Substance use

It is estimated that approximately one in five Canadians aged 15 years and older experience substance use in their lifetime [1]. Substances include:

  • Alcohol
  • Opioids and other prescription drugs
  • Tobacco
  • Cannabis
  • Methamphetamines
  • Cocaine
  • Heroin
  • Ecstasy

Problematic substance use is when any substances are used in a manner, frequency, situation, or amount that is harmful to a person or those around them [2]. Examples of situations of problematic substance use that can lead to a brain injury include:

  • Excessive consumption causing impaired faculties (i.e. loss of balance or reduced vision)
  • Impaired driving
  • Opioid overdose
  • Lowered inhibition and an increase in risk-taking behaviour

Barriers to recovery for substance use and brain injury

Individuals coping with addiction/problematic substance use and brain injury face a lot of challenges that make recovery more difficult.

Lack of services for complex needs
Brain injury survivors that are struggling with addiction/withdrawal do not have access to many rehabilitation services that can treat both addiction and brain injury.  Either the program requires participants to be sober, or the addiction programs are not equipped to handle the complex needs of people with brain injury. This makes it difficult for people to get the help they need.
Continuing addiction after brain injury
People with a brain injury may have a continuing addiction that they struggle with during their recovery. In some cases, an addiction may develop post-injury. The use of substances (including alcohol) can have negative effects on a person’s recovery and even make symptoms worse.
There is a stigma around substance use/addiction that can impact the quality of life for the survivor and their support circle [3]. A stigma is framing a situation in a negative light, and is often adopted by society as a whole.

The stigma surrounding substance use is made worse when you factor in the stigmas that still exist around brain injury and disabilities. It can take a long time to dismantle these stigmas, and they can be harmful to people.

Advocating for more support for substance overdose survivors

Survivors of opioid overdose, addiction and brain injury need more supports and services that can help them cope with these concurrent challenges. Advocating for more research into the relationship between overdoses and brain injury as well as services is one way to bring further attention to this important issue.

Visit the advocacy section of our website to find out how to be an effective advocate as well as templates for letters.

Addiction & problematic substance use

Substances like alcohol can have detrimental effects on a person before and after a brain injury. This is especially true if a person is coping with addiction.

Addiction is used to describe an attachment to a substance or behaviour that is out of control [4]. The Centre for Addiction and Mental Health (CAMH) indicates that you can determine if you or someone you know has an addiction if there 4 C’s are present:

  • Craving
  • loss of Control of amount or frequency of use
  • Compulsion to use
  • use despite Consequences

In extreme cases, addiction and problematic substance use can completely destroy a person’s life, leading to homelessness, severe health consequences (such as brain injury) and a loss of support from family and friends.

Opioids and brain injury

Problematic substance use is a big problem in Canada, costing thousands of lives and billions of dollars. Here are the most recent statistics from the Canadian Centre on Substance Use and Addiction.

  • Substance use costs Canadians almost $46 billion a year (2017)
  • Over 5,000 people died from opioids in 2017

Illegal street opioids laced with dangerous components such as fentanyl increase the risk of overdose and can cause catastrophic brain injury or death through oxygen deprivation.

While there are a lot of statistics on the number of deaths related to the opioid crisis in Canada, more information is needed on the number of people who acquire a brain injury due to an opioid overdose.


See sources

Opioid overdose

Opioid overdoses can have catastrophic results, including brain injury. Brain injuries present new challenges and changes that can be difficult to cope with, particularly if the survivor is also trying to cope with substance use. It takes a long time to figure out the extent of the changes they have experienced and establish a continuing care plan that will help them with rehabilitation and the recovery process. The effects of the brain injury will change them as well. It’s a scary experience that can be hard to put into words or share with others and can have a huge impact on mental health and wellbeing.

This can feel incredibly lonely, but it’s important to remember that there are people and places that can provide support. Whether this is a family member, a friend, a support worker or even a local brain injury association , there are resources available to help a survivor succeed in their next steps.

Topics in this section include:

What are opioids?

Opioids are a drug used to manage pain, typically after surgery. They induce feelings of euphoria (happiness or ‘feeling high’). When prescribed by a doctor and taken in the recommended dosages, opioids can be safe. These prescriptions are often made with codeine, fentanyl, morphine, oxycodone, hydromorphone, or medical heroin.

Opioids can also be produced and obtained illegally and in a variety of forms. When obtained on the black market, opioid production is not controlled. Often these opioids contain unsafe doses of fentanyl or carfentanil. Carfentanil is specifically for large animals (like elephants), not humans. It’s approximately 100 times more toxic than fentanyl and 10,000 times more toxic than morphine. The smallest amount could cause an overdose.

How do opioid overdoses cause a brain injury?

An opioid overdose can cause damaging effects such as slowing breathing/heart rate and starving the brain of oxygen. The parts of the brain that use the most energy and oxygen are the most vulnerable. When loss of oxygen is more severe it can also damage areas of the brain that are fed by the smallest blood vessels that are furthest from the heart.  The medical term for partial oxygen deprivation is hypoxia. Hypoxia can worsen into anoxia when a person completely stops breathing.

Opioids have their effect by causing the brain to release dopamine, the brain’s natural opioid, in greater amounts. When used over a long period of time, the brain adapts by reducing the number of receptors, a process known as tolerance. Opioids alter the brain and how a person responds to normal rewards in the environment. Things that would normally make someone feel good and happy may no longer be motivating. That is why some people may, use drugs in a dangerous way, even though they know their opioid use is causing problems. This leads to a greater risk of overdose. Approximately 12 people die from opioid overdoses in Canada every day, having the biggest impact on Canadians aged 15-24 [1].

Currently there isn’t much research on individuals who acquire a brain injury through an opioid overdose. What is evident is that those who do survive an overdose from opioids can be left with catastrophic brain injuries that deeply affect the survivor and those close to them.

Substance use can continue to be a concern after a brain injury. The difficulties with attention, memory and judgment may make it more difficult to benefit from care. Substance use after brain injury can often interfere with the brain’s natural recovery and participation in treatment.

Effects of an opioid overdose

Depending on what parts of the brain are damaged and how long the brain was without oxygen, the survivor may experience [2]:

  • Limb weakness
  • Balance and coordination issues
  • Spasticity or rigidity in muscle tone
  • Abnormal, involuntary movements
  • Loss of vision
  • Memory loss
  • Speech and language challenges
  • Changes in cognitive abilities related to thinking and decision-making – this can affect future planning, work and social interactions
  • Changes in personality – this includes irritability, impulsiveness, and social impairments

The impact of overdose can range from subtle to severe. Some people may notice that they are more forgetful, less coordinated or have more trouble getting and staying organized. For survivors of many episodes of overdose, or longer and more severe anoxia, they may experience fundamental changes to their personality and abilities. Recovery does occur, but many changes may be lasting and require rehabilitation.

If you have had an opioid overdose and are experiencing subtle challenges, see the section below on ways to find help after an opioid overdose and brain injury

Substance use rehabilitation and brain injury

One of the existing challenges with treatment for substance use and brain injury at the same time is that current facilities/programs are not equipped to handle both. The majority of brain injury rehabilitation, community, and support programs require participants to be sober. Similarly, centres and programs that specialize in addiction support are not able to handle the complex needs of someone with a brain injury.

This does not mean that a support plan can’t be created – it just means that the survivor will need to work with caregivers and medical professionals with knowledge of what services are available.

See sources