National Overdose Response Crisis (NORS)

The opioid epidemic is currently Canada’s most significant public health crisis, claiming an average of 22 Canadian lives daily—more than car accidents, homicides, and heart attacks combined. COVID-19 social isolation further exacerbated the overdose epidemic across Canada. Between 50-70% of overdose victims die while using substances alone.

In Alberta, a record 2,051 people died from overdoses in 2023 – tripling the 2016 numbers. Over 90% of these deaths involved non-pharmaceutical opioids like fentanyl, which is often tainted and unpredictable. But with the right resources, overdose fatalities are preventable and overdoses are reversible.

Dr. Sumantra (Monty) Ghosh is an internist and disaster medicine specialist in Edmonton and Calgary, and assistant professor at the University of Alberta and University of Calgary. In December 2020, Ghosh and his team launched the National Overdose Response Service (NORS), a Canada-wide hotline to prevent and reverse opioid overdoses by ensuring people don’t use drugs alone. 

NORS provides 24/7, toll-free, confidential, and non-judgmental support and supervision. The peer-driven service operated by volunteers with personal experience in substance use, has built a strong trust with its users. If a caller becomes unresponsive, NORS dispatches an ambulance or a local volunteer. A recent study (Mocanu et al., 2024), showed that between 2020 and 2023, 57.7% of NORS callers lacked access to physical sites due to various barriers. Additionally, over 30% preferred using NORS even when physical sites were available, highlighting accessibility gaps, especially in rural areas. The study found that social barriers, stigma, and fear of gender-based violence also deterred some individuals from using physical sites.

In its three years of operation, NORS has successfully managed over 117 overdose events. In particular, NORS provided a lifeline during the COVID-19 pandemic, a period marked by increased isolation and overdose deaths.

AbSPORU Provided Critical Implementation Science Expertise

A $2-million grant from Health Canada supports the operation and evaluation of the NORS program. AbSPORU supported NORS, the first service of its kind in Canada, through an implementation science lens to evaluate factors such as acceptability, safety, adoption, and satisfaction. A survey co-designed by individuals with lived experience of substance use, service operators, and researchers was sent to more than 11,000 Canadians to gather key perspectives from various stakeholder groups on this service.

AbSPORU’s Learning Health System (LHS) Team supported the NORS evaluation by aligning knowledge mobilization goals with CIHR grant requirements. Through multiple meetings, the LHS Team and NORS researchers mapped out audiences, messaging, dissemination strategies, and identified additional funding opportunities. The LHS Team crafted a knowledge mobilization engagement plan to share the project’s impact, increase uptake and to conduct necessary research to better understand how to reach key demographics, including people in rural areas, Indigenous communities, and people of color, who often lack access to harm reduction resources like supervised consumption sites. 

As a key partner, AbSPORU contributed significantly to the program evaluation using implementation science. Ghosh describes that, given the complexity and scope of the analysis, the support from the LHS Team was invaluable. They ensured the data was accurate and robust, providing the expertise needed for a comprehensive evaluation. Their openness to learning about the project and offering valuable input helped refine the study.

Additionally, the LHS Team facilitated connections between the NORS team and Ontario SPOR SUPPORT Unit (OSSU) leaders, Dr. Hilary Edelstein (Assistant Director) and Dr. Vasanthi Srinivasan (Executive Director), who supported Ghosh’s contribution to a symposium in Ottawa. The symposium engaged policymakers and government stakeholders, with Health Canada offering sponsorship opportunities. Edelstein and Srinivasan provided valuable insights on funding advocacy, jurisdictional considerations, government engagement strategies, and funding advocacy, aimed at expanding the NORS project across Canada.

Informing Policy in Addictions Research and Medicine

The data from NORS has shown that virtual supervision can effectively prevent fatal overdoses. The service has grown from to over 100 volunteers and staff, handling thousands of calls for supervised drug use and crisis support. Ghosh notes, “If they were using alone without any support, they definitely would have lost their lives.”

While the evaluation results are still pending, they are expected to help inform ways that NORS and other virtual overdose response services can improve, tailor their services to specific populations, and navigate around complex perceptions from community members around harm reduction.

The continued collaboration between NORS and AbSPORU is expected to inform future policy and funding decisions, helping to expand and tailor NORS services to better meet the needs of specific populations, and advocating for the continued support and expansion of virtual overdose response services across Canada.

 Jessica is alive today because of the National Overdose Response Service. At 17 she lived alone, several provinces away from her family in a harm-reduction facility for women. When it was too difficult to access a supervised consumption site — a 45-minute walk away — for in-person drug-use supervision and support, she called NORS where she formed relationships with peer operators who had firsthand experience of what she was going through. When she suffered an overdose while using the hotline, an operator called EMS to resuscitate her. Jessica was later connected with the support and treatment she needed, is now sober, reunited with her family and hopes to become a motivational speaker to help others. – from “National hotline a proven harm-reduction strategy in the drug-poisoning epidemic”, Faculty of Medicine and Dentistry, University of Alberta (2024 June 7)

AbSPORU is proud to support the groundbreaking work of Ghosh and his team on the NORS initiative. By providing virtual supervision and connecting isolated individuals to emergency services, NORS saves lives while offering dignity and support to the most vulnerable. This collaborative national effort underscores the importance of innovative, community-driven solutions in tackling public health crises. As the program evolves, its impact will serve as a model for other overdose response initiatives, showcasing the power of collective action in saving lives and improving community health.

With files from the University of Alberta Faculty of Medicine and Dentistry (2024), Folio (2021), and University of Calgary Cumming School of Medicine (2021).

Mocanu, V., Viste, D., Rioux, W., & Ghosh, S. M. (2024). Accessibility gaps of physical supervised consumption sites in Canada motivating the use of overdose response technology/phone based virtual overdose response services: a retrospective cohort study. The Lancet Regional Health–Americas, 34. DOI:https://doi.org/10.1016/j.lana.2024.100770