The Lures and Risks of Fentanyl Abuse – An Opioid Epidemic in Canada

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The recent spike in opioid drug overdoses in Metro Vancouver caught the attention of Canadians when a total of 16 overdoses, including six in one hour, were reported in just one day. In recent years, Canada’s four largest provinces have seen significant increases in fentanyl-related deaths. British Columbia, for example, saw a dramatic increase from 5% of total illicit drug deaths in 2012 to over 25% in 2014 [1]. Canadians are among the biggest users of opioid drugs in the world and fentanyl is the fastest growing drug abused in Canada [2].

Fentanyl is an opioid roughly 50 to 100 times more potent than morphine and is primarily used to treat severe pain in cancer patients. Due to its low cost, this powerful prescription is frequently mixed with illegal drugs like heroin, oxycodone, or crystal methamphetamine, with or without the user’s knowledge. According to the Canadian Centre on Substance Abuse, there were 655 deaths between 2009-2014 directly linked to fentanyl [3].

The sudden spike in abuse comes shortly after OxyContin was pulled from pharmacy shelves in 2012 and replaced by a tamper-resistant version called OxyNEO. With its harder coating, its purpose was to prevent this highly addictive drug from being manipulated or ‘crushed’ for the purpose of abuse [4]. Currently fentanyl is available in a slow-release medicated patch on a prescription basis in Canadian pharmacies, but can be easily smoked or chewed for a more potent impact. Even when used properly, patches can still contain 60-80% of the original dose, which can be extracted and abused [5].

In an effort to increase awareness of fentanyl-related overdoses, the B.C. Centre for Disease Control partnered with the RCMP and the Vancouver Police Department in February 2015 to initiate a public campaign to recommend the following precautionary strategies [6]:

  • Do not use alone
  • Start with a small amount of the drug first
  • Mixing substances, including alcohol, increases risk of overdose
  • Call 911 right away if someone overdoses
  • Make a plan/know how to respond if someone overdoses
  • Use Insite if possible (Vancouver)
  • Carry naloxone (for opioid-related events)

Despite public awareness campaigns, public health officials have called for increased action for prevention, treatment and law enforcement for drug abuse. A number of Canadian provinces and cities have launched naloxone programs and take-home kits. Naloxone, often referred to as an opioid antidote, reverses the effects of an overdose by restoring normal breathing and consciousness [7]. Considered the ‘Epipen for Addicts’, naloxone works by binding to the same sites in the brain as opioids and can even kick drugs off the receptors even once they have already taken effect. As of March 2015, the B.C Take Home Naloxone program has reversed more than 180 overdoses [7].

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Naloxone cannot be abused and has no pharmacological activity in the absence of opioids. It cannot make you high and it is not possible to overdose on naloxone; the most common side effect with using this antidote is opioid withdrawal, which may include aches, irritability, nausea and vomiting. Research has also shown that the availability of naloxone does not increase risk-taking behaviours, nor does it cause people to use more opioids [7]. Although this drug is only available through prescription for people at severe risk of overdose, Health Canada recently announced it would review its prescription status following recent events.

Of course, the most effective strategy would be to get fentanyl off the streets. Police in North Bay partnered with pharmacists to develop a PATCH4PATCH program, where patients prescribed fentanyl would return their used patches when getting new ones at the pharmacy [8]. However, while the program seems promising in preventing the abuse of fentanyl in prescription form, it is the illicit version that is becoming a growing concern.

While the drug’s primary origin has not yet been determined, the RCMP say the drug is being imported from overseas in a powdered form. Pharmaceutical grade producers in China that are associated to organized crime groups are believed to be the source [9]. Similar to taxation strategies to reduce smoking, a crackdown on accessibility has been met with an increase in the illicit smuggling of contraband and organized crime [10].

Still, public health messaging and campaigns promoting a smoke-free Ontario have reduced the prevalence of smoking over the last decade [10]. The increase in fentanyl-related deaths is alarming and its abuse presents a considerable health risk to people who use drugs recreationally or illicitly. While the RCMP continues to fight illegal smuggling of fentanyl, the circulation of public health messaging and awareness campaigns in combination with pharmaceutical policies will work to reduce fentanyl and opioid-related morbidity and mortality.

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References:

  1. Know Your Source. Fentanyl-Related Overdoses FAQ. Accessed 28 August 2015. http://knowyoursource.ca/questions-about-fentanyl.
  2. Canadian Centre on Substance Abuse, Canadian Community Epidemiology Network on Drug Use. CCENDU Drug Alert: Increasing availability of counterfeit oxycodone tablets containing fentanyl, February 2014. Accessed 28 August 2015. ccsa.ca/Resource Library/CCSA-CCENDU-Oxycontin-Fentanyl-Alert-2014-en.pdf
  3. Canadian Centre on Substance Abuse, Canadian Community Epidemiology Network on Drug Use. CCENDU Drug Alert: Deaths Involving Fentanyl in Canada, 2009-2014. Accessed 28 August 2015. http://www.ccsa.ca/Resource%20Library/CCSA-CCENDU-Fentanyl-Deaths-Canada-Bulletin-2015-en.pdf
  4. Paperny A.M. OxyContin’s gone, but Canada’s pill-popping problem is worse than ever. Accessed 28 August 2015. http://globalnews.ca/news/406186/oxycontins-gone-but-canadas-pill-popping-problem-is-worse-than-ever/
  5. Health Unit. Fentanyl Patch Return Program: Appendix A to Report No. 040-15. Accessed 28 August 2015. healthunit.com/uploads/2015-06-18-report-040-15-appendix-a.pdf
  6. McKee G, Amlani A, Buxton J.A. Illicit fentanyl: An emerging threat to people who use drugs in BC. BCMJ 57(6), page 235. http://www.bcmj.org/bc-centre-disease-control/illicit-fentanyl-emerging-threat-people-who-use-drugs-bc. Accessed 28 August 2015.
  7. Toward the Heart. Fentanyl. Accessed 28 May 2015. http://towardtheheart.com/fentanyl.
  8. Ontario Association of Chiefs of Police. PATCH4PATCH Initiative. Accessed 28 August 2015. http://www.oacp.on.ca/Userfiles/Files/NewAndEvents/PublicResourceDocuments/Master%20Patch%204%20Patch-FINAL%202014.pdf
  9. Quan D. ‘A witch’s brew’: Authorities boost warnings over illicit street drug fentanyl after rash of deaths. Accessed 28 August 2015. http://news.nationalpost.com/news/canada/a-witchs-brew-authorities-boost-warnings-over-illicit-street-drug-fentanyl-after-rash-of-deaths
  10. PROPEL Centre for Population Health Impact. Tobacco Use in Canada: Patterns and Trends. 2013 Edition. Accessed 28 August 2015. http://www.tobaccoreport.ca/2013/TobaccoUseinCanada_2013.pdf

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