Nearly three-quarters of Vancouver drug users tested in a recent study ended up with fentanyl in their blood even though they said they hadn’t taken it to their knowledge.
That means “a considerable portion of fentanyl use in B.C. is unintentional,” said the local researchers in a just-published article in The Harm Reduction Journal that detailed their work.
The study appears to be a sign of how much this synthetic opioid, which is cheap to manufacture and 50 to 100 times more toxic than heroin, is being mixed with illicit drugs.
Researchers from the B.C. Centre for Disease Control, the UBC Faculty of Medicine and the UBC School of Public and Population Health surveyed local drug users at harm-reduction facilities to better understand fentanyl use. There has been a startling increase in drug overdoses the last two years in Canadian cities, with fentanyl implicated in many.
The numbers spiked again two weeks ago, hitting 40 in one week in Vancouver emergency rooms with overdoses linked to contaminated heroin and synthetic opioids, according to Vancouver Coastal Health.
The disturbing trend has led police and health-care workers to advocate for very different strategies to deal with the epidemic.
The recent research confirms what Vera Horsman, a licensed practical nurse who works at the Drug Users Resource Centre on Cordova Street, sees on the ground.
“Pot is often misted with it, it’s been cut into crystal meth, it’s being substituted for heroin, it’s everywhere,” she said.
Fentanyl contaminates a variety of drugs
The fentanyl crisis is ongoing. In 2014, 90 fentanyl-related deaths were reported in British Columbia, compared to 13 in 2012.
Coroners suspect people are dying of overdoses because they didn’t know they were ingesting the powerful drug.
The just-published study found that 73 per cent of people surveyed who tested positive for fentanyl had reported “no known fentanyl use” in the previous three days.
Green tablets — “green meanies” — sold as oxycodone, a narcotic pain reliever, can contain a “huge amount or very little” amounts of fentanyl, said Jane Buxton, the harm-reduction lead at the B.C. Centre for Disease Control and one of the authors of the study.
People who are not used to taking opioids have a lower tolerance and are at greater risk of overdosing, said Buxton. This is what happened to a 30-year-old couple and a 17-year-old boy earlier this year, who died after consuming drugs recreationally that contained fentanyl.
Since the risk is especially high among people who don’t normally use drugs and might not be aware of the exceptional risk of taking drugs contaminated with fentanyl, it has forced health officials to change their messaging.
“We used to always say, ‘Don’t use alone.” Now we say, “Make sure if you’re using, there’s somebody there who’s not using that’s not high that can call for help,” said Buxton.
Police powerless but Narcan offers hope
The fentanyl-related overdose epidemic is related to a larger problem. Researchers at the Canadian Research Initiative on Substance Misuse concluded in another report, released in November and endorsed by more than 70 health practitioners, that doctors are massively over-prescribing synthetic opioids. Fentanyl is one. Because of the over-prescription, it is spilling out into the illegal drug market.
“The entry of organized crime groups into the manufacturing of counterfeit pharmaceutical opioids (which often contain fentanyl) to fuel the street market for illicit or diverted opioids is arguably a direct result of longstanding unsafe physician prescribing practices,” said the report, which also concludes that law-enforcement efforts do not provide a “promising solution to this problem.”
Police and health officials have been running a public awareness campaign, “Know Your Source,” since March, aimed at recreational and regular drug users.
But Horsman is skeptical of the campaign’s efficacy, at least in the Downtown Eastside, where people already know fentanyl contamination is a problem.
Instead, she and others say that a more effective strategy is to teach people how to administer anti-overdose medication.
In 2012, the B.C. Centre for Disease Control initiated a Take Home Naloxone program, spearheaded by Buxton. So far, the program has trained at least 4,500 people at 116 sites.
While the program was originally launched to prevent heroin overdoses, it has proven to be an effective weapon in the fight against fentanyl.
Buxton said evidence shows that the program has reversed 290 overdoses, though she added that “with word of mouth, we know there’s way more.”
Christy Sutherland, the medical director at PHS Community Services Society, advocates its use. She’s a lead for an advice hotline for physicians who help patients with addictions.
“I get phone calls throughout the day and I often advise them to get their patients a Narcan kit.”
But it’s not just physicians who are asking for it. “There’s a huge amount of interest on the ground,” said Horsman, who runs the training program at the resource centre.
“People are realizing, not only is this useful, but they can actually save a life. And it’s become a huge drawing together in the community. People are watching out for each other.”
That’s been true for Paul Nunner, a peer-support worker at the resource centre, who has become a Narcan advocate.
“I encourage a lot of people to have that training, especially with what’s being mixed in with the drugs these days,” he said.
He recalls the first time he heard about the program. “At first I didn’t even know what it was,” he said. “I was like, ‘What’s Narcan? What’s this all about?’”
Six months later, he has administered the antidote four times and now regularly walks the neighbourhood in search of people in trouble.
In the past, he’s seen overdoses happen and felt powerless to stop them. But now, he said, “It’s hands on, jump in, no hesitation.”