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Ministry Status: Routine Monitoring and Engagement

Naloxone

Frequently asked questions

Who can distribute free naloxone kits to the public?

Publicly-funded naloxone is distributed through the:

  • Ontario Naloxone Program (ONP): needle syringe and hepatitis C programs
  • Ontario Naloxone Program for Pharmacies (ONPP): participating pharmacies
  • Provincial Correctional Facilities Take Home Naloxone Program: participating provincial correctional facilities

Who can get a publicly funded naloxone kit?

ONP:
Ontario’s needle syringe programs and hepatitis C programs provide kits containing Narcan® Nasal Spray (4mg/0.1ml) to:

  • Clients of needle syringe and hepatitis C programs
  • Friends and family of clients
  • Newly released inmates.

ONPP:
Participating* pharmacies distribute injectable naloxone (0.4mg/1ml) kits to:

  • someone currently using opioids
  • a past opioid user at risk of returning to opioid use
  • a family member or friend of someone who is at risk of an opioid overdose.

A pharmacist may also exercise his/her professional judgement on whether or not to provide naloxone kits for eligible persons.

* Pharmacy participation in the ONPP is voluntary. The decision to participate in the program is up to each pharmacy.

The ministry is exploring other opportunities to make nasal spray naloxone available for Ontarians.

Pharmacies may order naloxone nasal spray for patients who request it if the patient is willing to pay out of pocket.

Provincial Correctional Facilities Take Home Naloxone Program:
At-risk inmates from participating provincial correctional facilities are given kits when they are released from custody.

How can my organization become an ONP site?

Participation in the ONP is currently limited to needle syringe programs and hepatitis C programs. Your organization can refer clients who are at high risk of opioid overdose, or their family and friends to either existing ONP sites or ONPP pharmacies.

Who provides training to the person who receives a naloxone kit?

ONP:
Program staff provide training to the eligible person.

ONPP:
For those who receive a naloxone kit for the first time, a pharmacist is expected to provide the necessary professional training to the eligible person.

Replacement kits are available without training provided that the individual had previously received professional training, whether from a pharmacist or through the ONPor Provincial Correctional Facilities Take Home Naloxone Program.

Provincial Correctional Facilities Take Home Naloxone Program:
Inmates from participating provincial correctional facilities who are deemed to be at-risk for an opioid overdose after leaving the facility will receive training from nurses who work at the correctional facility.

How can the public find out where in their community they can get a free naloxone kit?

The Ontario government maintains a list of pharmacies, community programs and provincial correctional facilities that distribute free naloxone kits. This list can be accessed at Ontario.ca/OpioidOverdose.

How can a pharmacy be added to the list of locations that distribute free naloxone kits?

Pharmacies are encouraged to review the current list to ensure they are already listed. The list, which is updated on a monthly basis, can be accessed at Ontario.ca/OpioidOverdose.

If your pharmacy participates in the ONPP and would like to be added to the list, please send an email request to PublicDrugPrgrms.moh@ontario.ca.

In the event that your pharmacy would like to be removed from the list, please send a request and rationale (e.g., change in pharmacy operation, no trained staff, etc.) to PublicDrugPrgrms.moh@ontario.ca.

For either request, please provide the following information:

  • Your name
  • Your pharmacy name and full address, including contact information (e.g., email, phone, fax)

What is included in a publicly funded naloxone kit?

ONP and Provincial Correctional Facilities Take Home Naloxone Program:

Each nasal spray naloxone kit includes:

  • One hard case
  • Two doses of Narcan® Nasal Spray (4 mg/0.1ml)
  • One pair of non-latex gloves
  • One card that identifies the person trained to give the naloxone
  • One instructional insert (English and French)
  • One product monograph (English and French)

ONPP:
Pharmacies are to procure naloxone and the required supplies to assemble the naloxone kit through usual suppliers. The naloxone kit will be assembled by a pharmacist, or a person under the supervision of a pharmacist, and contain the following:

  • Two 1 ml ampoules or vials of naloxone hydrochloride 0.4 mg/ml injection
  • Two safety engineered syringes with 25 g one inch needles attached
  • Two safe ampoule-opening devices (also known as breakers, snappers, or openers), as applicable
  • One pair of non-latex gloves
  • One card that identifies the person trained to give the naloxone.

The ministry is aware that some supplies (e.g., ampoule openers/snappers/breakers) can be ordered from Canadian- based suppliers.

The Ontario Pharmacists Association has also compiled a list of the required kit components, as well as some suppliers for these items, in the event that pharmacists are unable to procure some or all of the elements through their usual suppliers.

* Please note: At the launch of the ONPP, the ministry provided a one-time drop shipment of pre-assembled injectable naloxone kits for select pharmacies that dispensed methadone and/or Suboxone. The one-time drop shipment has ended with no plans for other shipments at this time. As such, all participating pharmacies should be preparing pharmacy-assembled naloxone kits at this time.

Why do publicly funded naloxone programs provide naloxone in different formats?

When the ONP program launched, only injectable naloxone was available in Canada. Since that time, nasal spray naloxone has become available and is provided by the ONP and provincial correctional facilities. Injectable naloxone is distributed by the ONPP. Both injectable and nasal spray naloxone are effective at reversing the effects of an opioid overdose. 

I prescribe opioids to my patients. Should these patients obtain a naloxone kit?

Many people use opioids safely. It is important that you discuss overdose risks with your patients. If you have concerns about a particular patient overdosing you can direct them to the government’s naloxone web page to find the nearest naloxone distribution site.

Apart from Ontario’s three publicly funded programs, the government is exploring additional community access points for naloxone.  Expansion of naloxone access will be posted on the government’s naloxone web page.

Can the staff at my organization be trained on how to respond to an opioid overdose?

At this time, there is no standardized provincial training program. The ministry is currently exploring the possibility of developing one.

I am a first responder (e.g., firefighter, police officer, paramedic). Where can I get a naloxone kit?

All paramedics in Ontario have been equipped with and trained to provide naloxone since early 2016.

All ambulance communications officers who dispatch 9-1-1 calls for ambulance were provided information on naloxone kits in early 2017 in order to assist callers who may have access to a naloxone kit.

The Ontario government is currently exploring how providing naloxone to first responders beyond EMS could fit into a comprehensive overdose prevention and harm reduction approach.

What about other individuals who are interested in getting a naloxone kit on behalf of their organization (e.g. bars, restaurants, schools, etc.)?

The purpose of Ontario’s three publicly funded programs is to serve patients, their families and friends, and those who care for them on an individual basis.

The government is currently exploring additional community access points for naloxone. If access to naloxone kits is expanded, details will be posted on the government’s naloxone web page.

Individual organizations that are not eligible to receive publically funded naloxone are able to purchase it directly from the manufacturers.

How can a person who is leaving a hospital (e.g., emergency room) get a naloxone kit?

If a person who is being discharged from a hospital needs a naloxone kit, they can be directed to the most appropriate pharmacy that carries naloxone kits, particularly if the participating hospital outpatient pharmacy is closed.

The ministry encourages individuals to phone ahead to check if their pharmacy is participating in the ONPP and has naloxone kits in stock. They may also ask the pharmacist questions about naloxone kits.

Note that the ONPP only funds community pharmacies, including outpatient pharmacies. The ONPP is not associated with hospitals at this time (i.e., inpatient pharmacies and emergency departments).

Drug costs, including the procurement of naloxone kits, for hospitals would typically be covered under the hospital global budget. It is a hospital-based decision to provide naloxone kits to patients through access points such as the emergency room or inpatient pharmacy.

Is naloxone legal to carry?

Yes, naloxone kits are legal to carry. Publicly funded naloxone kits include an identifier card that confirms that the carrier of the kit has been trained to use it.  

Can a person be charged with possession of drugs while they’re helping someone who has overdosed?

Bill C-224, the Good Samaritan Drug Overdose Act, is intended to amend the Controlled Drugs and Substances Act (CDSA). It will be reviewed by the Parliament of Canada later this year. If passed, the amendment would exempt from a possession charge someone who seeks emergency medical or law enforcement assistance for themselves or others after overdosing on a controlled substance.

Are there any provincial regulations regarding the administration and/or distribution of naloxone in Ontario?

Injectable naloxone (0.4mg/1ml) is a behind-the-counter product available without a prescription in Ontario. 

Pursuant to an Interim Order dated July 6, 2016, the federal Minister of Health has authorized the importation and sale of Narcan® Nasal Spray (4mg/0.1ml) for use in the emergency treatment of known or suspected opioid overdoses.

As a product that contains naloxone hydrochloride, Narcan® Nasal Spray, when indicated for emergency use for opioid overdose outside hospital settings, is exempt from the Prescription Drug List established under the federal Food and Drugs Act.

Naloxone hydrochloride nasal spray has been scheduled by the National Association of Pharmacy Regulatory Authorities (NAPRA) as a Schedule II (non-prescription) drug. 

Are there any contraindications to naloxone use?

Injectable naloxone is considered safe for everyone unless there is a reason to believe a person has a previous allergy (or hypersensitivity) to naloxone.

Health Canada has advised that the use of Narcan® Nasal Spray may not be appropriate for young children and pregnant women.

Why does the Ministry of Health and Long-Term Care promote chest compression as part of the response to an opioid overdose?

Ontario’s Chief Medical Officer of Health (CMOH) sought guidance and advice from experts and stakeholders from across sectors, including Emergency Medical Services, the government, law enforcement, the medical community, researchers, and public health. These consultations focused on what resuscitation measures are most appropriate for lay people to administer during an opioid overdose.

There was consensus that chest compression-only CPR is the most appropriate resuscitation measure for people who are not trained in CPR to administer during an opioid overdose. This intervention is preferred because it can address the effects of both a respiratory and cardiac arrest, and it can significantly improve a person’s chance of survival.

Can naloxone harm people?

Naloxone only affects people who are using opioids. If a person has been using opioids, naloxone may put them into withdrawal. This can be very uncomfortable for the person, but is not life-threatening.

Where can I, and my patients, get more information?

For more information on naloxone and opioid overdose, including publicly funded naloxone programs, please visit the government’s naloxone web page.

Where can I refer my patients for additional support?

The Drug and Alcohol Helpline provides 24/7 telephone (1-800-565-8603), email and live web chat help for people who need help with an addiction. They provide information about treatment services and support in the community; offer support and strategies to people suffering from an addiction; and provide basic education about drug and alcohol problems.

The Centre for Addiction and Mental Health offers various specialized treatment programs for people suffering from drug, alcohol, gambling or other addiction issues.

For More Information

Call ServiceOntario, Infoline at:
1-866-532-3161 (Toll-free)
In Toronto, (416) 314-5518
TTY 1-800-387-5559.
In Toronto, TTY 416-327-4282
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