Opioid misuse is a public health crisis in Canada. To prevent harms related to opioids, many Ontario workplaces are now legally required to keep naloxone kits on site. The easy-to-administer medication is proven to quickly counteract the effects of an opioid overdose.

Statistically, workers in the construction industry are particularly vulnerable to opioid misuse and its harms. Between 2018 and 2021, 366 people who were identified as being employed in Ontario’s construction sector lost their lives due to opioid toxicity. The problem also worsened amongst the general public: in 2021, opioid deaths increased by 16 per cent over the previous year, while opioid-related emergency room visits jumped by 36 per cent.

If you’ve never witnessed opioid use or an overdose at your workplace, you might ask why it’s necessary to make naloxone part of your health and safety program. It comes down to being prepared.

“Just because you don’t see opioid use on your site, doesn’t mean your workers aren’t struggling with substance use outside of work,” says Kathy Martin, IHSA’s Mental Health and Wellness Specialist. “It’s best to be proactive because you don’t know when tragedy will strike. Naloxone can be another tool in your emergency-response toolbox.”

Martin adds that education and training on naloxone in workplaces can reduce stigma surrounding substance use and addiction. Going even further, by fostering an open and inclusive workplace culture and implementing effective policies and programs for injury prevention, impairment management, and mental health support, you can also help to prevent opioid misuse in the first place.

What is naloxone?

Also known as Narcan (the most common of its brand names), naloxone is a medication that temporarily reverses the effects of an opioid overdose. It is typically given as a nasal spray, though a needle-injection version is also available. If administered immediately, it can restore an opioid overdose victim’s breathing within two to five minutes. Naloxone has been around for nearly 40 years and is often used by emergency medical services.

What are the requirements for naloxone in workplaces?

Ontario’s Occupational Health and Safety Act (OHSA) now requires employers to:

• Provide a naloxone kit when they become aware, or ought reasonably to be aware, that there may be a risk of a worker having an opioid overdose at the workplace.

• Maintain the naloxone kit in good condition.

• Ensure that, any time there are workers in the workplace, the naloxone kit is in the charge of a worker who works near the kit and who has received training on recognizing an opioid overdose, administering naloxone, and any hazards related to the administration of naloxone.

IHSA recommends that all firms in the construction, transportation, and electrical utilities sectors provide naloxone kits in their workplaces as a preventive health and safety measure.

Why does IHSA recommend having a naloxone kit?

Problematic opioid use is a workplace hazard that disproportionately impacts workers in construction and its related trades. Some risk factors include:

• Systemic workplace issues, such as rushed contracts requiring workers to “get the job done at all costs,” and poor supervisor training on issues like addiction, impairment management, accommodations, etc.
• Over-prescription of pharmaceutical opioids for pain management—due to the physically demanding nature of construction work and higher rates of injury.
• Stigma around substance-use disorders within families, the healthcare system, and society, which can make it difficult for individuals to reach out for support.

If a worker experiences an opioid overdose while on the job, quick access to naloxone could be the difference between life and death. Across Canada, naloxone has already saved thousands of lives.

Teaching workers about naloxone is also a way to encourage non-judgmental workplace discussions about mental health and addiction. In general, people struggling with substance-use issues are far less likely to access services and supports if they believe they will be judged by others or stigmatized due to their condition.

How do I build a naloxone first-aid program?

The Canadian Centre for Occupational Health and Safety (CCOHS) offers the following guidance:

• Develop naloxone-specific policies and procedures in consultation with your joint health and safety committee or representative.
• Ensure all employees know their responsibilities if an opioid overdose occurs at the workplace.
• Workers designated to administer naloxone should also be trained to recognize the signs of an opioid overdose and understand the steps to take. First aid training, including cardiopulmonary resuscitation (CPR), is recommended.
• Make appropriate personal protective equipment (PPE) available for employees who administer naloxone, to protect against exposure to biological hazards.
• Provide support after an incident. The experience may be traumatic; workers may benefit from psychological counselling.
• Schedule refresher training annually.

Where can I get a free naloxone kit for my workplace?

• Canadian Red Cross
• St. John Ambulance

Ontario’s Workplace Naloxone Program helps employers to comply with the OHSA’s naloxone requirements by providing one free nasal-spray naloxone kit per workplace. Employers can contact the Canadian Red Cross and St. John Ambulance to order a kit.

Identifying and opioid overdose

It is possible to overdose on any opioid, whether it’s a prescription medication or illicit substance.

The signs and symptoms of an overdose include:

• Slow, irregular, or no breathing
• Slow or no heartbeat
• Pinpoint (very small) pupils
• Pale, clammy skin
• Blue lips or nails
• Extreme drowsiness
• Unconsciousness

When given promptly, naloxone can temporarily stop the effects of opioids and help restore breathing during an overdose—giving you enough time to call 911 for emergency medical assistance.