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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.
Achilefu, A., Joshi, K., Meier, M., & McCarthy, L. H. (2017). Yoga and other meditative movement therapies to reduce chronic pain. Journal of the Oklahoma State Medical Association, 110(1), 14–16.
Alberta Health. (2017, February 7.). Opioids and substances of misuse. Alberta Report, 2016 Q4. Retrieved from http://www.health.alberta.ca/documents/Opioids-Substances-Misuse-Report-2016-Q4.pdf.
American College Health Association. (2016). American College Health Association-National College Health Assessment II: Reference Group Executive Summary, Spring 2016. Hanover, MD: American College Health Association; 2016.
Arnold, R. (2017). Fast Facts and Concepts #83. Why patients do not take their opioids. Palliative Care Network of Wisconsin. Retrieved from https://www.mypcnow.org/blank-aw14v
Back, S. E., Payne, R. L., Wahlquist, A. H., Carter, R. E., et al. (2011). Comparative profiles of men and women with opioid dependence: Results from a national multisite effectiveness trial. American Journal of Drug and Alcohol Abuse, 37(5), 313–323.
Brooner, R. K., King, V. L., & Kidorf, M. (1997). Psychiatric and substance use comorbidity among treatment-seeking opioid abusers. JAMA Psychiatry, 54(1), 71–80.
Browne, R. (2016, October 5). As the opioid crisis rages, there’s a push to keep cops away from overdose calls. Vice. Retrieved from https://www.vice.com/en_ca/article/as-the-opioid-crisis-rages-theres-a-push-to-keep-cops-away-from-overdose-calls
Canadian Centre on Substance Abuse. (2017). Calling 911 in drug poisoning situations. Canadian Community Epidemiology Network on Drug Abuse Bulletin. Retrieved from http://www.ccsa.ca/Resource%20Library/CCSA-CCENDU-Calling-911-Drug-Poisoning-2017-en.pdf
Canadian Public Health Association. (2016). Fentanyl’s path of death and destruction. CHPA Health Digest, Volume XL, No. 2. Retrieved from http://www.cpha.ca/en/about/digest/40-2/5.aspx
Carter, C. I., & Graham, B. (2013). Opioid overdose prevention and response in Canada. Canadian Drug Policy Coalition: Policy Brief Series. Retrieved from http://drugpolicy.ca/wp-content/uploads/2013/01/CDPC_OverdosePreventionPolicy_Final_July2014.pdf
Centre for Addiction and Mental Health. (n.d.). Opioid addiction. Retrieved from http://www.camh.ca/en/hospital/health_information/a_z_mental_health_and_addiction_information/Opioid-Dependence/Pages/default.aspx
Center for Behavioral Health Statistics and Quality. (2016). Key substance use and mental health indicators in the United States: Results from the 2015 National Survey on Drug Use and Health (HHS Publication No. SMA 16-4984, NSDUH Series H-51).
Centers for Disease Control and Prevention. (2012). Grand Rounds: Prescription drug overdoses—a US epidemic. Morbidity and Mortality Weekly Report, 61(1), 10–13.
Centers for Disease Control and Prevention. (2015). Today’s heroin epidemic infographics. Retrieved from https://www.cdc.gov/vitalsigns/heroin/infographic.html
Centers for Disease Control and Prevention. (2016). Increases in drug and opioid overdose deaths—United States, 2000–2014. Morbidity and Mortality Weekly Report Weekly, 64(50), 1378–82.
Centers for Disease Control and Prevention. (2016). Prescription opioid overdose data. Retrieved from https://www.cdc.gov/drugoverdose/data/overdose.html
Centers for Disease Control and Prevention. (2016). Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics.
Centers for Disease Control and Prevention. (2017). Heroin overdose data. Retrieved from https://www.cdc.gov/drugoverdose/data/heroin.html
Cicero, T. J., Ellis, M. S., Surratt, H. L., & Kurtz, S. P. (2014). The changing face of heroin use in the United States: A retrospective analysis of the past 50 years. JAMA Psychiatry, 71(7), 821–826.
Compton, W. M., Jones, C. M., & Baldwin, G. T. (2016). Relationship between nonmedical prescription-opioid use and heroin use. New England Journal of Medicine, 374(2), 154–163. Retrieved from http://www.nejm.org/doi/full/10.1056/NEJMra1508490#t=article
Coomber, R., & Sutton, C. (2006). Harm Reduction Digest 34: How quick to heroin dependence? Drug and Alcohol Review, 25(5), 463–471. Retrieved from http://onlinelibrary.wiley.com/doi/10.1080/09595230600883347/abstract
Darke, S. (2012). Pathways to heroin dependence: Time to re-appraise self-medication. Addiction, 108(4), 659–667.
Davis, C. (2016, March 1). “Over the counter” naloxone access, explained. The Network for Public Health Law. Retrieved from https://www.networkforphl.org/the_network_blog/2016/03/01/745/over_the_counter_naloxone_access_explained
Global News. (2016, November 17). A province-by-province look at opioid-overdose stats, including fentanyl. Retrieved from http://globalnews.ca/news/3072316/a-province-by-province-look-at-opioid-overdose-stats-including-fentanyl/
Gomes, T., Mamdani, M. M., Paterson, J. M., Dhalla, I. A., et al. (2014). The burden of premature opioid-related mortality. Addiction, 109(9), 1482–1488. Retrieved from http://odprn.ca/wp-content/uploads/2015/04/Gomes-2014-Addiction-PYLL.pdf
Gomes, T., Juurlink, D., Yao, Z., Camacho, X. et al. (2014). Impact of a prescription monitoring program on the prevalence of potentially inappropriate prescriptions for monitored drugs in Ontario: A time series analysis. CMAJ, 2(4), E256–E261. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4251507/
Gomes, T., Mamdani, M. M., Paterson, J. M., Dhalla, I. A., et al. (2014). Trends in high-dose opioid prescribing in Canada. Canadian Family Physician, 60(9), 826–832.
Grattan, A., Sullivan, M. D., Saunders, K. W., Campbell, C. I., et al. (2012). Depression and prescription opioid misuse among chronic opioid therapy recipients with no history of substance abuse. Annals of Family Medicine, 10(4), 304–311.
Hager, M. (2017, March 13). Majority of bystanders who administer opioid antidote don’t call 911: Study. The Globe and Mail. Retrieved from http://www.theglobeandmail.com/news/national/majority-of-bystanders-who-administer-opioid-antidote-dont-call-911-study/article34280596/
Health Canada. (2017, February 17). Government of Canada announces new funding to combat opioid crisis. Retrieved from https://www.canada.ca/en/health-canada/news/2017/02/government_of_canadaannouncesnewfundingtocombatopioidcrisis0.html
Jones, C. M., Baldwin, G. T., Manocchio, T., White, J. O., et al. (2016). Trends in methadone distribution for pain treatment, methadone diversion, and overdose deaths—United States, 2002–2014. Morbidity and Mortality Weekly Report, 65(26), 667–671.
Jones, C. M., Paulozzi, L. J., & Mack, K. A. (2014). Sources of prescription opioid pain relievers by frequency of past-year nonmedical use United States, 2008–2011. JAMA Internal Medicine, 174(5), 802–803.
Lankenau, S. E., Teti, M., Silva, K., Jackson Bloom, J., et al. (2012). Initiation into prescription opioid misuse amongst young injection drug users. International Journal of Drug Policy, 23(1), 37–44.
Ludden, J. (September 2, 2016). An even deadlier opioid, Carfentanil, is hitting the streets. National Public Radio. Retrieved from http://www.npr.org/sections/health-shots/2016/09/02/492108992/an-even-deadlier-opioid-carfentanil-is-hitting-the-streets
Mahoney, K. (2016, August 10). FDA supports greater access to naloxone to help reduce opioid overdose deaths. FDA Voice; US Food and Drug Administration. Retrieved from https://blogs.fda.gov/fdavoice/index.php/2016/08/fda-supports-greater-access-to-naloxone-to-help-reduce-opioid-overdose-deaths/
Miech, R., Johnston, L., O’Malley, P. M., Keyes, K. M., et al. (2015). Prescription opioids in adolescence and future opioid misuse. Pediatrics, 136(5), e1169–e1177.
Ministry of Public Safety & Solicitor General. (2017, March 2017). Illicit drug overdose deaths in BC, January 1, 2007–March 31, 2017. The Coroners Service of British Columbia. Retrieved from http://www2.gov.bc.ca/assets/gov/public-safety-and-emergency-services/death-investigation/statistical/illicit-drug.pdf
National Institute on Drug Abuse. (2015). Prescription opioid use is a risk factor for heroin use. Retrieved from https://www.drugabuse.gov/publications/research-reports/relationship-between-prescription-drug-heroin-abuse/prescription-opioid-use-risk-factor-heroin-use
National Institutes of Health. (2017, January). Overdose death rates. Retrieved from https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates
Noble, M., Treadwell, J. R., Tregear, S. J., Coates, V. H., et al. (2010). Opioids for long-term treatment of noncancer pain. The Cochrane Collaboration. Retrieved from http://www.cochrane.org/CD006605/SYMPT_opioids-long-term-treatment-noncancer-pain
Ontario Drug Policy Research Network. (2016). Safety and use of opioids: A summary of ODPRN research on prescription opioid use in Ontario. Retrieved from http://odprn.ca/wp-content/uploads/2016/08/FINAL-ODPRN-Opioids-Summary-Report-Aug-2016_compressed.pdf
Ontario Drug Policy Research Network (n.d.). The burden of premature opioid-related mortality. Retreived from http://odprn.ca/research/public-reports/prematureopioidmortality/
Paulozzi, L. J., Budnitz, D. S., & Xi, Y. (2006). Increasing deaths from opioid analgesics in the United States. Pharmacoepidemiology of Drug Safety, 15(9), 618–627.
Popovich, N. (2016, May 25). A deadly crisis: Mapping the spread of America’s drug overdose epidemic. Guardian. Retrieved from https://www.theguardian.com/society/ng-interactive/2016/may/25/opioid-epidemic-overdose-deaths-map
Rudd, R. A., Seth, P., David, F., & Scholl, L. (2016). Increases in drug and opioid-involved overdose deaths—United States, 2010–2015. Mortality and Morbidity Weekly Report, 65(50–51), 1445–1452.
Schwartz, A. (2015, April 25). Michael Botticelli is a drug czar who knows addiction firsthand. New York Times. Retrieved from https://www.nytimes.com/2015/04/26/us/michael-botticelli-is-a-drug-czar-who-knows-addiction-firsthand.html?_r=0
Senate Caucus on International Narcotics Control Substance Abuse and Mental Health Services Administration. Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-46, HHS Publication No. 13-4795. Rockville, MD: SAMHSA, 2013.
Stobbe, M. (2016, December 9). A grim tally soars: More than 50,000 overdose deaths in US. STAT. Retrieved from https://www.statnews.com/2016/12/09/opoid-overdose-deaths-us/
Szalavitz, M. (2016, May 10). Opioid addiction is a huge problem, but pain prescriptions are not the cause. Scientific American. Retrieved from https://blogs.scientificamerican.com/mind-guest-blog/opioid-addiction-is-a-huge-problem-but-pain-prescriptions-are-not-the-cause/
Utah Department of Health. (2016). Prescription opioid deaths. Retrieved from http://health.utah.gov/vipp/pdf/RxDrugs/PDODeaths2015.pdf
Volkow, N. D. (2014, May 14). America’s addiction to opioids: Heroin and prescription drug abuse. National Institute of Drug Abuse. Retrieved from https://www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2016/americas-addiction-to-opioids-heroin-prescription-drug-abuse
Vowles, K. E., McEntee, M. L., Julnes, P. S., Frohe, T., et al. (2015). Rates of opioid misuse, abuse, and addiction in chronic pain: A systematic review and data synthesis. Journal of Pain, 156(4), 569–576.
Whalen, J., & Spegele, B. (2016, June 23). The Chinese connection fueling America’s fentanyl crisis. Wall Street Journal. Retrieved from https://www.wsj.com/articles/the-chinese-connection-fueling-americas-fentanyl-crisis-1466618934.
White, P. F. (2017, March). What are the advantages of non-opioid analgesic techniques in the management of acute and chronic pain? Expert Opinions in Pharmacotherapeutics, 18(4), 329–333.
Whitworth, M. (2015, October 22). Can you really become addicted to a drug after just one hit? Vice. Retrieved from https://www.vice.com/en_us/article/reasons-why-you-cant-get-addicted-to-drugs-after-one-hit
Yokell, M. A., Delgado, M. K., Zaller, N. D., Wang, N. E., et al. (2014, December). Presentation of prescription and nonprescription opioid overdoses to US emergency departments. JAMA Internal Medicine, 174(12), 2034–2037. Retrieved from http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1918924
Vancouver Police Department. (2006). 1.6.28. Guidelines for police attending illicit drug overdoses. In Regulations and Procedures Manual. Vancouver, British Columbia. Retrieved from http://vancouver.ca/police/assets/pdf/manuals/vpd-manual-regulations-procedures.pdf