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What do you know about opioid abuse and addiction? Take our quiz to see how your knowledge stacks up, and find answers to questions like these:
- Is it risky to take prescription pain meds?
- Who’s at risk for addiction?
- Does opioid overdose reversal always work?
North America is experiencing a brutal opioid epidemic. In 2015, 33,000 Americans died from overdoses involving prescription painkillers, heroin, and synthetic opioids, according to the National Institutes of Health in the US. And Canada is no different. In Ontario alone, opioid deaths have increased by 242 percent between 1991 and 2010, according to a 2014 study in Addictions. Many opioid overdoses can be reversed with timely medical treatment, however—someday, you may be in a position to save a life. This brief guide shows you how.
The illicit use of heroin and prescription painkillers is rare among college and university students. Yet this epidemic is affecting demographics that were previously considered relatively immune to drug crises. “I had a severe injury for which I was prescribed opioids. Weening myself off them was difficult. I got headaches, felt incredibly nauseous, [experienced] body pains, and considered taking the opioids to make them go away,” says a second-year undergraduate at the University of Victoria, British Columbia. For info on getting help with abuse and addiction, see Get help or find out more.
What are opioids and opiates?
Opioids (sometimes called opiates) are a class of drugs commonly used to treat pain. The illegal drug heroin is also an opioid. There are three common types of opioids:
These can be prescribed by a health care provider to treat moderate to severe pain. Common prescription opioids include hydromorphone (Dilaudid® and Hydromorph Contin®), oxycodone (OxyNeo®), morphine, and methadone.
Fentanyl is the name of a synthetic opioid that is extremely powerful (about 50 times more so than heroin), and therefore highly dangerous. It is intended only to treat severe pain, such as from advanced cancer. Recently, fentanyl has been illegally manufactured to sell on the street. Street fentanyl is sometimes mixed with other drugs, such as cocaine and heroin, which increases risk of complications due to the danger of mixing substances.
Methadone is also a synthetic opioid that can be prescribed for pain relief. Because it doesn’t give the same “high” associated with other opioids, methadone is used in drug treatment programs to substitute the opioid of abuse more safely.
Heroin is an illegal, highly addictive drug. It is usually injected but can also be smoked or snorted.
“My partner struggled with opioid abuse, on and off for several years. He had a troublesome childhood and overcame a lot of personal struggles and became very successful in business, however he had been coping for years with alcohol and drugs. He’s doing very well today and no longer abuses opioids. We had a tenant die in our home from an overdose and this was a real wake up for him.”
—Second-year undergraduate, University of Victoria, British Columbia
What to do if someone may have overdosed: Call 911 immediately
- Act quickly: Most deaths occur one to three hours after the overdose, so you have a window for intervention.
- Get medical help: People survive overdoses because professional help was available. You do not need to be sure the person has overdosed on opioids (or any other substance) before calling 911. Calling 911 usually ensures quick medical help.
- Tell the 911 dispatcher: Let them know if the person’s breathing has slowed or stopped and if they are unresponsive. Give the dispatcher the exact location.
- Be aware of police policy in your area: In Canada, drug-related offenses are considered federal crimes. A Good Samaritan law—one that would protect people who seek help for those suspected of overdosing from criminal charges—would need to be enacted on a national level, according to the Canadian Drug Policy Coalition. While advocates push for that legislation, some provincial and territorial police departments have policies that prevent them from going to the scene of an overdose unless necessary. This reduces the likelihood of negative consequences for those seeking help on others’ behalf.
What does an opioid overdose look like?
» The signs of opioid overdose include:
- Small pupils
- Droopy arms and legs, and the inability to stand or walk
- Slurred speech
- Shallow and uneven breathing
- Being unresponsive
- Loss of consciousness
» As the window for intervening narrows, signs include:
- Pale face
- Blue lips
- Gurgling chest sounds
Could I be at risk for opioid abuse?
Opioid addiction is difficult to treat. Avoiding illicit drug use is the safest strategy. Here’s how to look out for yourself:
- If you are using a prescription opioid medication that was not prescribed to you, seek help.
- If you are using an opioid medication prescribed to you, recognize your reasons why: Opioid medications are prescribed for long-term pain associated with various medical issues or for short-term pain control after surgery or an injury. If you are using opioids for other reasons—e.g., to get high or buzzed—seek help.
- If you are using opioids for pain relief, and your pain is becoming more difficult to control, discuss that with your physician immediately.
- If you have a family history of drug abuse/addiction and need medication for short-term pain, consider asking your physician for a pain medication other than opioids. Having a family history of drug abuse/addiction puts you at a higher risk for abuse and addiction.
- If you are abusing opioids or may be addicted, you will need support with your recovery. See Get help or find out more (below).
Where can I get help with opioid abuse or addiction?
- Ask your physician or other health care provider for a referral to an addiction specialist.
- Check with your provincial or territorial health insurance for addiction specialists and treatment covered by your plan. For example, the Ontario Health Insurance Program (OHIP) covers the cost of methadone.
- Ask at your student health centre, counselling centre, place of worship, or community centre about addiction assistance.
- Call your local hospital for help finding medical professionals with addiction expertise.
- Look at community directories or online for a specialist in your area: Make sure the person is licensed or certified in mental or behavioural health, or is a licensed counsellor in social work or professional counselling.
- Try Narcotics Anonymous for local, free, anonymous support groups. To find a meeting in your area, see Get help or find out more (below).
- Many detox centres offer free initial consultations.
- For more key info and resources, see Get help or find out more (below).
What are the options for accessing reversal treatment?
Many opioid overdoses can be reversed with treatment. The opioid reversal medications naloxone and naltrexone can be delivered via a nasal spray, by injection, or intravenously. These reversal drugs (or antidotes) are also known by various brand names (e.g., Narcan®).
Naloxone treatment can be accessed in several ways:
- At hospital emergency rooms
- Via police departments and paramedics (ambulance responders), after calling 911
- Via some fire departments
- In most provinces and territories, via some bystanders who may have a history of opioid abuse or family members who are abusing opioids
- As of 2016, the Ontario government made naloxone available in pharmacies without a prescription to help cut down on overdoses across the province, making them the third province to do so. Alberta and British Columbia have similar programs.
What exactly does “unresponsive” mean?
Here’s what being unresponsive looks like, according to the Harm Reduction Coalition:
- Not answering to their name
- Not responding to information they may not want to hear (e.g., “I’m going to call 911”)
- Not responding to physical stimulation (e.g., rubbing your knuckles into their sternum, the place in the middle of their chest where the ribs meet, or pinching their earlobes)
- If the person wakes up but their breathing seems shallow or their chest feels tight, call 911 anyway
See Where can I get help with opioid abuse or addiction? on the page.
Sharon Cirone, MD, Ontario College of Family Physicians.
Tara Gomes, PhD, Assistant Professor, University of Toronto; Scientist, Li Ka Shing Knowledge Institute of St. Michael’s Hospital; Scientist, Institute for Clinical Evaluative Sciences; Principal Investigator of the Ontario Drug Policy Research Network.
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