Harm Reduction

Naloxone is a medication that temporarily reverses the effects of an opioid overdose. Opioids are a type of drug that slows down breathing. Examples of opioids include but are not limited to fentanyl, hydromorphone, morphine, heroin, methadone, codeine and oxycodone. 

Naloxone is available in two different forms: 

An overdose is a medical emergency, 911 should always be called.

Below are possible signs of an overdose:

• Person can’t be woken up
• Breathing is slow, or has stopped
• Snoring or gurgling noises
• Fingernails and lips turn blue or purple
• Pupils are tiny or eyes are rolled back
• Body is limp

When is a person at risk of an overdose?

• When using alone
• Reduced tolerance
• Mixing with another depressant, such as alcohol or a benzodiazepine (Xanax)
• Switching to a different opioid
• Buying from a new source
• New user
• When you have been sick, tired, run down or dehydrated
• Mixing opioids with prescription medications
• No one is immune from overdose, whether using as prescribed or illicitly

How to respond to an opioid overdose with naloxone

1. Shout their name and shake their shoulders.
2. Call 9-1-1 if they are unresponsive.
3. Give naloxone with 1 spray into nostril or inject 1 vial or ampoule into arm or leg.
4. Perform rescue breathing and/or chest compressions.
5. Stay with them - If there is no improvement after 2-3 minutes, repeat steps 3 and 4.

Watch a short video on how to administer naloxone (2 minutes).

For a more detailed demonstration video visit Ontario Harm Reduction Network (10 minutes).

Sanguen Health Centre provides overdose prevention training and naloxone kits to community members who are concerned about opioid overdose in our communities.  

The Good Samaritan Drug Overdose Act provides immunity from simple possession charges for those who call 911 in an overdose situation. It is important to remind those at risk of overdose or family/friends that this law will offer legal protection. For more information, check the Good Samaritan Drug Overdose Act on the Public Health Agency of Canada website. 

Naloxone is free and available without a prescription. Find naloxone from a local pharmacy or from the list of community agencies below.

Kitchener

Waterloo

Cambridge

In 2017, The Ministry of Health launched the Ontario Naloxone Program (ONP) and designated public health units in Ontario as naloxone distribution leads for eligible community organizations to increase the distribution of naloxone to those most at risk of opioid overdose.

The responsibilities of the local public health unit include the following:

• Ordering naloxone
• Distributing naloxone to eligible community partners 
• Coordinating and supervising naloxone inventory
• Training community organization staff on naloxone administration/eligibility criteria
• Supporting policy development and supporting naloxone availability

The Region of Waterloo Public Health and Paramedic Services has partnerships with community organizations, local hospitals, police services, fire departments and ambulance services across the region.

For more information about becoming an ONP, email the harm reduction team at harmreduction@regionofwaterloo.ca 

Where can I find information about overdoses in the community?

The Opioid Overdose/Drug Poisoning Dashboard provides the number of overdose calls to Waterloo Region Paramedic Services over time. Because there are many overdoses that occur in the community where 9-1-1 is not called, this data underestimates the actual number of overdoses Region-wide. However, it is the best method to measure overall trends. This dashboard is updated monthly.

Where and when are overdoses occurring in the community?

The heat maps shared in the Opioid Overdose/Drug Poisoning Dashboard illustrate geographically, the areas most impacted by overdoses. Information related to times, days of the week and specific locations are not shared publicly in order to protect the privacy of those impacted. 

Community Drug Alerts

Alerts are issued through the Overdose Monitoring Alert and Response System (OMARS) and are shared through the Waterloo Region Integrated Drug Strategy (WRIDS) website to alert the public when there is a high and imminent risk of overdose occurring in the community. 

For the most current alerts, check the Overdose Alerts page. 

To receive overdose alerts, subscribe on the WRIDS website. 

For more information about reports and data sources email the harm reduction team at harmreduction@regionofwaterloo.ca 

The Needle Syringe Program (NSP) distributes new harm reduction supplies (safer injection, safer inhalation, safer sex, disposal containers and wound care supplies); supports disposal of used injection equipment; and provides education related to blood borne infections, skin and vein problems, and overdose prevention. Needle syringe programs have existed in Ontario since 1989 and have operated in Waterloo Region since 1989.

These programs help to:

• Reduce the spread of HIV and Hepatitis C
• Reduce the number of used needles discarded in public places
• Educate about safer sex and sexual health and increase condom use
• Increase referrals to treatment programs, health and social services 

A variety of harm reduction supplies are available through our Needle Syringe Programs (NSP) across the region. Check in with a program partner before visiting to make sure they carry the needed supply as some programs may not carry all the supplies listed below.

• Naloxone kits (nasal and injectable)
• Safe injection supplies (syringes, stericups, etc.)
• Safe inhalation supplies (bowl pipes, mouthpieces, etc.)
• Wound care supplies (gauze, saline, etc.)
• Safe sex supplies (condoms, lubricant, etc.)
• Sharps disposal containers

Learn more about Safe Sharps Disposal.

The Region of Waterloo Public Health and Paramedic Services supports Needle Syringe Programs (NSP) across the region to offer non-judgemental and confidential access to harm reduction supplies and services.

To find harm reduction supplies in another Ontario community, check the Ontario Harm Reduction Distribution Program (OHRDP) interactive map. 

Kitchener

Waterloo

Cambridge

Stigma involves negative attitudes or discrimination based on a person’s situation. Some examples of stigma include country of origin, race, culture, drug use, mental health, poverty, sex work and a history of incarceration. Individuals who use substances often experience high levels of stigma impacting their ability to access health care and social services. The following are implications of stigma for clients and service providers:

Willingness to access services

• Discourages access to prevention, testing, case management, and health care services.
• Feelings of shame and worthlessness also prevent people accessing treatment.
• Discourages disclosure of drug use to health/social service providers.

Risk and behaviors

• Less likely to access harm reduction services that will keep them safer.
• Impacts access to educational or other resources.
• Increases risk for overdose if people use alone due to hiding their drug use from their loved ones.

Self-worth

• Less likely to make changes to reduce their harmful behaviors, and making other positive changes such as reducing use, finding housing or accessing medical care.

Relationships and trust

• Assumptions are made by health and social service providers: e.g., they won’t show for appointments; follow through with referrals; abide by rules of agency, etc.
• These reinforce stigma, lower expectations, and present barriers to recovery and reintegration.

Funding

• Stigma affects political will to provide adequate funding and programs for people that use drugs, especially individuals who use drugs via injection.

The above content has been adapted from the Ontario Harm Reduction Distribution Program (OHRDP).

Using supportive language

Language is powerful. It reflects our values and beliefs, and impacts our thoughts and actions. Language used in society to describe people who use drugs is often negative and degrading. Terms like abuser, junkie, addict, and drug user perpetuate stigma and discrimination. The language used to describe people who use substances or those who struggle with addiction can have a lasting impact on self-esteem and can influence how they are treated. As a result, people who use drugs often become marginalized and alienated from the supports and services they need out of shame or to protect themselves from poor treatment.

Stigmatizing language does not help people with substance use issues to improve their lives. By describing a person as a “junkie” or “user”, it highlights one part their identity, and disregards all other parts that matter to them, their families and their communities. Individuals are more than their substance use, they are people first. 

Supportive terms

People with lived experience - first-hand accounts and impressions of living as a member of a minority or oppressed group. In the context of harm reduction, people with lived experience refers to those who have used substances in the past and share those experiences for many purposes.

People with living experience - first-hand accounts and impressions of currently living as a member of a minority or oppressed group. In the context of harm reduction, people with living experience refers to those who actively use substances, but also share those experiences as they happen.

Peer workers – a term used when a person with lived or living experience is employed by a harm reduction program to help provide services to those who actively use substances.

It is important to note that while we should not attach negative labels to other people, individuals should be able to self identify as they wish.

The above content has been adapted from the Toronto Public Health Website and the Government of Canada, “Changing how we talk about substance use”. 

[1] Kelly, J.F., & Westerhoff, C.M., (2009). Does it matter how we refer to individuals with substance-related conditions? A randomized study of two commonly used terms. International Journal of Drug Policy, in press

There is a broad range of substance use from abstinence to dependence. An individual’s substance use may change throughout their life, for a variety of reasons. The following graphic describes the continuum of substance use.

About the continuum of use:

• People do not automatically move along the continuum.
  • Some people may only use substances socially for their entire lives
  • Some people can move around the continuum over time
• People can be at different points of the continuum for different substances.
• Where a person is on the continuum, does not necessarily impact their ability to manage and minimize risks. For example:
  • Someone that is “heavily addicted” may still use new equipment every time
  • Someone who has used cocaine for a long time may overdose
  • Someone who uses substances socially may overdose or spend too much
• For people struggling with dependency, it is often normal to not use substances for a while, then use substances again (sometimes referred to as “relapse”). This is like many other forms of addiction.
• The reason(s) people start to use substances are not always the reason(s) they continue to use substances.

The above content has been adapted from the Toronto Public Health website, Stigma: Why Words Matter and Substance Use Spectrum. 

• Doing Nothing Not An Option
• We Are In This Together
• Stop The Stigma
• We Are A Caring Community