This document discusses Canada's opioid overdose crisis and the role of naloxone in reversing overdoses. It notes that Canada leads in per capita opioid consumption and accidental overdose is a leading cause of death. It outlines how various countries and programs have distributed naloxone kits. It then provides details about Sanguen Health Centre's proposed naloxone program, including participant eligibility, training, and prescribing and dispensing procedures. Key information about naloxone and overdose response and prevention is also summarized.

2.  Canada leads the world in per capita
consumption of opioids
 Accidental overdose is the 3rd leading cause of
unintentional death
 Oxycontin delisting

3.  In 1995, England and Germany became the
first countries to distribute Naloxone to
opiate users.
 In Turin, Italy Naloxone is available over the
counter.
 In Scotland, Naloxone is
prescribed by qualified
nurses and pharmacists

4.  Drug overdose is the leading cause of
accidental death in the US
 Started distributing naloxone in 1999
 Currently there are 183 Public Health
programs and they report 10 000 overdose
reversals
Harm reduction saves lives

5.  Edmonton street outreach program first to
operate take home naloxone in Canada
 August 31, 2011 Toronto Public Health
became the first health unit in Canada to
operate naloxone program
 August 31, 2012 Ottawa Public Health and
the BC CDC launched Naloxone programs

6.  In January, a community wide Naloxone
information session was held
 Very well attended in person and via OTN at
several sites across the region and province
 Since that time, several potential prescribers
have stepped forward in
Guelph and Waterloo Region

7. • Naloxone is an opiate antagonist which means that it binds to the
same receptors in the brain that opiates do and temporarily
removes the opioids and their harmful effects. This reverses the
respiratory depression that can cause overdoses to be fatal.
• Naloxone is ONLY effective with OPIOID overdoses (i.e. heroin,
oxycontin, morphine).
• The only known side-effect of Naloxone is withdrawal symptoms
for someone with an opioid addiction, and skin sensitivity to the
injection.

9. • When Naloxone is injected into a muscle or inhaled intra-
nasally, it takes between 2-4 minutes to work.
• Naloxone lasts for up to 45 minutes.
• Since Naloxone only temporarily removes the opioids from
the receptor sites in the brain, the opioids will return back to
those receptors once the naloxone is gone, and the overdose
symptoms can return
• It is therefore REALLY important to call 911 even if Naloxone
is used!!!

10.  A prescription medication
 1 supplier in Canada – Sandoz
 Average cost: $11.35/ ampoule
 Not on the provincial formulary (ODB)
 Not covered by EAP (Exceptional
Access Program)
 Currently supplied by OHRDP (Ontario
Harm Reduction Distribution Program)

11.  2 Ampoules of 1cc .4mg Naloxone Hydrochloride
 3 – 1cc 25g 1-inch safety engineered intramuscular
syringes (an extra syringe if one malfunctions)
 Naloxone step-by-step pamphlet
 Alcohol Swabs (for opening ampoule)
 Prescription identifier Card

12.  Goal:
 To provide take home Naloxone kits to people
who use opioids in order to prevent deaths caused
by overdose

13.  Sanguen discussed the proposed Naloxone
program with:
 Guelph General Hospital ER and Emergency
Mental Health Unit
 EMS (Guelph-Wellington & Waterloo Region)
 Police (Guelph & Waterloo Region)
 Cambridge Fire Department
 Public Health Department (Guelph-Wellington &
Waterloo Region)

14. Naloxone Medical Directive
(Sanguen: Dr. Chris Steingart)
Sanguen Health Centre Staff (Registered
Nurses, Social Workers, and Outreach Workers)
trained and certified to dispense Naloxone

15.  Has a history of or is currently using opiates
 Is at risk for overdose
 Willing to take the overdose training
 Willing to complete the follow-up evaluations
 No previous hypersensitivity to Naloxone

16.  Overdose risks and prevention tips
 Overdose myths – what not to do
 How to recognize opioid overdose
 5 steps to intervening
 Debriefing / Evaluation

17. Mixing Tolerance
•Avoid mixing drugs Tolerance is the body’s ability to increasingly
•Most overdose deaths occur because multiple withstand the effects of the substance
drugs have been taken (i.e. alcohol, •Develops over time so that the amount
benzodiazepines + opioids) needed to feel the same effects increase
•Prevention: Use one drug at a time, or use •Can decrease rapidly when someone is not
less of each drug! Remember: You can always using
do more, but you can’t do less. •Prevention: use less drugs when tolerance
lower (break from detox, prison)
•
Overdose
Prevention
Inconsistent Drug Quality Using Alone
& Potency
•Drug quality is unpredictable. •If you overdose, there will be no one to help
•Illegal drugs are unregulated, therefore their you
strengths unpredictable •Prevention: use with a friend (do not share
•Prevention: Inject a very small amount or needles), leave door unlocked, call someone.
snort the first bit to test the strength.
Carefully check out a new product. Does it
taste, smell, and look different?

18. Opioids • Breathing is very slow, erratic or • Vomiting
not at all • Loss of consciousness
• Finger nails &/or lips blue or purple • Unresponsive
• Body is limp • Pinpoint pupils
• Deep snoring or gurgling sound
Stimulants • Seizures • Headache, dizziness
• Pressure/tightness in chest • Difficulty breathing
• Foaming at the mouth • Sudden collapse
• Racing pulse
• Loss of consciousness
• Perfuse sweating
• Vomiting
Hallucinogens • Psychosis
• Catatonic syndrome (person
may sit in a trance-like state)
• Seizures
• Nausea, vomiting

19. DO NOT Implications
Put the person in a bath/cold water Person could drown or go into shock
Induce vomiting Person could choke
Inject them with anything (i.e. Does not help and can cause the
saltwater, cocaine, milk) other than person more harm. Wastes time.
naloxone
Slap too hard, kick them in the groin, Could cause the person serious harm
burn the bottom of their feet
Let them sleep it off Person could stop breathing and die

20. DO NOT Implications
Giving a shot of cocaine increases
Give the person a shot of coke/speed or a overdose risk, because cocaine can numb
Speedball (combination of a stimulant the urge to breathe.
and depressant injected together in the Speedballing is dangerous because
bloodstream) stimulants constrict blood vessels, and
cause the heart to beat faster, which can
depletes the body of much-needed
oxygen, making the overdose worse.
Put ice down the pants / put the Likely won’t work. Also, these can slow
person in a cold shower down the respiratory system (worsening
the OD) and cause shock/hypothermia.

21.  Call 911
 You do not have to tell them your name, that you
suspect an overdose, or that drugs are involved
 Once the paramedics arrive, tell them as much as
you know about the drugs the person was using and
what you did. This is to ensure that they can provide
the best care and response.

22. 1.) Stimulation
2.) Call 911
3.) Give Naloxone
4.) Rescue Breathing
5.) Is it Working? Give Naloxone Again

23.  Toronto Public Health
▪ POINT (Prevent Overdose in Toronto) Program
 Preventing Overdose Waterloo Wellington
▪ http://www.preventingoverdose.ca/
 Harm Reduction Coalition
▪ www.harmreduction.org

24. 29 Young Street East
Waterloo, ON
176 Wyndham St. N
Guelph, ON
www.sanguen.com
(519) 603- 0223
(877) 351- 9857