Opioid Poisoning, Harm Reduction & Overdose Response
Introductions & Presenters
Simone (she/her)
Roles: Harm-reduction advocate, mother, thrifter, vinyl collector.
Yanna (they/them)
Described self humorously: “Cat, dog, dog, cat, I do stuff and things.”
Organizations represented
2Thrive HIV Prevention + Support
Sanguen Community Health / Harm Reduction
Presenters explicitly positioned themselves as neighbours who “support harm reduction in my neighbourhood.”
Session Road-Map
Topics covered
Intros
Opioids: definitions, intoxication vs poisoning
Overdose response: step-by-step demonstration
Debriefing & supports: what to expect, techniques, resources
Q&A period
House-keeping
Content may trigger emotions (drug poisoning, trauma, death, grief)
Participants free to leave; give thumbs-up/down for follow-up
Questions/clarifications welcome throughout
Encourage self-kindness and post-session contact if needed
Harm-Reduction Philosophy
Core stance
Recognizes that total abstinence is not realistic/possible for everyone
Aims to guarantee same choices, opportunities & access to healthcare for people who use drugs (PWUD) as for people who do not
Popular misconceptions: “Harm reduction = just syringes & Narcan”
Full scope
Drug-use supplies: fentanyl test strips, Narcan, syringes, crack pipes, condoms
Overdose prevention & education
Housing access, racial equity, social justice, ending the war on drugs
Multiple pathways to recovery & unconditional love
Empowering PWUD voices, removing stigma, wound/vein care, human-to-human connection, community building, saving lives
Integrating Trauma-Informed Principles
Source: SAMHSA National Center for Trauma-Informed Care (NCTIC)
Guiding pillars
Trauma awareness: trauma is common, avoid triggers/re-traumatization
Safer spaces & trust: must be earned, hard to regain once lost
Choice, collaboration, connection: autonomy & relationship building
Strength & skill building: reframe “deficits” as adaptive strengths
Self-awareness: reflect, acknowledge, apologize when mistakes occur
Policy Context: “It’s Not About the Drugs”
Overdose crisis driven more by prohibition policies than by any single drug class
Toxic drug supply
Traditional plant-based drugs largely replaced by synthetic analogues
Made in unregulated settings; increased potency & unpredictability → fatal poisonings
“War on drugs” identified as primary driver of toxicity
Drug Categories & Typical Effects
Cannabinoids, Opioids, Stimulants, Empathogens, Depressants, Dissociatives, Psychedelics
Effects range (examples excerpted from slide):
Opioids: relaxation, pain relief, euphoria, constricted pupils, perspiration, tolerance/withdrawal
Stimulants: energy, confidence, dilated pupils, reduced appetite, anxiety, psychosis, comedown
Empathogens (MDMA, etc.): connection, warmth, clenched jaw, dehydration
Depressants (alcohol, benzos): relaxation → unconsciousness
Dissociatives (ketamine, PCP): floaty detachment, “K-hole”
Psychedelics (LSD, psilocybin): heightened senses, hallucinations, panic potential
Why People Use Drugs (HeretoHelpBC framework)
To feel good (pleasure)
To feel better (self-medicate trauma, anxiety, depression)
To do better (performance, productivity)
To explore (novelty, insight)
Survival (cope with harsh conditions)
Opioid Chemistry & Terminology
Classic opiates originally from opium poppy; now largely synthesized
Slide showed structural diagrams of morphine, heroin, hydromorphone, oxycodone
Medical role: analgesia
Key side-effects
Respiratory depression (slowed breathing)
Sedation
Euphoria (reinforcement)
Common Opioids Listed
Fentanyl
Heroin
Hydromorphone (Dilaudid)
Hydrocodone
Oxycodone (OxyContin, Percocet)
Morphine (Kadian)
Buprenorphine (Suboxone)
Methadone (Methadose, Dolophine)
Codeine (Codeine Contin)
Opium
Drug-Supply Adulterants & Additives
Benzodiazepines (esp. etizolam, flualprazolam)
Produce prolonged sedation → complicates overdose response because naloxone will not reverse benzo effect
Xylazine (“tranq”, veterinary sedative)
Slows breathing & heart rate
Causes severe, hard-to-heal wounds
Key point: Naloxone only reverses opioid effects; always call 911 when non-opioid substances possibly involved
Factors Affecting Individual Drug Response
Physiology: age, weight, medical conditions
Hunger/dehydration status
Dose & frequency
Route (snort, swallow, smoke, inject, rectal)
Environment & mood (set/setting)
Poly-substance use
Opioid Withdrawal
Often intolerable → described as “worst flu ever”
Onset: within hours of last dose
Duration: can exceed a week depending on drug
Symptoms (not exhaustively listed in slide but implied): sweating, cramps, nausea, anxiety, etc.
Naloxone / Narcan Basics
Pharmacology
Opiate antagonist; competes at opioid receptors, displacing opioids
Effect duration: 30\text{–}60\,\text{min} (sometimes up to 120)
Safety profile
No action on non-opioid receptors → no drug interactions
Safe for pregnant people & children
Anaphylaxis essentially unknown
Limitation: triggers acute withdrawal in opioid-dependent persons; effect is temporary so re-overdose possible
Dosage Forms
Nasal:
Single spray device, 4\,\text{mg} naloxone per dose
Absorption less efficient → higher dose needed; can burn nasal passages & precipitate harsher withdrawal
Injectable:
Ampoule/vial, 0.4\,\text{mg} per dose IM/SC/IV
Essential skill in high-overdose settings (less withdrawal, cheaper)
Fentanyl Myths & Facts
Myth: “Touching fentanyl will make me overdose.”
Fact: Incidental skin exposure extremely unlikely to harm; wash with soap & water.
Myth: “First responders have overdosed just from contact with patients.”
Fact: No documented cases.
Myth: “PPE cannot protect you from fentanyl exposure.”
Fact: Standard universal precautions (gloves, masks) are sufficient.
Stimulant Overdose (Overamping)
Less predictable than opioid poisoning
Risk factors
Sleep deprivation
Dehydration / lack of nutrition
Hot, stressful environment
“One hit too many”
Poly-drug use (esp. stimulants + depressants)
Symptoms matrix (selected):
Rapid/irregular heartbeat, chest pain, seizures, extreme paranoia, overheating, foaming, stroke risk
Response principles
Provide calm presence & space
Validate feelings; avoid “No” language
Offer choices, de-escalate, monitor physiology
Continuum of Opioid Intoxication → Poisoning
Intoxication
Drowsy, euphoric, nausea/vomiting, dizziness, unsteady
Heavy “Nod”
Drifting in/out of consciousness but responds to stimuli; breathing may slow. Actions: keep awake, walk, breath-coaching.
Overdose
Breathing dangerously slow/absent, pinpoint pupils, cyanosis, cannot rouse.
Act immediately (5-step protocol)
Recognizing Opioid Overdose
Primary signs
Breathing: slow, irregular or stopped; snoring/gurgling
Colour: lips/fingernails blue-purple; grey/ashy on darker skin tones
Pupils: pinpoint, non-reactive
Unresponsive, limp; possible rigidity or vomiting
Note: progression can be gradual—continuous monitoring needed
Scene Assessment (“What are we looking for?”)
Hazards: sharps, drug paraphernalia, traffic, violence
Context: witnesses for history, exact location for EMS, visibility to others
Pause briefly to gather plan—prevents mistakes made in panic
Five-Step Overdose Response (Ontario Naloxone Kit Protocol)
Stimulate (Shout & Shake)
Name, shoulder shake, sternum/clavicle rub, trapezius squeeze, nail bed pinch, verbal “I’m giving you Narcan.”
Call 911
If solo, call before naloxone; if team, designate caller
Give Naloxone
Place on back, open airway, insert nozzle in nostril → firm press (click)
For injection: 0.4\,\text{mg} IM into arm/leg
Rescue Breathing and/or Chest Compressions
Overdose = respiratory arrest. If trained, give 1 breath every 5\,\text{s} ((~12) breaths/min); combine with compressions if no pulse. If not trained, follow dispatcher.
Is It Working?
Assess after 2\text{–}3 minutes. If no or minimal improvement, repeat naloxone + breaths/compressions.
Maximize at 3–4 doses if available; continue until EMS arrives or breathing normal.
Recovery Position
Once spontaneous breathing restored and person stable but not fully alert, place in lateral recovery position (hand under cheek, knee bent) to maintain airway & prevent aspiration.
After-Care & Immediate Support
Possible presentations:
Sudden or gradual awakening; if benzos involved, may remain sedated
Withdrawal syndrome (nausea, cramps, sweats, anxiety, intense craving)
Communicate clearly
Explain they overdosed, received naloxone, EMS en route
Offer space, calm tone, practical items: fresh clothes, sugary drinks/snacks
Encourage medical assessment or develop safety plan; inform naloxone still blocking opioids → re-use may be ineffective until it wears off
Debriefing, Team Roles & Collective Care
Overdose events are traumatic for all involved
Encourage each responder to have a defined role (caller, airway, naloxone, crowd control, kit runner)
Post-event debrief: who is comfortable? who needs time? identify learning points
Follow Vikki Reynolds’ concept of “Collective Accountability”
Replace/redistribute naloxone kits rapidly → more kits = safer community
Personal Grounding & Self-Care Techniques
5-4-3-2-1 Grounding (acknowledge 5 things you see, 4 feel, 3 hear, 2 smell, 1 taste)
Ten slow, counted breaths
Splash face with water; mindfully note sensations
Sip cool water consciously
Instrumental music + abstract drawing following sound waves
Actual physical grounding: touch soil/plants
Common Cognitive Distortions to Challenge
“I’m the only one who cares.”
“I’m personally responsible for this person’s life.”
“Nothing will work; we’ve tried everything.”
Resources & Further Learning
Low-Impact Debriefing guide: Tend Academy (link provided)
AIDS Bereavement & Resiliency Program of Ontario (ABRPO) tools
Vikki Reynolds – materials on resisting burnout & “Zone of Fabulousness”
Instructional videos
DOPE Project: How to Use Narcan
UW School of Pharmacy: Nasal & Injectable Naloxone Made Easy
National Overdose Response Service (NORS) phone: 1\text{-}888\text{-}688\text{-}NORS \,(6677)
Local Consumption & Treatment Services: 150 Duke Street West, Kitchener, open every day 09{:}00\text{–}21{:}00
Contact emails for presenters (Simone, Yanna, Alex, Alice, etc.)
Key Numerical / Formulae Recap
Naloxone effective window: 30\text{–}60\,\text{min} (up to 120\,\text{min})
Naloxone doses: nasal 4\,\text{mg} vs injectable 0.4\,\text{mg}
Rescue breathing cadence: 1 breath every 5\,\text{s} \,(12\,/\text{min})
Re-dose naloxone every 2\text{–}3\,\text{min} if no improvement
These notes condense every major and minor point from the transcript—including philosophical underpinnings, practical steps, numerical data, myths, examples, and resource links—into an organized study aid suitable for exam preparation or training refreshers.