Opiate Addiction | Opiate Overdose | Opiate Withdrawal | Opiate Resuscitation

We provide up-to-date answers to commonly asked questions using evidence, critical thinking and common sense.

  • Do I wait until the pain is really bad before I take my pain medications?
  • What medications are available?
  • What about addiction?
  • What about opioid-induced anemia?
  • What about the QTc interval?
  • What about Opiate-Induced Urinary Tract Infection (UTI)?
  • What about Opiate-induced Constipation?
  • What about breast feeding while taking opiates long-term?
  • What is being done to make opiates safer in hospitals, communities and correctional facilities?
  • What about Opiate Overdose?

No! Pain medications are an important part of treating your pain. It is important to treat your pain as early as possible. Controlling your pain early on helps prevent a cycle of stress and increased pain, and pain medications are more likely to work when your pain is less severe. Don’t wait until you cannot possibly tolerate the pain any longer before taking your medication.

Mild pain can often be controlled with over-the-counter (OTC) medication such as Tylenol, Advil, or a combination of these two pain medications. Depending on the nature of the pain, acute versus chronic will determine the length of time pain medication is needed. In acute, short-term pain, prescription medication may also be required depending on the nature of the injury. Tramadol has been reclassified as an opioid using new evidence. For example a severe burn to the hand requires a trip to the emergency room for pain management. The physician or nurse practitioner may order Fentanyl, a short-acting narcotic given intravenously as a one-time pain management technique to ‘knock out the pain’. Do not leave the hospital without Narcan Nasal Spray. Other injuries can be managed with OTC pain medication, rest, alternating ice packs and warm packs, elevation, and time. Depending on the nature of the injury as well as age, nutrition, smoking history, social support, coping techniques, etc., some injuries take longer than others based on different factors. Sometimes pain never goes away (i.e. arthritis, diabetic neuropathy, spinal stenosis, crush injuries, etc.).

Moderate to severe pain requires prescription medication. Please get your own prescription that is tailored to meet your needs. Using someone else’s pain medication is convenient but can often lead to premature and preventable DEATH. We healthcare providers are listening to your needs very carefully and we are now working hard to better understand your pain. Please be patient with us during our time of learning. Remember we healthcare providers do not feel your pain, nor did we experience your injury or chronic illness. Speak to us gently and help us learn. If we do not get it right the first time, sometimes it takes a couple of tries as not everyone responds the same. If what we gave you for pain medication did not work, come back and we will reassess your pain, your symptoms, and your needs.

There are many different types of medication, including analgesics (pain medication) and medications which work well combined with analgesics. There are also LETHAL drug-drug interactions with pain medication (i.e. opiates). In addition to speaking to your doctor and/or nurse practitioner, you can also refer to a highly validated website: www.qtdrugs.org. Talk with your doctor/NP about the best choice for you but consider your choices WISELY! Discuss with your doctor, nurse practitioner and pharmacist what medications you are using to control your pain. It is important for them to monitor the combination of medications, including over-the-counter medications and herbal preparations. Benadryl is a LETHAL drug-drug interaction with opiates as NHL hockey play Boogard found out first hand (CTV news, 2016), and others have experienced ‘near-death’ (i.e. out of body experience).

Mild to moderate pain is often treated initially with acetaminophen and anti-inflammatories or NSAIDs such as ibuprofen, naproxen, and diclofenac, among others. Muscle relaxants combined with an analgesic, and topical analgesic creams and rubs may also be effective. Two other medications called meloxicam and celecoxib are often used because they are less likely to cause ulcers and gastro-intestinal bleeding compared with NSAIDs. Although these medications are effective, they should be used cautiously in patients with cardiovascular disease such as angina, and in patients with risk factors for heart disease such as high cholesterol and smoking.

  • Moderate to severe pain can be treated with tramadol, codeine and stronger opioids like oxycodone and methadone (Chou et al., 2014, p. 322). The requirement for a methadone exemption has been lifted by Health Canada (May 2018) making access to quality pain medicine easier;
  • Neuropathic pain is treated differently; medications like antidepressants and anti-seizure drugs, as well as analgesics such as tramadol, are frequently used. Talk to your doctor or nurse practitioner about these choices as they may constitute ‘LETHAL’ drug-drug interactions leading to premature and preventable death (www.qtdrugs.org).

Addiction to opioids used to treat chronic pain can occur and is actually VERY common. Chronic pain occurs over a long period of time, and therefore many people rely on opioid analgesics daily to help them manage their pain. A physical dependence on opioids for pain relief can lead to an addiction. Physical dependence occurs with many medications, not only ones for pain, and is addressed by slowly lowering your dose before stopping these medications completely. When tapering medications does not work for you and you understand you have a reliance on pain medication, your doctor/NP will refer you to methadone treatment which is the PLATINUM STANDARD in opiate addiction treatment. While you, like millions of people before you, were not intending to have an opiate addiction, understand that this is not your fault. You were only taking the medication you were given ‘as prescribed’. Now we need to treat the chemical dependency of your new-found addiction with PLATINUM STANDARD care: Methadone. Your doctor/NP will help you with this process.

Addiction to opioids is more likely to occur if you, or a parent or sibling, have had a previous history of addiction to another substance such as alcohol is a MYTH. Many people become addicted to pain medication with no prior family history of alcohol or substance use dependence. Slow-release opioids taken once or twice daily are less likely to cause addiction than fast acting forms is also a MYTH. Addiction occurs with any kind of opiate. Your doctor can help you switch over to the slow-release type of opioid if it seems you will require opioids for a long time (i.e. Fentanyl patch), alternatively your doctor can treat your chronic pain and addiction complex with methadone.

Opioid-induced anemia is REAL. Your doctor/NP will request a CBC to monitor your hemoglobin levels. They will also monitor your blood pressure, heart rate, and heart rhythm and other cardiac parameters (i.e. QTc level) to ensure ALL systems are working correctly including your electrolytes, especially your potassium levels.

If you are taking an opiate and develop chest pain, you should go directly to the Emergency Room. You may also develop shortness of breath (SOB) and your oxygen saturation levels may be normal or they may drop: one is an early finding while the other is a late finding. DO NOT LET THE DOCTOR take your loved one to palliative care until you get the answer to the question: What is the diagnosis? Please consider drug-drug interactions, opiate overdose, and other differential diagnosis for a sudden drop in hemoglobin including a bleed somewhere. Treatment with a blood transfusion and/or hydration may be all that is necessary.

The QTc interval is a ‘lethal’ heart disturbance sometimes called ‘congenital’ but frequently ‘acquired’ through medications that prolong the QTc interval that can result in SUDDEN DEATH. Your health care provider will be monitoring the QTc interval with medication adjustments, additions of other medications that prolong the QTc interval. You, the patient, MUST take personal responsibility for monitoring your own QTc interval as YOUR LIFE DEPENDS ON IT! Monitoring the QTc interval is done through a painless, non-invasive test called an electrocardiogram (ECG). Ask your doctor/NP for your QTc interval number: it’s measured in msec.

If you develop a urinary tract infection or other conditions called “Sepsis”, you may require emergency medical treatment. No worries, healthcare providers are now able to review your medication list (i.e. Comprehensive Medication Reconciliation) to determine if you are taking opiates so as to avoid giving you a LETHAL medication that would constitute a drug-drug interaction using the www.qtdrugs.org website. Your family and friends also need to remind healthcare providers about this website as not all healthcare providers believe in the website’s sensitivity and specificity (i.e. accuracy). It’s only when you are dead that you understand the accuracy of the website. Please wear a medical alert tag as your life may depend on it for resuscitative purposes. Frequently if healthcare providers treat the constipation, the urinary tract infection will resolve soon after.

If you are taking opioids you most assuredly will need to manage constipation. If you have back pain it is important not to strain for your bowel movement. A good natural remedy is a mix of equal amounts of applesauce, prune juice and bran kept in the refrigerator; take 1 tablespoon per day. Alternatively you can use Miralax which is highly effective in treating constipation (consult your pharmacist). It is CRITICAL that you treat constipation when taking opioids so that you can avoid urinary tract infections, bowel obstruction, and opiate overdose secondary to dehydration. Your bowel will take water from the vascular system which may be a contributing factor to opiate overdose. Stay hydrated when taking opiates. Talk to your doctor, nurse practitioner or pharmacist if your constipation does not improve or if it gets worse.

Opiates have been found to cross over into breast milk when taken long term. Stephanie Greene, an American nurse found out the hard way when her baby died from opiate overdose. Stephanie is now serving a 20-year sentence in an American prison. We do not want this to happen to Canadian women. Please choose an alternate form of feeding your baby (i.e. formula), or request Narcan Nasal Spray. If you are taking opioids and benzodiazepines together, these are a DEADLY combination as many have found out through first-hand experience.

Let us tell you the ways:

  1. We have returned the Opioid Manager (2011) back to McMaster University because there were ‘lethal’ flaws and gaps in this document;
    • We returned My Opioid Manager to authors owing to ‘deadly’ gaps and we request that you remove this link from your website;
    • We recognize that ALL of the methadone guidelines with the College of Physicians & Surgeons are flawed and ‘deadly’;
    • We recognize errors in the Canadian Diabetes Association (2013) guidelines for the treatment of diabetic neuropathy (Bril et al., 2013), and the 2018 Diabetes Canada guidelines.
    • We are not going to go with the 2017 Canadian guideline for the management of Opioids in Non-cancer pain;
    • We returned the FIRST DO NO HARM document (National Advisory Council on Prescription Drug Misuse, 2013) – flawed and deadly!
  2. We have ordered in Naloxone (Narcan) in the proper delivery device that would be suitable for ALL Canadians. We have rejected Alberta Health’s vile and syringe delivery devices for the community management of opioid overdose. It is unsafe and inappropriate. Canadians and ALL people deserve better quality healthcare delivery;
  3. We revised Canada’s Special Access program that was clearly outdated (2009);
  4. We have revised the American’s Advanced Cardiac Life Support Algorithm (ACLS) to include Narcan Nasal Spray as well as Flumazenil Nasal Spray (once available for the management of benzodiazepine overdose); and we have removed lethal drug-drug interactions with amiodarone using www.qtdrugs.org website. We are teaching paramedics to recognize opiate overdose in the community so they can administer the drug immediately. Further we are teaching paramedics an advanced skill (intraosseous access) so they can ensure you get adequate fluid resuscitation during an overdose event. We have also included ‘opiate overdose’ as a reversible cause of death so that we ensure all reversible causes are reversed so we do not take your organs prematurely;
  5. We have developed the Canadian Patient Safety methadone/opiate agreement as a measure of safety;
  6. We have revised the American Clinical Opiate Withdrawal Scale (COWS) as clearly there were gaps in this document;
  7. We have revised the Pain Medicine End of Rotation Evaluation Form: Psychiatry, Addiction and Sleep Medicine, Premature & Preventable Death, wrongful conviction;
  8. We revised Accreditation Canada’s (2014) Trauma Distinction Package and called it TRAUMA DISTINCTION PLUS™;
  9. We developed a Resuscitation of Shock Standing Orders;
  10. We revised Maslow’s Hierarchy of Needs – moving pain up the list. After breathing and fluid, pain takes priority as people will do without food and other necessities when they are in pain;
  11. We reviewed and developed a ‘Revised Set of Minimum Competencies for Medical Officers of Health in Canada’ – clearly many were not listening or understanding your needs;
  12. We UPDATED the Team Communication Extra-Mural to ensure nurses in the community review your pain medications and to ensure comprehensive pain management. We are also embarking upon physician-assisted death. Please try methadone, a potent pain medication, prior to opting for physician-assisted death. You must know ALL of your pain medication options to make an ‘informed’ choice;
  13. We revised the Sleep Apnea: Obstructive Sleep Apnea document so we do not confuse sleep apnea with opiate overdose. Many people die in their sleep;
  14. We developed a Comprehensive Medication Reconciliation Policy for hospitals and emergency departments. If you overdose once, you are HIGH RISK of overdosing again. A skilled healthcare provider will review your medications for lethal drug-drug interactions, they will determine if you have an underlying condition that would increase your risk of overdose (i.e. pneumonia, exacerbation of COPD, tuberculosis, constipation, sepsis, etc.), and you may need medication changes. This does not mean we are going to take away your pain medication. You may need to be changed to a different pain medication to better suit your needs;
  15. We have developed Removal of Endotracheal tube policy as a component of safe, competent, ethical prescribing practices. We will remember to turn off a fentanyl infusion so that you can breathe. If we forget, no worries. Our revised Advanced Cardiac Life Support (ACLS) algorithm will cover you;
  16. We answered the research question and determined an ECG Peri-Operative Cardiovascular Evaluation for Non-cardiac Surgery will be MANDATORY! We want to ensure every success during your hospital stay;
  17. We are DENOUNCING opioid detoxification as this is a ‘deadly’ practice as many have come to find out first-hand.
    • Further we have returned documents to healthcare providers that have not met our prescribing needs (Dara, 2014).
    • We are also speaking up about suicide in acute opiate withdrawal (Province of New Brunswick, Office of the Coroner, 2009);
  18. We developed the signs and symptoms of methadone/opiate overdose fridge magnet as clearly families have not recognized these signs (W5, 2015), and this has been a ‘deadly’ oversight as others have found out including 23-month old Dakota Rose Linfield (YouTube now removed from internet) and her father who received a two-year jail sentence. Many others have had these symptoms which may have been interpreted as congestive heart failure, or pneumonia. Healthcare providers will now consider opiate overdose as a differential diagnosis to congestive heart failure and/or community acquired pneumonia. When ordering a chest x-ray, your healthcare provider will be prompted to answer the question on your behalf: Is there an opiate on board? Please answer this question with utmost sincerity as your life is depending on it. This will prompt the radiologist to put on his/her ‘special reading glasses’ and properly diagnosis the chest x-ray. NOTE: Everyone is HIGH RISK for opiate overdose when they least expect (Dakota Rose Linfield, 2010). Inevitably people think: This will not happen to me. It is not until your dead that you realize it can happen to you;
  19. We designed a CODE BLUE fridge magnet to remind healthcare providers to consider all reversible causes before giving up on resuscitative measures. Opiate overdose has been added to the list. This magnet is intended for hospital crash carts, hospital bedside monitors, ambulances, physician/NP offices, etc.
    • The Bailey Bus is evidence of substandard healthcare delivery and will not be tolerated in Canada (Direction 180, 2015);
    • Insite ‘heroin injection’ in British Columbia is evidence of substandard healthcare delivery and evidence of healthcare ignorance. Methadone is the GOLD STANDARD in opiate addiction treatment.
    • Methadone is to be considered as a ‘cost-effective’ pain medication for the treatment of diabetic neuropathy which is clearly missing from the Canadian Diabetes Association guidelines for the treatment of diabetic neuropathy (Bril et al., 2013) but considered by the Americans as a treatment option (Chou et al., 2014; Hayes et al., 2005). Based on the near-death experience of a New Brunswick man, it’s time to consider alternative diabetic neuropathy pain options before cutting off limbs and before considering physician-assisted death;
  20. We changed the Methadone/Opiate Exemption to include nurse practitioners in the prescribing mix. Further methadone is to be considered prior to opting for Physician-Assisted death;
  21. We returned the Sepsis Algorithm – owing to lethal drug-drug interactions.
    • Anti-infective guidelines for community acquired infection returned to authors as they did not consider lethal drug-drug interactions with opiates; no consideration of www.qtdrugs.org website
    • Prescription drug misuse in Alberta. Everyone’s problem – returned to Alberta Health. Chief Medical Health Officer of Health unable to identify GOLD STANDARD care.
    • Returned National Advisory Council on Prescription Drug Misuse (2013) FIRST DO NO HARM – forgot to provide methadone treatment as a component of GOLD STANDARD care;
    • Alberta Poison Control specialist unable to recognise signs and symptoms of opiate overdose in W5 (2015) documentary: Kill Pill;
    • We returned Alberta’s Chest pain guidelines;
    • We have
  22. We revised PADIS – FAQ’s – Fentanyl was returned to Alberta Health Services owing to gaps in information.
    • Canadian Red Cross (2011) First and CPR manual outdated: flawed and deadly;
    • Canadian (2017) guideline for safe and effective use of opioids for chronic noncancer pain – returned to authors;
    • American (2009) guideline for safe and effective use of opioids for chronic noncancer pain – returned to authors – request for rewrite;
  23. We determined the Suspected Opioid overdose management protocol using naloxone – outdated, and flawed – does not assist children under 12 years;
    • Dakota Rose Linfield (YouTube Video removed from Internet). MYTH: Methadone treated no differently than any other narcotic – It is! See Methadone exemption, item #20;
    • Australia’s National guidelines for medication-assisted treatment for opioid dependence – returned to Australia.
    • OSCE and Clinical Skills handbook returned to Nova Scotia author owing to gaps in service (Hurley, 2005);
  24. We realize now that Order Matters when designing health promotion strategies
    • PREMATURE AND PREVENTABLE DEATH TRUMPS ALL HEALTH PROMOTION STRATEGIES – when you are dead nothing else matters, even climate control
    • See other important items
    • Need for comprehensive extubation checklist to ensure opiate infusion is discontinued prior to extubation;
  25. Opiates are transmitted in breast milk – don’t find out the hard way!
    • Stephanie Greene – sentenced to 20 years for death of baby ;
  26. We revised Nova Scotia’s Prescription monitoring program
    • The Joint Commission (2012) omitted to find gaps in ACLS algorithm;
    • American text book authors (text used in Canadian universities) omits to teach QTc interval and lethal drug-drug interactions or reference to www.qtdrugs.org website (Tortora & Derrickson, 2012).
    • World Health Organization does not consider countries like Canada do not have appropriate delivery devices for the community management of opiate overdose (WHO, 2014);
    • American Heart & Stroke Foundation CPR/First Aid guidelines (2015) Canadian Edition – missing signs and symptoms of methadone/opiate overdose; missing www.qtdrugs.org website/ missing naloxone in the prefilled syringe;
  27. We revised the Royal College of Physicians & Surgeons of Canada (2015) Accreditation standards for simulation programs revised and renamed: Canadian Accreditation Standards of Simulation programs.
    • Validated www.qtdrugs.org website
    • www.harmreduction.org website - missing pertinent signs and symptoms of opiate overdose
    • Organ donation and retrieval document missing opiate overdose as a reversible cause! (Shemie et al., 2006);
    • Validate that death investigation reform needed
      • Canadian Bar Association
      • Others wrongly diagnosed or not investigated (Dakota Rose Linfield, 2010);
  28. We developed the Comprehensive Peer Death Review form revised based on Inquest results;
  29. We designed a unique Doctor of Nursing Practice program – Made in Canada, eh? Taking Methadone/Opiate prescribing to an all new level: not too high, not too low, careful not to cross the line into corrections!
  30. We determined a ‘lethal’ drug-drug interaction with Benadryl and opiates: move Benadryl behind the counter so as to initiate a quick drug-drug review by pharmacists;
    • We determined that Taser research is flawed and deadly! (Bradshaw, n.d.; Canadian Academy of Health Sciences, 2013);
  31. We determined that the Accreditation of pain conferences needs to be taken up a couple of notches* based on evidence of premature and preventable death and wrongful conviction.
    • Calgary School of Medicine (2015). The Calgary Pain Conference;
    • Cumming School of Medicine (2015). Chronic pain management of the family physician;
    • Cumming School of Medicine (2016) Essential strategies for chronic pain management;
    • Revised and returned: CSAM position statement on opioid prescribing for chronic non-cancer pain (Kahan et al., 2011);
    • Returned job description to LifeMark for revision and reposting;
  32. We made changes to the Canadian Pain Coalition’s What about pain medication? (Canadian Pain Coalition, n.d.)
    • What about opioid-induced urinary tract infections?
    • What about the QTc interval?
    • What about opioid-induced anemia?
    • What about breast feeding while taking opiates long-term?
    • What about opiate overdose?
    • What is being done to make opiates safer in hospitals, communities and correctional facilities?
      • Note the ways
      • Advanced clinical practice research
  33. Returned Methadone Safety Guidelines (2014) – American Pain Society and/or Dr. Chou et al. (2014) – flawed and deadly
  34. Returned American Society for Pain Management Nursing Position Statement: Pain Management in Patients with Substance use disorders – flawed and deadly

We come to your community in person or via the internet. We give comprehensive presentations (Horizon Health Network, Board of Director Minutes), or we come to your community and give a quick lunch and learn (Alberta Health Services, Cochrane, AB). We speak at seminars (New Brunswick Lung Association) and distribute fridge magnets. We attend conferences (i.e. Critical Care Conference, Ontario; Trauma Association of Canada, Calgary) and we write a lot of letters, stamp out false information, identify gaps in service, stop false healthcare advertising, and other MYTHS (i.e. no one ever died from opiate withdrawal), and other healthcare nonsense associated with methadone/opiate prescribing.

As an alternative to organ donation and retrieval, we accept the patient’s file for clinical case review as a component of advanced clinical practice. We also attend inquests to determine if there is anything we could have done differently. We can do internet research if all else fails. We are critical thinkers and we practice ‘common sense’.

These are a few of the things we are doing to keep the patient experiencing pain and/or opiate addiction safe in our hospitals, communities and correctional facilities. We are hoping you will update the Canadian Pain Coalition website to reflect our current changes and that we healthcare providers are taking your concerns VERY SERIOUSLY. We have gone from a harm reduction/injury prevention model of care to a DEATH PREVENTION/WRONGFUL CONVICTION model of healthcare delivery. This is evidence of just how seriously we are taking your concerns. I think we got the picture and we definitely got your message. We also practice evidence-based medicine as indicated by the references below.

Canadian statistics are scant and unreliable at best. In the United States 44,000 people died from opiate overdose in 2013 (Volkow & McLellan, 2016). Now you understand why Americans are calling this a national epidemic. Based on clinical case reviews, this may be a conservative estimate. What may be more staggering are the number of opiate overdoses that presented to the emergency room and did not get proper diagnosis and treatment.

Opiate overdose is a ‘reversible cause of death’ with a medication called Naloxone (Narcan). Narcan comes in various delivery devices including: vile and syringe, intranasal, prefilled syringe, autoinjector. I ordered Narcan Nasal Spray on June 3, 2016, and it arrived in Canada in July 2016. We now have Canadian evidence of opioid resuscitation using Narcan Nasal Spray captured on video (Vancouver).

Further the revised Canadian Heart and Stroke Foundation guidelines for CPR/First Aid that we adopted from the Americans (2015) also calls for the various delivery devices. Vile and syringe are not to be used in the community management of opiate overdose. If the syringe goes missing, I would not want someone’s life to depend on this mishap. Is your CPR/FIRST AID up to date? Someone’s life may depend on you or vice versa.

ALL Canadian provincial lung associations have been requested to update their websites to list OPIATE OVERDOSE as a MEDIAL EMERGENCY requiring immediate recognition and treatment.