Fentanyl: A Growing Concern

The number of deaths from fentanyl use continues to climb, with the latest fatal case in Kindersley earlier this month.

Fentanyl is a synthetic opioid, similar to that derived from the poppy plant, and is 50 to 100 times more potent than morphine on a milligram to milligram basis.  Fentanyl has been used for many years in operating rooms for pain control and sedation, as well as in a patch form for treating chronic pain.

Dr. Peter Butt specializes in substance abuse as an Associate Professor at the University of Saskatchewan. He says there have been problems in the past with the misuse of the fentanyl patch, but in recent years has been marketed by criminal organizations in clandestine labs as oxy-80's to take advantage of the shortage of Oxycontin.

"More recently what we've seen over the last two to three years is the appearance of elicit fentanyl made in labs by organized crime and then sold on the street, and it's sold in two forms. In Saskatchewan, we see it primarily made into relatively soft pills, typically a blue-green colour - although the colour doesn't matter," he said. "It's also made available in a powder form typically in port cities like Vancouver, where it might be mixed with heroin or used as a replacement for heroin."

Butt says the dangers of fentanyl is primarily overdose, which results in slowing of the breathing, congestion of the lungs, an arrest in breathing, heart attack, and death, adding that the more potent the opioid is, the more likely it will be fatal.

"In the case of fentanyl, in terms of the elicit fentanyl, people don't really know how much fentanyl is in there, they don't know how potent it is. This is a different situation where users don't have a clue what it is that they're using," he said. "The deaths that we're seeing now from elicit fentanyl are predominantly in what I would say are relatively naive users. They tend to be younger, adolescent, young adults, tend to be in suburban areas or smaller regional centres, and that seems to be the demographic that's being targeted for sales on one hand. I think because of the cost, which works out to be about $20 a pill, it's not so popular among the more street-involved intravenous drug users."

Hundreds of deaths across Canada have resulted from the use of fentanyl. In 2014, there were ten deaths related to the drug in Saskatchewan, and three more this year. Earlier this August, three separate overdoses occurred in Kindersley.

"A lot of the time people take it in the moment - a party drug or something like that, but they need to stop and step back and realize that if they don't know what they're taking, there could be significant harm attached to it," added Butt. "A large part of this is dialing things back and getting people to reflect, in a prevention approach, why they are taking these sorts of substances and why is it necessary as part of their life or lifestyle."

The Office of the Provincial Coroner recently released a report that compares the number of drug-related deaths on an annual basis, which Butt says is extremely useful in mounting public health, police, or prevention response in a community, noting that an increased availability of Naloxone kits could save lives.

"Naloxone is the drug that's used to reverse an opioid overdose, and by making it more readily available - because currently it has to be prescribed, making it more readily available as an injection, like an EpiPen for someone that is having an allergic reaction, it can be more accessible to users, their friends or family members, and to first responders, so that if someone is down because of a drug overdose, they can administer the antidote which would give them more time to get them to a hospital," he said.

In addition to fentanyl, Saskatchewan is seeing more and more cases of crystal meth, according to Butt.

"It seems to be taking over increasingly from cocaine. That's highly problematic because the high from crystal meth is so much longer than that of cocaine, and when people are taking it chronically, then sometimes they become psychotic, their behaviour greatly deteriorates, and of course it has very toxic effects on the brain," he said. "We need to rethink our approach to addiction and the support and resources that are available there, because you know quite frankly, we have more people dying per year from AIDS through IV drug use, than we do from fentanyl overdoses. We've got a problem that needs to be brought out, light shone on it, and more resources placed in an intelligent way to address the issues."

Butt says a more concerted effort to get information out to the public is needed in order to combat this growing problem, by utilizing media and public health resources to not only deal with the supply prevention, but also in helping those who are struggling with drug addiction.

"When they're dealing with a very potent opioid like fentanyl the detox requires good medical management, it requires protocols that will take them through the detox and the withdrawal phase in a more controlled fashion. Often it takes a week or more. Subsequent to that of course, we need to be providing care to people to deal with their drug addiction, different types of treatment programs,  and support, because for people with a more severe addiction, this is a chronic disease. We don't treat chronic diseases with a couple of acute interventions, like detox and a relatively brief stay in a rehab center, it's something that's sustained over a long period of time. Diabetes, high blood pressure.. There are lots of examples where people are under care and receive the support that they need to help them manage that throughout their life."

Butt urges the public to stop and question their actions before they put anything foreign into their system, as the risks could mean life or death.

"People that are smoking marijuana need to stop and think too about the industry that they're supporting, because a lot of the marijuana distribution isn't local. It's national, it's inter-provincial, and it's also through organized crime, so the marijuana use may very well be tied to the distribution of fentanyl and crystal meth," added Butt. "No hands are necessarily clean in this business."