What is it?
Opioids are a group of chemicals that can change a person’s mental state. This means they are mind-altering or psychoactive (si ko ak tiv). Opioids are often used to help manage pain. They can be made in a lab or found in plant form.
Opioids come in different forms:
- Tablet, pill or liquid in the mouth
- Spray into nose
- Skin patch
- Injected into a blood vein
- Injected into a muscle
- Pump implanted under the skin
The form a person uses depends on the type of opioid and the type of pain being treated.
How do opioids work?
These drugs reduce pain by attaching to receptors in the brain, spinal cord, and other areas of the body. The receptors also control breathing, so if you take too much, your breathing may slow down or stop all together. This is considered an opioid overdose. You may suffer severe brain damage or death if you are not able to breathe for even a few minutes.
It is possible to use opioids safely for pain if they are manufactured safely and you take the correct dose. This is why a doctor’s prescription is required.
What are prescription opioids?
Opioids can be very effective in treating severe pain if used as the doctor prescribes. There are two types of opioid medications:
- Over-the-counter medication for pain relief that contain codeine
- Tylenol 1
- Some cough syrups.
- Opioids that must be prescribed by a doctor or dentist, which include stronger pain medications:
- Tylenol 2, 3 and 4
- OxyNeo (replaced OxyContin)
When is using prescription opioids a problem?
Many parents and caregivers do not realize when a youth is misusing a prescription opioid. They also may not realize how harmful these drugs can be. Many people think opioid painkillers that are prescribed are not as dangerous as other drugs like cocaine or methamphetamine. This is not true. Opioids can have harmful effects even when they are used as prescribed. Their harmful effects can increase and put your life in danger when they are not medically supervised, or if they are combined with alcohol or other drugs.
How do I recognize the signs of a problem?
Signs of a problem with opioids or other substances may include:
- Mood changes (irritable, depressed or agitated)
- Lack of interest in school or other activities
- Changes in energy, sleep or appetite
- Change in friends
- Borrowing money or having extra cash.
Around the house, watch for missing pills or unfamiliar pills. If your teen has a prescription, keep control of the bottle and be aware if they run out of pills too quickly, lose pills or request refills.
What is Fentanyl
Fentanyl is an opioid medication, like morphine or oxycodone. It is usually prescribed only for the severe pain of diseases like cancer. Fentanyl is much stronger than most other opioids—up to 100 times stronger than morphine—and is very dangerous if misused. Even a small amount can cause an overdose and death. It is manufactured under strict guidelines and should only be used under medical supervision.
Sometimes prescribed fentanyl patches are sold on the illegal drug market. Fentanyl can also be produced illegally, or smuggled into Canada from other countries. It is very risky to use fentanyl that is produced illegally because it is impossible to know what it is made of and how strong the drug is. Even very small doses, as little as the size of two grains of salt, can kill you.
What are the signs of an overdose?
An overdose is a medical emergency. If you suspect or witness an overdose, call 9-1-1, even if naloxone has been administered.
You may be able to save a life if you have a naloxone kit and can quickly recognize the signs and symptoms of an overdose while waiting for paramedics to arrive.
How to recognise an overdose:
The person will have one or more of these signs or symptoms:
- Does not respond or wake up easily
- Body is limp
- Breathing slowly or not at all
- Lips and nails are blue
- Skin is cold and clammy
- Choking or throwing up
- Making snoring or gurgling sounds
- Pupils are tiny
What is a naloxone kit?
Naloxone is a medication that can temporarily reverse the effects of an opioid overdose. B.C. has a Take Home Naloxone program that offers training in how to prevent and recognize and respond to an overdose. In BC, you can get a take-home naloxone kit at no cost from pharmacies or a harm reduction site. Kits are available at no cost to:
- people at risk of an opioid overdose
- people likely to witness and respond to an overdose such as a family or friend of someone at risk
If you are a family member, caregiver or friend to someone you suspect is using opioids, we encourage you to be prepared by following these three steps.
Step 1: Complete the free online take home naloxone training here
Step 2: Get a naloxone kit from your pharmacy or closest harm reduction site (click here for locations). Or, if you get health services through the First Nations Health Authority, the First Nations Health Benefits plan will cover the cost of injectable and nasal spray forms of naloxone (available via pharmacies).
Step 3: Keep the naloxone where it can be easily reached to respond to an overdose.
Tips for supporting and talking to your child
There are no scripts for tricky conversations such as talking about opioids and other substances with your child. Here are some tips for supporting a child who is thinking about or currently using opioids or other substances:
- Start the conversation and stay connected. The teen and preteen years are a time when your child may want to pull away. It is important to respect their independence and stay connected at the same time. Build a strong relationship with your child by taking part in activities with them and getting to know their interests and their friends.
- Be supportive. There are many reasons youth use opioids: for example, to feel good, to fit in or to cope with stress. If your child is experimenting, or thinking about it, be ready to help them look at why and how they came to this decision. Be sure they consider other ways to take care of their needs and get support.
- Focus on well-being. Have open, ongoing talks so your child is able to express their ideas and hear yours. Let your child know that you care about their well-being. This means helping them develop the skills to make wise decisions - to know when to take risks and when to play it safe. Help your child consider the bigger impact that opioids may have on their life and to not just focus on the moment.
- Be an example. Think about how you make decisions on how to have fun and spend time with friends. What do you do to deal with stress or keep going when things get tough? How does substance use fit in? Be honest about your own struggles. Talk about why people use substances and the possible benefits and harms of substance use. Suggest other ways to deal with pressures in life.
- Be ready. Pay attention to what is going on in your child’s life. Notice any sudden changes in mood or school work. Your child could be going through a normal stage, but it could also be a sign of substance use or a mental health challenge. Always be ready to listen. Respect their need for independence, but also be sure they know you are ready to help.
- Listen without judgement. This means listening to understand, and seeing your child as a person with struggles that are real. It means putting aside your own views and values and being careful not to criticize while your child describes what they are struggling with. It may be difficult, but it is important to build trust and to let your child know that they can come to you for help. Keeping this trust is critical, especially as you explore ways to best support your child through their substance use journey to recovery and well-being.
When your child won't talk
Some youth are very reluctant to start difficult conversations with their parents, especially if they’ve had an angry or disapproving response in the past.
If your child doesn’t seem to want to talk, try to:
- Set aside some time each day to be with your child. Ask open-ended questions about their day and things going on in their life. Let them know that if they want to talk you’re happy to listen. This might help them feel more comfortable coming to you in future.
- Find another trusting adult they can talk to. You could suggest a relative, teacher, counsellor or youth peer support worker.
What should I do if I suspect a problem?
If you think your child may be misusing opioids:
- Pick a good time to bring up the issue, when everyone is calm and there are no distractions. Let your child know you care, and that is why you are raising the issue.
- Ask questions, be curious. People often deny they have a problem if they feel they are being accused. It is better to ask questions that encourage your teen to talk and not just give yes or no answers.
- Refer to specific events. Talk about the behaviour that worries you. State the facts in an honest, but tactful way. For example, "I'm really concerned about you— you didn't seem to be yourself when you came home last night".
- Offer support. Let your child know that you are prepared to help change things that may be a part of why they use opioids.
- Inform and equip yourself. Get to know the signs and symptoms of an overdose. Learn how to prevent, recognize and respond to an overdose and where Naloxone kits can be accessed in the community. Keep in mind that a small amount of fentanyl can be deadly. Some youth may think prescription drugs are less harmful than street drugs. The truth is that all opioids (prescription or illegal) have a risk of overdose.
- Keep lines of communication open. Talk to your child about what to do if they experience an overdose. Let them know you care about them and develop a safety plan together. A safety plan would ensure they are not using alone and can get help in case of an overdose. This could mean that they always use substances in the company of a sober buddy that can respond to an overdose. Or they have someone to check in on them after they may have used substances.
- Make sure your home is safe. Keep opioids and all other drugs in a safe and secure place (e.g. locked in a cabinet), and check them regularly. At least once a year, clean out your medicine cabinet and bring unused or old medications to your pharmacy for safe disposal. If your teen needs pain relief, talk to your health care provider about the risks of different pain medications and monitor your teen’s usage.
The above two sections were informed by “Prescription opioids, including fentanyl: What Parents and Caregivers Need to Know” with permission from The Centre for Addiction and Mental Health and School Mental Health ASSIST for use in British Columbia.
If you’re looking for support as a parent/caregiver, the Kelty Mental Health Resource Centre’s Parents in Residence offer non-judgemental, compassionate peer support, and can help you access information, resources and networks.