Ontario fentanyl deaths demonstrate the drug's national impact

Daily Brew

[Fentanyl recovered by the RCMP/CBC News]

Now that fentanyl is the leading cause of opioid overdose deaths in Ontario, it’s clear that the dangerous narcotic is a cross-Canada problem.

As many users are unaware they’re even taking the drug, the crisis is likely to continue to expand, Dr. Matthew Young of the Canadian Centre on Substance Abuse (CCSA) tells Yahoo Canada News.

“One of the things that I think has been a little bit misunderstood about the whole issue of fentanyl is that most of those who end up either fatally or non-fatally overdosing on fentanyl were not seeking that drug,” says Young, a senior researcher with the CCSA.

Fentanyl is an opioid that is up to 100 times more toxic than morphine. It was first developed as a surgical anesthetic, but more recently was developed into a patch that administers the drug through the skin. It is generally prescribed to patients with cancer and severe chronic pain.

As opioids such as OxyContin and Oxycodone become harder to acquire, the use of cheaper and more dangerous drugs like fentanyl is rising. Some illicit drug users are using fentanyl intentionally, in part because of the potency, and the fact that heating it before injecting it makes it even stronger. 

Perhaps even more worryingly, fentanyl is often added to street narcotics as an adulterant – which means that users may not realize they’re using it, increasing the risk of overdose.

“An adulterant is a chemical that’s added [to a drug], and the user doesn’t necessarily know what they’re getting,” says Young. “What it comes down to is that the amount of fentanyl that is contained in the powders and pills that are on the illicit markets is unknown.”

That makes fentanyl even more dangerous, Young says, because the dose can change considerably from time to time – and just a small difference in the amount of fentanyl in a pill or powder can increase its risk.

“A tiny error can have tragic consequences,” Young says.

Experts have been sounding the alarm about fentanyl for several years. Health officials in Ottawa told CBC News about the risks of the drug in 2010. A report from the CCSA and the Canadian Community Epidemiology Network on Drug Use (Young was the lead author) found that fentanyl-related deaths increased significantly across the country from 2009 to 2014.

Deaths in Alberta have spiked considerably in recent years – in the first five months of 2015, there were 145 fentanyl-related deaths in the province compared to just six in all of 2011. Fentanyl was detected in more than a third of illicit drug overdose deaths in B.C. in 2015.

According to figures given to the Globe and Mail by Ontario’s Office of the Chief Coroner, a quarter of the province’s opioid-related deaths in 2014 were tied to fentanyl.

Even as the use of fentanyl – intentional or otherwise – continues to increase across Canada, other opioids are emerging as potential dangers.

“There is some indication that we may already be seeing other kinds of opioids used as adulterants,” Young says. There are fentanyl analogues in circulation, he says, that can be more or less toxic than fentanyl itself. And another called W-18 has been seen on Canada’s West coast.

“One of the things about fentanyl is that because people aren’t necessarily seeking it out, and because it’s being sold as other things, we don’t want to miss the real issue,” Young says. “What we’re really dealing with here is a crisis of adulterated opioids.”