Opioids & Naloxone Programs

Opioid Use Disorder

• Needing more to feel the same effects
• Trying and failing to quit
• Spending a lot of time getting, using, or recovering from opioids
• Using despite negative effects on your life
• Buying opioids illegally
• Feeling sick if use stops suddenly (withdrawal)
• Showing signs like nodding off, small pupils, slowed breathing, confusion, or extreme drowsiness

Signs:

• Pinpoint pupils
• Slow, shallow, or stopped breathing
• Loss of consciousness or unresponsiveness
• Blue or purple lips and fingernails (due to lack of oxygen)
• Choking or gurgling sounds
• Limp body

Symptoms:

• Extreme drowsiness or inability to stay awake
• Confusion or disorientation before losing consciousness
• Nausea or dizziness (if conscious)
• Feeling faint or lightheaded

Signs and Symptoms of Opioid Overdose (video)

References: Overdoselifeline, Cleveland Clinic, www.cdc.gov

Since the early 2010s, Canada's unregulated opioid supply has become more potent and less predictable. Fentanyl, a highly potent opioid approximately 50-100 times stronger than morphine, gradually replaced heroin as the dominant opioid in the unregulated supply. More recently, the fentanyl supply itself has become highly contaminated, including by other even higher potency opioids such as carfentanil, benzodiazepines and benzodiazepine analogues, and non-opioid sedatives called alpha-II agonists, including xylazine and medetomidine. The increasing potency of the unregulated opioid supply, alongside contamination with non-opioid drugs, has substantially contributed to increased overdose deaths in Ontario.

Non-opioid drugs purchased on the unregulated market, such as cocaine, may also be contaminated with high-potency opioids. While uncommon, this contamination can be especially deadly, as the people using the drugs may have no tolerance to opioids and so may be particularly vulnerable to overdose. It is crucial that anyone using unregulated drugs has naloxone available, and uses with someone who could administer it in the event of an overdose, even if you do not think you are going to use an opioid.

Opioid overdose can also be caused by sharing drug equipment with someone who has used them to ingest opioids, even if you are using them to ingest a different substance. Use brand new syringes or pipes every time you use to avoid contamination. Visit a harm reduction service provider to access sterile supplies.

Remember, even if you are buying drugs from someone you know and trust, you cannot be sure what is in them. It is impossible to see, smell, or taste whether the drugs you are buying contain what you think they do.

Benzodiazepines

Benzodiazepines are medications used to treat anxiety, seizures, and insomnia, and are also found in the illegal drug market. They are not opioids but are increasingly present in the illegal opioid supply. Because both benzodiazepines and opioids cause sedation, using them together can increase the risk of overdose.

Although naloxone does not reverse the effects of benzodiazepines, it does reverse opioid overdose and can be safely given to people who may have taken both opioid and non‑opioid drugs. If someone has overdosed on a mixture of benzodiazepines and opioids, naloxone may restart their breathing even if they remain sedated.

Medetomidine

Medetomidine is a type of drug called an alpha-II agonist, which is a non-opioid sedative used by veterinarians. It is not approved for human use. It is commonly found mixed into the unregulated opioid supply. People who use opioids mixed with medetomidine are likely to experience very heavy sedation, slow heart rate, very low or no pulse, low blood pressure, hallucinations and/or nausea, among other possible symptoms. In the event of an overdose involving opioids and medetomidine, naloxone may restore someone’s breathing but they may remain unresponsive. For more information on responding to an overdose, including those involving drugs like medetomidine, see the Recognizing and Responding to Overdose section below.

If used regularly, medetomidine can lead to dependence and withdrawal if use is discontinued abruptly. Often, individuals who use opioids may not know the drugs they have been using were contaminated with medetomidine, so they may not expect to experience medetomidine withdrawal. It is important to watch for symptoms, since medetomidine withdrawal can be fatal. Symptoms include very fast heartbeat, very high blood pressure, uncontrolled nausea and vomiting, going in and out of responsiveness even while awake, heavy sweating, shaking, twitching, anxiety and/or restlessness. Go to the hospital if you:

• Can't stop throwing up
• Have chest pain
• Are going in and out of responding or being aware, even while awake
• Are otherwise experiencing more severe withdrawal than usual

For more information:

• Fentanyl
• Benzodiazepines
• Let's Talk Medetomidine
• The drug supply continues to fluctuate in both potency and content. For up‑to‑date information, visit the Toronto Drug Checking Service website.

• If at all possible, do not use drugs alone; ensure there is someone present who can administer naloxone in the event of an overdose.
  • If using alone, call the National Overdose Response Service (NORS) at 1‑888‑688‑6677, available nationwide
  • Or see this video: How to Spot Someone so They Never Use Alone (video)
• Avoid using opioids at the same time as other substances, such as alcohol or benzodiazepines, as this increases overdose risk.
• Start with a small dose when trying a new substance. Illegal drugs can be much stronger than expected.
• Know your tolerance. It can change after a break, even a short one.
• Carry naloxone, and try to have someone with you who is trained to use it when you are using it. It can temporarily reverse an opioid overdose.
• When responding to an overdose, call 9‑1‑1, even if naloxone has been given. The effects of naloxone wear off after approximately 30–90 minutes. Without medical attention, a person may go back into an overdose when naloxone wears off.

Signs of an overdose

• Very slow or no breathing
• Blue or gray lips/fingernails
• Limp body, deep snoring, gurgling sounds
• Unconscious or unresponsive
• Small pupils, vomiting, cold or clammy skin

If you suspect someone is having an overdose, follow these steps:

1. Shout their name and shake their shoulders. If they are unresponsive, call 911. Opioids last longer than naloxone, which means that naloxone might wear off before the opioids have left someone’s system. If this happens, an individual can overdose again, so it’s very important to seek medical attention and make sure a person is not left alone, even when naloxone is given and symptoms improve.
2. Give naloxone (one spray into the nostril or inject one vial into the arm or leg).
   • If using the spray: Lay the person on their back. Peel back the package and remove the device. Support their neck and tilt their head back. Place the tip of the nozzle in one nostril. Press the plunger firmly to release naloxone into the person’s nose.
   • If using the injection: Tap the ampoule (the vial containing the medicine) to send all the liquid to the bottom. Snap open the ampoule by breaking off the top. Using the syringe and needle included in the kit, pull the plunger to draw up the liquid. Inject it into muscle in the upper arm or upper thigh. Press the plunger all the way down.
3. Give 30 chest compressions and/or two rescue breaths if you have been trained and feel comfortable doing so.
   • If there is no improvement after two to three minutes, repeat steps two and three.

STOP giving Naloxone when breathing returns to normal.

STAY with the person. The Good Samaritan Drug Overdose Act protects you legally if you call 9‑1‑1 during an overdose.

If the person begins breathing on their own, or you have to leave them alone, put them in the recovery position. Roll them on their side with their head tilted back slightly to open the airway. Their hand supports their head and their knee stops the body from rolling onto their stomach. Monitor them, as they may be confused, upset or going into withdrawal when revived. When the naloxone wears off, they are at risk of overdosing again.

Always give naloxone, even if they were not intending to take an opioid. Giving naloxone to someone who has taken non‑opioid drugs will not cause harm.

View our Recognizing and Responding to an Opioid Overdose info sheet here.

Free Naloxone kits are available through GEPH and community organizations that participate in the Ontario Naloxone Program (ONP) for:

• People at risk of opioid overdose (for example, people who are actively using opioids or unregulated drugs)
• Family and friends of people who are at risk of opioid overdose

AND through pharmacies that participate in the Ontario Naloxone Program for Pharmacies (ONPP):

• Current and past people who use opioids at risk of returning to opioid use
• Family and friends of the above
• Other individuals in a position to assist someone experiencing an opioid overdose

Call ahead to make sure they have kits available.

Training

Individuals and organizations can call the Health Unit to book a training session and get naloxone kit(s).
Brantford-Brant
(519) 753-4937 ext. 6472, HealthyCommunities@bchu.org
Haldimand-Norfolk
(519) 900-9600 ext. 1086, SubstanceUse@geph.ca

Download GEPH’s Naloxone Training Guide (PDF)

Download and print GEPH’s Naloxone Info Sheet.

Naloxone kits are also available from other community organizations and at many pharmacies in Brant, Haldimand, and Norfolk. For participating locations, please see the Naloxone Only Distribution Program Locations tab below.

For pharmacy locations near you where you can get naloxone kits and training, click HERE.

Updated July 2026.

Brantford

Six Nations & County of Brant

Haldimand & Norfolk

NOTE: Naloxone can also be accessed for free & without a prescription at many pharmacies. Call ahead to make sure a pharmacy has kits in stock.

• Ontario Harm Reduction Network
• Get help with substance use – Canada.ca
• Community Addictions Peer Support Association – CAPSA
• GEPH Opioid Information System
• Toronto’s Drug Checking Service
• Canadian AIDS Treatment Information Exchange (CATIE)
• Government of Canada – Information on Opioids & Naloxone