An overdose occurs when a person uses a drug or combination of drugs at a higher dosage level than the body can handle. The person may pass out, stop breathing, or experience heart failure, seizure or death.

What are the signs and symptoms of an opioid overdose?

Recognize the signs and symptoms of an overdose, including:

• Difficulty walking, talking and staying awake
• Blue or purple lips or nails
• Very small pupils
• Cold and clammy skin
• Dizziness and confusion
• Extreme drowsiness
• Choking, gurgling or snoring sounds
• Slow, weak or no breathing
• Inability to wake up, even when shaken or shouted at

If you think someone is overdosing, call 911 immediately. For more information about opioid overdose, visit Health Canada or Ontario.ca/opioids

Who is at risk of an opioid overdose?

You or your friend or family member is at risk of an opioid overdose if you/they:

• Are taking prescription opioids that were not prescribed to you/them and could be too strong
• Are buying opioids from the street and don’t know how strong they are
• Have bought street drugs laced with opioids
• Have overdosed on opioids before
• Are mixing opioids with other downers like alcohol or benzodiazepines (e.g., Valium, Xanax)
• Have stopped using opioids for a while (this lowers tolerance)
• Are using opioids alone
• Are using opioids in a new or different way (e.g., injecting, snorting or crushing)
• Are taking a higher dose than normal
• Are living with or have a history of mental illness (e.g., depression, psychosis)
• Are living with health issues (e.g., liver, kidney, heart, breathing issues)
• Lack sleep (impaired judgment) or food
• Are in a hurry to use
• Have a new dealer or are using unknown substances

How to reduce the risk of an opioid overdose

• Do not mix drugs or take drugs with alcohol. The risk of overdose increases if opioids are mixed with alcohol, sleeping or anxiety pills, other opioids or other prescription medications
• Do not use alone. Make sure someone is around to check on you in case you overdose
• Try a small amount first. If switching to a stronger opioid, use less and do a test dose
• Start low and go slow if using opioids after cutting down, or not using for a while
• Have and be trained to use naloxone

Create an overdose plan

Talk with your friends and family about overdose and create a realistic plan you can use in the event of an overdose. Make sure they know where you keep your naloxone.

What is naloxone?

Naloxone is a non-opioid medication that counteracts the effects of opioid overdose. Naloxone is available as an injection or a nasal spray. Always call 911 if someone is overdosing on opioids, whether or not naloxone is used.

Who can get naloxone?

• Naloxone is available without a prescription, at no cost for people who are at risk of opioid overdose and for concerned friends and family members of those at risk of opioid overdose
• If you are a community agency interested in becoming a naloxone distribution site, please contact the Substance Use Prevention and Harm Reduction Program at 1-877-464-9675 ext. 76683 or email substance@york.ca

Where can I get naloxone?

Family and friends are encouraged to pick up a naloxone kit at no cost to support those using opioids who are at risk of overdosing.

You can get naloxone from:

• Participating pharmacies: Visit ontario.ca/page/where-get-free-naloxone-kit
• Participating community agencies
  • Addiction Services for York Region 1-800-263-2288 or 905-841-7007
  • AIDS Committee of York Region 1-800-243-7717 or 905-884-0613
  • Caritas School of Life 1-800-201-8138 or 416-748-9988
  • The Krasman Centre 1-888-780-0724 or 905-780-0491
  • 360°Kids 905-475-6694; for youth and young adults aged 16 to 26
  • Inn from the Cold 905-895-8889
  • The Vitanova Foundation 905-850-3690 or 416-744-8940
• York Region Public Health
• Substance Use Prevention and Harm Reduction Program 1-877-464-9675 ext. 76683 or email substance@york.ca
• Sexual Health Clinics 1-800-361-5653 or TTY 1-866-252-9933, select “1” or “Sexual Health Line”

Where can I get help?

To get help for an addiction, please contact your health care provider, Addiction Services for York Region or access other community supports in York Region.

Overall opioid-related harms

Since 2007, there has been a steady increase in the rates of opioid overdose emergency department visits, hospitalizations and deaths in York Region.

Emergency Department Visits for Opioid Overdoses

York Region Residents

The rate of emergency department visits for opioid overdoses in York Region has slowly increased between 2007 and 2016, mirroring the increase in the Ontario rate.

In 2017:

• There were 233 emergency department visits for opioid overdoses in York Region residents (rate of 20.3 per 100,000 residents)^1,2
  • 25 to 44 year olds had the highest rate of opioid-related emergency departments visits in York Region^1,2
• Note: Since April 2017, Ontario hospitals have been required to report emergency department visits for opioid overdoses

York Region Municipalities

• Georgina and King had the highest rates of emergency department (ED) visits for opioid overdoses per 100,000 YR residents ^1,3
• Markham had the lowest rate of ED visits for opioid overdoses per 100,000 YR residents ^1,3
• Vaughan, Richmond Hill, Markham and Georgina had the highest numbers of ED visits for opioid overdoses¹

Hospitalizations for Opioid Overdoses

In 2017:

• There were 74 hospitalizations for opioid overdoses in York Region residents (rate of 6.5 per 100,000 residents)^2,4
  • 25 to 44 year olds had the highest rate of hospitalization for opioid overdoses, followed by 65+ year olds, in York Region^2,4

Opioid-Related Deaths

In 2017:

• There were 34 opioid-related deaths in York Region residents (rate of 3.0 per 100,000 residents)^2,5
  • 25 to 44 year olds had the highest rate of opioid-related deaths in York Region^2,5
    • Among 25 to 44 year olds, males had a much higher rate than females^2,5
  • 45 to 64 year olds had the second highest rate of opioid-related deaths in York Region^2,5
    • Among 45 to 64 year olds, males had a slightly higher rate than females^2,5
• Fentanyl was present at time of death in almost three-quarters of opioid-related deaths in York Region⁵**

**Technical Note: Drug categories are not mutually exclusive meaning there may have been more than one drug present at death.

Opioid Use in Youth

In 2017:

• 10% of York Region students (grades 9 to 12) reported using prescription opioids for non-medical reasons in the past year⁶
  • Most common source of prescription opioids reported by students who used prescription opioids for non-medical reasons was a parent or sibling⁶
• 12% of Ontario students (grades 9 to 12) reported using prescription opioids for non-medical reasons in the past year⁶

Prescription Opioids

In 2018:

• 97,091 York Region residents were dispensed a prescription opioid for pain (rate of 80.8 per 1,000 residents)⁷
• 43,048 York Region residents were dispensed an opioid for cough (rate of 35.8 per 1,000 residents)⁷
• 2,041 York Region residents were dispensed an opioid for opioid agonist therapy (rate of 1.7 per 1,000 residents)⁷

Technical Notes

• Data last updated on May 29, 2019
• Population estimates used to calculate emergency department (ED) visits and hospitalization rates are rounded which means there may not be direct comparability to similar calculations
• There is a significant delay in opioid-related death data
• There is a slight delay in emergency department visit data
• The following ICD-10 codes were used to filter data extraction for ED visits and hospitalizations:
  • T40.0 (poisoning by opium), T40.1 (poisoning by heroin), T40.20-T40.23, T40.28 (poisoning by other opioids), T40.3 (poisoning by methadone), T40.40-T40.41, T40.48 (poisoning by other synthetic narcotics), T40.6 (poisoning by other and unspecified narcotics)
• Categories for drug present at time of death are not mutually exclusive
• Prescription opioid use data includes all prescriptions for opioids dispensed form community pharmacies, regardless of payment type

Sources

1. National Ambulatory Care Reporting System (NACRS) [2007-2017], Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO, Date Extracted 2018 April 26.
2. Statistics Canada. Table 17-10-0139-01 Population estimates, July 1, by census division, 2016 boundaries.
3. Statistics Canada. 2017. Population and dwelling counts, for Canada and census subdivisions (municipalities), 2016 and 2011 censuses (table). Population and Dwelling Count Highlight Tables. 2016 Census.
4. Discharge Abstract Database (DAD), 2003‒2017, Ontario Ministry of Health and Long-Term Care, IntelliHealth Ontario. Extracted 2019 April 26.
5. Opioid-related morbidity and mortality in Ontario 2018. Public Health Ontario. Available from: https://www.publichealthontario.ca/en/dataandanalytics/pages/opioid.aspx- /ageSex
6. Ontario Student Drug Use and Health Survey [OSDUHS]. Centre for Addictions and Mental Health, 2017.
7. Ontario Drug Policy Research Network. Ontario Prescription Opioid Tool. Toronto, ON; April 2019. DOI: 10.31027/ODPRN.2018.01. Available from: http://odprn.ca/ontario-opioid-drug-observatory/ontario-prescription-opioid-tool/

What is stigma?

Stigma is prejudice and discrimination toward people who are living with or impacted by opioid use. Stigma can result in negative attitudes or actions towards those who use opioids and other substances and can lead to feelings of guilt, shame and greater harm to the individual and community.

Stigma includes negative attitudes, judgments, behaviors, and language that is hurtful. Stigmatization excludes people from activities that are open to others, for example; getting and keeping a job, a safe place to live and services.

How programs and policies are created can also discriminate and make it difficult for people who use substances to get needed services. For example, when service is withheld or delayed until substance use is better managed.

Why does stigma matter?

The effects of stigma can include:

• Believing negative labels make people feel alone and less worthy of respect
• Reduced confidence and lack of hope can impact a person’s ability to get a job, find housing, maintain relationships and make it harder to ask for help
• Isolation and lack of connection to family, friends and community
• Barriers to accessing health care services, which may result in delayed diagnoses and treatments
• Use of substance as a coping strategy
• Increased risk taking behaviors
• Using substances alone which increases risk of overdose

Stigma can be a major barrier for people impacted by opioid use to accessing health care and social services and can prevent people from getting the help they need.

Reduce stigma

Together we can reduce stigma, increase inclusion, empathy and connections by:

• Reflecting on our thoughts, values and beliefs about substance use and accept differences
• See people for who they are, not for their drug use
• Listen with compassion and respect so people feel heard and understood
• Take time to learn about opioids and addiction
• Talk about stigma and share experiences that impact ourselves or others
• Organize or attend stigma reduction education or community events
• Involve people who are living with or impacted by opioid use in stigma reduction work
• Use respectful language. For example: “a person who uses drugs” rather than “drug user”
• Review policies and programs to promote access to services for people who use opioids

What is York Region doing?

The Opioid Education and Response Workgroup (OERW) developed the York Region Opioid Action Plan. One of the recommendations from the plan included development of the Opioid Awareness & Education Stigma Reduction committee. The committee includes people from community organizations and people with lived experience working together to reduce stigma associated with opioid use. If you have any questions about the Opioid Awareness and Education Stigma Reduction subgroup, please email substance@york.ca or call 1-877-464-9675 ext. 76683

Resources:

Language Matters, Canadian Public Health Association

Stigma: Understanding the Impact of Prejudice and Discrimination, Center for Addiction and Mental Health

Stigma Around Substance Use, Health Canada

The Opioid Education and Response Workgroup

The Opioid Education and Response Workgroup (OERW), in consultation with people who have lived experience, developed the York Region Opioid Action Plan that outlines recommendations to reduce opioid harms under four distinct pillars:

• Prevention
• Harm reduction
• Treatment
• Enforcement and first response

In addition to actions under the four pillars, the Opioid Action Plan calls for ongoing monitoring of opioid-related trends followed by early warning and response, as required. The Plan also highlights the need to address stigma surrounding substance use and addiction and the importance of agency participation and collaboration.

The OERW is co-chaired by York Region Public Health and York Regional Police. Partners include: Addiction Services for York Region, 360 Kids, a local doctor specializing in addiction medicine, AIDS Committee of York Region, a community member, Central Local Health Integration Network, Georgina Fire and Emergency Services, Krasman Centre, Loft Crosslinks Outreach Van, Ontario Addiction Treatment Centres, Total Health Pharmacy, TrueNorth Medical Centres, Vaughan Fire and Emergency Services, York Catholic District School Board, York Region District School Board, York Region Paramedic and Senior Services, York Region Social Services, York Region Strategies and Partnerships, and York Support Services Network.

How to Participate

Community partners, stakeholders, healthcare professionals and organizations are encouraged to incorporate aspects of the York Region Opioid Action Plan in their organizational plans and professional practice.

York Region Opioid Action Plan

York Region Opioid Action Plan Executive Summary

For more information please contact the Substance Use Prevention and Harm Reduction Program at 1-877-464-9675 ext. 76683 or email substance@york.ca

This program is based on a harm reduction approach that encompasses a range of practical strategies and ideas focused on reducing the harmful consequences associated with drug use and other risky health behaviours ¹. York Region Public Health currently supports three parts of the harm reduction supplies and distribution program, including:

• Naloxone distribution
• Needle supplies/exchange
• Safer crack/crystal meth smoking supplies

Naloxone distribution

Naloxone is available at no cost in York Region at participating pharmacies, public health offices and clinics, and some community agencies. Police and fire services can also pick up naloxone from York Region Public Health.

If you are a community agency interested in becoming a naloxone distribution site, please contact the Substance Use Prevention and Harm Reduction Program at 1-877-464-9675 ext. 76683 or email substance@york.ca

You can get naloxone at no cost from:

• Participating pharmacies: Visit ontario.ca/page/where-get-free-naloxone-kit
• Participating community agencies
  • Addiction Services for York Region 1-800-263-2288 or 905-841-7007
  • AIDS Committee of York Region 1-800-243-7717 or 905-884-0613
  • Caritas School of Life 1-800-201-8138 or 416-748-9988
  • The Krasman Centre 1-888-780-0724 or 905-780-0491
  • 360° kids 905-475-6694; for youth and young adults aged 16 to 26
  • Inn from the Cold 905-895-8889
  • The Vitanova Foundation 905-850-3690 or 416-744-8940
• York Region Public Health
  • Substance Use Prevention and Harm Reduction Program 1-877-464-9675 ext. 76683 or  email substance@york.ca
  • Sexual Health Clinics 1-800-361-5653 or TTY 1-866-252-9933, select “1” or “Sexual Health Line”

Needle supplies/exchange

This program allows York Region to distribute single-use and sterile injection supplies and equipment to eligible community partners to distribute to clients. Supplies include needles, syringes, alcohol swabs, acidifiers, filters, cookers, tourniquets and personal sharps containers. York Region also has a sharps disposal program that allows clients to return used sharps for safe disposal.

If you are a community agency interested in becoming a needle supplies/exchange and distribution site, please contact the Substance Use Prevention and Harm Reduction Program at 1-877-464-9675 ext. 76683 or email substance@york.ca

Safer crack/crystal meth smoking supplies

This program allows York Region to distribute single-person use crack/crystal meth smoking supplies and equipment to eligible community partners to distribute to clients. Supplies include push sticks, screens, straight stems, bowl pipes, alcohol wipes and mouth pieces. Similar to the needle supplies/exchange program, York Region has a sharps disposal program that allows clients to return small amounts of used needles and sharps for safe disposal.

If you are a community agency interested in distributing crack/crystal meth smoking supplies, please contact the Substance Use Prevention and Harm Reduction Program at 1-877-464-9675 ext. 76683 or email substance@york.ca

Harm reduction supplies are available at no cost from:

• Loft/Crosslinks - Street Outreach Van
• AIDS Committee of York Region
• York Region Public Health - Sexual Health Clinics

Additional resources

• Government of Canada’s Opioid Page
  
• Health Quality Ontario
• Health Professionals Additional Resources
• Mobile York South Simcoe (MOBYSS)
• Ontario Drug Policy Research Network
• Ontario Harm Reduction Distribution Program
• Healthy Quality Ontario - Opioid Wisely
• Public Health Ontario’s Interactive Opioid Tool
• York Region Needle Exchange Services
• Government of Ontario – Understanding Opioids
• 310-COPE Community Crisis Response at 1-855-310-2673 or (TTY) 1-866-323-7785