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Drugs

Ottawa overdose prevention

Have Your Say….your feedback is needed to help us communicate about opioid overdose prevention.

What is fentanyl?

Fentanyl is an opioid that is much more toxic than most other opioids. Opioids include drugs like heroin, morphine, fentanyl, methadone and codeine. Fentanyl is usually prescribed in a patch form as a painkiller. It is around 50 to 100 times more toxic than morphine. This makes the risk of accidental overdose much higher.

There are also different Fentanyls being made illegally and sold on the streets. This illicit fentanyl is often made as a powder and mixed with other drugs (like heroin, cocaine or crack). It is also being pressed into pills and sold as things like ‘oxycodone’ (oxycontin, oxys, eighties) or other pills including speed and ecstasy/MDMA. 

What’s the risk with fentanyl?

Anything can be cut with fentanyl poster. Overdose awareness poster.Anything can be cut with fentanyl poster. Overdose awareness poster.When fentanyl is mixed with other opioids, alcohol, benzodiazepines, or stimulants like cocaine, it increases the risk of accidental overdose.

Illicit fentanyl is much more toxic than other pharmaceutical opioids. There is no easy way to know if fentanyl is in your drugs. You can’t see it, smell it or taste it.  Any drug can be cut (mixed) with fentanyl. Even a very small amount can cause an overdose.

When you are getting drugs from anywhere other than from a pharmacy or medical professional, like from a friend, ordering online, or a dealer, there is no way to be sure exactly what is in them or how toxic they may be.  

It’s important to know that drugs other than fentanyl can also cause an overdose! 

Check out our tips on overdose prevention and naloxone to reduce your risk! 

Carfentanil

Carfentanil is an opioid that is used by veterinarians for very large animals like elephants.  It is not for human use.  It is approximately 100 times more toxic than fentanyl and 10,000 times more toxic than morphine.  This means carfentanil can be deadly in extremely small amounts.

Carfentanil has been found here in Ontario.  It is being cut in to other illicit drugs like heroin and counterfeit pills made to look like prescription opiods (including green pills stamped ‘CDN’ on one side and ‘80’ on the other).  There is no easy way to know if carfentanil is in your drugs, you can’t see it, smell it or taste it.  It is extremely toxic and a very small amount can cause an overdose. 

What's the risk with counterfeit drugs?

Counterfeit pills can be manufactured to look almost identical to prescription opioids (i.e. Oxycontin, Percocet) and other medications. Obtaining drugs from a non-medical source such as a friend, ordering online, or a drug dealer is very risky and potentially life-threatening as there is no way to know what is actually in them or how toxic they may be. Drugs should only be purchased from a local pharmacy or a medical professional.

Examples of counterfeit pills found in Ottawa.

Overdose

Learn how to prevent, recognize and respond to an overdose. Anyone who uses drugs can be at risk for overdose.

You may not know that someone you love is using drugs. By learning more, you could save their life.

What is an overdose?

An overdose happens when a person uses more of a drug, or a combination of drugs, than the body can handle. As a result, the brain is not able to control basic life functions. The person may:

  • Pass out,
  • Stop breathing,
  • Have a heart attack, or
  • Experience seizures depending on what drugs they have used.

Learn the signs and symptoms of different types of drug overdoses below!   

Anyone can overdose: first time users, people who have been using for a long time, people who use regularly, people who only use once and a while, seniors, young people, overdose doesn’t discriminate.

  • There is no exact formula for figuring out how much of a certain drug, or combination of drugs, will lead to an overdose. How strong a drug is (potency), how a drug is taken- whether swallowed, snorted of injected, how much of a drug, and how often a drug is used all are factors.
  • Factors like weight, health, and tolerance for a drug at that particular time all play a role.
  • Overdose risk is higher when you haven’t used in a while (whether you took a break, or were in treatment, hospital, or jail).

Ottawa Overdose Statistics

Figure 1: Emergency Department Visits for Drug Overdoses in Ottawa

This report provides available monthly trend data on drug overdose-related emergency department visits. It provides information on the overdose-related emergency department visit trends relating to overdoses in the last 6 months.

The data used in this report is from:

  • Drug overdose-related emergency department data
  • Ottawa Paramedic Service response data
  • Ottawa Paramedic Service naloxone administration data

Emergency Department Visits for Drug Overdoses in Ottawa

July 2017 report [PDF 369 KB] (Data)

June 2017 report [PDF 279 KB] (Data)

May 2017 report [PDF 240 KB] (Data)

April 2017 report [PDF 283 KB] (Data)

In 2015, 48 Ottawa residents died from unintentional drug overdose:

  • 29 of these, or almost 2 in 3 deaths were due to opioids
  • Fentanyl was involved in 14 of these deaths, more than 1 in 4

Figure 2: Unintentional drug overdose deaths in Ottawa by type of drug involved, 2015

 Unintentional drug overdose deaths in Ottawa by type of drug involved, 2015

Data source: Office of the Chief Coroner for Ontario, extracted December 2, 2016. Analyzed by Epidemiology Team, Ottawa Public Health.

Age: These 48 overdose deaths were not distributed evenly across ages; some age groups were more impacted than others. One third of those who died, 15 people, were under 40 years old. See chart below.

Figure 3: Age distribution of Ottawa unintentional drug overdose deaths, 2015 (48 deaths total)

 Age distribution of Ottawa unintentional drug overdose deaths, 2015

Data source: Office of the Chief Coroner for Ontario, extracted December 2, 2016. Analyzed by Epidemiology Team, Ottawa Public Health. (Data table below)

The rate of drug overdose deaths increased 32% in Ottawa between 2014 and 2015 and only 6% in the rest of Ontario.

The increase in unintentional overdose deaths in Ottawa and in the rest of Ontario has been due to increased unintentional opioid overdose deaths, and since 2014, fentanyl has been involved in the largest proportion of drug overdose deaths in Ottawa. For more information see “Drug-related death in Ottawa, 2000-2015”.

Overdose prevention- Reduce Your Risk

If you are going to use:

Don’t Use Alone

  • If you overdose when you are alone there will be no one there to help you.
  • When using with someone else, don’t use at the same time. Be sure your friend is willing to call for help, and make a plan for what to do if an overdose happens.  
  • If you do use alone, tell someone before you use. Leave the door unlocked and have someone come check on you.

Don’t Mix Drugs

  • Don’t mix drugs with other drugs or alcohol.
  • Mixing with other drugs puts you at higher risk of overdose.
  • If you are going to mix, use one drug at a time or use less of each drug.  

Go Slow

  • The quality of street drugs is unpredictable. Fentanyl is being cut (mixed) into both opioid and non opioid drugs:
    • Made as a powder and mixed into cocaine, heroin, and crack.
    • Made as pills and being sold as ‘oxycodone’ (eighties, oxys) or other pills including ecstasy/MDMA.
  • You may not be able to taste, smell or see it. Even very small amounts can cause an overdose.
  • Start using in small amounts and do “testers” (or test doses) to check the strength of what you are using.

Carry Naloxone

  • Naloxone is a medication that can temporarily reverse an opioid overdose.
  • Naloxone is available free to people who use drugs and their family and friends!
  • Learn more about Naloxone and where to get a kit.

Know your tolerance 

  • Tolerance is the body’s ability to ‘handle’ the effects of the drug being used. Tolerance to a drug develops over time.
  • Drug tolerance will decrease when somebody has taken a break from using – whether intentionally or unintentionally (like while in treatment, hospital or jail).
  • Your tolerance will also change depending on: 
    • Weight,
    • Illness,
    • Stress,
    • Lower immune system (from hepatitis for example),
    • Lack of sleep,
    • Other drugs/medications being used, and
    • General health. 
  • Use less drugs when your tolerance may be lower.
  • Your risk of overdose increases if you are a new user or haven’t used in 3+ days!

Be aware

  • Drugs can be tampered with at any point. People buying or selling drugs may not be aware if it has been cut with anything before they sell it to you.

A paramedic speaks about overdose prevention and calling 911.

Signs and symptoms of an overdose

An overdose may look different from one person to the next and depending on the drugs involved.  An overdose is a medical emergency and the first step is always to call 911.  

Type of drug

Common signs and symptoms of an overdose

Opioids 

(like heroin, morphine, fentanyl, methadone, oxycontin)

Image of opioid overdose signs and symptoms

Download: Signs and Symptoms of an opioid oversdose [PDF 1.8 MB]

  • Breathing is very slow, or irregular, or they may not be breathing at all
  • Fingernails and/or lips are blue
  • Body is limp
  • Deep snoring or gurgling sounds
  • Loss of consciousness/passed out (can’t wake the person up)
  • Unresponsive  (not answering when you talk to them or shake them)
  • Pinpoint (tiny) pupils
  • Vomiting

Stimulants

(like cocaine, speed, crystal meth, MDMA/ecstasy)

  • Seizures
  • Pressure and tightness in chest
  • Foaming at the mouth
  • Racing pulse
  • Excessive sweating
  • Vomitting
  • Headaches/dizziness/ringing in the ears
  • Hard time breathing
  • Sudden collapse
  • Loss of consciousness/passed out (can’t wake the person up)

Hallucinogens

(like acid, LSD, ketamine, magic mushrooms)

  • Catatonic syndrome (person will be in a trance like state)
  • Psychosis (their reality is altered may be having hallucinations or delusions)
  • Nausea/vomiting
  • Seizures

What is Naloxone?

Naloxone is a medication that can temporarily reverse the effects of an opioid overdose. Opioids include drugs like heroin, morphine, fentanyl, methadone and codeine.

How does Naloxone work?

In an opioid overdose a person’s breathing slows down or stops. Naloxone blocks the effect of opioids on the brain. It temporarily reverses these effects on a person’s breathing. Giving naloxone can prevent death or brain damage from lack of oxygen.

Naloxone will only work on opioid-related overdoses. It is important to remember that a lot of other drugs are being cut with fentanyl. If the person has used any drugs and is showing signs of an opioid overdose call 911 and give naloxone.

How long does Naloxone take to work?

Naloxone usually starts working in 1 to 5 minutes. Repeated doses may needed if the person is still showing signs of overdose.

The effects of naloxone only last for 30 to 60 minutes. If the opioid is still in the body after the naloxone wears off, the overdose can return. This is why it is so important to call 911 in every overdose situation!

Are there age restrictions for administering naloxone? Is it safe to give to teens?

Naloxone is a very safe drug which is used across ages. If your teen is overdosing, you would give naloxone regardless of age. You would also give naloxone if your child was pregnant or lactating, and also if they have medical conditions such as heart, respiratory, liver or kidney disease.

Will it "harm" my child if I give them naloxone and it turns out they were NOT overdosing? 

No. The main “risk” of giving naloxone to someone who is dependent on opioids is that it will cause them to suddenly go into withdrawal, these symptoms are temporary and not life threatening, though they can be unpleasant, and will stop once the naloxone wears off.

The only reason to NOT give naloxone would be if there was history of allergy to naloxone or its ingredients -which you likely wouldn’t know.  

Naloxone Facts

Learn more about Naloxone from the following University of Waterloo video: 

Take-Home Naloxone Kits

Take-Home Naloxone Kits

Being able to recognize the signs of an overdose quickly and having a naloxone kit can save a life. Naloxone can buy time while paramedics are en route. Take-home naloxone kits do not replace the need for emergency care or minimize the importance of calling 911. 

You can get a take-home naloxone kit for free from pharmacies and other agencies in Ottawa. When you get your kit you will also receive training on overdose prevention, recognizing an overdose and how to respond. Below is a list of places where you can get a free Naloxone kit in Ottawa

  • Ottawa Public Health’s Site Needle & Syringe Program provides free kits and training for clients and their family or friends.  Visit our 
    • Site Office @ 179 Clarence St (in the Byward Market) from 8:30 am to 4:30 pm Monday to Friday
    • Mobile Site Van (provides service throughout the City of Ottawa): 5:00pm to 11:30pm 7 days a week, phone 613-232-3232
  • Many local Ottawa Pharmacies: To  find a participating pharmacy near you:
    • Call the Drug and Alcohol Helpline @ 1-800-565-8603.  
    • Check this list of pharmacies that have naloxone. This list is managed by the Ministry of Health and Longterm Care. Should a pharmacy be missing from the list, please contact the Ministry
    • Once you have located a pharmacy, Ottawa Public Health suggests you call ahead to make sure that they currently have naloxone available.
  • The Ottawa Hospital- offers training and naloxone kits for registered patients at risk of overdose.  
  • Sandy Hill Community Health Centre’s Oasis Overdose Prevention Service (221 Nelson Street 1st floor, 613 569-3488) 
    • available through walk-in services Monday-Friday  

How to respond to an opioid Overdose

5 Steps to Save a Life

 An illustration of the five steps of how to respond to an opioid overdose.

  1. Shake & shout: Shake the person’s shoulders and shout their name
  2. Call 9-1-1: If the person is not responding
  3. Naloxone: Inject 1 ampoule (1ml) of naloxone into the arm or leg muscle
  4. Compressions or CPR and/or rescue breathing as trained
  5. Is it working? If there is no change after 3-5 minutes give the next dose of naloxone and continue with compressions/recue breathing/CPR until ambulance arrives

If you have to leave the person at any time put them in the recovery position.  The recovery position helps keep a person’s airway open so they can breathe and can prevent them from choking on vomit or spit.

Recovery Position

An illustration of the 3 steps leading to the recovery position

  1. Responder extending victims closest arm above the victims head
  2. Responder positions other arm across the victims chest and bends furthest leg at the knee.  Victim is rolled towards responder and placed on side
  3. Victim laying on side with head stabilized on extended arm. Knee is bent and stabilized

It is important to stay with a person after giving them naloxone: 

  • The person may be confused and frightened when they wake up. You will need to tell them what happened.
  • A lot of opioids can last longer in the body than naloxone, so an overdose could return. It is important to make sure that the person knows not to take any more drugs!
  • It is important to tell paramedics everything you know about the situation so they can provide the best care.
  • Naloxone may cause people who have used opioids to go into withdrawal. This may make the person want to use again.  Using more will increase the risk of overdose as the naloxone wears off. 
  • This can be very uncomfortable for the person but is not life threatening.  Withdrawal symptoms may include:
    • Muscle aches,
    • Sweating,
    • Nausea/vomiting,
    • Agitation,
    • Irritability. 

For full training on how to give naloxone, visit the locations listed above.

Learn about tips on how to respond to overdoses of a stimulant like cocaine, crystal meth, speed, MDMA, or Ritalin. 

Information for Parents

You are your child’s best defense against drug use.

The top two things that a parent or guardian can do is to be informed about drug issues and talk to your kids about drugs.  For more information, including  tips for talking to your kids about drugs, information on opioids including  fentanyl, how to spot an overdose,  what to do in an overdose,  and where to get naloxone go to Youth and Opioids: What Parents Need to Know on Ottawa Public Health’s Parenting in Ottawa website.  

Information for Pharmacists

Naloxone Distribution

Pharmacists are highly respected as the medication management experts of the health care team. By becoming a participant in the Ontario Naloxone Program for Pharmacies (ONPP), your pharmacy can increase access to naloxone and be part of the enhanced response to overdose prevention in our community.  For more information on how to participate in the ONPP, please see this notice from the Ministry of Health and Long Term Care   

Used Medication Disposal at Pharmacies

Pharmacies play a fundamental role in raising awareness about the importance of properly disposing of unused or expired medications by providing a drop-off locations for such medications as over-the-counter, prescription and natural health products through Health Products Stewardship Associations’ (HPSA) Medications Return Program (OMRP), and for sharps materials and devices through its Sharps Collection Program (OSCP).

  • Ottawa Public Health (OPH) is working in partnership with the Health Products Stewardship Association (HPSA) to raise public awareness of the importance of safe disposal of unused or expired medications. Success depends on participating pharmacies being informed about the procedures, guidelines and regulations of the Ontario Medications Return program (OMRP),  and actively offering the collection and management of unused or expired medications returned by the public. 
  • You can call the HPSA to register your location at 613-723-7282 or send an email to info@healthsteward.ca. The OMRP covers the costs associated with the responsible disposal of health products returned by the public. There is no cost to you.
  • If you would like to receive FREE copies of the Take it Back! public rack cards, pictured below, you may use the order form, or call or email the Health Products Stewardship Association to receive copies.  They will be happy to send you English and /or French copies, free of charge, to your pharmacy location(s).
  • Please find a list of products that are accepted and not accepted through the Ontario Medications Return Program.  
  • Your  pharmacy clients will be able to find the closest participating pharmacies to their  location through the HPSA website homepage by typing in their postal  code or address.

Ottawa Public Health Opioid Email Updates

You can also join the distribution list for Ottawa Public Health Opioid Updates for communications regarding overdose prevention and naloxone programming.  To register  for the list please email jackie.kay-lepors@ottawa.ca

For all other inquiries please contact  the Ottawa Public Health Information Line at healthsante@ottawa.ca or call  613-580-6744 ( TTY: 613-580-9656, Toll free: 1-866-426-8885) Monday to Friday from 8:30 am to 4:30 pm (closed on statutory holidays).

Information for festival organizers

The 2017 Festival Season is well under way, and Ottawa Public Health (OPH) would like to assist you to reduce the risk of accidental overdoses at your event. There are specific actions that you, as a festival organizer, can take to decrease the risk of overdoses at your events, whether through event organisation and design, by providing health promotion and harm reduction information, medical services and event security.  Please click on these links for more information of interest to festival organizers.

From the Canadian Centre on Substance Use and Addiction:

OPH Opioid 101 Webinar

We encourage you and your staff and volunteers to watch the OPH “Opioids 101” webinar, an informative overview of opioids, overdoses and naloxone.

Website

StopOverdoseOttawa.ca for general information about opioids, fentanyl, overdose, naloxone, as well as links to find pharmacies who carry naloxone, where to drop off used or expired medications, and community resources.

PDF documents

A number of resources are available, many of which can also be ordered in print at : Overdose resources for professionals These include:

  • Signs and Symptoms of Opioid Overdose
  • Fentanyl Facts
  • Opioid Information Fact Sheet for parents
  • Anything Can Be Cut with Fentanyl/ Opioid Awareness poster
  • Parenting in Ottawa Opioid specific postcard (printed cards available)
  • Anything Can Be Cut with Fentanyl/ S&S of Opioid Overdose postcard (printed cards available)

Festivals FAQ

What is OPH doing?

  • We are seeking an opportunity to meet with festival organizers to discuss how to prevent drug and alcohol related harms at their events by increasing awareness of the present risk of opioid overdose in our community, particularly due to bootleg fentanyl, and of the actions that festival organizers can take to help prevent opioid overdoses and overdose deaths at festivals.
  • OPH has also developed resources specifically for festival organizers, including FAQ;s, tips to help you prevent alcohol and drug harms at your event(s), and overdose awareness materials for you and your staff and volunteers  which is available on StopOverdoseOttawa.ca

What can Ottawa Public Health (OPH) provide?

  • Ottawa Public Health can provide a short presentation to festival organizers of the local overdose context. The audience for this presentation can also include festival workers and/or volunteers or they can link back to web series for watching on their own time. 
  • Ottawa Public Health, along with the Ottawa Overdose Prevention Task Force also launched the StopOverdoseOttawa.ca website where you can find more information on drugs and overdoses.
  • For more print or downloadable resources, you can also visit www.Ottawa.ca/StopOverdoseResources

How can I raise awareness on this issue?

  • You can include the StopOverdoseOttawa.ca link to your communications. This website contains lots of information for followers including how to recognize an overdose, fentanyl in party drugs and naloxone. You can also link to OPH party safe blog.
  • You can share information resources such as “Anything can be cut with fentanyl” posters and Signs & Symptoms of Overdose. Some festival organizers have chosen to post bathroom stalls but they could also be posted at entrances or wherever you see fit. Postcards could be handed out to participants.

How can I get some up to date data regarding opioids?

  • You can join the distribution list for Ottawa Public Health Opioid Updates for communications regarding overdose prevention and naloxone programming.  To register  for the list please email jackie.kay-lepors@ottawa.ca

How can I prevent an overdose?

  • Raising awareness is crucial. Make sure that your staff and volunteers know the signs and symptoms of an overdose and that they know how to respond if the situation arises.
  • Find out if your first aid attendants or other first responders attending your event have or plan to receive naloxone administration training and have kits on site.
  • Raising awareness among your participants using the StopOverdoseOttawa.ca website and distribution of material can also be beneficial.

Where can I get Naloxone and Naloxone administration training?

  • Visit StopOverdoseOttawa.ca for more information regarding naloxone purchase and training.
  • If needed, OPH can facilitate connecting with pharmacists for your Naloxone purchase and the provision of Naloxone administration training should you wish to purchase naloxone for your first aid attendants.

Local Resources

Fentanyl Facts [PDF 103 KB]

Treatment Information

Detox

Support Services and Treatment

Methadone Services

If you are feeling sadness or experiencing any other negative emotional reactions here are some links to resources that might help:

Figure 1 Data: What are the emergency department (ED) overdose trends in the last 6 months?

Week Ending Week Count
2016-10-15 18
2016-10-22 30
2016-10-29 16
2016-11-05 18
2016-11-12 21
2016-11-19 18
2016-11-26 22
2016-12-03 20
2016-12-10 25
2016-12-17 23
2016-12-24 18
2016-12-31 20
2017-01-07 19
2017-01-14 20
2017-01-21 26
2017-01-28 21
2017-02-04 28
2017-02-11 25
2017-02-18 33
2017-02-25 26
2017-03-04 22
2017-03-11 33
2017-03-18 23
2017-03-25 22
2017-04-01 18
2017-04-08 25
2017-04-15 18
2017-04-22 28
2017-04-29 30

Data table for Figure 3: Age distribution of Ottawa unintentional drug overdose deaths, 2015 (48 deaths total)

Age group Percentage of deaths
10 to 19 years 2%
20 to 29 years 12%
30 to 39 years 19%
40 to 49 years 15%
50 to 59 years 37%
60 years and older 15%

 

Site Needle & Syringe Program

The City of Ottawa’s Clean Needle Syringe Program is an effective mandatory health program, which has been in operation since 1991. The availability of these programs have been deemed a necessary public health measure to prevent the spread of communicable diseases, primarily HIV and Hepatitis-C virus, and to minimize the risks associated with substance use in society.

Hours and venues of service

Venue

Days

Hours

Telephone

Site Needle & Syringe Program,
179 Clarence Street, Ottawa

Monday to Friday

8:30 am to 4:30 pm

  • Thursday, December 24: 8:30 a.m. to noon
  • Christmas Day: closed
  • Boxing Day: closed
  • Thursday, December 31:  8:30 a.m. to noon
  • New Year’s Day: closed
 

Site mobile van travels to various locations within the City of Ottawa

7 days a week

5 pm to 11:30 pm

  • Thursday, December 24: 10 a.m. to 5 p.m.
  • Christmas Day: closed
  • Boxing Day: regular schedule
  • Thursday, December 31: 10 a.m. to 5 p.m.
  • New Year’s Day: regular schedule

613-232-3232 
Collect calls accepted

Program services provided

  • General counselling and support
  • Health education/promotion
  • Substance use counselling
  • Harm Reduction supplies 
  • Needle/syringe disposal
  • Condoms and lube
  • Confidential hepatitis B and C testing
  • Confidential testing for gonorrhea, chlamydia and syphilis
  • Hepatitis A/B and influenza vaccination
  • Anonymous HIV testing
  • Emergency Contraception (Plan B) 
  • Pregnancy testing
  • Referral to health and social service agencies including drug treatment services
  • Peer Overdose Prevention Program (POPP)

Site program goals and services:

To educate clients to reduce and avoid the risk of transmission of HIV, hepatitis and other blood-borne pathogens by:
  • Increasing awareness of the risks involved in needle sharing, other drug using behaviours and unprotected sex. To enhance the skills needed to change high-risk behaviours and/or maintain low and no risk behaviours.
  • Providing accurate information on all modes of HIV transmission (including sexual transmission), testing and prevention.
Providing health education, needle exchange, and condom distribution. To encourage self-esteem in substance users and other clients and an awareness of health issues by:
  • Increasing awareness of health status regarding HIV and hepatitis B and C by offering testing.
  • Encouraging and providing hepatitis A/B and influenza vaccination.
  • Providing health education, anonymous HIV testing, confidential testing for hepatitis B and C, Chlamydia, gonorrhea, syphilis, provision of hepatitis A/B vaccine, HIV and hepatitis C counselling and partner follow-up.
To provide a supportive environment for substance users and other clients to access medical and social services by:
  • Gaining a client's trust to a point of access for meeting their service and health care needs.
  • Referring substance users to treatment, counselling services, medical and other social service supports.
  • Providing crisis counselling, referrals to community agencies and drug treatment programs.

Partner agencies

Over the past few years, accessibility of needle exchange and other harm reduction services in Ottawa have been greatly increased through partnerships with other agencies serving the same clientele. The Site Program currently has 20 partner agencies that deliver needle exchange services.

Both Site Program and partner agency staff are alert for, and take advantage of, opportunities to educate clients on the safe use of syringes/glass stems and other drug using equipment.

AIDS Committee of Ottawa
19 Main Street, 613-238-5014

Carlington Community Health Centre
900 Merivale Road, 613-722-4000

Centre 454
454 King Edward Avenue,613-235-4351

Centre 507
507 Bank Street, 613-233-5626

Centretown Community Health Centre
420 Cooper Street, 613-233-4697

Elizabeth Fry Society of Ottawa
311-211 Bronson Avenue, 613-237-7427

Lowertown Community Resource Centre
40 Cobourg Street 613-789-3930 

Minwaashin Lodge – STORM Van 
424 Catherine Street 613-265-7558

Ontario Addictions Treatment Centres
401 Somerset Street W. 613-233-1114
1318 Carling Avenue, 613-627-0856
263 Montreal Road, 613-749-9666

Operation Come Home
150 Gloucester Street, 613-230-4663
24 hour help line: 1-800-668-4663

OPH Site Needle and Syringe Program
179 Clarence Street, 613-234-4641
Site Van, 613-232-3232

Ottawa Freedom Center
265 Montreal Rd., 613-422-2294

Ottawa Inner City Health
5 Myrand Ave. 613-562-4500
*no harm reduction services provided on site

Pinecrest-Queensway Health and Community Services
1365 Richmond Road, 2nd floor, 613-820-2001

Sandy Hill Community Health Centre
221 Nelson Street, 613-789-6309

Shepherd's of Good Hope

230 Murray Street, 613-241-6494 
256 King Edward Avenue, 613-562-7845

Somerset West Community Health Centre
55 Eccles Street, 613-238-1220
NESI Van 613-761-0003

South-East Ottawa Community Health Centre
1355 Bank Street, suite 600, 613-737-5115

Wabano Centre for Aboriginal Health
299 Montreal Road Vanier, 613-748-5999

Youth Services Bureau of Ottawa
147 Besserer Street, 613-241-7788

Mandate of the Ontario Ministry of Health and Long Term Care

Background

In the late 1980's, the rate of HIV and Hepatitis B and C infection grew to epidemic proportions among injection drug users. The Ministry of Health acknowledged the urgent need to implement harm reduction strategies to control the epidemic. The human costs, as well as the financial burden HIV infection was placing on the health-care system, were a major concern.

The Ontario Ministry of Health, under the Health Protection and Promotion Act mandated that:

"The board of health shall ensure that injection drug users can have access to sterile injection equipment by the provision of needle and syringe exchange programs as a harm reduction strategy to prevent transmission of HIV, hepatitis B, hepatitis C and other blood-borne infections and other associated diseases in areas where drug use is recognized as a problem in the community. The strategy shall also include counselling and education and referral to primary health services and addiction/treatment services. The board of health shall produce an annual report of program activities and forward a copy to the Minister of Health."

Consultation Survey about Enhancing Harm Reduction Services in Ottawa

The survey is now closed. Thank you to those who participated.

This valuable feedback will be used when making decisions about expanding harm reduction services in Ottawa. 

Introduction

On June 20, 2016, Ottawa Public Health (OPH) presented a report to the Ottawa Board of Health. The report presents some possible ways to expand harm reduction services in Ottawa. Harm reduction services, such as OPH’s Site Needle and Syringe Program, help reduce harm to people who use drugs and also protect our community. This is done by distributing supplies (such as needles) for safer drug use, teaching about safer drug use, and referring people to other health and social services.

OPH’s harm reduction services also include overdose prevention training and Naloxone kits for people who inject opioid drugs (opioid drugs include heroin as well as pain killer medications such as morphine, fentanyl, and oxycontin). OPH also offers testing for HIV and hepatitis C, pregnancy testing, emergency contraception, vaccinations, and first aid.

Enhancing Harm Reduction Services – Data, Guiding Principle and Next Steps

The possible ways to expand harm reduction services include longer hours, increased number of harm reduction service locations, and two (2) specific tools that are currently not offered in Ottawa:

  1. Harm reduction dispensing units (HRDU)
  2. Supervised injection services (SIS)

Frequently asked questions

What is harm reduction?

Harm reduction:

  • Focuses on keeping people safe as well as preventing death, disease and injury
  • Aims to reduce harm from drug use through programs such as needle and syringe programs, methadone maintenance treatment, supervised injection services, and outreach and education programs
  • Saves lives and improves quality of life for people who use drugs by supporting them to be part of society and by linking  them with health and social support services
  • Recognizes that drug use may continue despite the risks
  • Benefits the community through less open drug use, proper disposal of used needles, and reduced health and enforcement costs related to drug use1,2

What harm reduction services are currently available in Ottawa?

In Ottawa, harm reduction services are provided according to Best Practice Recommendations for Canadian Harm Reduction Programs. Ottawa has many locations across the city that offer harm reduction service. These services are a mix of fixed (agency-based) and mobile van services.  Harm reduction services are provided by Ottawa Public Health’s (OPH) Site Needle and Syringe Program (NSP), as well as 20 community partners, including 3 mobile services. These programs:

  • Distribute safer drug using supplies (needles, cookers, sterile water, alcohol swabs)
  • Dispose of used drug using supplies
  • Distribute safer sex materials (condoms and lubricant)
  • Provide prevention education related to human immunodeficiency virus (HIV), hepatitis C, skin and vein problems
  • Provide training in overdose prevention and Naloxone to people at risk of opioid overdose
  • Offer testing for sexually transmitted and blood-borne infections (STBBI) such as HIV and hepatitis C, pregnancy testing, emergency birth control, vaccinations and first aid.

In Ottawa, agencies also distribute safer crack use equipment, coordinated through Somerset West Community Health Centre. 

What are the current hours of operation of harm reduction services in Ottawa?

Right now, there are 22 places in Ottawa where people can get harm reduction services. These are ‘fixed’ locations that operate from office settings and agencies across the city, including community health centres and Ottawa Public Health. Most of these ‘fixed’ services are open Monday to Friday during regular business hours (8:30 am to 4:30 pm, Monday – Friday). A few fixed services offer some weekend hours during the day. Ottawa has three (3) mobile harm reduction vans that run in the evenings (5 to 11:30 pm) most days throughout the year.

For more information about harm reduction services, including a list of all agencies, visit OPH Site Needle and Syringe Program website.

Do harm reduction programs enable or encourage drug use?

Many studies have concluded that needle programs and other harm reduction services do not increase drug use. 

For people who do not want to quit using drugs, are not ready to quit using drugs, or cannot quit using drugs, harm reduction services have been shown to prevent human immunodeficiency virus (HIV), hepatitis C and other drug-related harms, and death for people who use drugs. 

Harm reduction is often the only link that some people have to health and social services. Harm reduction services increase the possibility that drug users will:

  • Re-engage in broader society
  • Engage in less crime
  • Lead productive lives
  • Quit using drugs

Do harm reduction programs increase public disorder or threaten public health and safety?

Research has shown that harm reduction programs do not increase public disorder or threaten public safety. In fact, they tend to have the opposite effect. Harm reduction programs have a positive impact on public health and safety by:

  • Preventing blood borne infections such as human immunodeficiency virus (HIV) and hepatitis C among people using drugs
  • Ensuring that more needles and syringes are disposed of safely through programs, rather than discarded in the community
  • Supporting agreements between police and harm reduction services that ensure drug trafficking laws are enforced. This creates an environment where open drug dealing is discouraged, and people who use drugs are encouraged to access needed services.5,6,7

What is a harm reduction dispensing unit (HRDU)? 

A harm reduction dispensing unit (HRDUs) is a machine that distributes safer drug using supplies such as needles and other safer injection supplies for free only to people who have been provided special tokens by harm reduction or needle and syringe program staff. 

Why do we need harm reduction dispensing units (HRDUs) in Ottawa?

There is a need to expand access to harm reduction services (safer drug using supplies) across the City of Ottawa. Some areas of the city have no harm reduction services. Harm reduction dispensing units (HRDUs) are useful in that they:

  • can provide access to harm reduction supplies in areas of the city that do not have fixed access through an agency, and
  • can provide access during times of the day when services are closed.

HRDUs have been successful in reaching high-risk hidden populations, as the anonymous and confidential nature makes these services attractive to these groups.8

Are harm reduction dispensing units (HRDUs) used anywhere else?

Syringe dispensing machines were first introduced in Denmark and Norway in the late 1980s. After this, they were introduced in many countries in Europe including Switzerland, Germany, France, Italy, the Netherlands, and Austria; they are also in Australia and New Zealand.9 Currently, the only dispensing machines in Canada are in Vancouver. These two (2) units dispense safer crack-use supplies and are located at two Drug User Resource Centres. 10

What is a supervised injection service?

A supervised injection service is a health service that provides a safer and clean space where people can inject drugs with a nurse supervising. The nurse may help in case of an emergency such as a drug overdose. The nurse can also provide clinical services, health teaching, and referral to other services.

Supervised injection services usually have four (4) main goals11,12

  1. To reduce spread of infectious diseases (HIV and hepatitis C);
  2. To reduce the number of drug overdose deaths;
  3. To bring people who inject drugs into contact with other heath and social and treatment services; and,
  4. To reduce issues in the community such as drug use in public places, and discarded needles.

Services may include:

  • Distribution of supplies for safer injection
  • Supervision of a nurse while injecting
  • Safer drug use education
  • Overdose prevention and intervention
  • Medical and counselling services
  • Referrals to drug treatment

Assistance with housing and other support services13

Are supervised injection services legal?

In Canada, supervised injection services operate through an exemption under Section 56 of the Controlled Drugs and Substances Act (CDSA). The exemption allows health services to operate without the risk that its clients or staff will be charged for the crime of having illegal drugs. Exemptions are granted by the federal Minister of Health in situations that are seen as “necessary for medical or scientific purpose or is otherwise in the public interest”.14

Where else are supervised injection services operating?

 The first supervised injection service opened 30 years ago in Switzerland. Today, there are more than 90 supervised injection services in the world, mostly in European countries and Australia.15 There are two supervised injection services in Canada, both in Vancouver:

  • Vancouver’s In-site is located in the Downtown Eastside and is operated by the Vancouver Coastal Health Authority
  • Dr. Peter Centre operates a small supervised injection service that is part of their services for people living with human immunodeficiency virus (HIV).

Is there any research to support supervised injection services?

International research on supervised injection services has shown that these services are positive for people using the service as well as for the broader community. Supervised injection services have been shown to:

  • Reduce overdose deaths and save lives;
  • Reduce sharing of needles that causes HIV and Hepatitis C;
  • Increase use of detox and addiction treatment services;
  • Be cost-effective;
  • Reduce public drug use;
  • Reduce the numbers of publicly discarded needles and injection supplies;
  • No increase crime in the surrounding area.

What does the evidence say about supervised injection services and drug-related crime?

Research on Vancouver’s Insite found less public injecting, fewer publically discarded needles, and no increase in crime in nearby neighbourhoods. 17,18,19 Research in Sydney, Australia found no increase in robbery, theft, drug-related loitering or drug-related criminal offences in nearby neighbourhoods after opening Sydney’s Medically Supervised Injecting Centre.20 

Are there ‘no-go zones’ around supervised injection services?

A “no-go zone” is an area that certain people are not allowed to enter. There is concern that a supervised injection service would have a ‘no-go zone’ – an area a few blocks around the supervised injection service – that police would not be allowed to enter. There is no such thing as a ‘no-go zone’. The Ottawa Police will enforce the criminal code everywhere in Ottawa and can lay charges and seize drugs.21 According to the Controlled Drugs and Substances Act, the only place that would be exempt from drug possession laws is inside the building where supervised injection services are being offered.  Police cannot enforce drug possession laws in these locations.22 

What are the different models for providing supervised injection services?

There are three (3) models for providing supervised injection services:23,24 

  1. Fixed service that is integrated within existing health and harm reduction services
    In this model, supervised injection services are offered with other services for people who use drugs. These other services may include harm reduction services, drug treatment, health care, housing, and other social services. With this model, clients can access many needed services at one place.
  2. Fixed service that is stand-alone, not within existing health and harm reduction services
    In this model, the service is a supervised injection only. It is not with other services as with the model above. It provides a supervised, safe space for people to inject drugs. Staff can refer people to other agencies for services such as harm reduction services, drug treatment, health care, housing, and other social services.
  3. Mobile service is a van that can travel around the city to meet clients where they are
    This service is offered using a specially fitted van that has one (1) to three (3) safer injection booths where between 1 and 3 people can inject at once.  As with fixed sites, a mobile van offers harm reduction services such as needle and syringe programs (NSP), testing for HIV and hepatitis C, and referral to other services. The mobile service can travel to where people need services. 

Why do we need supervised injection services if we already have harm reduction services such as needle and syringe programs?

Supervised injection services would improve harm reduction services that are currently offered in Ottawa. Supervised injection services provide a safe and clean space for people to inject, especially for people who are homeless. While current harm reduction program staff do teach about safer drug use and overdose prevention, right now staff are not able to supervise injections and they are not able to help if someone overdoses after they have left. Without a safe place to inject, people may inject in public spaces. Injecting in public is not only an issue for people who are homeless, but people living in shared accommodation or shelters may be afraid of losing their accommodation if they inject on the premises, so they turn to public spaces.25

Won’t supervised injection services attract more people who use drugs to our community?

Most people using supervised injection services will be clients who already access harm reduction services. Research has found that people who inject drugs will only travel short distances (i.e. a few city blocks) to use health services, including supervised injection services.26,27

Why should we invest in harm reduction services rather than more treatment services? 

A “one size fits all approach” can not address the harms of drug use in our community. We need harm reduction services to provide health services to those people who are actively using drugs, and treatment services for those who want to reduce or stop using drugs.28 It is not a matter of one or the other. We need to invest in both harm reduction and treatment services to meet client needs across the spectrum of drug use. 

What are the anticipated costs of expanding harm reduction services as proposed? Who would pay for this expansion?

It is too early to know how much it will cost to expand harm reduction services in Ottawa. All involved organizations will need to explore what the costs will be for them and apply for funding as needed. 

If you have any questions, please contact the Site Needle and Syringe Program at site@ottawa.ca.

References: 

  1. Cheung, Y. W. (2000). Substance Abuse and Developments in Harm Reduction. Canadian Medical Association Journal. June 13, 2000. 162(12): 1697.
  2. British Columbia Ministry of Health (2005). Harm Reduction: A British Columbia Community Guide. Available online: http://www.health.gov.bc.ca/library/publications/year/2005/hrcommunityguide.pdf
  3. Satcher, D. (2000). Evidence-Based Findings on the Efficacy of Syringe Exchange Programs: An Analysis of the Scientific Research Completed Since April 1998. Washington, D.C.: U.S. Department of Health and Human Services.
  4. Hagan, H. et al. (2000). Reduced injection frequency and increased entry and retention in drug treatment associated with needle-exchange participation in Seattle drug injectors. Journal of Substance Abuse Treatment. 19(3), 247-252.
  5. Huo, D. et al (2005). Drug use and HIV risk practices of secondary and primary needle exchange users. AIDS Education and Prevention. 17(2), 170–184.; Watters, J. K. et al. (1994).
  6. Watters, J.K. et al (1994). Syringe and Needle Exchange as HIV/AIDS Prevention for Injection Drug Users. Journal of the American Medical Association. 271:115-120.
  7. Paone, D. et al (1995) Syringe Exchange: HIV Prevention, Key Findings, & Future Directions. International Journal of the Addictions. 30, 1647-1683.
  8. Islam, M et al. (2008). The effectiveness and safety of syringe vending machines as a component of needle syrnge programs in community settings. International Journal of Drug Policy, Dec; 19(6):436-411.
  9. Islam, M Et al. (2007). Assessing the Role of Syringe Dispensing Machines and Mobile Van Outlets in Reaching Hard-to-reach and High-risk Groups of Injecting Drug Users (IDUs). Harm Reduction Journal; 14 (4).
  10. Newspaper Article: The Province, February 11, 2014. Available online: http://www.theprovince.com/Vancouver+home+Canada+first+crack+pipe+vending+machines/9490689/story.html
  11. Strike, C et al. (2012). Toronto and Ottawa Supervised Consumption Assessment Study. Available online :  http://www.stmichaelshospital.com/pdf/research/SMH-TOSCA-report.pdf
  12. Fischer, B et al. (2002). Safer injection facilities (SIFs) for injection drug users (IDUs) in Canada, Canadian Journal of Public Health, 93(3), 336-338.
  13. Dolan, JK et al. (2000). Drug consumption facilities in Europe and the establishment of supervised injecting cetnres in Australia. Drug and Alcohol Review. 19(3):337-46.
  14. Controlled Drugs and Substances Act. (S.C. 1996, c.19).
  15. Global Platform for Drug Consumption Rooms. Available online: www.salledeconsommation.fr
  16. See Research Summary in Toronto Drug Strategy Implementation Panel (2013). Supervised Injection Toolkit. Toronto, ON. Available: http://www.toronto.ca/legdocs/mmis/2013/hl/bgrd/backgroundfile-59914.pdf
  17. Wood E., et al. (2004). Changes in public order after the opening of a medically supervised safer injecting facility for illicit injection drug users. Canadian Medical Association Journal, 171(7): 731-734.
  18. Wood E., et al.  (2006). Impact of a medically supervised safer injecting facility on drug dealing and other drugrelated crime. Substance Abuse Treatment, Prevention, and Policy, 1(1): 13
  19. Boyd N et al. (2008). Final report – Public order and supervised injection facilities: Vancouver’s SIS. Vancouver BC.
  20. Freeman K., et al (2005). The impact of the Sydney Medically Supervised Injecting Centre on crime. Drug Alcohol Review; 24(2):173-84.
  21. Personal Communication: Superintendent Cameron, Ottawa Police October 21, 2013.
  22. Controlled Drugs and Substances Act. (S.C. 1996, c.19).
  23. Drug Consumption Rooms in Europe Models, Best Practice & Challenges (2014). Available online: http://www.eurohrn.eu/images/stories/pdf/publications/dcr_europe.pdf
  24. TOSCA Report (2012). Available online: http://www.catie.ca/Sites/default/files/TOSCA%20report%202012.pdf
  25. Toronto Public Health. (2013). Supervised Injection Services Toolkit. Available online: http://www.toronto.ca/legdocs/mmis/2013/hl/bgrd/backgroundfile-59914.pdf
  26. Toronto Public Health. (2013). Ibid.
  27. Strike, C et al. (2012). Toronto and Ottawa Supervised Consumption Assessment Study. Available online: http://www.stmichaelshospital.com/pdf/research/SMH-TOSCA-report.pdf
  28. Toronto Public Health. (2013). Supervised Injection Services Toolkit. Available online: http://www.toronto.ca/legdocs/mmis/2013/hl/bgrd/backgroundfile-59914.pdf

What is being done about discarded needles in our communities?

Keeping Ottawa neighbourhoods safe is our collective responsibility. Improperly discarded needles, crack pipes, and other drug paraphernalia found in our communities have been identified as a serious concern. In an effort to promote community safety, Ottawa Public Health (OPH), along with numerous City and community partners, has implemented a variety of measures to address this issue.

Needle Drop Box Program

It is against the law to dispose of your needles, crack pipes (glass stems), or other sharps in the garbage or recycling (By-law 2009-396 Schedule J). As a result of this by-law, Ottawa Public Health created and administers the Needle Drop Box Program. This program provides Ottawa residents with secure and tamper-proof drop boxes located at 78 locations across the City to allow for the safe and convenient disposal of sharps. In 2015, approximately 876,765 needles were retrieved from the Needle Drop Boxes. For information on the safe handling and disposal of needles, please visit What to do with use needles and crack pipes or if you would like to inquire about obtaining a Needle Drop Box for your business or community, please call the Ottawa Public Health Information Line (OPHIL): 613-580-6744.

Needle Hunters Program

The Needle Hunters Program is a major component of the City of Ottawa’s corporate response to discarded needles, crack pipes, and other drug paraphernalia found in our communities. The Needle Hunters are a group of people who proactively search for and dispose of these items in priority neighbourhoods across the City. Their clean up routes are constantly monitored and adjusted in order to target areas of particular need.

In place since 1998, the Needle Hunters operate year-round, and work seven days a week. A Needle Hunters winter route was initiated in during the 2012-2013 winter season in many of the ByWard Market area parking garages and covered/accessible areas. Currently, they monitor/patrol the communities of:

  • ByWard Market/Lowertown
  • Centretown
  • Vanier
  • Carlington

In 2015, the Needle Hunters recovered 17,169 needles and 1,531 crack pipes.

Working with City services to quickly respond to discarded needles

Ottawa Public Health works with other City departments through the City Contact Centre 3-1-1 to respond to requests for the pick-up of improperly discarded used needles. The City makes an effort to respond to all needle retrieval requests within one hour. In 2015, 1,111 needles and 32 crack pipes were retrieved via collaborative action among City staff.

IMPORTANT: If you have picked up used needles or other drug paraphernalia in your neighbourhood, please report these finds to Ottawa Public Health at needlereporting@ottawa.ca and indicate the following information: 

  • Your name and contact information
  • What was found
  • How many
  • The exact or closest address to the pickup location
  • The date of the pickup

Providing needle pickup and disposal training

Ottawa Public Health provides information and training to service providers and community groups on the safe handling and disposal of needles. For more information on the safe handling and disposal of needles, please see What to do with use needles and crack pipes or call the Ottawa Public Health Information line 613-580-6744 to arrange for a training session.

Working with individuals who use needles

Ottawa Public Health operates the Site Clean Needle Syringe Program. This program operates on the harm reduction principle of providing clients with an adequate amount of sterile needles to meet their requirements for safe injecting. The main goal of this program is to prevent the spread of communicable diseases, primarily HIV and Hepatitis C, and minimize the risks associated with substance use in the greater community. Our Public Health professionals also educate intravenous drug users on how to dispose of needles safely and the risks of failing to do so. We provide them with sharps containers and information on various disposal locations. In 2015, the Site Clean Needle Syringe Program, including all of their partner agencies, retrieved approximately 453,371 discarded needles. For more information please visit the Site Needle & Syringe Program webpage.

Monitoring community needs and program effectiveness

Ottawa Public Health consults with a broad segment of the community on local needs and concerns, and carries out a number of initiatives to ensure the program’s effectiveness including:

  • tracking the number of discarded needles and drug paraphernalia found in the City and directing our programs and resources to areas in need
  • tracking and analyzing local injury and disease rates
  • ongoing research including program evaluation and implementation of best practices
  • advocating for increased resources for needle clean-up and recovery programs.
     

Estimated number of needles retrieved

Needles retrieved

2008

2009

2010

2011

2012

2013

2014

2015

Needle Drop Boxes

229,400

235,783

258, 654

245,923

*923,870

824,110

941,866

876,763

Household Hazardous Waste Depots

55,667

80,000

93,333

148,233

99,500

96,334

198, 670

68, 666

Needles retrieved by City staff

1,527

3,816

985

    1,978

1,195

751

3,037

1, 111

Needles picked up by Needle Hunters

3,350

4,094

3, 944

6,349

8,325

7,645

13,046

17, 169

Site Program & partner agencies

273,415

432,784

389, 848

435,448

404,128

428,538

451,284

453, 371

Total

563,359

756,477

746,764

 837,931

1,437,018

1,357,379

1,607,899

1, 417, 080

* In 2012, in response to concerns that needle drop box figures underestimated the total number of needles retrieved out of the drop boxes, OPH implemented a more accurate method for calculating the contents of needle drop boxes, based on sharps weight from each box.

Please note that the collection from the Needle Drop Boxes and the Household Hazardous Waste Depots is an estimate and may include other sharps and/or drug paraphernalia, much of which is used for medicinal purposes.

Estimated number of crack pipes retrieved

Crack pipes retrieved

2008

2009

2010

2011

2012

2013

2014

2015

Crack pipes picked up by City staff

545

2

44

96

34

41

7

25

Crack pipes picked up by Needle Hunters

278

1,203

1, 064

1,271

1,558

1,421

1,928

1, 531

Total

823

1,205

1, 108

1,367

1,592

1,462

1,935  

1,556

Please note that as of July 31, 2007, Ottawa Public Health no longer distributes sterile crack pipes or safer inhalation equipment.

Improperly discarded needles retrieved by ward by City staff and Needle Hunters

Ward

Total Item Count

Percentage

Undetermined

72

0.39

1

65

0.36

2

301

1.65

3

3

0.02

4

4

0.02

7

22

0.12

8

54

0.30

9

1

0.01

10

7

0.04

12

14,713

80.49

13

6

0.03

14

2,620

14.33

15

12

0.07

16

336

1.84

17

22

0.12

18

3

0.02

20

13

0.07

21

18

0.10

22

8

0.04

Total

18,280

100.00