FAQ - Opioids, Overdose and Naloxone

Opioids are substances that bind to receptors located in the brain. They can be of natural origin (extracted from common poppy pods, ex. morphine, codeine), synthetic (manufactured in a lab, ex. fentanyl), or semi-synthetic (derived from a natural opioid, ex. heroin, oxycodone).

Pharmaceutical opioids must be prescribed by a healthcare professional and are generally used to relieve acute or chronic pain or to treat opioid dependence (ex. methadone), but they can also be used in other contexts (diarrhea, cough).

Recreationally used opioids can be pharmaceutical products that have been prescribed and then misused or stolen, but the majority come from the black market and are manufactured in clandestine labs.

In recent years, extremely potent opioids intended for animals (ex. Carfentanil, which is 100 times more potent than fentanyl) and synthetic opioids from the Nitazene class (developed for humans but never commercialized) have been found in illicit drugs sold in Canada and have been linked to deaths.

Intoxication occurs when two conditions are met: a legal opioid is taken improperly (ex. not following the prescribed dosage, using it contrary to recommendations, taking someone else's medication) AND it causes a serious health problem.

Poisoning can also occur when consuming an illicit drug that contains an opioid that is too potent or in excessive amounts. Even a very small amount of opioid can lead to a fatal overdose in a person who has never used it before.

• Difficulty walking, talking or staying awake
• Blue, purple or gray coloring of the lips or nails (cyanosis)
• Extreme drowsiness (difficulty staying awake or loss of consciousness)
• Slow, weak or nonexistent breathing
• Very small pupils
• Cold and moist skin
• Dizziness and confusion
• Choking, gurgling or snoring sounds
• Inability to wake up, even if shaken or with a loud noise (a scream)
• Limp or motionless body

When used properly, opioids prescribed for pain relief are effective and safe. As with any other medication, it is important to follow certain guidelines to reduce the risks associated with improper use.

• Follow the frequency and indications of prescribed doses.
• Do not take someone else’s medication, and do not share your medications, opioids or otherwise, with another person.
• Return unused medications or leftovers (once your therapy is over by doctor’s order) to avoid confusion.
• Avoid taking drugs that are no longer useful.
• Educate your loved ones about the risks of taking opioids that are not prescribed to them.
• Keep your medication out of the reach of children and use child-resistant containers.
• Request a naloxone kit from your pharmacist and inform your loved ones where it is located and how to use it.

Users of illicit drugs should also exercise caution, as drugs sold on the black market may contain substances other than what they believe they have purchased. From a harm reduction perspective, public health generally recommends:

• Avoid using alone, if possible.
• Utilize drug checking services offered by supervised consumption centers, if available.
• Obtain naloxone and learn how to use it.

Naloxone is an antidote used to reverse the effect of an opioid overdose. It is not effective against overdoses caused by other substances, such as stimulants, benzodiazepines, or alcohol. In Canada, naloxone is offered for free through pharmacies and community resources that provide support to drug users.

If you use opioids or are in contact with people who use opioids, you can receive a free kit from your pharmacist or from a drug user support resource, such as a supervised consumption center. Depending on your province of residence, certain requirements or restrictions may apply, particularly concerning age and the need for identification.

Click here to access a list of where to obtain naloxone in each province and territory.

• Keep naloxone at room temperature and protect it from light.
• Note the expiration date to replace the kit in a timely manner. In an emergency, it is possible to use an expired product. It may be less effective, but it can still help while waiting for emergency services to arrive.
• Keep the naloxone in its original package before use. 

Naloxone comes in two forms: injectable (into a muscle) and intranasal (administered via a nasal spray).

The intranasal naloxone spray is ready to use. You simply place the nozzle into a nostril and press the plunger. Injectable naloxone requires preparing the dose from an ampoule and syringe (provided in the kit), then injecting it into the muscle of the shoulder or thigh.

Due to its ease of use, intranasal naloxone is often preferred for individuals who use prescription opioids or occasionally use illegal opioids. Regular users of illegal opioids are at a higher risk of overdose. For them, injectable naloxone is sometimes preferred.

Important tips

• Make sure you fully understand when and how to use naloxone. Your pharmacist or healthcare provider will explain all the steps when giving you the kit.
• Naloxone is only effective for opioids. That said, it is not dangerous to administer it if you are unsure what the person has consumed.
• Call 911 first or have someone else do it while you administer the naloxone. Even if the overdose victim responds to naloxone, it is important to call for emergency help. The antidote only works for 20 to 90 minutes, which may be shorter than the effects of the opioid taken. The person is at risk of overdosing again once the effects of the antidote wear off.
• Do not hesitate to offer help. The Good Samaritan Act provides some legal protection for witnesses or victims of overdose such as possession of an illegal substance.

• If you are taking an opioid chronically and feel ready to stop or reduce the dose, ask to meet with your pharmacist who can suggest alternative or complementary medications or treatments.
• Pharmacists can help you find support resources in your community if you have a substance use issue and can support you in your efforts if you wish to quit.