Fentanyl deaths are a Canada-wide 'disaster'

Most recreational drug users don't expect the extreme drowsiness, difficulty breathing and slowed heartbeat that can come after popping one little green pill.

But when they think they are taking OxyContinand the concoctionactually contains fentanyl, a drug hundreds of times more powerful than heroin, those symptoms can kick in and lead to an overdose.

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Fentanylisa highly potent drug that many recreational drug users take unknowingly,putting them at highrisk of an overdose. In the past few years, more Canadians are dying this way, but health officials say it's a difficult scenario to prevent.

"This really is a disaster that's happening right across Canada," says Philip Emberley, the Canadian Pharmacists Association's director of pharmacy innovation. "I don't think any community is actually immune to this at all."

Fentanylis a strongopioidthatdoctors prescribe to help patients manage chronic pain. It's estimated to be 80 times as powerful as morphine and hundreds of times more powerful than heroin, according to the U.S.Centers for Disease Control and Prevention.

It's also found its way onto the streets, sometimes sold as fake OxyContin pills, or laced withother drugslike cocaine.

For many years, Canada hashad "large numbers" of opioid-related deaths, says BenediktFischer, a senior scientist at the Centre for Addiction and Mental Health in Toronto. And among them theproportion of fentanyl-related deaths has been rising, he says, especially in certain provinces.

Last year, 300 people died from illegal drug overdoses in B.C., according to the Coroners Service of British Columbia, and it appears 25 per cent of those deaths involved fentanyl. Three years earlier, the coroner's office only detected fentanyl infive per cent of these types of deaths.

In Alberta, 120 people died last year after ingesting fentanyl, according to Alberta Health,compared to only six in 2011.

Between 2005-09, 210 people in Ontario died at least in partas a result offentanyl overdoses, according to an annual report fromthe office of Ontario's chief coroner.

'Regular' folks dying

Just as alarming is that many of the faces behind these statistics do not fit the profile of hard-core drug addicts.

It's a false assumption that most are "your stereotypical, street-level, life-long heroin or opioid junkie addict," saysFischer. Instead, many are "regular, often middle-class folks."

This summer, investigators traced a number of suspiciousdeaths back tofentanyloverdoses. JackBodie, a 17-year-oldVancouverite,died after ingesting fake Oxy pillslaced with the drug. Less than two weeks earlier, a North Vancouver couple was founddead after ingesting toxic levelsoffentanyl.

We're not even stopping this problem from expanding.- BenediktFischer, CAMHsenior scientist

In both cases, friends and family described the victims as recreationaldrug users.

"That is where we start to get into overdose situations," Emberley, from the Canadian Pharmacists Association, says of people who have limited experience with drugs.

When doctors prescribe fentanyl, it is only offered to patients who have taken another type of opioid before. Emberley says that's because patients need a certain level of tolerance to handle a dosage of this highly potent drug.

What's more, themargin of error for adose that delivers a high versus an overdose is "very small," says MarkLysyshyn, a medical health officer for Vancouver Coastal Health.

That's particularly problematic since most people don't realize they're taking fentanyl. Dealers sometimes combine it with other drugs, which can create a lethal combination, or attempt to pass it off as other drugs, often OxyContinpills.

Lysyshyn compares the fake pillsto a chocolate chip cookiewith the chips being fentanyl.

"If you happen to get a cookie with lots of chocolate chips, then ... you're going to have an overdose," he says. "If you don't, then maybe you'd be OK."

'Very difficult' to raise awareness

Awareness is instrumental to preventing more deaths, Lysyshyn says, but it's "very difficult" to reach that target audience.

Vancouver Coastal Health and other partners started the Know Your Sourcecampaign to help educateintermittent drug usersabout fentanyl.

It encourages people who choose to useto have a sober friend present, test a small amount first and call 911 if anyone experiences the early signs of an overdose, which can include drowsiness and difficulty breathing.

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The program also educates people about naloxone, a medication capable of reversing the effects of an opioid overdose. Naloxone is readily available for people at InSite, a supervised injection site in Vancouver.

But it ismuch harder to get if you are an intermittent drug userwho may not frequent places like InSite.

Insufficient prevention

The struggle toraise awareness about fentanyl is only part of the problem.CAMH's Fischer believes Canada is alsolagging in prevention.

"We're not even stopping this problem from expanding. It continues to increase," he says. "The interventions are clearly not sufficient."

More awareness, better access to naloxone and fewer fentanyl prescriptions are needed, he says.

Indeed, a recent CAMH study showed thatbetween 2000 and 2010consumption rates of prescriptionopioids in Canada were among thehighest in the world. In 2010-13, fentanyldispensingrose by nearly 16 per cent.

David Juurlink, the head of Sunnybrook Health Sciences Centre's clinical pharmacology and toxicology division in Toronto, has been arguing for doctors to prescribe the drug less frequently for years.

"We have to deny people these drugs... If we don't, people are going to continue to die," says Juurlink.

He's not just talking about patients who've developed prescription medication addiction, or who have incorrectly mixed drugs or developed severe side effects. His point is that all these prescriptions make the drug more widely available on the street for illegal purchases.

"We really have an epidemic ofopioid-related harm."