Which of the following should be done if you encounter a victim of an opioid overdose?

Because of the ease of use and its effectiveness, some organizations have decided to include naloxone as part of their first aid program, or make it available to assist the public. “Take-home” kits that use either a nasal spray or an injection are available from most pharmacies or local health authorities. The kits do not require a prescription. The kits expire and should be replaced as needed (approximately every 18-24 months).

Please also see the OSH Answers on Opioids (including Fentanyl) - Precautions for first responders for more information.

If an employer opts to offer additional first aid measures (including over-the-counter medications, administration of oxygen, use of epinephrine auto-injectors, naloxone, etc.), it is suggested that they first seek legal counsel so that they are aware of any liability issues, and to check with your local jurisdiction responsible for health and safety. For example, in some jurisdictions, distribution of over-the-counter medications is not recommended (although an individual who can purchase using a vending machine may be permissible). In other jurisdictions, distribution of over-the-counter medications may be permitted under specific circumstances (including the appropriate training of first aid personnel).

Employers should have policies and procedures in place, developed in consultation with the health and safety committee or representative. All persons responding to a situation must know what their duties and responsibilities are during the incident response.

Persons providing naloxone should have the training necessary to recognize the signs of an opioid overdose, and understand what steps to take.

It is recommended that these individuals have training in first aid, including cardio pulmonary resuscitation (CPR).

Training in how to respond to a potentially violent person is also necessary. Be aware that naloxone can temporarily reverse the effects of the opioid. The person given naloxone may experience acute opioid withdrawal, leading to pain, distress, and agitation. There is a risk of injury to people who are nearby. Withdrawal symptoms can also include nausea, vomiting, convulsions, tremors, increased blood pressure, heart issues, and pulmonary edema (fluid accumulation in the lungs). Naloxone itself may have side effects including aggressive behaviour, convulsions, body aches, diarrhea, increased heart rate, and other symptoms.

Appropriate personal protective equipment (PPE) is recommended to protect against biological exposure. Follow routine practices when exposure to blood or other body fluids is possible.

Support after an incident is also recommended. The experience may be traumatic, and psychological/mental health counselling may be necessary.

If storing naloxone, follow the manufacturer’s instructions. Typically, naloxone must be stored at room temperature (between 15 and 25°C), and kept in the box until ready for use. Protect from light.

Naloxone can expire. Check the expiry date, and be sure there is always a current dose available.

Intervene quickly

When a person is overdosing on opioids, their overall condition changes. They stop reacting to their surroundings and can lose consciousness. Take the following steps if you suspect that someone is overdosing on opioids:

1. Check for signs of an opioid overdose:

• The person does not respond to sound or pain.
• Their breathing is laboured or snore-like, or they are not breathing.

If the person seems to be unconscious, try making them respond to sound or pain:

• Yell their name and talk to them loudly.
• Rub the centre of their chest (sternum) hard.

2. If the person is unresponsive, call or have someone call 911.

The Good Samaritan Drug Overdose Act

If you are on your own without a phone:

• Administer a dose of naxolone (an antidote to opioid overdoses).
• Perform chest compressions for 2 minutes.
• Lay the person on their side.
• Find a way to call 911 and follow instructions.
   

3. Give a dose of naloxone to the intoxicated person.

For intranasal naloxone:

1. Lay the person on their back. Tilt their head backwards, supporting their neck.

2. Remove the nasal spray from the box. Don’t test it.

3. Hold the device with your thumb under the plunger. Place your index and middle fingers on either side of the spout.

4. Gently insert the tip of the spout into one nostril. Your fingers should be right up against the nose.

5. Press firmly on the plunger with your thumb to administer the dose.

6. Remove the device from the nostril.

For injectable naloxone:

1. Remove the cap or break the ampoule.

2. Draw up all the naloxone in the container into the syringe.

3. Inject the naloxone into a muscle of the intoxicated person, such as their thigh or shoulder, keeping the needle and syringe at a 90-degree angle. The injection can be done through light clothing.

4. If the person is unresponsive, perform one of the following manoeuvres:

• Cardiopulmonary resuscitation (CPR): Do CPR, if you know how, using the barrier mask.
• Chest compressions: Give 2 compressions (5 cm deep) per second.

5. If the person is unresponsive after 3 minutes:

• Give the person a second dose of naloxone.
  • If you used intranasal naloxone, administer the dose in the other nostril.
  • If you used injectable naloxone, use a new container.
• Repeat CPR or chest compressions as long as the person is unresponsive. Stay with them until the paramedics arrive, even if they regain consciousness.

6. If the person wakes up:

• Lay them on their side.
• Explain what just happened.
• Explain how it’s important that they be seen by a health professional.
• Tell the person that they should not use opioids in the next few hours to avoid another overdose.
• Stay with them until the paramedics arrive.

Since the effects of naloxone last only a few minutes, there is a risk of a relapse of overdose symptoms. If the person starts overdosing again, give them another dose of naloxone using a new container. The intoxicated person must be taken to the hospital right away for observation and treatment.

Actions to avoid

When someone is overdosing on opioids:

• Do not delay giving them the naloxone.
• Refrain from performing CPR if they are conscious.
• Don’t leave them alone.
• Don’t give them other drugs.
• Don’t make them take a cold bath or shower.
• Don’t hit them to try to make them regain consciousness.
• Don’t inject a saline solution into their veins.

Using naloxone

Naloxone is an opioid-specific antidote which temporarily reverses the effects of an opioid overdose.

Naloxone is safe and poses no health risks to either the opioid-intoxicated or non-intoxicated individual.

Obtaining naloxone

Intranasal naloxone is available free of charge and without a prescription at any Québec pharmacy.

Injectable naloxone (ampoule or vial) is also available. Ampoules and vials are provided with retractable needles and syringes, alcohol wipes and gloves.

To find a pharmacy near you that keeps naloxone in stock, visit the page Find a Resource That Can Provide Naloxone .

Storing naloxone

Naloxone should be stored in a cool, dark place until its expiration date.

Injectable naloxone

Wait until you are using the syringes to fill them.

Make sure you dispose of syringes and needles safely. To learn more, visit the page Recovery of Used Syringes and Needles. You can also give them to the paramedics.

Intranasal naloxone

Leave the spray in its box until it’s time to use it. 

Useful links

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