy to get new ones. Used patches can be dangerous to the environment, to children and to animals. Do not flush or throw out the patch.

• Return policy FAQs for patients
• Patch return record sheet

What can I do to help end stigma?

• Educate yourself about substance use disorders.
• Substance use disorders are a medical condition that deserve care like any other health condition or disorder.
• Reflect on your own potential biases toward people who use substances.
• Speak up when you hear or witness someone being treated or spoken to/about in a disrespectful manner.
• Change the way we talk about substance use.

Why language matters?

Stigma can be reduced by changing the language we use. For example:

• Speak to the person first before you talk about their substance use. Individuals are more than the substances they use. For example, ask a person about themselves first before you address their substance use.
• Use people first language that focuses on the individual. For example: person who uses drugs vs. drug user, person with substance use disorder vs. addict.
• Use neutral, medically accurate language.
• Use language that promotes the fact that recovery is possible.
• Use language that expresses care and concern, rather than judgement.
• Avoid using slang or derogatory language (e.g. junkie; clean vs. dirty).

For more information visit the Health Canada website.

Many people who use substances will share that they have experienced trauma or violence at some point in their life. This could include abuse or neglect, physical or sexual violence, accidents and sudden unexpected loss. For some, these experiences affect their ability to cope and they resort to substances as a coping strategy, making them at risk for substance use problems.

What is a trauma and/or violence informed approach?

Trauma and violence informed approaches, recognizes the connections between violence, trauma, negative health outcomes and behaviours (Health Canada, 2018). It recognizes an understanding of trauma in all areas of service delivery and places a priority on the trauma survivor’s:

• physical safety,
• emotional safety,
• opportunities to make choices, and
• control over their treatment

What can you do?

Any time you are engaging with other people, recognize that trauma and violence:

• can happen to anyone of any age, cultural background and socioeconomic status.
• is the result of violence, abuse, neglect, loss, disaster, war and other emotionally harmful experiences.
• can influence a person’s behaviour and the choices they make.
• is more common than the research shows.

Many trauma survivors who use substances to cope are at risk of being re-traumatized and struggle to access supports. Taking a trauma and violence informed approach in all interactions with other people can help reduce these risks and promote recovery for trauma survivors.

Helpful tips for taking a trauma and violence informed approach:

• View every person as possibly having experienced trauma as well as having strength and resilience.
• View the survivor as having the ability to make changes and being able to recover from trauma.
• Be attentive to the person and ask what they need. This helps the person take part in their care.
• Create safety and trust, by allowing the trauma survivor their reactions without judging them.
• Be honest, compassionate and consistent.
• Offer opportunities to make choices and be willing to work with them. This helps survivors recognize their strengths and take control of their lives.

For more information on trauma and violence informed approaches check out the Government of Canada’s web page on trauma and violence informed approaches to policy and practice and Alberta Health Services e-learning modules on trauma informed care.

Crisis services

Counselling and treatment services

Rapid Access Addiction Medicine (RAAM) clinics in Durham Region (Lakeridge Health) offer fast access to quality care on a walk-in basis for people living with alcohol and opioid-related addictions. Services include medical treatment and same-day counselling services without a doctor’s referral.
Oshawa Hospital: Mondays and Thursdays, 9 a.m. to 11 a.m., 905-576-8711 extension RAAM (37226)
Pinewood: Tuesdays and Thursdays, 9 a.m. to 11 a.m., 905-576-8711 extension RAAM (37226)

Pinewood Centre of Lakeridge Health offers inpatient and outpatient assessment and treatment for mental health and addiction issues.
905-721-4747

Carea Community Health Centre offers counselling and programs for mental health concerns and addictions.
Oshawa: 905-723-0036
Ajax: 905-428-1212

Canadian Mental Health Association provides a broad range of mental health services.
905-436-8760
Toll Free: 1-844-436-8760

Durham Mental Health Services provides services to teenagers 16 years of age and older who are dealing with mental health issues and substance abuse.
905-666-0831

John Howard Society provides referrals and support to navigate addictions, medical, and mental health services through our Harm Reduction Programs.
905-579-8482 extension 244 (Xchange staff)
905-431-6782 (Harm Reduction Outreach Program)

ConnexOntario provides free and confidential health services information for people experiencing problems with alcohol and drugs, mental illness and/or gambling. The information and referral service is live-answer 24/7, confidential, and free.
1-866-531-2600

Frontenac Youth Services offers a mental health crisis hotline and school services to youth who are 12 to 18 years of age within Durham Region. This organization also provides substance abuse treatment for youth.
1-888-454-6275

211 is a free, multilingual, 24/7 helpline answered by community navigators who help callers connect with services and programs in their community. The helpline is supported by an online database of community, social, health and government services.

Narcotics Anonymous (Central Lake Ontario Area branch) provides resources on alcohol and other drugs. 
Helpline: 1-888-811-3887

Ontario Shores Mental Health Sciences offers inpatient and outpatient assessment and treatment for mental health concerns.
1-877-767-9642 (Access to programs and services)

Project X-Change

• Canadian Centre for Substance Use and Addiction (CCSA)
• Health Canada
• The Centre for Addiction and Mental Health
• Prescription opioids information sheets for parents and youth: English | French