Dependence & Overdose

Everyone's relationship with substances is different. Sometimes, using substances might not turn out to be as helpful or enjoyable as you thought it would. Maybe you didn’t like the way it made you feel, maybe you had a bad trip and wanted it to end sooner, or maybe you’ve experienced an overdose.

Reflecting on when and why you turn to substances might help you better understand the deeper emotions that could be contributing to negative experiences with substance use. Some folks might change how often they use substances, how much, or maybe they stop altogether. Whatever path you decide is best for yourself is valid.

Understanding Dependence

Regular substance use can lead to more long-lasting changes in your brain, and when you feel you have to use a substance to feel good on a regular basis, you can become dependent on it. You may be dependent on a substance if you:

Develop a tolerance to the same amount of substance and need more to feel its effects.
Feel withdrawal effects when you’re not consuming the substance.
Feel like you should be able to control your use better, or think about the substance a lot.
Spend a lot of time recovering from its effects.
Give up a lot of social activities or things you do for fun in order to make time for substance use.
Keep using even if physical or mental health problems appear or worsen.

Dependence can happen to anyone using any substance, and there’s no shame in being dependent on a substance. If you notice your tolerance going up, you may consider taking breaks to lower your tolerance.* It could also be helpful to check-in with yourself about whether your substance use is serving your needs. If you’re finding that being dependent on a substance is starting to affect you in ways you want to change, it may be worth exploring other options instead of, or in addition to, your substance use. For example, methadone is a legal substance used as a treatment for people who are dependent on opioids. Methadone programs also offer interventions like counselling and other health services – click here to learn more.

*Remember that taking a tolerance break means your body is adjusting to not using the substance as often, or at all. If you return to using that substance in the future, consider using less than what you previously would, as your body may respond to it differently after a break. For example, starting low and slow when drinking alcohol after not drinking for a while. This can help reduce your chances of overdose.

Overdose 101

An overdose is when you take more of a substance than your body can handle. You can overdose on most substances, but some overdoses can be more life-threatening than others. For example, taking more of a hallucinogen than your body can handle might lead to a long and bad trip, and can leave you emotionally rattled for a few days afterwards. On the other hand, taking more of a depressant than what your body can handle can slow or stop your breathing, which requires urgent medical attention.⚠️

With illegal or unregulated drugs, you can’t always know how much you’re getting, how strong or potent they are, or if they’ve been cut or contaminated with any other substances or fillers. That’s why overdoses tend to be more common with drugs that are illegal or unregulated, than ones that are legal or have been prescribed to you. Not knowing what’s in the substances you’re using, or how strong they are, can make it more likely for you to experience an overdose. To learn more about how to reduce the chances of an overdose and use substances more safely, check out our harm reduction tips here.

Right now, Canada is in a drug contamination crisis.

There are lots of people dying from overdose-related deaths at really high rates. Opioid drugs are talked about more these days because lots of folks use them for managing their physical pain, trauma, mental health, and more.

It's common for cocaine, crack, and opioids to be contaminated with other substances and fillers. Fentanyl is an opioid drug that needs to be diluted before you use it because it's very strong on its own. But since the street supply is so unpredictable, new contaminants are being identified all the time. Lately, there's been a rise in overdoses from benzodiazepine contamination found in the fentanyl supply. This could change to something else in the future.
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Some organizations and community centres offer drug testing services that folks use to check their substances before they use them. These services can determine if your drugs are cut with anything, and if so, with what. They're also not specific to downers – you can bring other substances, like stimulants and hallucinogens, to be tested, too. Getting your supply tested before you use or share can be a way of taking care of your health, well-being, and safety.

Responding to an Overdose

Responding to an overdose means recognizing the difference between someone who is resting, having a good time, or who may need your help. Learning what an overdose looks like and how to respond means that you could end up saving someone’s life, and you won’t get into legal trouble for using or possessing illegal substances.

In Canada, The Good Samaritan Drug Overdose Act protects anyone from charges like possession of illegal substances when they contact emergency services to help with an overdose. However, there are some things the Act doesn’t cover. Read up on it here!

If you’ve heard about opioids, you might’ve also heard about naloxone. Naloxone is a fast-acting drug that’s used to temporarily reverse opioid overdoses. It can return a person’s breathing in 2-5 minutes after it’s been given and lasts for about 20-90 minutes. While naloxone only works on substances that contain opioids, it’s still worth administering even when you’re not sure what the person may be overdosing on. Naloxone’s only effect is reversing opioid overdoses, so nothing else will happen if it's given multiple times, or if the person is overdosing from benzos, or another substance, and not from opioids. When in doubt, use naloxone!

Naloxone comes in two forms – a nasal spray or an intramuscular injection. In Canada, we can get naloxone at most pharmacies! 🙌 All you need to do is to provide your health card. If you don’t have a health card, check out the local public health units, community centres, or harm reduction groups in your area – they can provide you with free naloxone, as well as info and resources!

Overdose Response for Downers

When a person has overdosed on downers, you might notice a bluish grey colour around their mouth and fingers, cold or clammy skin, and tiny pupils. They may also be making deep, gurgling sounds. Sometimes their breathing has slowed, stopped, or they are fully unconscious. If someone isn’t breathing or responding to you, you’ll want to:

Shout the person’s name or try to wake them up with noise. If they don’t respond to noise, you can also try pinching them in the spot between their neck and shoulder.
If they don’t respond or aren’t breathing, call 9-1-1. It’s important that the person who has overdosed is medically examined.
Tilt their head back and check their mouth’s airway for anything that might be obstructing it. Then, begin rescue breathing – pinch their nose and provide two large breaths, and check to make sure their chest rises when you give them air.
If they are still unresponsive, continue giving them one breath for every five seconds that passes. Breathing is so important since the brain needs oxygen to survive – brain damage can begin just minutes after an overdose. 🧠
Administer naloxone. If possible, have someone else continue giving them breaths while you prepare the naloxone. Make sure you’ve called 9-1-1 before giving naloxone, so that emergency medical care is on their way and will arrive by the time you’re finished.
If nothing’s changed after a few minutes, give the person another dose of naloxone in their other nostril or leg, and continue rescue breathing.
If they begin breathing, place the person in the recovery position. This means placing the person on their side, with one arm supporting their head, and the opposite leg of that arm extended. Make sure the person isn’t on their back or stomach to make it easier for them to breathe and prevent choking if they throw up.
Stay with the person until emergency services arrive.
Remember that when revived with naloxone, some folks may be irritable, angry or frustrated about being revived. Naloxone can cause symptoms like withdrawal, which can be an uncomfortable experience. As calmly as you can, explain what happened, and let them know that the sick feeling will go away in about 30 to 75 minutes.

*** CPR and chest compressions can be used if the person is found not breathing and the overdose wasn’t witnessed. In a witnessed or suspected overdose, unless the person has gone into cardiac arrest, try to focus on rescue breathing over chest compressions. ***

Overdose Response for Uppers

When a person has overdosed on uppers, they may be experiencing shortness of breath, nausea, sweating, anxiety, as well as pain and numbness in their chest, arms and neck. Sometimes their heart races, their eyes twitch, and they can have a seizure or a heart attack. If someone is experiencing an overdose on uppers, you can:

Call 9-1-1.
Stay with them. Remember that oxygen is key – try to encourage them to take slow, deep breaths with you. Try to keep them calm, as much as possible.
If you can, grab some ice, wet towels, or blankets that have been in the freezer to help lower their body temperature. Uppers tend to make folks feel overheated and agitated, so staying cool can help. Just make sure to remove them after a few minutes so the person doesn’t get hypothermia.
Remove anything in the room that could be an obstacle if they’re having a seizure. This could be furniture like tables or chairs.

After an Overdose

For many folks, experiencing or witnessing an overdose can be traumatic. When survivors regain consciousness (or come down from the high), they may be experiencing withdrawal, disorientation, irritation, sickness, or pain. You may be left managing some heavy thoughts and feelings after the experience and not know what to do. Finding the appropriate supports or strategies to help you cope with these experiences can be a place to start, whenever you feel ready.

Remember that no matter where you are in your substance use journey, you are always deserving of love, care, and respect. 💞

If you would like to talk to a trained peer about your substance use without judgement, the National Overdose Response Service is available 24/7 and can be reached by phone at 1-888-688-NORS(6677).