Minister Hadju said in her letter to Provincial and Territorial Ministers of Health on August 24, 2020, “the overdose crisis is one of the most significant public health crises in recent Canadian history [...] we need immediate action from all levels of government and health care practitioners to prevent further deaths from the contaminated illegal drug supply …” We at the National Overdose Response Service could not agree more. In fact, this reality has catapulted us into action.
Since April 2020 COVID-19 has taken the lives of 29,669 people in Canada. This impact was colossal on our most marginalized population, communities, loved ones, and even ourselves as we navigated rapid change and the collective stress of uncertainty. Public Health implemented the closures or reduced capacity of many businesses, services, and institutions to slow the spread of COVID-19. However, the services - such as mental health and substance use support, shelter services, safe injection sites, medical services, food banks and drop-in centers where folks could do laundry, shower, eat meals and receive support - were lifelines for people already marginalized by drug use. The increased collective stress, isolation and limited access to life-sustaining resources only exacerbated the impacts of the opioid epidemic. And we saw a sharp rise in overdose fatalities with the onset of COVID-19 which led to an 88% increase in overdose fatalities compared to the previous year. Overall, between January 2016 to March 2021, 22,828 people in Canada have died from opioid toxicity. It is the insurmountable loss and grief that led to the creation and formation of a national solution, The National Overdose Response Service.
The genesis of NORS is a strange and adventurous tale of hope that speaks to the resiliency and compassion of humanity during times of collective crisis and suffering. In reflection, it is hard to imagine that our team of riffraff and renegades came together in the creation and evolution of this wild endeavor, as with any project of this magnitude, it became far greater than the sum of its parts.
The concept was adopted from The Never Use Alone organization, which is a group of peers in the United States who had the brilliant idea to provide virtual and telephone support to those consuming substances to prevent the risk of death from an overdose. Grenfell Ministries Program Director and founder Rebecca Morris-Miller came to the Board of Directors and proposed that we replicate a similar service here in Canada. The decision was unanimous, and the first free phone-based remote consumption services were launched for the province of Ontario on February 1/2020 called the Ontario Overdose Prevention Line. Through this project’s success, we connected with Dr.Monty Ghosh, and then with Brave Technology Cooperative who was one of the first to offer an app-based virtual safer consumption space across North America. Together, we launched the National Overdose Response Service on Dec. 15, 2020.
The National Overdose Response Service (NORS) is a peer-run and peer-led phone-based overdose prevention service to support Canadians and Indigenous communities. The service works when a person is about to use drugs alone, they can call 1-888-688-NORS (6677). A caller is then connected to a virtual overdose supervisor who will monitor them while they use drugs. If there is a concern of overdose during the call - such as the caller becoming non-responsive - the supervisor will connect with local 911 dispatch services. In some instances, a caller may not feel safe with police showing up with EMS or living in an area of Canada that EMS cannot quickly access. In this case, callers have the option of providing the number of a friend or someone they trust to respond to them should they have an overdose.
NORS offers a practical solution to keeping people safe while using drugs. Our mission is simple to keep those using substances safe from an overdose while upholding people who use drugs’ right to dignity, respect and confidentiality while providing access to supportive resources.
Number of calls: Between Dec 15, 2020, and Oct 31, 2021, the NORS line had over 2981 service calls.
Overdose Outcomes: While the majority of phone calls for NORS required no action, the line had over 33 overdoses reported between Dec 15 2020 to Oct 31, 2021. All of these calls were successfully responded to and the overdoses were reversed.
Call types: Many of the calls were not just for virtual drug use supervision support, but rather were for other purposes. We had received over 199 general inquiries from agencies and organizations. 587 of the calls were from people seeking psychosocial support including individuals requesting crisis, mental health, and methamphetamine psychosis support.
Growth of Service Uptake: The NORS service has steadily grown in utility, peaking in September 2021. Trends in the uptake of the phone service are in relation to media coverage, National Overdose Awareness Campaigns, and social media and marketing strategies.
Geographic Distribution: The vast majority of calls were coming from Ontario, followed by Quebec, Alberta, and British Columbia.
Substance and route of use: Traditional site-based supervised consumption has many limitations. SCS’s mainly support IV drug use. We know that drug toxicity has increased exponentially and people are at risk when they use illicit substances of any kind, in any way. Our data shows that people who call the line are primarily IV drug users, however, a large portion of callers disclose using a multitude of substances in many ways. NORS service access is not limited to the route of administration.
Outcome Success Summary
- Expands supervision to wherever a person is using drugs
- Provides overdose response in areas not well served by emergency services
- Provides overdose response in areas not well served by good public policy or harm reduction services
- Decreases social isolation
- Increases social connection
- Connects service participants to community resources
- Provides information for local safe drug use supplies
- Increases service access (i.e. not limited to route of administration or location, especially with inhalational supervised consumption services being limited in Canada)
- Effective use of peer to peer expertise and knowledge sharing
- Increases an equitable access to service
For us at NORS, connection is our purpose. We know that the main success of the line is about the work of ending the isolation, stigma, and social/geographical barriers that drive overdose fatalities. How many times a caller is connected to another human who cares for their continued wellbeing, no matter their life circumstances. That combined with the ability to know the when and the where of a potential fatality allows for a purposeful flow of information to get help to the caller if they need it. This is its primary success, connection to a loving, non-judgemental team of badass harm reductionists. We are so proud of our team that fights everyday against insurmountable odds. We find it deeply meaningful to save lives, end isolation, provide connection and care above and beyond the function of the line, and for bringing the program to life across Canada.
Boyd, J., Collins, A., Mayer, S., Maher, L., Kerr, T., & McNeil, R. (2018). Gendered violence
and overdose prevention sites: a rapid ethnographic study during an overdose epidemic in Vancouver, Canada. Addiction, 113(12), 2261-2270. https://doi.org/10.1111/add.14417
COVID-19 daily epidemiology update - Canada.ca. Health-infobase.canada.ca. (2021).
Retrieved 2 December 2021, from https://health-infobase.canada.ca/covid-19/epidemiological-summary-covid-19-cases.html.
Hyshka, Dong, Meador, Speed, Abele, LeBlanc, McFarlane, McNeil, Salokangas, Schoen, &
Wild, Supporting people who use substances in shelter settings during the COVID-19
pandemic. Edmonton, Alberta: Canadian Research Initiative in Substance Misuse; May
17, 2020. 82 p. Version 1. Retrieved from: https://crism.ca/wp-content/uploads/2020/06/CRISM-Guidance-Supporting-People-Who-Use-Substances-in-Emergency-Shelter-Settings-V1.pdf
National Overdose Response Service (NORS). (2021). Retrieved 2 December 2021, from https://www.nors.ca/.
Opioid- and Stimulant-related Harms in Canada. Health-infobase.canada.ca. (2021). Retrieved 2
December 2021, from https://health-infobase.canada.ca/substance-related-harms/opioids-stimulants/.
Statistics Canada. (2020). Changes in federal, provincial and territorial custodial populations
during the COVID-19 pandemic, April 2019 to April 2020. Retrieved 8 January 2021, from
Rezene, L. (2020). COVID-19, the Opioid Epidemic and the Housing Crisis. Child & Youth
Services, 41(3), 304-306. https://doi.org/10.1080/0145935x.2020.1835181
Wyant, R. (2017). Bail and Remand in Ontario [Ebook]. Ontario: Ministry of the Attorney
General. Retrieved from https://www.attorneygeneral.jus.gov.on.ca/english/about/pubs/wyant/