Fentanyl, the Opioid Crisis and Naloxone
There is a growing opioid crisis happening around the world and it’s getting particularly worrisome here in Canada. The casualty rate is growing dramatically and across not only the opioid user demographic but that of the non-opioid drug user as well. There are several factors that are slowly being sewn into to our understanding of where this opioid crisis has come from, but what I intend to focus on here is the proliferation of fentanyl on the illicit drug market.
Before I go any further, I want you to know that whether or not you use opioid drugs, this does affect you, and what follows may save your life or the life of someone you care about.
In January 2017, the province of British Columbia saw a 36.5% increase in overdose deaths compared to January 2016. In Alberta, 338 people died from opioid-related overdoses between January and Oct. 27 of 2016, with fentanyl linked to 193 of those deaths.
Fentanyl is an extremely potent pharmaceutical opioid. Although it has been around since the 70s, its presence in the illicit drug supply has grown dramatically over the last 10 years and is continuing to rise. It is up to 100 times more potent than heroin or morphine. It only takes 3mg to overdose, compared to the 30mg it takes to overdose on heroin—3mg is an extremely small amount of a substance. A couple specks are all it takes to die from this stuff. Carfentanil, another dangerous opioid proliferating on the illicit market, is even more potent.
Take a look at this picture comparing the different volumes of fentanyl and heroin that lead to an overdose.
The fentanyl epidemic is coming in from multiple angles.
The three points that follow are generalized and are far from an exhaustive list of variables:
We have the increase of direct fentanyl addiction as a likely result of Purdue Pharma’s lies about the addictive potential of oxycontin. Purdue Pharma lobbied doctors to prescribe it like wild throughout the 90s before pulling it from the market. This left a vast number of unfortunate people, now with severe opioid dependence, without a safe supply. Many of those people turned to the streets in search of what the black market could offer.
This increased demand for street opioids, but a dramatic lack of access to Oxycontin for anyone, gave vast rise to heroin addiction and the spread of fentanyl. Within the problem of fentanyl addiction is the microcosm of bootleg fentanyl pills. These pills present an increased risk of overdose due to the lack of consistent dosages in products being purchased by addicts. Even a milligram more or less may mean death by overdose.
Since the demand for fentanyl was billowing on the street and it was possible to import enough of it in bulk from China without fear of being flagged by Canadian customs, the raw product has been funneled into the drug supply at large. We see a disturbing level of fentanyl contamination in the heroin supply and, in a similar fashion to bootleg fentanyl pills, the presence of fentanyl in the heroin supply vastly increases the chances of fatal overdose. In this case, “fentanyl overdose” is clearly a misnomer — it’s actually more like fentanyl poisoning.
A quick aside:
Heroin dependence is not necessarily what we have been led to understand it to be. As destructive as it can be, and as grim as the stereotype of the junkie is in our conditioned minds, it is possible to have a steady life and be a heroin addict. There is quite likely someone in your life right now who you would never guess has a heroin addiction until they turn up dead due to fentanyl poisoning
Fentanyl contamination has spread beyond the opioid supply and has found its way into non-opioid drugs, such as cocaine. The gravity of this must be stressed because what this means is that no matter what drug you are using, you are at risk of dying of a potential overdose. This risk is highest if you are using powdered drugs.
It isn’t even possible to test for the presence of fentanyl with a standard reagent test, which can be used to determine what a drug actually is. This is because it might be such a small amount of fentanyl that despite testing even three different pinches of that drug, the fentanyl hasn’t made it from the core sample into the test. (Although the emergence of a fentanyl specific test kit is on the rise.)
I want this to be VERY CLEAR:
This affects all of us because either we are ourselves are using drugs or someone we care about is doing so. At this point, even if that use is well within the realm of being “responsible” and all safety precautions have been taken, dying from fentanyl is still a risk.
So what do we do?
Well… introducing Naloxone.
When someone is having an opioid overdose, the opioid receptors in their brain have become so saturated that the breathing rate is depressed, potentially to the point of death. Naloxone is an easily administered and highly effective drug that goes into the brain and kicks the opioids out of the receptor site to wake that person up and stop the overdose. However, it is only temporary and once it wears off that person will begin to overdose again, so it is imperative that emergency services are called.
Naloxone kits are not hard to get. Here in Kitchener, Ontario, Canada, I attended a free seminar on the nasal spray version of Naloxone (you just squirt it up the nose of someone who has overdosed) and was given a free Naloxone kit. I did this not because I use opioids, but because I attend gatherings where people use drugs, and if I can be this easily prepared to save a life, goddammit, I will be.
Of course having Naloxone might save your life, but it won’t prevent fentanyl in your drugs.
I’m not saying “don’t do drugs,” but I am saying it’s time to get real serious about ensuring the security and cleanliness of your supply. And I am suggesting that when offered random drugs at a party, take a moment to consider what you are willing to risk for that high.
According to the CBC, “A Victoria [British Columbia, Canada] pharmacy that provides free testing of street drugs has found more than 90 per cent of the dozens of samples it has tested contain some amount of fentanyl.” Similarly, according to The Georgia Straight, “the latest data supplied by Vancouver Coastal Health (VCH), 85 percent of heroin mixtures (and 80 percent of all drugs) checked at Insite between July 7 and September 8 (332 checks) tested positive for fentanyl.”
Do your best to inform yourself about the risks in your community right now, and if you can, find a local harm reduction or community safety organization to get more information—or even to be trained on using naloxone. Just in case.
This is a huge issue in the world right now and what you have read here is far from an exhaustive list of the dangers and problems with the current world opioid epidemic. We barely scratched the surface of how prolific the opioid epidemic is, or the role Purdue Pharma and Oxycontin likely played in its development. Nor have we even addressed the psychological underpinnings of addiction itself.
Below, you will find links to other videos and articles that can offer a deeper insight into the opioid crisis and the role of fentanyl within it.
- How a little-known patent sparked Canada’s opioid crisis
- A Killer High: How Canada got addicted to fentanyl
- Vice: DOPESICK (Documentary & Collection of articles)
- Almost 2,000 opioid-related deaths in Massachusetts show fentanyl dangers rising (note: you really have to filter through sensationalization with ABC News)
- Fentanyl overdoses killed hundreds of Canadians this year, experts say 2017 could be deadlier
**Featured image courtesy of Wikipedia
***Big thanks to Dr. Ian Mitchel for helping me with checking the legitimacy of my statements in this article. And Sasha Koegler for editing support 🙂