Opioid Overdose Management

In the past few years, a new public health crisis has been identified. Deaths from the direct effect of opioid drugs are escalating. Many new potent opioids, including fentanyl and its analogues, are available on the streets. These may be used as substitutes for heroin and cocaine, or found as contaminants of these drugs. Even those who use opioids regularly may not be tolerant to these relatively potent opioids, resulting in unexpected overdoses. The opioid known as carfentanil is an example of a fentanyl analogue.

Opioids typically cause a person to have a depressed level of consciousness, a decreased respiratory rate and small or pinpoint, pupils. With increasing intoxication, respirations can stop, and further injury from hypoxia, including coma and cardiac arrest, can occur.

Health-care Professionals

Most pharmaceutical opioids, heroin and fentanyl, should respond to usual doses of naloxone. The desired response to naloxone should be establishment of adequate respirations, to have an O₂Sat > 90% and a pCO₂ < 45 mmHg. The patient does not need to be fully awake and alert. With naloxone dosing health-care providers have always been taught to "start low and go slow" to prevent acute opioid withdrawal. Although uncomfortable, opioid withdrawal is generally not life threatening.

MPC has guidelines for pre-hospital and hospital opioid resuscitation here.

General Public

Treatment for the opioid overdosed person currently consists of supportive care and the antidote naloxone. Naloxone is available in Manitoba from “Take-Home Naloxone” distribution sites which offer free take-home naloxone kits and training to individuals who are either at risk of an opioid overdose, or a friend or family member of a person at risk of an opioid overdose. In addition, anyone can purchase a naloxone kit at a community/retail pharmacy or store that has naloxone kits for sale.

MPC has guidelines for the lay rescuer here.

In recognition of National Poison Prevention Week, Manitoba Poison Centre would like to raise awareness about cannabis safety with a focus on safe storage and reducing access to children.
Since legalization of cannabis in 2018, the Poison Centres* has seen a shocking increase in cases of children accidentally eating edible cannabis products and requiring hospitalization. In 2018, we answered 71 cannabis edible related calls while last year we answered 718. That is an increase of over 820% in four years!
Easy access due to improper storage has been the common denominator that has led to an increase in children consuming cannabis edibles. In many of these cases, these products look almost identical to desserts, treats and popular brands of candy.
Follow us for Poison Prevention information and local participation in Manitoba during National Poison Prevention Week.

Twitter (@SharedHealthMB)
Facebook (Sharedhealthmb)
Instagram (sharedhealthmb)

During National Poison Prevention Week, look for hashtags #CheckforPoisons (Canada) and #NPPW2022 (North America) to stay up to date with messages and activities taking place related to poison prevention.
Check out the Manitoba Poison Centre website (manitobapoison.ca) for great resources to help families stay safe:
Common Poisons Section

Browse through a searchable list of household products to learn more about their poison risk, and what to do if someone has been exposed.

Learn about the top 10 most common household exposures in 2021, separated by age group.
Check out the poison storage checklist, made by our friends at Parachute (Canada national charity dedicated to injury prevention).

For Families Section

Learn about poison prevention strategies you can use in your home.
Visit our cannabis hub to learn about why cannabis is more dangerous for children than for adults, and what you can do to prevent an unintentional poisoning from occurring.

Additional Resources

Check out the NEW About Kids Health Poison Hub https://www.aboutkidshealth.ca/poisonprevention

Remember: If an unintentional poisoning occurs, contact your local poison centre:
Manitoba: 1-855-7764766
For a full list of Canadian Poison Centre Numbers: Canadian Association for Poison Centres and Clinical Toxicology

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Opioid Facts and Myths

Facts

Fentanyl and its analogues can be absorbed through mucous membranes.
Many users have snorted the drugs and have become overdose victims. In the medical literature, there was a single report of a veterinarian mistakenly splashing himself in the eye with carfentanil which required a dose of an antidote to resuscitate him.

There is some evidence that carfentanil was one of the incapacitating agents used to stop the Chechen takeover of the Dubrovka theatre in 2002. In this instance, carfentanil was delivered as a gas into the theatre and would have been absorbed through the lungs. In the media, there are two videos of police officers, who inhaled carfentanil powder developing symptoms.

Fentanyl and analogues are absorbed from the GI tract.
These drugs, as contaminants, are often taken by mouth in pill form. Absorption might be slightly slower but the overdose effect is the same once absorbed.

Carfentanil is potent enough to sedate an elephant. Special protection must be worn at all times.
Large animal veterinarians do use these potent fentanyl analogues to sedate or anaesthetize animals. Individuals protect themselves by wearing gloves, long sleeves and eye protection when handling the drugs. Border security personnel and post office staff, when opening suspicious packages, are using similar protection but also open these exhibits under a fume hood.

Suspected drug labs are particularly dangerous.
When entering a drug lab where illicit opioids are being manufactured, the powders of fentanyl or its analogues may be free to be inhaled. The US Drug Enforcement Administration recommends that individuals entering suspected drug lab and pill pressing facilities are appropriately protected using Hazmat gear. Field testing substances is NOT recommended as equipment will NOT have many of the new analogues in the library so will give false positive or negative results. Police wear a mask to double seal an exhibit.

Myths

Fentanyl powder and its analogues can poison you if touched.
The lay press and even some government publications have sensationalized the issue to state that fentanyl powder and/or its analogues can poison you if touched. This is not the case. Inadvertent dermal exposure to the powder will not cause toxicity. If however, powdered drug remains on the skin, (e.g. on your hand) and subsequent oral contact is made (e.g. hand goes in mouth), absorption might occur through mucous membranes.

Rescuers may succumb to opioid overdose when helping victims.
Although very small doses of fentanyl and its analogues can be dangerous, there are no reports of rescuers succumbing to opioid overdoses when helping victims. There are no reports of peers, EMS workers or hospital staff getting ill by providing basic lifesaving care to these victims. Universal precautions should be followed as per usual.

Need Help?

1-855-776-4766