This resource does not replace the Occupational Health and Safety Act (OHSA) and its regulations and should not be used as or considered legal advice. Health and safety inspectors apply these laws based on the facts they find in the workplace.

Overview

Opioids and naloxone

Starting June 1, 2023, employers must provide naloxone in the workplace if certain circumstances described in the Occupational Health and Safety Act apply.

Naloxone (pronounced na-lox-own) is a drug that can temporarily reverse the effects of an opioid overdose. Opioids are drugs that are prescribed by a medical practitioner to treat pain. However, opioids are also used recreationally. Some commonly used opioids include:

  • morphine
  • heroin
  • oxycodone
  • fentanyl
  • codeine
  • hydromorphone

While opioids can be an effective part of pain management for medically supervised patients, opioid addiction and overdose are a significant challenge in Ontario.

Naloxone only reverses overdoses from opioids. It will not reverse overdoses from other kinds of drugs, such as benzodiazepines or stimulants like cocaine and amphetamines.

Naloxone safety

Naloxone rapidly reverses the symptoms of an opioid overdose. Naloxone can either be injected intramuscularly (in a muscle) or given as a nasal spray.

After the naloxone is administered, it is a best practice to stay with the worker who was experiencing the opioid overdose until an ambulance arrives, in case first responders need help or information.

Naloxone is considered safe for everyone, unless there is a reason to believe a person has an allergy to naloxone.

If you are not sure what caused someone to become unconscious, giving naloxone is not likely to cause further harm.

If a person has been using opioids, naloxone may put them into withdrawal. Opioid withdrawal is a set of symptoms arising from the sudden withdrawal or reduction of opioids following previous heavy usage. While withdrawal is uncomfortable, it is usually not life threatening.

Protection from liability

Protection from liability available under the Good Samaritan Act, 2001 would generally apply to a worker who voluntarily administers naloxone at the workplace in an emergency in response to an opioid overdose.

How employers can determine if they need to provide naloxone in the workplace

As of June 1, 2023, the Occupational Health and Safety Act (OHSA) will require that naloxone be available in some workplaces in case a worker has an opioid overdose. The requirements do not change how an employer may choose to manage worker impairment from drugs or alcohol that may pose a risk to workplace safety.

Not all employers have to comply with the OHSA requirements to provide naloxone in the workplace.

Employers must provide a naloxone kit when an employer becomes aware, or ought reasonably to be aware, of the following scenarios:

If all of these scenarios are present, the employer must comply with the OHSA requirements to provide naloxone in the workplace.

If any one of these scenarios are not present, an employer does not need to comply with the OHSA requirements to provide naloxone in the workplace.

1. There is a risk of a worker opioid overdose

An employer can become aware that there may be a risk of one of their workers having an opioid overdose in their workplace in a variety of ways, for example:

  • A worker opioid overdose may have already occurred in the workplace.
  • A worker who uses opioids may voluntarily disclose this risk to their employer.
  • An employer may observe opioid use among workers in their workplace or discover that opioid use is occurring in their workplace during a workplace investigation.
  • An employer may find discarded opioid paraphernalia, such as used needles, in their workplace.
  • The joint health and safety committee (JHSC), health and safety representative (HSR), a union representative, human resources (HR) staff, and/or someone else in the workplace may bring this risk to the employer’s attention.

If an employer is aware that one of their workers uses opioids as prescribed by a medical practitioner, it is unlikely that this would, alone, create an awareness of the potential risk of a workplace opioid overdose because such use is under medical supervision.

If the employer is not or has not become aware of a risk of one of their workers having an opioid overdose at the workplace, an employer would not need to comply with the OHSA requirements to provide naloxone in the workplace.

The OHSA requirements do not apply to workplaces where the risk of an opioid overdose is created by a non-worker, such as:

  • a customer
  • a client
  • a patient
  • other member of the public who may be present in or near the workplace

If there is no risk of a worker opioid overdose, an employer would not have to comply with the OHSA requirements.

2. There is a risk of a worker opioid overdose happening in the workplace where the worker performs work for the employer

For the OHSA requirements to apply, there must be risk of a worker having an opioid overdose while at the workplace where the worker performs work for the employer. The requirements do not apply if there is a risk of it happening outside of the workplace.  

For example, an employer may be aware that a worker on leave from the workplace is at risk of having an opioid overdose. However, because the worker is not presently working, there is no risk of the worker overdosing at work. In this scenario, the employer would not be required to provide a naloxone kit in the workplace under the OHSA.

The OHSA does not require an employer to assess or to inquire about the risk of one of their workers having an opioid overdose in the workplace. However, an employer can conduct a risk assessment of the workplace(s) where workers perform work for them, as a best practice.

3. The risk is posed by a worker who performs work for the employer

For the OHSA requirements to apply to an employer, the risk of a worker having an opioid overdose at a workplace must be from a worker that performs work for the employer. The requirements do not apply to an employer if the risk is created by another worker who does not perform work for the employer.

For example, if the risk of an opioid overdose is presented by a worker of one employer on a work site shared by multiple employers, only the employer of the worker who is at risk would be required to provide a naloxone kit in that workplace.

An employer would not need to comply with the OHSA requirements to provide naloxone in the workplace if:

  • there is no risk that a worker would have an opioid overdose at the workplace
  • a worker is at risk of having an opioid overdose at the workplace, but that worker does not perform work for the employer

Number of naloxone kits required

An employer who is required to provide a naloxone kit in their workplace must provide at least one naloxone kit in each workplace in which they are aware, or ought reasonably to be aware, of the risk of one of their workers having an opioid overdose.

An employer is not required to provide a naloxone kit in a workplace where this risk is not present. For example, imagine an employer operates two separate restaurants. They are aware of the risk of a worker, who performs work for them, having an opioid overdose in one of the restaurants, and the worker only works in that one restaurant. In this scenario, the employer only needs to provide a naloxone kit in the restaurant where the risk is present, not the restaurant where the risk is not present.

The OHSA does not specifically require an employer to provide more than one naloxone kit in their workplace. However, the OHSA requires an employer to take every precaution reasonable in the circumstances for the protection of a worker (clause 25(2)(h) and subsection 25.2(5) of the OHSA). An employer may determine that they need to provide multiple naloxone kits in their workplace as a reasonable precaution to protect their workers. For example, an employer may make this determination because:

  • multiple workers who perform work for them are at risk of having an opioid overdose at their workplace
  • the employer’s work location may be large enough that multiple kits are required to ensure that naloxone can be administered quickly

Naloxone kit contents

Employers must make sure their naloxone kits are maintained in good condition.

Nasal spray kits

Each nasal spray naloxone kit must include:

  • 1 hard case (for example, a zippered hard black case with red “naloxone” cross)
  • 2 doses of naloxone hydrochloride intra-nasal spray (4 mg/0.1 ml)
  • 1 one-way rescue breathing barrier
  • 1 pair of non-latex gloves

Injectable kits

Each injectable naloxone kit must include:

  • 1 hard case (for example, a zippered hard black case with red “naloxone” cross)
  • 2 (0.4 mg/1 ml) vials or ampoules (a small glass container) of naloxone
  • 2 safety-engineered syringes with 25g 1" needles attached
  • 2 alcohol swabs
  • 2 devices (known as “breakers,” “snappers,” or “openers”) for opening ampoules safely
  • 1 one-way rescue breathing barrier
  • 1 pair of non-latex gloves

Accessing, storing and maintaining naloxone kits

When accessing kits for the workplace, employers should not use the community-based Ontario Naloxone Program (ONP) or pharmacy-based Ontario Naloxone Program for Pharmacies (ONPP) programs.

Employers must promptly replace any single use items in the kit that are used and ensure that no items in the kit are expired. Employers must follow the manufacturer’s instructions for using, storing and maintaining naloxone kits. Typically, this means that naloxone must be:

  • stored at room temperature (between 15 and 25°C)
  • kept in the kit until ready for use
  • protected from light

Naloxone has an expiry date. The expiry date is written on the ampoules or vials (for injectable naloxone) or on the nasal spray device. If the naloxone in the workplace is expired, it must be replaced.

Employers can bring naloxone kits that are expired or unused to any Ontario pharmacy for safe disposal.

Employers are also required to post the names and workplace locations of the workers who are in charge of the naloxone kit and who have received the required training in a conspicuous place close to the naloxone kit where that information is most likely to come to the attention of other workers.

Naloxone kit location and worker training

If an employer is required to provide a naloxone kit in the workplace, they must also ensure that, at any time there are workers in the workplace, the naloxone kit is in the charge of a worker who:

The OHSA does not specify the number of workers who must receive the required training. Every workplace has different hours of operation (such as multiple shifts, etc.). If an employer is required to provide a naloxone kit in the workplace, they must determine how to ensure that at any time when there are workers in the workplace, there is a worker present who has been trained and works in the vicinity of the naloxone kit.

Training requirements

Employers who are required to provide naloxone kits in their workplaces must ensure that the worker who is responsible for the naloxone kit has received training. The employer must ensure the training meets all the required elements. This includes training that allows the worker to:

Employers are not required to use a specific training provider to comply with the training requirements. An employer could either:

  • provide the training itself
  • use an external training provider

Administering naloxone

The employer must ensure that the worker who is in charge of the naloxone kit can safely administer naloxone in the workplace.

Employers should call 911 immediately if a worker falls unconscious in the workplace.

Naloxone alone is not enough to assist a worker who is unconscious and experiencing an opioid overdose in the workplace. Naloxone is meant to ensure they receive immediate life-saving treatment until emergency medical personnel can take over their care.

Employers should remember that a worker who has fallen unconscious or who has otherwise become unresponsive may not have experienced an opioid overdose. They may be suffering from another medical condition such as a diabetic emergency or an irregular heartbeat. In that case, administering naloxone will not be of any assistance.

If the worker with naloxone training is not trained in first aid, as a best practice, they should be accompanied by someone who is trained in first aid when they respond to a suspected opioid overdose. This can help to ensure that first aid is administered if the medical event is not an opioid overdose.

After naloxone is administered

With more powerful opioids, such as fentanyl and carfentanil, the worker experiencing an opioid overdose may not respond to the first dose. Multiple doses of naloxone may need to be administered until first responders arrive. A worker experiencing an opioid overdose may also overdose again after the naloxone wears off.

Hazards related to the administration of naloxone

Naloxone can temporarily reverse the effects of opioids. This means the person given naloxone may experience acute opioid withdrawal, which can cause pain, distress and agitation. Opioid withdrawal symptoms can include aggressive behaviour. This is one hazard that could create a risk of injury to people who are nearby, including to the worker administering the naloxone.

The employer must ensure that the training provided to the worker in charge of the naloxone kit includes training on any hazards related to the administration of naloxone. This is important for the occupational health and safety of the worker that is administering the naloxone. Training may include topics such as:

  • how to respond to a potentially violent person
  • protections related to biological exposure because opioid withdrawal symptoms can include nausea, vomiting and diarrhea

Disclosure of personal information

Employers are not permitted to disclose more personal information than is reasonably necessary to comply with the naloxone requirements. Only personal information that is necessary to ensure compliance with the requirements should be disclosed.

For example, the worker in charge of the naloxone kit could be told by the employer that there is a risk of a worker having an opioid overdose in the workplace so that they are prepared to respond, if necessary. However, the worker in charge of the naloxone kit would not necessarily need to know all the personal information that the employer has about the worker who is at risk of having an opioid overdose.

Examples of workplace scenarios involving naloxone

The following are examples of some scenarios that an employer could encounter in their workplace related to opioid use, followed by general information about how the naloxone-related provisions of the OHSA may apply.

Not all employers have to comply with the OHSA requirements to provide naloxone in the workplace. Employers should conduct their own inquiries into the risk of opioid overdoses in the workplace, consult the OHSA and its regulations and apply the law to the circumstances in their workplace. They may wish to consult a lawyer if they have questions.

Disclaimer

This material is intended to provide you with general information only. It is not intended to provide specific advice about your particular circumstances. This resource is not comprehensive and does not cover all possible scenarios. Each and every workplace is different, and only an inspector can determine whether there has been compliance with the OHSA.

The ministry does not make any warranty to you that this material is accurate or free from errors. The ministry is not and shall not be made liable or responsible in any way for any loss or damage (including any type of damage) that may result from actions taken or not taken by workplace parties based on their reliance on or use of this information.

This resource does not replace the Occupational Health and Safety Act (OHSA) and its regulations and should not be used as or considered legal advice. Health and safety inspectors apply and enforce these laws based on the facts they find in the workplace.

You are aware that your workers use opioids

There may be a risk of one of your workers having an opioid overdose in your workplace if you:

  • have observed opioid use amongst your workers
  • know that one of your workers had an opioid overdose in your workplace

Further inquiry may be needed. Consult the criteria for when employers must provide naloxone kits listed above.

A customer has overdosed in your workplace

A customer has overdosed in your workplace, but it wasn’t one of your workers. In this scenario, the OHSA requirement to have a naloxone kit in the workplace would not apply to you.

For the OHSA requirements on naloxone to apply to you, the risk of an opioid overdose must be from one of your workers at your workplace. The OHSA requirements on naloxone do not apply to workplaces where the risk of an opioid overdose is only created by a non-worker, such as a customer, client, patient or other member of the public.

A customer opioid overdose occurring in your workplace does not, alone, indicate that you may need to provide a naloxone kit in your workplace under the OHSA.

However, there may be other factors to consider when making your decision. Consult the criteria for when employers must provide naloxone kits listed above.

A worker discloses that they use opioids

A worker voluntarily discloses to you that they use opioids as prescribed by a medical practitioner. This alone does not indicate that there may be a risk of one of your workers having an opioid overdose in your workplace because such use is under medical supervision.

In this scenario, the OHSA requirements may not apply, and you may not be required to have a naloxone kit in the workplace. There may be other factors to consider when making your decision. Consult the criteria for when employers must provide naloxone kits listed above.

The OHSA requirements on naloxone don’t require you to ask your workers about their opioid use. Under those requirements, you must not disclose more personal information than is reasonably necessary to comply with them.

A worker discloses the possibility of an opioid overdose

One of your workers voluntarily discloses the possibility of an opioid overdose to you, a joint health and safety committee member, or health and safety representative. This could indicate that there may be a risk of one of your workers having an opioid overdose in your workplace. In this scenario, the OHSA requirements would likely apply to you.

However, there may be other factors to consider when making your decision. Consult the criteria for when employers must provide naloxone kits listed above.

You have found opioid paraphernalia in your workplace

If you or someone else in the workplace discovered discarded opioid paraphernalia in your workplace, such as used needles, this could indicate that there may be a risk of one of your workers having an opioid overdose in your workplace.

However, there may be other factors to consider when making your decision. Consult the criteria for when employers must provide naloxone kits listed above.

A union or human resources recommend having a kit

If a union representative or human resources professional recommend a kit be made available at the workplace because they believe there may be a risk of one of your workers having an opioid overdose, this could indicate that that there may be a risk of one of your workers having an opioid overdose in your workplace.

However, there may be other factors to consider when making your decision. Consult the criteria for when employers must provide naloxone kits listed above.