The opioid crisis is a leading public health concern in Canada. While its effects are far-reaching, Indigenous communities are disproportionately impacted by opioid-related harms. Knowing the signs of opioid poisoning and how to respond equips you to act quickly and effectively when a crisis occurs. It could help save a life.
Opioids
What are opioids?
Opioids are a family of drugs that are primarily used to manage pain. Examples of opioids include: morphine, heroin, codeine, oxycodone (ex. OxyContin, Percocet), methadone, and fentanyl.
What is an opioid poisoning?
An opioid poisoning occurs when a person takes more opioids than their body can cope with, either intentionally or unintentionally. As a result, the central nervous system is unable to control basic life functions, like breathing and body temperature, which can lead to serious consequences including brain injury and death.
Both prescription opioids and illegal opioids can cause poisoning. The unregulated drug supply is highly toxic and unpredictable. Any unregulated drug may be contaminated with fentanyl.
Signs of Opioid Poisoning
An opioid poisoning may look different from one person to the next and depending on the drugs involved. An opioid poisoning is a medical emergency. Always call 911 or your local emergency line (Moosonee: 911, Moose Factory: 705-658-1111, Attawapiskat: 705-997-1111, Fort Albany: 705-278-1111, Kashechewan: 705-275-4004, Peawanuck: 705-473-2525).
Common signs and symptoms of opioid poisoning include:
Very slow or irregular breathing, or no breathing at all
Blue fingernails and/or lips
Loss of consciousness/passed out (not easily woken up)
Deep snoring or gurgling sounds
Unresponsive (not answering when you talk to or shake them)
Pinpoint (tiny) pupils
How to Respond to an Opioid Poisoning
Key message: Naloxone can be given by anyone to help temporarily reverse an opioid poisoning until emergency medical assistance arrives, but it is not a substitute for professional medical care. If you witness or suspect an opioid poisoning, always call 911 or your local emergency line. The Good Samaritan Drug Overdose Act provides some legal protection to anyone who seeks emergency support for a drug poisoning.
Step 1: Shout the person’s name and shake their shoulders.
Step 2: Call 911 (or the emergency services number for your community) if the person is unresponsive, or ask someone to call 911 or your local emergency number for you. An opioid poisoning is a medical emergency.
Step 3: Give naloxone.
Lay the person on their back.
Remove the naloxone device from the packaging. DO NOT test the device.
Tilt the person’s head back and support their neck with your hand.
Hold the device with your index and middle fingers on either side of the nozzle.
Insert the nozzle into the nostril, then press the plunger down firmly with your thumb to give the dose.
Step 4: Perform chest compressions and rescue breathing, if you are trained in CPR or move them into the recovery position.
Give a second dose of naloxone after 2 to 3 minutes if the person has not woken up or if their breathing is not improved. You can give a dose of naloxone every 2 to 3 minutes, as needed.
Step 5: Stay with them until emergency medical assistance arrives. Symptoms of opioid poisoning can return. Naloxone is only active in the body for 20-90 minutes. The effects of most opioids last longer.
Naloxone
Naloxone is a fast-acting medication that can temporarily reverse the effects of opioid poisoning. Naloxone can be given by anyone to reverse the effects of opioid poisoning until medical help arrives. If you think someone is experiencing an opioid poisoning, call 911 or your local emergency services number and give naloxone, even if the drug taken is unknown.
How does naloxone work?
Opioids bind to specific receptors in the brain and body to reduce the amount of pain a person feels. Too many opioids can cause someone to stop breathing. Naloxone binds to the same receptors, but without activating them. Naloxone blocks opioids from binding to these receptors, rapidly reversing the effects of opioids on the body.
How long does naloxone take to work?
Naloxone works quickly. It can restore normal breathing within 2-3 minutes in a person whose breathing has slowed or stopped due to opioid poisoning. A single dose of naloxone may not be enough to counteract certain opioids, such as fentanyl. Give naloxone again after 2-3 minutes if the person has not woken up or if their breathing has not improved.
How long is naloxone active in the body?
Naloxone is active in the body for roughly 20-90 minutes. Many opioids stay active in the body much longer! Symptoms of opioid poisoning can return as the effects of naloxone wear off. Repeat doses of naloxone may be necessary.
Is naloxone safe?
Naloxone is safe for all ages and only works if a person has opioids in their system. It does not cause dependence. Giving naloxone to someone who is unconscious due to a non-opioid drug poisoning or for other reasons is unlikely to cause more harm.
Opioid poisoning is a life-threatening medical emergency. Naloxone can be given regardless of age, if the person is pregnant or lactating, or if they have existing medical conditions to temporarily reverse the effects of an opioid poisoning.
Naloxone allergy: The only reason not to give naloxone to someone experiencing an opioid poisoning is if that person has a known allergy to naloxone or any of its ingredients. If allergy status is unknown, give naloxone.
Mushkegowuk Health is now a naloxone distribution site under the Ontario Naloxone Program (ONP). If you or someone you know is at risk of opioid poisoning, visit our health office, located at 11 Elm St. N, Timmins, to pick up naloxone.
Naloxone kits are free. No ID or prescription is required.