A recent announcement by the provincial government outlines an opioid strategy intended to prevent addiction and overdose deaths in Ontario. The strategy includes: access expansion to Suboxone to treat addiction and prevent withdrawal symptoms; expanding access to naloxone to prevent overdose deaths; implementing evidence-based standards on opioid prescribing to prevent unnecessary dispensing and over prescription; and the launch of an improved reporting system to gather data on the incidence of overdose deaths in the province to hopefully develop proactive interventions.
But drug policy reform advocates, like Donna May who lost her daughter to complications brought on by a fentanyl addiction, say that the strategy is akin to attempting to hold the flood waters back with a kitchen sponge.
“Last week’s announcement can be likened to a mothers kiss on a scraped knee. It’s only intended to make you feel better. Those of us who have been a part of this epidemic cannot be fooled,” remarked May. “It’s nothing more than a band aid to appease those who have been knocking down the door of Minister of Health, Mr. Hoskins, and our Premiere, Kathleen Wynne, to get a response to the ongoing and increasing opiate overdose epidemic that has taken Ontario by surprise.”
The announcement from the province provided that in 2014 over 700 people died in Ontario from opioid-related causes, a 266 percent increase since 2002. A report released in 2014 by the office of the United Nations on Drug and Crime indicates that Canada is the national leader in opioid consumption followed by the United States, Denmark and Australia.
In June 2016, the province announced that Naloxone would be made available at local pharmacies without a prescription and free to opioid users, those at risk to use opioids and family or friends of someone at risk to overdose. The accommodation will save lives no doubt but health professionals and police across the province and the country have expressed concerns that the prepared Naloxone dosage is losing effectiveness in fighting more potent analogues of opioids that have recently presented on the street and in the mainstream.
This point is exacerbated by another recommendation made in Ontario’s addiction and overdose prevention strategy- the delisting of high-strength formulations of long-acting opioids from the Ontario Drug Benefit Formulary. As of January in Ontario 13,832 people were using these high-strength opioids. The action is intended to prevent addiction however an article in the Ottawa Citizen warns that this move may drive opioid users to illegal fentanyl and fentanyl analogues and consequently increase risk to opioid overdoses and death.
Synthetic fentanyl is more dangerous than prescription fentanyl owing to the fact that the analogues tend to be more concentrated, increasing risk to overdose.
A recent CBC report indicates that carfentanil –a synthetic of fentanyl, has made its’ way into Canadian communities. Carfentanil is 100 times stronger than fentanyl and 10,000 times more potent than morphine. Carfentanil was first synthesized in 1974 and used to sedate large animals, like elephants. Carfentanil has never been approved for human consumption and the effects of less than one microgram –invisible to the human eye, can be felt by an individual. Just 20 micrograms, less than a grain of salt, can be fatal to a person. The risk to overdose is incredibly high and current doses of Naloxone are expected to be ineffective.
Carfentanil isn’t exclusive to hardcore drug users. Typically injected, swallowed or absorbed through the skin via a patch, in Canada and the United States carfentanil is also cut into heroin, cocaine and other illicit substances. Experimenting youth and adults who may have a rare opportunity to cut lose a bit for the first time in years –folks who don’t use drugs on a regular basis whatsoever are being exposed to carfentanil.
Donna May refers to the situation as “the epidemic within the epidemic”. “It’s not just those that we would expect to die by overdose who are dying today. We are seeing rampant increase in death by overdose in mainstream society. These are our lawyers, doctors, accountants as well as the youth. Nothing is being addressed to combat the epidemic within the epidemic. Nothing is being done to address the fact that substances being used illicitly are being tainted with carfentanil and other fentanyl analogues.”
This summer the Canada Border Services Agency (CBSA) intercepted a kilo of carfentanil in Vancouver. The package en route to Calgary, was sent from China.
In a press release issued by the RCMP, Chief Superintendent, George Stephenson, Deputy Criminal Operations Officer commented of the seizure of carfentanil, “It is hard to imagine what the impact could have been if even the smallest amounts of this drug were to have made its way to the street. The illicit drug trade remains a dynamic and lucrative criminal activity that spans borders throughout the world. The different ports of entry, airports, and rail and road networks are all essential links for the supply of drugs. This highlights that our enforcement partnership with CBSA is critical to the RCMP’s efforts to combat illicit drugs and keep our communities safe from harm.”
In fact, the intercepted package of carfentanil was potent enough to kill every person in Canada “with enough left over to wipe out Sweden and Finland”.
An article published by the Tyee this September explains that “as a dust [carfentanil]could be inhaled or attach to mucous membranes, like the tongue, with almost instantly fatal effect. But once in the hands of a dealer/distributor, carfentanil is likely to become a public health hazard for everyone who comes in contact with it- addicts, first responders, health care workers and even bystanders.”
Wikipedia documents that, “in 2002, Russian military gassed Chechen rebels at a Moscow theatre during a hostage situation. Scientific analysis of survivors’ clothing and urine from the incident suggested there was evidence to support that carfentanil was one of two substances contained in the aerosol that was deployed. Reportedly, 125 died at the time due to a combination of the effects of the aerosol and a lack of medical care.”
Such risks have emboldened the position of many people, like Donna May, that it is time to legalize and regulate all illicit drugs of choice.
“We’ve been flooded with these analogues that are taking the lives of our children,” remarked May. “What if anything is going to be done to stop this? Are we going to put embargos on China so we don’t get anything from them? Are we going to stop the importation of pill presses? How can we? And how quickly can we? This is a new and looming crisis and nobody is even recognizing it. The only thing I can see that is going to sustain this epidemic is to decriminalize all drugs and all drug use and regulate all drugs of choice. And then work with the patient for titration and maintenance.”