With 145 deaths tied to fentanyl overdose in the first half of this year, Alberta is facing a public health crisis. And critics have charged that an inadequate response so far from the provincial government has allowed the province to reach crisis levels.
“From what I have seen they have done nothing,” Alberta Progressive Conservative MLA Mike Ellis tells Yahoo Canada News. “They have no plan for at least helping the police services to deal with the fentanyl crisis, which has been deemed a public health crisis by the Calgary Police Service.“
Fentanyl, an opioid painkiller prescribed to relieve chronic, intense pain—like that experienced with cancer—is increasingly being used illegally. Both the prescribed and illegally-manufactured form of the drug are being sold, and sometimes cut with other narcotics like heroin and cocaine.
And fentanyl is killing users, at increasingly high rates. The 145 deaths in Alberta in the first six months of 2015 represent a significant increase from last year, when it was tied to 120 deaths in all of 2014. In 2011, fentanyl was implicated in just six deaths in the province.
Alberta’s increase in fentanyl overdoses is escalating quickly, and critics say that’s in part because of the lack of adequate response from the Alberta government.
“From what I am watching or seeing, it’s that the province is being reactionary,” says Ellis, a retired police officer. “What needs to be realized is that this is probably one of the most dangerous drugs to ever hit the streets, so you have to take a proactive approach to dealing with this.”
A two-pronged approach is needed to do that, Ellis says. The province needs to make treatment options more available to opioid users, he says, but it’s also important to make sure police have the necessary funding and resources to get fentanyl off the streets before it’s ever in the hands of dealers or drug users.
Others have criticized the government’s response to the sharp increase in deaths related to fentanyl overdose, which are predicted by police to hit 300 this year. Calgary police don’t have a budget to widely post awareness posters they’ve created, for example, and the provincial government hasn’t yet released a plan for dealing with the drug. The government has also been charged with removing funds from additions and detox centres.
Alberta Justice Minister Kathleen Ganley met with 11 police chiefs last week, and has said she’s asked the Alberta Association of Chiefs of Police how to move forward. The province’s response to fentanyl is being led by the provincial ministry of health, her office tells Yahoo Canada News.
The provincial health minister has said she’s waiting for a fentanyl treatment proposal from the health authority before approving funding for new beds. Alberta’s department of health was not available for comment.
Opioid abuse has been rising in general across Canada for some years, due in part to a spike in the prescription of OxyContin and related painkillers. But the increasing availability and use of fentanyl represents a dangerous new direction because of the drug’s potency—up to 50 times that of heroin.
“A granule of fentanyl can kill you,” Ellis says. He points out that because the drug is so potent, police have to wear protective gear when dealing with a scene where they suspect fentanyl has been used. The strength of the drug, and the danger in taking it, needs to be made clear to the public, he says—particularly because many people may not even realize they’re taking fentanyl in the first place.
The drug is inexpensive to manufacture and profitable. For those reasons drug dealers who receive pure fentanyl, manufactured illegally, often cut it with other drugs like heroin and cocaine, increasing their potency. “It’s not like mixing is done in a controlled laboratory,” Ellis says. “Sometimes the drug dealer gets it right, sometimes they get it wrong.”
Others use fentanyl from the gel on prescribed patches—used or unused—which makes it difficult to control the dosage.
“This is Russian roulette,” Ellis says. “You’re looking at a 50/50 chance, if you consume this pill, that you’re gonna die.“
Other provinces have taken a variety of approaches to reducing deaths by opioid overdose. One of those is harm reduction, which includes safe-injection sites and needle exchanges.
Safe-injection sites have been used in Vancouver, where research has shown that they can reduce overdoses and deaths as well as harms like HIV and hepatitis transmission. Needle exchanges also help reduce deaths and illness. As well, they put drug users in contact with health and addictions staff who can point them towards treatment options if requested.
Those resources were key in her own recovery from opioid abuse, says Kelly Lanktree of southwestern Ontario. Lanktree became addicted to opioids after being prescribed OxyContin for pain related to a knee injury. Her use of needle exchanges in London, Ont., led her to methadone therapy, and she is now in recovery.
"My experience with harm reduction initiatives were imperative to my recovery, as well as my health,” Lanktree says. "I believe it is extremely important to ensure that these services are available to those who need them, as they truly do save lives."
Increasing those treatment options is one step in reducing fentanyl deaths, but access to detox facilities is just one aspect of treatment.
"Addictions are not something that are solved in a week or two weeks,” Ellis says.
And with strong opioids like fentanyl, quitting cold turkey is both ineffective and can be dangerous to the user’s health. In addition to making additional beds available in the short term, the province needs to invest in the resources people need for recovery in the long term.
Methadone management treatment (MMT) is one of those options, and the one that Lanktree says has been key to her recovery. Methadone is synthetic opioid that is often used to help people stop abusing other drugs. Treatment involves gradually reducing the use of opioids through methadone, which curbs withdrawal symptoms.
"I was slowly able to decrease the amount of opiates I was using, and the withdrawals symptoms I felt were decreasing as well,” Lanktree says her own experience with MMT. "I was slowly starting to feel like my normal self again, and eventually made it to the point where I was able to stop using altogether.”
Naloxone is another tool increasingly used by paramedics, police officers and drug users themselves in order to prevent death due to opioid overdose. The prescription drug, which is given as an injection, works as an antidote to opioid overdose and has been shown to save lives without serious side effects.
Some police forces in the United States have begun to equip officers with naloxone in order to prevent overdose deaths, and the Surrey RCMP is considering it for its own force. Other jurisdictions make the prescriptions available to front-line street-level workers as well as drug users who request it, along with those close to them. In Alberta, kits can currently only be prescribed to self-identified opioid users.
“Naloxone is absolutely imperative when it comes to reducing harm and saving the lives of opiate users, whether it be recreational or regular opiate users,” Lanktree says. "I had several close calls myself, and would have benefited greatly from access to naloxone.”
Community approach needed
Stemming the flow of fentanyl into Alberta and off the streets is more complicated.
Some fentanyl users purchase the prescribed patches illegally, sometimes from those who have a legitimate prescription. Because the drug is so potent users will even purchase used patches, which can still contain some fentanyl.
Facing its own increase in fentanyl overdoses, North Bay instituted a program requiring people with fentanyl prescriptions to turn in all their used patches to their pharmacist before they could get a refill of the drug. Overdoses dropped in the northern Ontario city dropped, and a private member’s bill to take the initiative province-wide has been tabled in the Ontario legislature.
From what he’s been told, much of the fentanyl sold illegally in Alberta is coming in from overseas, Ellis says. Combatting that requires additional resources for police forces in the province, he says, from undercover officers and more funding to narcotics units to officer education and public awareness campaigns.
“You must combat this from the street,” Ellis says. “We have to not only make sure that we deal with the triage part but then we also have to deal with getting this stuff off the streets.“
But the first step the province should take is to talk to the stakeholders — police, recovery centres, community groups and front-line workers — to find out what is needed to bring down the deaths, Ellis says. And the next step is to take action as a community.
“Do I believe that our police services are some of the best in the world, and for sure North America? Absolutely I do,” Ellis says. “But we cannot rely solely on one specific police service in one specific geographical area of the province. How we have dealt with things in the past has been as Alberta, and as a community.”