Purpose and Application
This policy is intended to ensure the protection of workers who administer naloxone during the course of their work as part of a program offered by the City or a City division. It applies to all City of Toronto divisions that enable naloxone administration by employees.
This policy is not intended to interfere with the current practices of City health professionals and first responders regarding naloxone administration.
Naloxone hydrochloride (also known as naloxone, Narcan or Evzio) is a medication that can temporarily stop many of the life-threatening effects of overdose from opioids. It is an opioid antagonist, which means that it ejects opioids from receptors in the brain, reversing the respiratory/central nervous system (CNS) depression caused by an opioid overdose. Naloxone can help restore breathing and reverse the sedation and unconsciousness that are common during an opioid overdose. In Canada, naloxone is available in intramuscular (i.e. injectable) and intranasal (i.e. nasal spray) formulations.
Opioids belong to a class of drug known as CNS depressants. CNS depressants are substances that slow the body down and can make people sleepier. Opioids may be prescribed or used illegally to reduce pain, manage opioid dependence or produce a state of relaxation. Common opioids include heroin, fentanyl, morphine, methadone, codeine and oxycodone.
The state that occurs when an opioid or an opioid combined with other substances overwhelms the body and as a consequence the CNS is no longer able to control basic life functions (i.e. breathing, heart rate, body temperature, consciousness).
Divisions that enable employees to administer naloxone as part of their job will:
- Establish a divisional program that addresses risk assessment, naloxone acquisition and replacement, staff roles, worker training, workplace violence, personal protective equipment, incident reporting, employee support, documentation and program review
Those with supervisory responsibilities will ensure that:
- A risk assessment is conducted before implementing a naloxone program in the workplace to:
- Decide whether clients or others that workers interact with are at risk of opioid overdose
- Assess readiness of workers to participate in training and administration of naloxone
- Consult with professionals (e.g. TPH, health professionals, emergency responders) regarding naloxone and its proper usage
Note: Toronto Public Health has an Organizational Opioid Overdose Risk Assessment Tool to assist in this process (see Appendix A)
- Clear roles and responsibilities are determined and defined for all workers enabled by the division and trained to respond to a suspected overdose (including first aid, CPR, AED use, training and protective measures)
- All workers who are enabled by their divisions to respond to an overdose are appropriately trained, initially and as needed to retain their competency in naloxone administration (see Training Standard in Appendix B)
- All workers who may administer naloxone under this policy are aware of the side effects and hazards [physical (e.g. violence and sharps), chemical (e.g. opioids and routes of exposure), biological (e.g. blood and bodily fluids) and psychological (e.g. workplace stress and violence)]
- Safe work procedures are developed
- Ensure appropriate personal protective equipment is selected, purchased, available and used when appropriate [e.g. disposable nitrile gloves, responder rescue mask, face shield or bag valve mask (for use in rescue breathing or CPR), sharps container]
- Follow-up care and support is provided, if requested or as needed, to workers who administer naloxone
- A Supervisor’s Report of Injury/Incident is completed for any event in which the worker administers naloxone under this policy
- Activities regarding naloxone administration are documented and maintained in accordance with the divisional program
Workers who are enabled to administer naloxone will:
- Participate in training provided by the employer
- Be competent to perform the duties associated with naloxone administration activities
- Be aware of the side effects and hazards associated with naloxone administration activities
- Ensure they are familiar with and complies with the employer’s emergency response procedures when responding to an opioid overdose
- Be familiar with and apply measures to protect themselves from inadvertent exposure to opioids when giving naloxone to another individual if this is expected of workers in their job duties
Occupational health and safety staff will assist in the development of divisional naloxone administration programs.
Joint health and safety committees/occupational health and safety representatives will be consulted during development and subsequent reviews and evaluation of a division’s naloxone administration program.
Occupational Health and Safety Act (R.S.O. 1990, c.0.1)
Occupational Health and Safety Coordinating Committee (OHSCC), February 26, 2020
June 21, 2020