Naloxone for Workplace Opioid Overdose – Compliance Game Plan
Keeping a naloxone kit at your workplace can save lives—and ensure compliance if you’re in Ontario.
The opioid crisis is having a devastating impact on Canadians, especially in the western and northern parts of the country. There were 19,355 opioid-related deaths in Canada between Jan. 2016 and Sept. 2020. The crisis has intensified even more during the COVID-19 pandemic. In BC alone, opioid deaths have topped 150 per month for 18 months in a row, reaching a record high of 209 in January 2022. Many opioid overdose deaths happen at work. What can a company do to guard against fatal overdoses in their own workplace? One answer is to implement a response plan for administering naloxone to victims. Here’s a X step game plan you can use that may save lives in your workplace.
Opioid Hazards in the Workplace
Opioid drugs like fentanyl, oxycodone, morphine and Hydromorphine, are prescribed to manage pain, including workplace injuries. Canada is among the highest opioid prescribing nations in the world, with nearly 1 in 8 people receiving a prescription for an opioid drug in 2018, according to the Canadian Institute for Health Information. While the brain and nerve stimulation impacts of opioid drugs block perception of pain, they also produce a buzz that impairs judgment and increases the risks of accidents and injuries. Opioids are also highly addictive.
Most opioid-related deaths are due to overdose, including at workplaces. While Canada doesn’t keep such statistics, the Bureau of Labor Statistics reports that 388 of the 4,786 workplace deaths in the US in 2020 (8.1%) were due to unintentional overdose from nonmedical use of opioid and other drugs. Overdose deaths were particularly common in 3 industries:
- Transportation & Warehousing; and
- Healthcare & Social Assistance.
Naloxone in the Workplace
A drug called naloxone hydrochloride has proven effective in temporarily stopping the life-threatening effects of opioid overdoses by restoring breathing and reversing sedation and unconsciousness. Because it has few side effects, the benefits of using it to treat overdose greatly outweigh the risks. That’s why police officers, emergency medical services providers and non-emergency professional responders carry the drug.
It’s also why employers should consider implementing their own program to make naloxone available in the workplace in case of overdose. On April 11, 2022, Ontario passed legislation (Bill 88, Working for Workers Act) requiring employers to keep a naloxone kit if they “become aware, or ought reasonably to be aware,” of a risk of overdose at the workplace. OHS regulations are expected to make naloxone kits mandatory at healthcare, construction (30% of work-related deaths overdose deaths in Ontario were to construction workers, according to an MOL news release) and other specified high-risk sites.
Employers must also ensure that, whenever there are workers in the workplace, the naloxone kit is in the charge of a worker who works in the vicinity of the kit and who’s received the training on how to recognize an opioid overdose, administer naloxone and acquaint the worker with any hazards related to its administration.
How to Create a Naloxone Program
Even if it’s not required, keeping a naloxone kit at your workplace may save lives. But you need to implement proper policies and procedures. The National Institute of Occupational Safety and Health (NIOSH) recommends that employers take the following steps:
Step 1. Perform a Naloxone Assessment
Naloxone isn’t just a first aid kit, fire extinguisher or other simple item that all workplaces must have. Because it requires special supplies and training, it’s advisable only where there are significant risks of overdose. So, the first thing you have to do—including in Ontario—is perform an assessment to determine whether you need a naloxone program at your site:
- Identify workers, clients, visitors and members of the public who are at risk of experiencing an overdose at your site;
- If your workers are likely to encounter overdoses at work, e.g., if your site is a medical or drug rehab clinic, identify which, if any, of your staff would be candidates to receive the training necessary to administer naloxone to an overdose victim; and
- Evaluate the potential consequences if naloxone weren’t available considering factors like how far you are from a hospital or EMS.
Finally, assess likelihood and consequences the way you would with other hazards:
- Likelihood High: Naloxone needed;
- Likelihood Low/Severity of Consequences High: Naloxone may be needed and you should get advice from local emergency responders and medical professionals who treat opioid use disorders; and
- Likelihood Low/Severity of Consequences Low: Naloxone probably not needed.
Step 2. Assess Liability Issues
Unlike aspirin or other drugs you can buy over the counter in a drug store or supermarket, naloxone requires a prescription to distribute and administer. However, in recognition of its lifesaving potential for overdoses, Health Canada has authorized use of naloxone without a prescription for emergency use for opioid overdose outside hospital settings. Even so, you need to jump through legal hoops to properly obtain the drug.
Step 3. Designate Naloxone Response Coordinator
You need a policy establishing protocols to ensure safe use of naloxone at your workplace. Best Practice: Appoint a qualified and properly trained person to serve as the workplace naloxone response coordinator with responsibility for:
- Collaborating with local partners to obtain naloxone legally, either directly or by prescription;
- Selecting workplace locations to store naloxone;
- Ensuring that naloxone kits are in ample supply, properly equipped and not past expiration date;
- Ensuring that authorized staff are adequately trained in overdose recognition, naloxone use and storage; and
- Maintaining required naloxone records and logs.
Step 4. Train Staff to Administer Naloxone
Even though Health Canada has authorized nonprescription use of naloxone for overdose emergencies, it still must be administered by a person with proper training. And because it must be administered immediately, that person(s) must be somebody on your own staff. (Note: This is spelled out in Bill 88.) According to NIOSH, such training should be provided at least once a year (plus refresher training as needed) and cover:
- Recognition of opioid overdose symptoms so staff can determine who may need naloxone;
- Calling or having somebody else call 911 to seek immediate emergency help;
- Understanding the hazards of drug powders or residue;
- How to safely administer naloxone by nasal spray and/or injection, depending on which method you use;
- How to provide any additional first aid measures necessary;
- Use of required PPE; and
- How to document and report overdose incidents in which naloxone was administered.
Signs & Symptoms of an Opioid Overdose
Unresponsiveness or unconsciousness
Slowed or stopped breathing
Snoring or gurgling sounds
Cold or clammy skin
Discolored lips or fingernails
Syringes, needles or other drug paraphernalia found near victim
Step 5. Properly Obtain Naloxone
Getting your hands on naloxone can be tricky. The drug comes in 2 forms—nasal spray and injection. The former is easier to administer but generally costs 5 times more than injectable naloxone. And because most hospitals, first responders and health providers use the injectable formula, nasal naloxone may also be harder to find. The good news is that local first responders and others involved in opioid overdose services should be able to help you find a pharmacy or other supplier, as well as a source where your authorized workers can receive naloxone training.
The next challenge is to ensure the stuff is dispensed to you legally. While rules for naloxone distribution differ by jurisdiction, the most common way to obtain it is by prescription from a pharmacy. In most jurisdictions, you can fill out what’s called a standing order enabling the pharmacy to distribute the drug to your organization. It may also be possible to buy naloxone directly from the manufacturer or through a donation made by a nonprofit or other third party that’s authorized to distribute the drug.
Step 6. Properly Store Naloxone
Under Ontario Bill 88 and medical protocols, employers must store workplace naloxone kits in locations that are clearly marked as containing the drug. These locations must also be readily accessible to staff members who are authorized to administer naloxone in the event of an overdose. Naloxone also must be kept in the box or storage container until used and stored away from light and at proper temperatures (generally ranging from 15° to 25° C/59° to 77° F, depending on the product. Follow the manufacturer’s instructions for storing the particular product you use, including with regard to whether you can store the product in a vehicle.
Step 7. Properly Maintain & Re-Stock Naloxone
Sometimes, a single dose of naloxone isn’t enough to restore breathing and arrest the toxic effects of an overdose. So, you need to stock at least 2 doses. You may also want to stock naloxone—in increments of 2—in multiple locations, depending on the size, layout and accessibility of your workplace. Because Naloxone has a limited shelf life, you need to track expiration dates and replace supplies. Account for the time needed to replace expired doses to avoid interruptions in supply.
Step 8. Provide Proper PPE for Naloxone Use
Furnish and ensure the proper use, storage and maintenance of PPE and first aid equipment necessary to deliver naloxone safely, which may include:
- Disposable nitrile gloves;
- Safety glasses;
- N95 masks; and
- Sharps disposable containers (when using injectable naloxone).
Step 9. Maintain Records of Naloxone Incidents
Keep records of overdose response incidents involving naloxone as you would with other serious workplace incidents. Require the authorized worker who administered naloxone to fill out an incident report listing:
- The date, time and place of the incident;
- Whether first responders were called and if they arrived;
- A description of first aid and response measures provided, such as rescue breathing;
- How many doses of naloxone were administered; and
- The outcome—whether the victim survived, etc.
The worker should also furnish a
after a certain number of days after they’ve had a chance to reflect on the incident, what went wrong, etc.
Step 10. Maintain Naloxone Logs
Last but not least, maintain a log tracking naloxone distribution and use at your site the way you do with first aid equipment and services.