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Opioids: What you need to know

Overdose Prevention







What are opioids? Know the risks Avoiding overdose Getting help


PLUS… • Who to call • How to help • Teens & seniors



You don’t need a referral and most therapies are covered for residents of BC. There are resources, services and medications that can help you be well. Visit your doctor or a care provider to explore treatment pathways. For more information, visit: islandhealth.ca/oat




From left, Dr. Christina Basedow, executive director Edgewood Treatment Centre; Nicole Benson, United Way Central and Northern Vancouver Island communications director; Carol Stuart, Vancouver Island University provost and vice-president academic; Sean McCue, publisher Nanaimo News Bulletin.

Who is affected? We all are. A lot of people are surprised to learn that the majority of overdose deaths occur in private residences and many of these people are employed in various trade industries. They do not use substances in public, they typically use alone, and their substance use issues are often hidden from their families, friends, and colleagues. They need our help. For the past 60 years, United Way Central & Northern Vancouver Island has been bringing together passionate individuals and agencies to collaborate, find solutions, and fund effective programs to help local people. Our efforts are now more urgent than ever. Thanks to Black Press, Vancouver Island University, and Edgewood Health Network for partnering on this resource guide. It is one more tool to help prevent harm, offer support, and provide education on this epidemic. Local, relevant resources are available to anyone in need by phoning 2-1-1 or going to bc211.ca Please donate to United Way this year to make sure life-saving programs continue to be available. Signy Madden, Executive Director United Way Central & Northern Vancouver Island

At Vancouver Island University, we are aware of the impact the opioid crisis is having on the communities we serve in the Nanaimo region and coastal British Columbia. Our faculty and students are working with local organizations on aligning and developing resources to address substance use and abuse and harm reduction approaches focused on saving lives. The Applied Environmental Research Laboratories is developing a leading-edge drug testing methodology that gives people immediate knowledge that could prevent an overdose or even death. The Centre for Community Outreach and Care helps build community support for children affected by the opioid crisis. Bachelor of Science in Nursing students conduct naloxone training for individuals. VIU is pleased to support the publication of the Overdose Prevention Resource Guide, and contribute to the well-being of the people of Vancouver Island and coastal British Columbia. Dr. Carol Stuart Interim Provost and Vice-President Academic Vancouver Island University

In 2018 BC set a disheartening record with more than 1,500 overdose related deaths. Although some of the early statistics for 2019 are cautiously optimistic, this public health crisis continues to kill approximately 2-3 British Columbians every day. Individuals, family members and the entire central Vancouver Island community has been tremendously impacted. The team at Edgewood is extremely passionate around finding a solution to help combat this crisis and has proudly partnered with Black Press Media to help publish the Central Island Overdose Prevention Resource Guide. At Edgewood we recognize the devastation associated with substance use disorders and co-occurring mental health and believe that we must work collaboratively with all our community partners in order to help combat this global problem. For over 25 years, our mission has been to provide treatment, education, training and support to individuals, families and workplaces. Together we can make a difference. Recovery is possible. Dr. Christina A. Basedow Executive Director, Edgewood




Opioid crisis BY THE NUMBERS: n 1,533 people died of drug overdoses in B.C. in 2018, including 242 on Vancouver Island n 78% of the people who died from drug overdoses were men in 2019 n 87% of deaths occur indoors n 71% of those who died were aged 30 to 59 n 0 deaths at supervised consumption and overdose prevention sites n 678 Take Home Naloxone Kits were distributed in the Island Health region in August 2019 n 291 active prescribers of Opioid Agonist Therapy in the Island Health region in August 2019

What’s inside Supervised Consumption Sites .......................5 Opioids & fentanyl...........................................6 Tips to prevent overdose.................................7 Naloxone: what you need to know ................8 Where to find naloxone ...............................10 Overdose epidemic: Who’s really affected.....12 Creating change through conversation.........13 OAT: Opioid Agonist Therapy ........................14 How to respond to opioid overdose .............16 Language matters: fighting stigma...............18 Talking with your teen about drugs...............20 Substance use in older adults .......................22 Safe disposal of medications & needles.........23 Harm reduction: what it is, how it works......24 Help for families.............................................27 Resource guide..............................................29

THERE WERE OVER 1500 SUSPECTED OVERDOSE DEATHS IN BRITISH COLUMBIA LAST YEAR. Working collaboratively with community partners to combat this crisis is critical.

TOGETHER WE CAN SAVE LIVES AND STOP THE CYCLE. Edgewood’s specialized addiction and mental health treatment programs are designed to fit the needs of every individual. Our tailor-made individual programming includes: Evidence-based therapies

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Supervised consumption is key to overdose prevention Island Health has seen more than 315,000 visits across its nine supervised consumption and overdose prevention sites on Vancouver Island since they first opened in December 2016. During the same time, staff reported more than 1,200 reversed overdoses, but zero deaths. Staff have also delivered additional supports and services to people who are using drugs and for people who are ready to begin a recovery journey, Island Health reported earlier this year. “Observed consumption services are more than just overdose prevention – these are the beginnings of a supportive community,” said Dr. Richard Stanwick, Island Health Chief Medical Health Officer. “And the staff and peers working at these locations play a vital role in addressing stigma and supporting people who are the most vulnerable.” Overdose prevention and supervised consumption services help people reduce their risk of overdose by using drugs under the supervision of trained staff, who also offer harm-reduction supplies, peer support, public health nursing, mental health and substance use supports and linkages and referrals to treatment. “Overdose prevention and supervised consumption services are a critical part of our response to the

overdose crisis,” said Judy Darcy, Minister of Mental Health and Addictions. “These services not only save lives but also connect people to treatment and recovery options and other supports to help them make safer choices and find a pathway to healing and a pathway to hope.” Island Health supervised consumption and overdose prevention sites are found in Duncan, Nanaimo, Port Alberni, Campbell River, Courtenay and Victoria. An average of 3,000 visits are made every week to these sites.

Island Health photo

“Observed consumption services are more than just overdose prevention – these are the beginnings of a supportive community.”


OPS: Services include harm-reduction supplies, 1 Duncan harm-reduction education, referrals to health services,

stance use treatment supports and access to mental health services,. Open daily from 10:30am to 11:30pm at 437 Wesley St. Nanaimo, 250-591-3999.


Port Alberni OPS – Services include education, prevenaddictions services and other social supports, and needle extion, outreach, harm reduction, naloxone kits, counselling, change services. Open daily from 1 to 7 p.m. at 221 Trunk Rd., substance use treatment and supports, access to mental Duncan, (entrance is through side door off of Ypres Street), health services. Open daily 8am to 4pm at 3699 3rd Ave., off 250-597-7779. Bute St., 778-419-0016. Nanaimo OPS: Services include education, prevention, outreach, harm-reduction, naloxone kits, counselling, sub-




OVERDOSE PREVENTION Opioids: What they are + how they work Opioids are a type of depressant that slows the body’s systems, including breathing, and can make people sleepy. They can be prescribed by a physician or used illegally. Opioids can be swallowed, injected, absorbed through the skin or inhaled or smoked, and are used to reduce pain, manage opioid dependence, or to make someone feel happy or relaxed. Common opioids include heroin, fentanyl, morphine, methadone, codeine and oxycodone.


What is fentanyl? An extremely potent opioid pain reliever, fentanyl is generally administered in a hospital via skin patch, injection or tablet, or prescribed by a doctor, to help control severe pain.

What makes fentanyl so dangerous? A cheap way for drug dealers to make we’re seeing high rates of overdoses and street drugs more powerful, illegal fentanyl related deaths. and fentanyl-like drugs such as carfentanil Illicit fentanyl is manufactured in clanare contaminating Canada’s illegal destine drug labs, overseas and in Canadrug supply. da. It may be cut into powders or At 20 to 40 times more pressed into pills, says the BC potent than heroin and Centre of Disease Control 100 times more potent website, Toward the Heart. than morphine, the risk Fentanyl is sometimes • call 9-1-1 immediately sold as fentanyl but other ilof accidental overdose is very high, especiallegal drugs can also contain • provide rescue breathing (mouth-to-mouth) ly when street drugs it, including heroin, cocaine, can contain unknown oxycodone, crack or meth. • administer naloxone amounts of fentanyl. It can It may be in powder, liquid be mixed with drugs, and is or pill-form drugs. These may found in counterfeit pills made contain toxic contaminants or have different levels of fentanyl in each batch. to look like prescription opioids. Even pills produced in the same batch may You can’t see, taste or smell it and a have little to lethal levels of fentanyl. few grains can be enough to kill you – why

Overdose: What to do:







Overdose is most common when: n Your tolerance is lower: you took a break, were in detox/ treatment or jail, or you are new to use n You have been sick, tired, run down, dehydrated or have liver issues n You mix drugs: prescribed or not, legal or illegal n The drugs are stronger than you are used to: changes in supply, dealer, or town

What an opioid overdose looks like: n Person cannot stay awake n Can’t talk or walk n Slow or no pulse n Slow or no breathing, gurgling n Skin looks pale or blue, feels cold n Pupils are tiny or eyes rolled back n Vomiting n Body is limp n No response to noise or knuckles being rubbed hard on the breast bone

TIPS TO PREVENT OVERDOSE n Know your health status and your tolerance. n If using, take one substance at a time (don’t mix with alcohol). n Use with friends. If you use alone, leave the door unlocked and tell someone to check on you. n Be aware: using drugs while on prescribed medications can increase overdose risk. n Do testers to check strength. Use less. Pace yourself. n Talk to an experienced person or a trusted healthcare provider about reducing risk. n Know rescue breathing and carry a naloxone kit.

Choose a safer route of taking drugs SAFER / NO USE





From Toward the Heart/towardtheheart.com OVERDOSE PREVENTION RESOURCE GUIDE




What is naloxone?

Naloxone: What you need to know to save a life What do we mean by opioid overdose? An overdose happens when the body is exposed to a toxic amount of a substance or combination of substances, and it can happen to anyone, regardless of substance use history, explains Toward the Heart in its Naloxone Administration course (towardtheheart.com). In response, the body cannot maintain the processes necessary for life, such as breathing, heart rate or body temperature. Someone experiencing an opioid overdose might exhibit slow, shallow irregular or no breathing, for example, may be unresponsive – you’re unable to wake them up – they may make unusual gurgling, snoring or choking sounds, and they may have blue lips or nails, cold, clammy skin and tiny pupils. While an overdose isn’t necessarily fatal, without quick treatment, brain damage can result. Naloxone is the drug used to counteract the effects of an opioid overdose and it’s available in BC without a prescription. Naloxone temporarily reverses life-threatening slowed breathing that accompanies an opioid overdose. While it doesn’t work with non-opioid drugs, such as cocaine or ecstasy, it won’t hurt the individual if they haven’t used an opioid. And if multiple substances have been used, administering naloxone will address the opioid. To administer naloxone, it can be injected into a large muscle, such as a thigh, upper arm or buttock, or given as a nasal spray. 8


Naloxone is a medication that reverses the effects of an overdose from opioids, such as heroin and fentanyl. It is available in BC without a prescription.

While naloxone works quickly – within three to five minutes – it stops working within 20 to 90 minutes and if overdose symptoms return, additional doses may be required. Naloxone kits Naloxone kits are available at no cost to people at risk of an opioid overdose or those likely to witness or respond to an overdose – such as the friends or family of someone at risk. Kits are also available for purchase from pharmacies, where pharmacists can instruct you how to administer it. Included in the kits are instructions about responding to someone who is overdosing, naloxone and syringes to administer it, alcohol wipes, gloves, disposable breathing mask. Learn more: If you’d like to learn more about naloxone and how to administer it in case of an overdose, Toward the Heart offers both a free online course and a video. The course, which takes just 15 to 20 minutes to complete, walks you through both background information and the administration of naloxone, including several instructive videos. Take the free, online course at towardtheheart.com/ naloxone-course • Learn more about overdose prevention at towardtheheart.com • For more information on overdose awareness in BC, visit stopoverdose.gov.bc.ca.

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Where can I find NALOXONE? Take-home naloxone kits are available at no cost to: • people at risk of an opioid overdose • people likely to witness and respond to an overdose such as a family or friend of someone at risk DUNCAN Margaret Moss Health Unit – Duncan 675 Canada Ave., 250-731-1322. Festubert (Youth only 12-24) – Duncan 371 Festubert St, 250-732-2395. OPS: Duncan - Trunk Road (CMHA) 221 Trunk Rd, 604-378-4010. Phoenix Wellness Clinic – Duncan 5878 York Rd, 604-260-7252. Cowichan District Hospital – Duncan 3045 Gibbins Rd, 250-737-2000. Duncan Mental Health & Substance Use Services 3088 Gibbins Rd, 250-709-3000.

Central Island Communicable Disease – Nanaimo

Cowichan Lodge – Duncan

8 - 1599 Dufferin Cresc, 250-740-6942.

2041 Tzouhalem Rd, 250-709-3098.

Gabriola Medical Clinic


695 Church St.,Gabriola Island, 250-247-9922.

Ladysmith Community Health Centre 1111 4th Ave, 250-739-5777. NANAIMO AVI – Nanaimo 102 - 55 Victoria Rd, 250-753-2437. Harris House – Nanaimo 375 Franklyn St, 250-753-6759. Nanaimo Mental Health & Substance Use Services/ACT Team 526 Wentworth St, 250-740-6998. Wesley St. OPS (CMHA) – Nanaimo 437 Wesley St., 250-591-3999. Trew Beginnings Clinic – Nanaimo 200 - 55 Victoria Rd, 250- 591-6454.

PORT ALBERNI NTC Port Alberni Quassa Office 4841 Redford St. Port Alberni Health Unit 4201 6th Ave., 250-731-1315. Port Alberni Safe Sobering Site 3628 5th Ave, 250-723-6511. Port Alberni Mental Health & Substance Use Services 4780 Roger St, 250-731-1350. West Coast General Hospital 3949 Port Alberni Hwy. Hupacasath First Nation 5500 Ahahswinis Dr, 250-724-4041.

Beach Medical Centre – Qualicum 703 Beach Rd, 250-752-2080. UCLUELET West Coast Mental Health & Substance Use 272 Main St, 250-726-1382.

PHARMACIES MILL BAY Island Pharmacy – Mill Bay Suite A - 845 Deloume Rd, 250-743-4421. Pharmasave – Mill Bay 11-A - 2720 Mill Bay Rd, 250-743-9011. DUNCAN Ingram Clinic Pharmacy – Duncan 101 - 149 Ingram St. STS Pain Pharmacy – Duncan 725 Canada Ave, 250-597-1612. Shoppers Drug Mart – Duncan 361 Trans Canada Hwy, 250-746-6118.

Tillicum Lelum Aboriginal Friendship Centre – Nanaimo


Real Canadian Superstore – Duncan

Community Services Centre

291 Cowichan Way, 250-746-0535.

602 Haliburton St, 250-753-6578.

245 Hirst Ave. W, 250-248-2093

London Drugs – Duncan

Nanaimo Health Unit

Oceanside Health Centre

119 Trans Canada Hwy.

1665 Grant Ave, 250-755-3317.

489 Alberni Hwy, 250-951-9550.

Save-On-Foods – Duncan

Nanaimo Regional General Hospital

Parksville Family Place/ Oceanside PH – 494 Bay Ave., 250-947-8242.

181 Trans Canada Hwy, 250-709-2378


Continued next page


NALOXONE RESOURCES Naloxone is available in BC without a prescription. In addition to take-home naloxone kits available at no cost for patients who use drugs or those are likely to witness an overdose (see list of locations on pages 10 and 11), naloxone kits are available for purchase at local pharmacies, where pharmacists can also provide instruction about administering it. Naloxone for Not-for-Profit Organizations: Notfor-profit organizations that work directly with clients at risk of opioid overdose may be eligible to participate in the Facility Overdose Response Box (FORB) program. Naloxone for Businesses: BCCDC THN kits are not currently available for private businesses, however, both intranasal and injectable formulations and supplies can be purchased from a community pharmacy. Pharmacists can provide training at the time purchase. Group Training for Businesses: Group training

Where can I find NALOXONE? .

Did you know?

sessions in Overdose Recognition and Response are Fentanyl is 20 to 40 times available in BC through St more potent than heroin John Ambulance. and 100 times more poNaloxone for Health tent than morphine, makCare Providers: Health ing the risk of accidental care employees seeking overdose very high. naloxone for use in the workplace should speak to their employer or regional Health Authority. Naloxone for medical offices: Clinics wishing to have naloxone on-site in case of an overdose can purchase naloxone and any related supplies from a local pharmacy, which should also be able to provide training on how to safely administer it, according to guidance by the College of Pharmacists of BC in collaboration with the BC Centre for Disease Control.

Continued from page 10

Thrifty Foods – Duncan

Central Drug Store – Nanaimo

No Frills – Port Alberni

2755 Beverly St, 250-715-2654.

101 - 1125 Dufferin Cres.

3455 Johnston Rd, 250-723-1624.


RX Ram Pharmacy – Nanaimo

Rexall – Chemainus

103 - 1629 Townsite Rd, 250-714-0703.


9762 Willow St, 250-246-3821.

Save-On-Foods, Brooks Landing – Nanaimo

LADYSMITH Pharmasave – Ladysmith 441 1st Ave, 604-245-3113.

103 - 2000 Island Hwy. Shoppers Drug Mart, Country Club Mall – Nanaimo

Shoppers Drug Mart – Parksville 154 Memorial Ave, 250-248-3162. Shoppers Drug Mart – Parksville 140 Island Hwy. E, 250-248-3611. Thrifty Foods – Parksville


38 - 3200 Island Hwy, 250-756-4991.

280 East Island Hwy, 250-947-2535

Pharmasave – Nanaimo

Thrifty Foods – Nanaimo

Pharmasave – Parksville

5 - 1273 Island Hwy. S, 250-755-1830.

5801 Turner, 250-729-7240.

281 East Island Hwy, 250-951-0243

Central Drug Store – Nanaimo 346 Campbell St., 250-753-5342.

Central Drug Store, Brickyard – Nanaimo

818 West Island Hwy.

Central Drug Store – Nanaimo

102 - 6010 Brickyard Rd., 250-751-2576.

Pharmasave – Qualicum

LANTZVILLE Central Drug Store – Lantzville 7186 Lantzville Rd.

Memorial Compounding – Qualicum

495A Dunsmuir St. Central Drugs (Pacific Station) – Nanaimo 5160 Dublin Way, 250-585-6178. London Drugs – Nanaimo 2 - 650 South Terminal Ave. London Drugs (North Town Centre) – Nanaimo 175 - 4750 Rutherford Rd. Shoppers Drug Mart, University Village – Nanaimo 102 - 510 5th St, 250-753-8234.

Save-On-Foods – Parksville

720 Memorial Ave. 699 Memorial Ave.

NANOOSE Nanoose Medicine Centre

Qualicum Medicine Centre

4 - 2451 Collins Cres, 250-468-9921.



Pharmasave (Campbell St.) 360 Campbell St Pharmasave (First St.) 131 First St, 250-725-4949.

Shoppers Drug Mart, Port Alberni Plaza 3717 10th Ave, 250-723-7387. Shoppers Drug Mart – Port Alberni 1 - 3855 9th Ave, 250-723-6641.

2 - 219 Fern Rd. W.

UCLUELET Harbourview Drugstore 1892 Peninsula Rd, 250-726-2733. OVERDOSE PREVENTION RESOURCE GUIDE



Opioid epidemic: Who is really affected? Who is affected by the current opioid overdose epidemic? “All of us,”says Central Vancouver Island Medical Health Officer Dr. Paul Hasselback. “We’re all affected by the opioid crisis. There are very few people I speak to who haven’t been affected in some way – whether through a friend, family member or neighbour,” Dr. Hasselback says. “It has become an ‘every person’ crisis.” One of the biggest myths around the current crisis – that it largely affects those living on the street – is just that: a myth. In fact, here in the Island Health region, more than 70 per cent of people who died of an overdose were living in a private residence. Only 11 per cent were homeless. Nearly half of males were employed at the time of death. However, while the majority also died in their homes, many also died alone, pointing to the importance of reducing stigma around drug use and harm reduction measures, including the recommendation that individuals who are going to use, not use alone. (See page 5). “Using alone in a home is certainly one of the highest risk factors, (and) the rhetoric around substance use is part of what’s killing people. Substance Use Disorder is a chronic, relapsing disease and it’s a constant struggle for individuals,” Dr. Hasselback says. Rather than being stigmatized, “people need to be embraced for trying to address Substance Use Disorder.” Of the overdoses reported in the region, many involve individuals who are employed. While statistics still show a predominance of males involved, over the last 12 OVERDOSE PREVENTION RESOURCE GUIDE

few years, more women have been affected, with one-quarter of all fatalities women, Dr. Hasselback notes. Further, 95 per cent of fatalities have involved those between the ages or 20 and 65, he adds. Island Health also notes that no overdose deaths have happened at a harm-reduction site. How do people come to opioid use? In some cases, a dependency emerges from previous emotional, psychological or physical trauma; other times a work or recreational injury; and in other cases, disposable income and recreational drug use can either grow into a dependence, or can lead to an accidental overdose when other drugs are laced with more lethal drugs, such as fentanyl. Those who are found to be using while on the job often do so to reduce symptoms of withdrawal, which can include severe flu-like symptoms, or to mask pain, not to get high, notes Dr. Richard Stanwick, Island Medical Health Officer. Among the Indigenous community, it’s estimated the impact is three to

five-times higher than the general population, Dr. Stanwick says, noting Island Health works closely with the First Nations Health Authority to support those communities.

A provincial health emergency Because testing has shown fentanyl to be present in so many illicit drugs in BC, typically finding its way into the province via drug producers in China, recreational users are also at risk. University students may believe their source of Ecstasy, for example, is trustworthy, only to fall victim to unintentional consumption of fentanyl. The impact of the opioid crisis – declared a provincial health emergency in 2016 – “has forced us to recognize the dependency on opioids,” Dr. Stanwick says. “It’s forced us to rip off the bandage, so to speak, and recognize the lethality of it. “It’s also estimated that the crisis has actually driven down the life expectancy of the province by as much as a


Creating tangible change through conversation Creating change often begins with a conversation. The Central Island’s Tillicum-Lelum Aboriginal Friendship Centre hosted the Opioid Dialogue and Community Engagement project earlier this year to bring people together in conversation about the opioid crisis. Largely funded by the University of Victoria’s Centre for Addictions Reaserch BC, with contributions from the Nanaimo Community Action Team, the six community discussions welcomed a broad cross-section of people to explore opioid use in the community. The dialogue began by creating a meaningful space

for people to share their experiences and explore what’s working and where gaps exist, says Bryn Tuba, Practicum Coordinator at the Friendship Centre. From those first sessions, the project then looked at two areas where tangible action could be readily undertaken: Grief and loss support, and greater access to peer support, Tuba says.

For example, while various grief and loss supports are available, the sessions highlighted that people often don’t know about those supports or have difficulty accessing them. The opportunity to provide greater peer support speaks

to the value to people who are using substances of being able to speak with someone who has experienced similar circumstances – “someone who has been through it themselves, and who understands the struggle,” Tuba explains. Emerging from that have been initiatives such as a low-barrier, dropin group at the Friendship Centre, co-facilitated by a substance use counsellor, that can help bridge gap to services and services. To learn more, visit tillicumlelum.ca

Opioid epidemic Continued from page 12 year,” Dr, Stanwick says. And with people often dying in their most productive years, it also affects the province’s economy, all in addition to the various tolls on the health care system, from the financial drain to the burnout among health care workers and first responders. Even for those who benefit from live-saving naloxone, the life-long impacts of the crisis can continue to be felt, whether from the long-term effects of addiction or brain damage that can come from non-fatal overdose. “We have to look at the dependency as a medical term that reflects the human brain and as with all dependency we should treat that from a health perspective.” Dr. Hasselback compares the public perception of the problem to where society was with mental illness two decades ago. Recognizing the truths of the crisis, “everyone needs to step up their level of compassion and understanding,” he says. “We need to have caring communities where everyone is treated with compassion, support and access to services that will take them from where they are to a healthier place.”

Have you lost a loved one due to an opioid overdose? We can help. 1080 St. Geo rge Cres cen t • Nanaimo BC • Tel 250 -591-8811 OVERDOSE PREVENTION RESOURCE GUIDE




OAT: Effective treatment for opioid addiction Opioid Agonist Therapy – or OAT – has been effectively used to treat opioid addiction for decades, but today, more options are available to individuals seeking an effective treatment for addiction to opioid drugs such as heroin, oxycodone, fentanyl and Percocet. Patients take medications such as Methadone, buprenorphine (Suboxone) or Kadian to prevent withdrawal and reduce cravings for opioid drugs. Not only do the medications reduce risk for overdose and other dangers associated with using opioids, but they also reduce risk for relapse and promote connections with health and substance use services. “The best way to reduce the risk of overdose if you have opioid addiction is to be on one of these treatments,” says Island Health’s Dr. Ramm Hering. How Opioid Agonist therapy works: “Very quickly after starting to use opioids, you become physically dependent,” Dr. Hering says. Biology plays a big role in this process as people suffering from opioid addiction have brain changes that play large part in people continuing to use. Once that happens, anywhere from an hour to six hours after using, a person will start feeling flu-like symptoms of withdrawal. With OAT, the long-acting opioid medications keep people out of physical withdrawal for 24 hours, “so they can get on with their normal life,” Dr. Hering explains. “It helps stabilize the person, giving them the space they need to work on the other challenges such as physical and mental health concerns, housing and financial instability and other personal challenges that are contributing to their harmful substance use.” 14 OVERDOSE PREVENTION RESOURCE GUIDE

By acting slowly in the body, the therapy prevents withdrawal without causing a person to get high, Dr. Hering explains. OAT also helps to reduce or eliminate cravings for opioid drugs. Treatment works best when combined with other types of support, like individual or group counselling. Each of the three OAT treatments has its own pros and cons patients should discuss, and each person will tolerate the treatments differently. Methodone, for example, has been used for more than 50 years. Because there’s a higher risk of overdose, patients will go to their local pharmacy for their dose for at least the first three months as they stabilize. The dose is gradually increased until they are symptom-free for the full 24-hours. Methodone can have

significant interactions with other medications and be tolerated poorly by people with certain other medical conditions, so needs to be prescribed very carefully. Suboxone is much less risky for overdose and patients who are stable can have their treatments at home quite quickly after starting, Dr. Hering says. However, it’s often challenging for patients to start as they typically need to be in moderate withdrawal to start it. Kadian carries a higher risk, so patients typically continue to take it at the pharmacy through the course of treatment. Methadone is taken as a drink, Kadian is a capsule with beads that is typically opened in the pharmacy and taken in apple sauce/pudding, while

OVERDOSE PREVENTION Continued from previous page Suboxone is a tablet that’s dissolved under the tongue. How to get treatment: You don’t need a referral for OAT treatment, and it can be discreetly prescribed by a physician or nurse practitioner. Simply contact your primary care provider, visit a walk-in clinic or contact a community OAT clinic to learn about treatment availability. You can also ask your care provider if you qualify for free OAT treatment. While any doctor can prescribe Suboxone, Methadone and Kadian are a little more specialized, Dr. Hering says. How you’ll feel on OAT: When first starting treatment, you may feel lightheaded or sleepy for a few days, but will quickly develop a tolerance to these effects, explains Canada’s Centre for Addiction and Mental Health. OAT doesn’t provide the high, but it can help keep the

physical cravings at bay. While people take OAT for years without any ill effects, they are powerful drugs and can be extremely dangerous if taken by someone other than the intended patient, so never sell or give away any of your dose. Children are particularly at risk – even a small amount can be fatal.

allows you to work on some of those underlying factors that drew you into addiction, such as physical pain or emotional trauma. “Part of recovery from addiction is learning how to tolerate distress,” Dr. Hering says. Learn more at islandhealth.ca/oat or camh.ca.

Looking forward: How long will you need to use OAT? Typically treatment will last at least a year or two, and many people will stay on OAT for many years, Dr. Hering says. If you do decide to stop OAT, it’s best to taper off the medication very slowly while simultaneously working to strengthen all other addiction supports. While timelines will vary with each person, stopping OAT before you’re ready carries a high risk of relapse and of overdose. Continuing OAT over a longer term helps keep you safe, and

OAT on the Central & North Island Since January 2016, the number of persons on OAT in the combined Central and North Island areas has increased by 75 per cent, says Dr. Paul Hasselback. At the end of August 2019, some 2,500 persons were on OAT; or, for every 1,000 area residents (including children), 6.4 people are currently on treatment for opioid substance use disorder.

Symptoms of opioid withdrawal For those using an opioid, substitution therapy is typically better than trying to go into withdrawal alone, which often leads to relapse, Island Health notes. During withdrawal from opioids, common – but temporary – symptoms include: Acute Withdrawal (first stage) • Heroin, morphine, oxycodone and hydromorphone – Symptoms appear 2 to 12 hours after the last dose, increase over the next three days and gradually disappear over 7 to 10 days. • Methadone – Symptoms appear 24 to 48 hours after the last dose, increase over the next 3 to 6 days, and gradually disappear over 3 to 6 weeks. • Fentanyl patch – Symptoms appear 8 to 24 hours after the last patch, increase over the next several days and gradually disappear over 1 to 2 weeks. • Buprenorphine (the opioid in Suboxone): Symptoms appear 1 to 3 days after last dose, increase over the next

3 to 7 days after the last dose and may continue for 2 to 6 weeks. • Codeine – Withdrawal is similar to morphine, but typically less intense. Typical symptoms, by frequency, include: Physical symptoms • muscle, bone and joint pain, especially in the legs and lower back • sweating, alternating with chills and waves of goose bumps • loss of appetite, nausea, vomiting, stomach cramps, diarrhoea • restlessness, nervousness, weakness • muscle spasms and kicking movements • insomnia • fever, headache, flu-like feeling • rapid heart rate • runny eyes, runny nose, sneezing, yawning Psychological Symptoms • anxiety

• obsession with getting the drug • irritability Post Acute Withdrawal (second stage) The symptoms can last for 2 to 6 months, gradually decreasing: Physical Symptoms • insomnia • weakness, tiredness • poor appetite • muscle aches Psychological Symptoms • unable to tolerate stress • overly concerned about physical discomfort Island health notes that times are approximate; individuals may have symptoms for a shorter or longer period of time. If any persist or worsen, have them checked by your doctor in case they are related to another problem. OVERDOSE PREVENTION RESOURCE GUIDE







Check for 1 or more of these signs of an overdose: LIPS AND NAILS are blue or grey




ST SNORIN or coug or cho




SNAP OFF T HE TOP OF THE AMPOULE It will break in two pieces with little pressure.







UNWRAP SYRINGE. PUT NEEDLE IN LIQUID, PULL UP PLUNGER Try to draw up all of the ampoule’s liquid into the syringe.

Turn the needle facing tip-up, gently push the plunger until most of the air is pushed out.


FIRMLY PUSH NEEDLE IN THIGH, BUT T, OR UPPER ARM MUSCLE Needle can go through clothes. Never put it in the heart.


It will click an will retr

TIPS ON HOW TO GIVE BREATHS : Give 1 breath every 5 – 6 seconds (or 10 – 12 times per minute). Check airway, remove anything blocking the airway.

You can breathe through the protective face shield from the kit.

Keep an eye on the chest to see if it is rising while you give breaths, and falling as the person exhales. Document source: www.fraserhealth.ca


you give goes into the lungs and doesn’t escape through the nose. Tilt the head back to open the th If person becomes ill, put person in recovery position.

Are you by yo Prepare the na between givin

Is someone e Have that per while you pre


Overdoses are a medical emergency & n eed medical care.

TRANGE NG SOUNDS ghing, gurgling, oking sounds


CALL 9 1 1


CANNOT BE WOKEN UP after you call their name or nudge their foot

1. Tell them your location. 2. Explain how the person is not breathing and not responsive.

RUB YOUR KN UCKLES HARD AGAINST THE IR UPPER CHEST To wake the person up. Call their name. Still unresponsive? If you haven’t already,

CALL 9 1 1 NOW.

Giving breath is critical. Give 1 breath ever y 5 seconds whether you have naloxone or not. Lorem ipsum

PERSON STILL UNRESPONS IVE? CONTI NUE TO N EXT STEP Person breathing normally? Stop here.

PINCH NOSE, GIVE 2 BIG BREATHS USING FACE SHIELD FROM KIT OR OTHER BARRIER IF NEEDED Check to make sure the chest rises when you give air.

TILT HEAD B ACK, CHECK AIR WAY Remove anything blocking the mouth’s airway.



nd needle ract.

ourself? aloxone ng breaths.

else w ith y ou? rson give breaths epare the naloxone.


1. Explain what happened because they may have forgotten overdosing. 2. Discourage more substance use for now. The sick feeling will go away nutes). when the naloxone w 3. Wait for the ambulance and encourage the person to go to the hospital. 4. Stay calm, now is not a good time to get upset with the person who overdosed.

Continue to give 1 breath every 5 seconds.


Hand supports the head

If you need to leave, or if the person becomes ill, put them in this position:

Knee stops the body from rolling forward onto stomach

For more information visit: www.viha.ca/mho/overdose




How to reduce stigma, and why that’s important When discussing substance use and the current overdose crisis, does language matter? Yes, say the province’s health professionals. “Treating people who use substances with respect improves health outcomes and helps save lives,” explains the BC Centre for Disease Control’s Toward the Heart website. The foundation of Toward the Heart – towardtheheart.com – is that every person has the right to the best health possible and should be treated with dignity and respect. It’s in this belief that Language Matters. The goal is to encourage the use of respectful, non-stigmatizing language when describing substance use disorders, addiction and people who use drugs. “Whether used in a healthcare setting or in the news media, negative and stigmatizing language discredits people who use drugs and can result in discrimination,” Toward the Heart explains. 18 OVERDOSE PREVENTION RESOURCE GUIDE

“Stigmatization contributes to isolation and means people will be less likely to access services. This has a direct, detrimental impact on the health of people who use drugs.” How can we change the conversation around overdose? • Use people-first language. This means referring to a person before describing his or her behaviour or condition – important because it acknowledges that a person’s condition, illness or behaviour is not that person’s defining characteristic. For example,“person with a cocaine-use disorder” instead of “cocaine user” or “addict.” • Use language that reflects the medical nature of substance use disorders. Numerous factors contribute to drug addiction, from personal factors to social, environmental and political ones. Avoid terms that reinforce a belief that addiction is a failure of morals or personality, rather than a medical issue. Use “addictive disease” and “substance use disorder” instead of “abuser” or “junkie.” • Use language that promotes

Supporting a loved one? “The most important thing in terms of family members is just understanding that addiction is an illness,” says Island Health’s Dr. Ramm Hering. “Very quickly when you become physically dependent, it’s not a choice. Have compassion for people with substance use – meet them where they’re at without judgment.”

recovery. Use language that conveys optimism and supports recovery, and respects the person’s autonomy, such as “opted not to” and “not in agreement with the treatment plan” instead of “unmotivated” or “non-compliant.” • Avoid slang and idioms. Slang terms and idioms have negative connotations and a significant level of stigma attached to them – use “positive” or “negative” when referring to drug tests, for example instead of “dirty” or “clean.” For information, including a video about creating a safer space with less stigma, visit towardtheheart.com/reducing-stigma


Helping kids make healthy decisions Starting children along the path of healthy choices begins at home, from modelling healthy behaviour to building strong decision-making skills. By making healthy, responsible decisions around your own use of substances, including caffeine, alcohol, tobacco, doctor-prescribed drugs and illicit drugs, you demonstrate positive behaviour for your children to mimic, says HealthLink BC. This can help children as they grow older and may be more influenced by peers. What can you do? Take care of yourself emotionally and physically and enjoy a healthy, balanced lifestyle. Practice safe behaviours and avoid injury. Follow your prescriptions – stick to the label instructions to show you respect medicines, trust your doctor, and cultivate a healthy relationship with drugs. Demonstrate other ways to

relieve or manage pain besides using opioids or other substances, like going for a walk, meditation or drinking plenty of water. The more equipped children are with strategies to manage pain and other problems, the better able they’ll be at embracing challenges with hope and confidence in their selfcare skills. If you feel you’re becoming dependent on a substance, talk to someone who may be able to help you re-establish a healthier relationship with substance use. This shows you can recognize a problem and address it. Help Kids Make Healthy Decisions By helping children learn how to make healthy decisions now, you may be able to help them avoid unhealthy habits later on: • Help them think through reasons they might choose to follow an example or not.

• Talk through your own reasons for making decisions and show how you decide on those steps. • Offer a manageable number of options when kids are making simple decisions – do you want to bake muffins, cookies or banana bread? • Sharpen thinking skills with what-if scenarios – what would you do if you won $100? Who would you choose to go on vacation with if we could bring someone? What would you do if you were invisible? • Encourage slower thinking about decisions so they don’t jump at the first thing they see – why would they rather go skating than play cards? What would happen if they made a different choice? • Help them reflect on decisions afterwards – what was good about their decision? What was not so good? Learn more at healthlinkbc.ca

Education. Community. Commitment. 3 things needed to address this public health crisis Vancouver Island University is working in partnership with community agencies and conducting research that is helping address the devastating challenge related to substance use and abuse and addiction on the Island and in BC coastal communities we serve.  VIU’s Applied Environmental Research Laboratories (AERL) is developing leading edge drug testing methodology that could save lives in this opioid epidemic.  VIU’s Centre for Community Outreach and Care (CCOC) is helping build community support for children and youth affected by the opioid crisis.  VIU’s Bachelor of Science in Nursing students are engaging the VIU community in harm reduction activities including providing a platform for dialogue about the opioid crisis and offering naloxone training.

viu.ca 17-09-8101




A traumainformed approach to substance use Island Health encourages a trauma-informed approach when discussing drug use and overdoses. This means recognizing and acknowledging trauma, and being aware and sensitive to its dynamics. Some youth may be more affected by these subjects than others. Youth may have witnessed family members, friends or significant others using substances, or they may have used themselves. Youth who have suffered recent losses or who are coping with grief or toxic stress may also be triggered by overdose materials and education. Teachers are experts in what is developmentally appropriate in educational settings.



with your teens about drugs While talking about drugs with your teen may not be easy, it is essential. Chances are teens are hearing about drugs anyway – from friends or social media, for example – but there’s a good chance at least some of that information won’t be accurate. Sharing factual information and your values, and teaching them how to make safe, healthy decisions about substance use can help prepare them. While it’s never too early or too late to talk about substance use with your kids, the recent rash of fentanyl-related incidents is a reminder of just how important this conversation is, notes Island Health. Keeping that line of dialogue open may let them talk about concerns they have about someone else who is using drugs or about their own use. They may want to talk about finding help to stop. Regardless of their questions, it’s important to provide accurate information. Health Canada offers the following suggestions: • think ahead about what you want to discuss but avoid saying everything you


think all at once. • look for opportunities to mention drug use, like when discussing school or current events. • offer teens control and let them pick the time and place. • give them room to participate and ask questions. • respect their independence and their opinion. • avoid being judgmental. • listen – if you’re a good listener they may be more inclined to trust your input. • tell them you’re trying to help them make good decisions by sharing information they may not already have. • be clear about why you’re worried and tell them that your main concern is for their well-being. • focus on facts rather than emotions; as a parent, if your teen is using drugs you may feel anger, sadness, fear or confusion, however talking about the issue is more productive than talking about your feelings. Learn more at islandhealth.ca and Canada.ca.


IS YOUR TEEN USING DRUGS? HELP IS AVAILABLE If you love and worry about a teenager who may be experimenting with or regularly engaged in relationship with alcohol or other drugs, you’re not alone. The Island Health workbook, Recognizing Resilience: A Workbook for Parents and Caregivers of Teens Involved with Substances, can help you understand and respond to substance use. Find additional information and support at Island Health’s Youth & Family Substance Use Resources (islandhealth. ca/learn-about-health/ substance-use-addiction/youth-substance-use). A consultation with a substance use counselling professional may also be beneficial for your family. Ask your family doctor or other health care professional for referrals, and visit Island Health’s Youth and Family Substance Use Services page.

Youth & family resources

illegal opioid drugs such as heroin and carry dangerous, unpredictable risks including addiction, overdose and death. To learn more: islandhealth.ca/learn-about-health/ substance-use-addiction/youth-substance-use

More resources

Additional resources are available from Here to Help, a project of the BC Partners for Mental Health and Substance Use Information, and From Grief to Action, a volunteer-based Some prescription drugs, BC not-for-profit providing a voice and a To learn more about local such as opioid pain relievers, support network for families and friends organizations providing serstimulants and benzodiazeaffected by drug use. vices for youth and families, pines, are used to get high Learn more at fromgrieftoaction.com and see the Resource Guide, because they have psychoactive heretohelp.bc.ca pages 29 to 31. – or mind-altering – properties. You’ll also find a toolkit (heretohelp.bc.ca/ In fact, Health Canada notes workbook/fgta-coping-kit) for parents or carethat psychoactive pharmaceuticals are givers concerned about a son or daughter’s early the third most commonly used substances experimental substance use or more serious substance among Canadian youth, after alcohol and cannabis. use. Find information about drugs and substance use, However, taking prescription drugs without a docstrategies for supporting a loved one, strategies for tor’s approval is dangerous and can be fatal. taking care of yourself, and treatment options – all from Prescription opioids can be just as dangerous as families who have been there themselves.

Talking about prescription drugs




SUBSTANCE USE IN OLDER ADULTS While many people think alcohol and drug problems only involve teens and younger adults, all ages can experience problems with drugs and alcohol, including older adults. Like any demographic, substance use in older adults carries risks beyond health concerns, and can cause potential problems involving money, legal issues and relationships with family and friends, explains HealthLink BC. Often, drinking or misusing medicine or drugs starts after a major life change, such as retirement, the death of a spouse or good friend, or a disease diagnosis. However, substance use in older adults may be overlooked. Why? Older adults are more likely to drink or use drugs at home rather than in public, and may not have responsibilities such as going to school or work that are affected by substance use. Additionally, signs of substance use can be similar to those of other health problems many older adults have, such as depression and dementia. In some cases, caregivers or families may be aware of the problem but may not want to discuss it. Alcohol – Older adults may need less alcohol than someone younger before become intoxicated, and because their bodies process alcohol more slowly, they may stay drunk longer. Older adults may also have vision and hearing problems and slower reaction times, which alcohol can worsen, putting them at greater risk for alcohol-related falls, car crashes and other kinds of accidents. As older adults may be taking numerous prescription and over-thecounter medications, they’re more likely to mix these with alcohol which can be dangerous, HealthLink BC notes. Medicines – This includes taking too much medicine or taking medicine when you don’t need to, using older medicines or another person’s med22 OVERDOSE PREVENTION RESOURCE GUIDE

icine, taking medicine to feel good or “high” or taking medicines while drinking alcohol. Others don’t take medicine as their doctor directs, such as not taking enough medicine or skipping doses.

Warning signs of substance abuse Signs of alcohol or drug use problems in older adults can include changes in behaviour and mental abilities. If concerned, a discussion with your doctor should include the drinking or medicine use, now and in the past, as well as over-the-counter medicines, herbs and dietary supplements.

Behavioural changes: • Falling a lot. • Experiencing incontinence. • More headaches and dizziness than usual. • Not keeping yourself clean. • Changing what and how you eat – you may not eat as much, for example. • Ignoring or losing touch with family and friends. • Beginning to think about suicide. • Beginning to have legal or money problems. • Changes in mental abilities

Mental signs of drug or alcohol use problems: • Begin to feel anxious much of the time. • Memory worsens. • Difficulty focusing or making decisions. • Losing interest in usual activities. • Mood swings or feeling sad or depressed. It’s important to remember that many of the signs listed here can also can be signs of other health problems many older adults have – not necessarily concerns with alcohol or drugs.

What does treatment look like? Treatment for challenges with alcohol or drug among older adults is the same treatment as for others. In addition to detoxification, medicine and counselling, therapy and 12-step or other support groups may be used. If medicine misuse is the problem, talking to a doctor, friend or family member may help. Treatment could be as simple as learning more about your medicines and organizing how you take them. You may be able to work with your doctor to reduce how many medicines you take or make it easier to take them. Learn at healthlinkbc.ca

Safe disposal of your medications What do you do with your unused or expired medications? If you’re like many people, you toss them in the garbage or down the drain. Not a good idea. Medication that goes down the drain ends up in the ocean, where it can have a negative effect on the marine environment. And medication in household garbage is not only easily accessible to children, pets and wildlife, but once it reaches the landfill, it can enter the leachate collection system and eventually wind up in the marine environment.

It’s easy to safely dispose of expired or unused medications. Simply take your medications to one of the many pharmacies participating in the Medications Return Program. Simply look up nearby return locations by using your postal code at healthsteward.ca Administered by the Health Products Stewardship Association, funded by brand-owners selling pharmaceuticals in BC, the program collects expired or unwanted medication for proper and safe disposal. In recent years, the program has collected return more than 4,900 kg of old medications annually from Regional District of Nanaimo residents alone!

No cost to drop off prescriptions The collection, transportation and final disposal of waste

medication is funded by the Health Products Stewardship Association. Accepted medications include prescription drugs, over-the-counter medications and natural health products. Remove or black out any personal identification from all medications to be returned. Collect all dry medications such as pills and tablets into a bag or container. Keep liquids, creams and inhalers in their original packaging. Bring your products to a participating pharmacy in your area. Some local pharmacies accept needles and syringes for disposal. Check first with your pharmacist to see if yours does.

THE RIGHT WAY TO DISPOSAL OF NEEDLES The safe disposal of needles saves others from getting hurt accidentally. Island Health shares what you need to know: • Stay calm; pick up the needle with care, using work gloves if desired • Don’t try to replace the cap on needles; don’t snap, break or bend needles or other sharps • Hold the needle point away from you and put it in a metal or hard plastic container with lid, like a drink bottle. • Replace cap on container securely and label it • Wash hands thoroughly with soap and water

• Drop off the sealed container at: community drop box (call your municipality about locations); participating pharmacy; dispose of the sealed container in a nearby waste bin; or your local public health unit Anyone who uses a needle to inject should dispose of it safely. However, sometimes discarded needles are found in public areas. Fortunately, the risk of being infected by an accidental needle stick is rare. If someone is injured by a discarded needle, stay calm, take reasonable care and follow these steps: • Wash injured area with soap and

warm water as soon as possible • Apply an antiseptic and a clean bandage; dispose of the needle safely • Call 8-1-1 for advice 24/7 • Visit your local emergency department or primary care provider, preferably within 24 hours • For more information, call Island Health’s Communicable Disease program on the Central Island, 8:30am to 4:30pm – 1-866-770-7798. Visit islandhealth.ca/safe-needle-disposal for more information. Learn more about harm reduction at: towardtheheart.com OVERDOSE PREVENTION RESOURCE GUIDE




HARM REDUCTION: WHAT IT IS, HOW IT WORKS By Heather Hobbs Manager, Harm Reduction, Services, AVI Harm reduction includes principles, policies and practices that aim to reduce the harms associated with substance use, substance use policies and related social conditions. Grounded in social justice, human rights, public health and experiential knowledge or ‘lived/living experience,’ harm reduction strategies are utilized by many people who use substances, members of their support networks and service providers. Harm reduction is often described as a set of strategies to keep us as safe as possible when we encounter the various risks present in our lives. For example, car seats and bike helmets can be considered harm reduction tools to reduce the risk of serious injury when navigating roadways. In the context of substance use, examples of some commonly known harm-reduction resources include the provision of sterile needles, needle collection boxes, naloxone kits, supervised consumption services, and medications such as methadone and suboxone to manage opioid addiction. 24 OVERDOSE PREVENTION RESOURCE GUIDE

Harm reduction is sometimes mistakenly understood as being different from the goal of abstinence and as merely a stepping stone to ‘real’ recovery. In fact, harm reduction is a way of being in relationship that honours the autonomy of each of us to make our own decisions about our lives and about changes we may want to make. Harm reduction supports us to stay as safe as possible within our status quo, to make incremental changes if we so choose, and to work towards the longer-term goals we may set for ourselves. Harm reduction honours each of us valuable human beings, where we are at, and where we may want to go. At its heart, harm reduction goes beyond the individual level and has positive impacts on community health. For most people who use substances, the harms we face are related to things like anxiety, isolation, racism, homophobia/transphobia, unmanaged pain, unsupported mental health and social conditions such as poverty. Substances can be a helpful balm to these harms as well as


Did you KNOW? According to the BC Centre for Disease Control’s Toward the Heart, research shows harm reduction activities do not encourage substance use. In fact, they are more likely than other methods to encourage people who use substances to start treatment. Harm Reduction activities can: • Reduce hepatitis and HIV • Reduce overdoses and deaths • Educate about safer sex and sexual health and increase condom use • Reduce injection substance use and used

needles in public places • Increase referrals to treatment programs and services • Increase employment and reduce crime • Reduce sharing needles and other equipment • Educate about safer consumption and reduce use Toward the Heart is part of the BC Centre for Disease Control. We believe every person has the right to the best health possible and should be treated with dignity and respect. To learn more, visit towardtheheart.com

Harm Reduction Continued from previous page

provide a source of relief, joy and relaxation. Healthier communities work to reduce social harms and ensure equitable access to the health and social supports we all need. This includes access to a safer supply of substances and policy change to current drug laws that are fueling the current overdose crisis. When our social conditions support all of our diverse needs, the harms we have typically attributed to substance use are reduced. For more information on harm reduction: • Harm Reduction International: hri.global/ • BC’s Harm Reduction program: towardtheheart.com • AVI: avi.org

1-888-494-3888 24 hours/day 7 days/week

Crisis Line, Chat, and Text Certified Crisis Workers provide: Short-Term Emotional Support Crisis Intervention Public Access to Mental Health Professionals Suicide Prevention and Safety Risk Assessment Island-Wide Resource Database Respect for Confidentiality, Diversity, Cultural Sensitivity and Personal Empowerment

Crisis Chat www.vicrisis.ca

Crisis Text 250-800-3806 Both from 6pm to 10pm 7 days/week

Island Health contracted services

• Youth programs • Emergency Assistance & Advocacy • Family programs • Counselling refferal, and more

Sharps Disposal • Medication Disposal Naloxone Kits Available. Our Pharmacists are available for medication advise and one-on-one medication reviews. PARKSVILLE 250-951-0227

281 E. ISLAND HWY. parksvillepharmasave.com

QUALICUM BEACH 250-752-3011

720 MEMORIAL AVE. qualicumpharmasave.com





Supporting yourself through a loved one’s addiction When an individual is struggling with addiction, it affects the entire family. You may find yourself struggling too as you worry for your loved one and try to support them at whatever stage of addiction or recovery they may be experiencing. You may worry too for the impact on the rest of the family an you may feel embarrassed or guilty about their addiction – wondering if you could have done more, or reacted differently. It’s also natural to feel anger, hurt and disappointment. Know you’re not alone and don’t blame yourself. Focus on what you can do and let go of what you can’t do. Nobody can force an someone who is addicted to substances to be well, says the community organization From Grief to Action (FGTA). Educate yourself Numerous organizations are working to support those living with addiction and their loved ones (See resource guide, pages 29 to 31). FGTA also recommends downloading Gone Too Soon: Navigating Grief and Loss as a result of Substance Use to read the stories and experiences of parents who have lost their children to drug-related harms.

action you agree with and you can work with. “If one-on-one help doesn’t appeal to you, join a group. There is no substitute for first-hand experience, and several groups (Parents Forever, Parents Together, Al-Anon, Nar-Anon) offer mutual support from people who have been there and are still struggling with addiction issues. Learn more about some of these at fromgrieftoaction.com.

“How can you help someone else if you aren’t physically and emotionally healthy yourself?”

Explore options Whether it’s spiritual support, counselling or a new activity to support your wellness, explore options to care for your own emotional wellness. And you don’t have to stick with the first counsellor you meet. Meet with several until you find one whose philosophy and course of


Stay connected “This is a time when you need to reach out to your family and friends, not to withdraw because of feelings

of shame. After all, both medicine and law recognize addiction as a disease. You’ll be amazed at how understanding most people are,” says FGTA. Care for yourself “How can you help someone else if you aren’t physically and emotionally healthy yourself?” FGTA asks. “Keep an eye on your own health and well-being. Self-care is not only essential but also can have the additional benefit of modeling coping techniques for your addicted family member.” Eat well, exercise, go for a walk, and spend time with others you find supportive. Talk to your GP or other health professional if you need more help. “Above all, don’t give up on your own life, dreams, and goals.” For more information, visit fromgrieftoaction.com.


HELP FOR FAMILIES, FRIENDS CONCERNED FOR LOVED ONES When substance use becomes an addiction, or recreational use leads to unexpected consequences, the impacts affect not only the individual involved, but their entire community of friends and family. Explains Moms Stop the Harm (MSTH), a network of Canadian families whose loved ones have died from drug-related harms or who have struggled with substance use: “Families have lived experience, and acknowledging their experience and expertise is essential when seeking solutions to the drug crisis. Recognizing families as partners is important. It brings a meaningful voice, a knowledgeable voice to the table during the quest for prevention and treatment of substance use disorders as well as in the policy-making and research process.� Moms Stop the Harm (MSTH) is a network of Canadian families

whose loved ones have died from drug-related harms or who have struggled with substance use. Calling for an end to the failed war on drugs, the group instead embraces an approach that reduces harm, and respects human rights, advocating for people who use drugs to be treated with compassion and support, not as criminals. In many communities, Healing Hearts peer-led groups meet regularly (typically monthly), offering a supportive place to share their pain with others who have the same experience without stigma and without blame. You do not have to be a member of MSTH to attend a Healing Hearts peer support group and you do not have to be active in advocacy to join. Learn more about Moms Stop the Harm at momsstoptheharm.com

From Grief to Action is a volunteer-based BC not-for-profit that provides a voice and a support network for families and friends affected by drug use. The organization works to promote recognition of drug use as a health issue; to raise public awareness of the needs and concerns of drug users and their families, and work towards overcoming stereotypes and marginalization; and to provide and promote support for families and friends of drug users. From Grief to Action also promotes effective educational programs designed to prevent drug abuse and works toward of a comprehensive continuum of care that meets the need for harm reduction, detoxification, treatment and recovery. Learn more: fromgrieftoaction.com OVERDOSE PREVENTION RESOURCE GUIDE



Overdose Prevention Guide A special community project published by Black Press Media’s Central Island publications Publishers Sean McCue, Nanaimo News Bulletin Teresa Bird, Alberni Valley News Warren Goulding, Cowichan Valley Citizen & Lake Cowichan Gazette Andrea Rosato-Taylor, Ladysmith Chronicle & Chemainus Valley Courier Peter McCully, Parksville-Qualicum Beach News & Westerly News Editor Jennifer Blyth jblyth@telus.net

Creative Director Lily Chan

Videographer Arnold Lim

Design Michelle Gjerde

nanaimonewsbulletin.com albernivalleynews.com pqbnews.com cowichanvalleycitizen.com

ladysmithchronicle.com lakecowichangazette.com chemainusvalleycourier.ca

About this project Recognizing the tragic consequences the current opioid crisis is having on our Central Island community, your Black Press Media community newspapers wanted to find a way to respond in a meaningful way – to make a difference. Inspired by our sister publications the Everett Herald, in Washington State, and Monday Magazine and the Victoria News in Greater Victoria, along with the work being done by so many here at home, we created the Overdose Prevention Guide. This publication would not have been possible without our community partners, United Way Central and North Vancouver Island, Vancouver Island University and Edgewood Treatment Centre, in addition to the support of the teams at Island Health and AVI. Thank you all for making a difference.

Be a Good Samaritan The Good Samaritan Drug Overdose Act complements the new Canadian Drugs and Substances Strategy, and supports the Federal Action on Opioids and the Joint Statement of Action to address the opioid crisis and prevent further overdose deaths. The Act provides some legal protection for people who experience or witness an overdose and call 9-1-1 for help, such as: charges for possession of a controlled substance; breach of conditions regarding simple possession of controlled substances in pre-trial release, probation orders, conditional sentences, parole. The Good Samaritan Drug Overdose Act applies to anyone seeking emergency support during an overdose, including the person experiencing an overdose. The act protects the person who seeks help, whether they stay or leave from the overdose scene before help arrives. The act also protects anyone


else who is at the scene when help arrives. The act does not provide legal protection against more serious offences, such as: outstanding warrants; production and trafficking of controlled substances; all other crimes not outlined within the act.

Save a life Staying at the scene is important to help save the life of the person experiencing an overdose. Witnesses should: • call for emergency help • be prepared by carrying naloxone to use if you suspect an opioid overdose • provide first aid, including rescue breathing (CPR), if necessary, until emergency help arrives; stay calm and reassure the person that help is on the way Tell others about the new Good Samaritan Drug Overdose Act.



24-HOUR VANCOUVER ISLAND CRISIS LINE – The Vancouver Island Crisis Line

provides a supportive listening ear for people in emotional distress and connection to emergency mental health services when needed. The phone number is the same for all areas of Vancouver Island. • Call from anywhere on Vancouver Island: 1-888-494-3888 • Crisis Chat services (6 to 10pm nightly) at vicrisis.ca • Crisis Text number (6 to 10pm nightly) 1-250-800-3806 BC211 – Providing free information and

referral regarding community, government and social services in BC. Info: bc211.ca


• Cowichan Valley: 250-597-3282 • Nanaimo: 250-753-7513 • Port Alberni & West Coast: 250-723-1177 BC MENTAL HEALTH AND ADDICTION INFO LINE – 1-800-661-2121, 9am to 4pm,

Monday to Friday. Sponsored by Canadian Mental Health Association BC Division. BC DRUG & POISON INFORMATION CENTRE HOTLINE – 1-800-567-8911. HEALTHLINK BC – Check the HealthLink

BC website or dial 8-1-1 for programs in your area. PROBLEM GAMBLING HELP LINE –

1-888-795-6111 8-1-1 – A free-of-charge provincial health

• Dial 2-1-1 on Vancouver Island/Gulf Islands to talk with an Information & Referral Specialist. This service is free, confidential, multilingual and available 24/7.

information and advice phone line available in B.C., operated by HealthLink BC, part of the Ministry of Health.

• TTY – Access for the deaf/hard of hearing community in BC is available by dialing 604-875-0885.


• Text the name of your city to 2-1-1 to chat with an Information & Referral Specialist. This service is free, confidential, and available daily between of 8am and 11pm. KUU-US CRISIS LINE – The KUU-US Crisis

Line is a resource for suicide prevention for Aboriginal people on Vancouver Island and in the province of B.C. Help is available 24 hours a day. If you’re facing a crisis, call any time. • Adult Crisis Line: 250-723-4050 • Youth Crisis Line: 250-723-2040 • Vancouver Island and through the Province of BC: 1-800-588-8717 BC ALCOHOL AND DRUG REFERRAL SERVICE – 1-800-663-1441 NARCOTICS ANONYMOUS 24-HOUR SUPPORT LINES – Cowichan Valley, Nanaimo,

Oceanside, Port Alberni, West Cost, Southern Gulf Islands: 1-866-265-7333

CRISIS SUPPORT Daily Mobile Crisis Response service available 7 days per week. To access call the Vancouver Island Crisis Line 1-888-494-3888


supplies and education, referrals to health services, addictions services and other social supports and needle exchange services. Open 1 to 7pm daily at 221 Trunk Rd., Duncan, 250-597-7779. NANAIMO OPS – Providing education, prevention, outreach, harm reduction, naloxone kits, counselling, substance use treatment, supports and access to mental health services, at 437 Wesley St., 250-591-3999. PORT ALBERNI OPS – Services include

education, prevention, outreach, harm reduction, naloxone kits, counselling, substance use treatment and supports, and

access to mental health services. Open daily 8am to 4pm at 3699 3rd Ave, (off Bute St) Port Alberni, 778-419-0016.

HEALTH, SUBSTANCE USE AND RELATED SERVICES ISLAND HEALTH – Providing health care services through a network of hospitals, clinics, centres, health units and residential care locations for more than 800,000 people on Vancouver Island, the islands in the Salish Sea and the Johnstone Strait, and the mainland communities north of Powell River and south of Rivers Inlet, including mental health, substance use, addiction and overdoseprevention services. islandhealth.ca FIRST NATIONS HEALTH AUTHORITY – FNHA is a province-wide health authority

whose vision is to transform the health and well-being of BC’s First Nations and Aboriginal people by dramatically changing healthcare for the better through services largely focused on health promotion and disease prevention. fnha.ca, 1-866-913-0033 AVI HEALTH CENTRE – NANAIMO – Offering low-barrier, free treatment and support to people struggling with opiate addiction, in addition to HIV Primary Care clinic, STI testing and treatment, and harm reduction education, treatment and support, at AVI Health Centre, 102-55 Victoria Rd, Monday to Thursday, 9am to 5pm, 250-754-9111, avi.org/our-services/ nanaimo CANADIAN MENTAL HEALTH ASSOCIATION – Dedicated to the promotion and

improvement of mental health and quality of life in the community, through effective services, advocacy, awareness and education, resource generation and partnerships, 126 Haliburton St, 250-244-4042, mid-island. cmha.bc.ca HERE TO HELP – A project of the BC Partners for Mental Health and Substance Use Information, a group of seven leading mental health and addictions non-profit agencies that have been working together since 2003 to help people live well and better prevent and manage mental health and substance use problems. Info: heretohelp.bc.ca




provides assessment and treatment to Canadian Armed Forces members struggling with alcohol, drugs and gambling, as well as other addictions. Patients are assessed by their Primary Care Physician who then works with an addiction counsellor to establish a plan of care and treatment based on the individual’s needs. Treatments include: assessment for substance related and addictive disorders; individual and group treatment; assessment for placement in inpatient alcohol or drug rehabilitation facilities; relapse prevention and follow-up. Additional mental health and stress programs are also available. Info: canada.ca/en/ department-national-defence/programs/cafmental-health-services.html#atp


for individuals who have a mental illness, substance use issues, developmental challenges, and brain injuries, with an emphasis on horticultural therapy, life skills, and vocational preparation and training, 250-7464204, providencefarm.wildapricot.org. OUTPATIENT TREATMENT (HIIYE’YU LELUM (HOUSE OF FRIENDSHIP) SOCIETY) – DUNCAN – Serves primarily Aboriginal

people and includes non-medical withdrawal management, screening and assessment, individual, family, and group counselling, life skills training, referral, and access to childcare and/or transportation for clients, 250-748-2242. TILLICUM LELUM ABORIGINAL FRIENDSHIP CENTRE – NANAIMO Promoting justice,

fairness and equality for Aboriginal people through a holistic approach to programming and services, weekdays, 9am to 5pm, at the Education Centre, 927 Haliburton St, 250-7538291; and Health Centre, 602 Haliburton St, 250-753-6578, tillicumlelum.ca 250-753-4417 CMHA SOCIAL CENTRE – NANAIMO – A

social, recreational and vocational program for adults living with mental health and/or substance use challenges. Offering support, community connection, resource information 30 OVERDOSE PREVENTION RESOURCE GUIDE

and access to an employment program. New participants always welcome! Mondays and Fridays 10am to 4pm; Wednesdays 1 to 7pm, 250-244-4042, 290 Bastion St. NARSF PROGRAMS – Provides a range

of counselling, therapy, health and harmreduction services to individuals, children, youth and families, with funding provided by the Ministry of Children & Family Development and Vancouver Island Health Authority, weekdays, 9am to 5pm 201 - 170 Wallace St, 250-754-2773, narsf.org. MENTAL HEALTH AND SUBSTANCE USE SERVICES – PORT ALBERNI – Provides a

range of health care and support services for adults with mental health and/or substance use issues. Services include assessment, treatment, counselling, education, walk-in services and referral to community resources. Open referral. Weekdays, 8:30am to 4:30pm, 4780 Roger St, 250-731-13110. WEST COAST MENTAL HEALTH AND SUBSTANCE USE – UCLUELET – Provides a

range of health care and support services for adults with mental health and/or substance use issues. Services include assessment, treatment, counselling, education, walk-in services and referral to community resources. 272 Main St., 250-726-1282. PORT ALBERNI FRIENDSHIP CENTRE –

Provides a wide variety of programs and services including individual and group

counselling for individuals, couples and families affected by substance use or mental health issues, and crisis intervention and pre-treatment preparation for residential treatment. Grounded in respect for Indigenous and traditional cultural healing practices, the program is open to the entire Port Alberni community, 3555 4th Ave, 250-723-8281, pafriendshipcenter.com. Self-referrals accepted. FIRST NATIONS FAMILY ALCOHOL AND DRUG TREATMENT – PORT ALBERNI –

Kackaamin Family Development Centre offers individual, couple and family drug and alcohol counselling in a residential setting, 250-7237789, kackaamin.org. GROUP SUPPORT – PARKSVILLE – Forward House Community Society offers a variety of support groups to adults with mental health challenges including peer support, women and men’s groups, LGBTQ support, and Narcotics Anonymous for individuals needing support for addiction challenges, 250-954-0785, forwardhouse.com/programs. NEW LEAF OUTREACH – NANAIMO –

Grassroots nonprofit organization providing services to individuals who use drugs, including advocacy, support, education, outreach, peer-based services, and referral to other services such as detox, treatment, and substance use outreach nurses. Operates within the frameworks of harm reduction and holistic recovery, 217-285 Prideaux St, 250618-6579, newleafoutreach.org


housing for adult males; provides group and individual programming and outreach services, weekdays, 8:30am to 4pm, 2368 Rosstown Rd, 250-758-5611.

NANAIMO REGION JOHN HOWARD SOCIETY – The Transitional Housing Program

provides safe, affordable, drug and alcohol free residences for men in recovery in a structured and supportive environment, 250-754-1266, johnhowardnanaimo.org.

YOUTH & FAMILY SERVICES FROM GRIEF TO ACTION – A not-forprofit society working to improve the lives of addicted youth and their families and friends, and a voice and a support network for families and friends affected by drug use. fromgrieftoaction.com DISCOVERY YOUTH & FAMILY SUBSTANCE USE SERVICES – Offering free, community-

based counselling services and access to residential care and treatment for youth ages 13-19; assisting youth and/or their families to reduce harms associated with substance use and related issues. For more information – South Island: call 250‐519‐5313 or email discovery. southisland@viha.ca; Central/North Island: call 250-739-5790 or email discovery@viha.ca.


innovative health, harm-reduction, and counselling services to individuals, children, youth and families, 250-754-2773, narsf.org


continuum of addiction recovery programs for men and women designed to provide a framework for sustainable recovery. Cedars specializes in the treatment of alcohol and drug addiction, and various process addictions including eating disorders and gambling. Treating clients in every stage of recovery provides invaluable continuity of care that ultimately means the best chance for longterm success. 250-733-2006, cedarscobblehill.com

EDGEWOOD – Our team of compassionate

and credentialled doctors, psychiatrists, nurses and clinical counsellors provide individuals the best chance at longterm successful recovery. We offer individualized Inpatient, Outpatient, and Family programming all in a safe, therapeutic environment. To complement over 25 years of experience, Edgewood incorporates evidence-based therapies such as CBT and DBT, Medically Assisted Treatment (MAT), Gender-specific groups, weekly one-on-one counselling, and Trauma specific programming. Contact us today: 250-751-0111. Email: info@edgewood.ca. Financing options available. 2121 Boxwood Rd, Nanaimo,

edgewoodhealthnetwork.com HARRIS HOUSE HEALTH CLINIC – Provides

confidential health care, harm-reduction supplies and support to individuals at risk of Hepatitis B, Hepatitis C, HIV and sexually transmitted infections, Monday, 10am to 3pm,Tuesday, 10am to 5pm, Wednesday, Thursday, Friday, 1pm to 9pm, 375 Franklyn St, 250-753-6759. Mobile Services: 1-844-4824239; Tuesday: Cowichan 3 to 8pm; Thursday: Parksville 1 to 6pm; Friday, Saturday: Nanaimo & Ladysmith, 4:30 to 9:30pm. CLEARVIEW COMMUNITY MEDICAL DETOX – NANAIMO – The 12-bed medically

supported facility serves the Cowichan Valley, Nanaimo, Parksville, Courtenay/Comox, Port Alberni, Campbell River and Tofino/Ucluelet, welcoming people with mental and physical health challenges with dignity, compassion and respect. Info: 250-739-5891. MENTAL HEALTH & SUBSTANCE USE SERVICES WALK-IN CRISIS COUNSELLING CLINIC – Providing single-session crisis

counselling and intake for substance use services. A link to mental health and substance use services for all ages. No appointment necessary – just walk in, weekdays, 10am to 6:15pm. 203 - 2000 Island Hwy, (back of Brooks Landing mall) 250-739-5710. VANCOUVER ISLAND MEN’S TRAUMA & COUNSELLING SERVICES – Supporting

anyone who identifies as a man who has experienced emotional, sexual or physical trauma as a child or an adult, with victim services, counselling and group programs. 102-1022 Pandora Ave., 250-381-6367, menstrauma.com


affordable, income-based counselling services to individuals, couples, children, youth and families around a variety of issues, including anxiety, depression, grief and loss, end-of-life, self-esteem, abuse, and family conflict. Office hours: 9am to 5pm Monday to Friday with openings most evenings from 4 to 8pm and some Saturday appointments. 3821A Cedar Hill Cross Rd., 250-472-2851, southislandcentre.ca. SMART RECOVERY – A self-empowering

addiction recovery support group. Meetings are Thursdays, 7 to 8:30pm. Family and friends meet on Tuesday, 6:30 to 8pm, 3151 Barons Rd., 250-802-2235/ 250-739-5880, smartrecoverybc.com. SPIRIT OF FREEDOM MINISTRIES – Christian program bringing new hope to the chemically dependent, their families and others, 9am to 1pm group sessions, 1-800-535-6011, sofm.org. TRANSITIONS WITHDRAWAL MANAGEMENT & SUPPORTIVE RESIDENTIAL PROGRAM – A NARSF

program. Referral through Discovery Youth and Family Addictions (VIHA) for youth with problematic drug and alcohol use to achieve their goal of abstinence or reduction of harmful consequences of substance use, 170 Wallace St, (around back, lower level) 250-754-2773.

RESOURCES Recognizing Resilience: A Workbook for Parents and Caregivers of Teens Involved with Substances, keltymentalhealth.ca Toward the Heart offers information on fentanyl and naloxone: towardtheheart.com Island Health’s Discovery Youth and Family Substance Use Services: viha.ca/youthsubstance-use/discovery HealthLink BC has overdose information and nurses available by calling 811 or visiting healthlinkbc.ca Mindcheck is an online resource for youth and families offering mental health resources and support: mindcheck.ca Here to Help BC offers a Resiliency Guide for Parents and Youth: heretohelp.bc.ca Keeping Youth Connected, Healthy & Learning (for school administrators): viha.ca/ NR/rdonlyres/D37BC183-1B0E-4F0B-B9495A8870A6049F/0/keepingyouthconnected.pdf OVERDOSE PREVENTION RESOURCE GUIDE


WE CAN HELP YOU FIND INFORMATION ON:  After-school programs

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 Grief and loss

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 Gender  Young parents and sexual identity

Anxiety  Grief and loss WE CAN HELP YOU FIND INFORMATION ON: and so much more… WE CAN HELP YOU FIND INFORMATION ON:  Counselling  Health  After-school programs  Gender and sexual identity  Crisis lines and suicide  Mentorships  After-school programs Gender and sexual identity  Anxiety  Grief and loss  Anxiety  Grief and loss  Drugs and alcohol  Recreation  Counselling  Health  Counselling  Health  Education  Young parents  Crisis lines and suicide  Mentorships 

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 Crisis lines and suicide Drugs and alcohol  Drugs and alcohol  Education  Education


Recreation and so much more…  Recreation

Young parents  Young parents and so much more… and so much more…

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Magazines - Overdose Prevention Central Island 2019  


Magazines - Overdose Prevention Central Island 2019