Fentanyl is 50 to 100 times more powerful than other opioids and must be carefully monitored to prevent overdose.
Fentanyl was detected in more than a third of British Columbians who died after overdosing on illicit drugs in the past year, as the deadly opioid believed responsible for at least a dozen deaths in the past few weeks alone becomes a grimly entrenched scourge in Western Canada.
Dozens of overdoses suspected to have been caused by fentanyl have been reported throughout B.C. since Dec. 19, including four in Vancouver and eight in Greater Victoria that were fatal. Deaths linked to fentanyl have also increased in other provinces, notably Alberta, where the drug was connected to more than 200 deaths in the past year.
The fatal overdoses are part of a larger issue: Preliminary numbers from the BC Coroners Service show that, of all illicit drug overdose deaths in B.C., fentanyl is being detected in a growing percentage every year. In 2012, the synthetic opioid was detected in less than 5 per cent, compared with 15 per cent in 2013 and 25 per cent in 2014. From January to Aug. 31 of 2015, fentanyl was detected in 35 per cent of all illicit drug overdose deaths in B.C.
However, Barb McLintock, spokeswoman for the service, cautioned against framing these as "fentanyl deaths."
"Even if we did end the year with fentanyl detected in one-third of the overdose deaths, that is still two-thirds in which it is not present, and the other illicit drugs are the cause of fatal overdoses," she said, referring to drugs such as heroin, cocaine and amphetamines.
"We do not want drug users thinking that if they can just avoid fentanyl they are not at risk, as that is very much not the case."
Statistics from the agency indicate the overall number of people dying of overdoses in B.C. has not significantly changed in recent years. There were 331 overdose deaths in 2013, of which fentanyl was detected in 49, and 356 deaths in 2014, including 90 in which fentanyl was detected. For 2015, the agency's statistics go only to Aug. 31, a period in which the province had recorded 257 overdose deaths, 91 of which had fentanyl detected.
Fentanyl, a narcotic that is often mixed into other drugs and ingested unknowingly, has become so common that warnings have popped up in the bathrooms of Vancouver bars and nightclubs, and as guerrilla street art around downtown Vancouver.
Fentanyl is a powerful synthetic opioid, anywhere from 50 to 100 times more potent than morphine, that was developed to treat severe, chronic pain. However, a North American crackdown on prescription opioids such as oxycodone has coincided with an increase in the illicit consumption of fentanyl, which is inexpensive and easy to manufacture.
Access to naloxone, an antidote for overdoses, is expected to ease the coming year.
Medical professionals and other harm-reduction advocates want naloxone, which can reverse the effects of an opioid overdose within minutes, to be easier to get. It is currently available only by prescription, and only opioid users who are at risk of overdosing can get it – even though a friend or partner of the user would likely be the one to administer it.
Health Canada announced this summer that it would review the drug's prescription-only status, and this week said a decision is expected in early 2016.
"Should Health Canada's review propose to make naloxone available without a prescription, provinces, territories, public health authorities and manufacturers of the drug would need to take additional steps to make it accessible for safe use," the federal department said in an e-mail.
In Alberta, fentanyl was linked to more than 200 fatal overdoses in 2015, prompting calls for the province to clear any hurdles that prohibit first-responders from administering naloxone.
U.S. states such as Kentucky and Ohio announced this year that pharmacists there would be able to dispense naloxone without a prescription; New York City announced three weeks ago that it would follow suit.
Meanwhile, Nanaimo Regional General Hospital announced this month that its emergency department is now the third in B.C. to offer take-home naloxone kits to patients seen for opioid-related medical emergencies. St. Paul's Hospital in Vancouver and Royal Inland Hospital in Kamloops also distribute the drug to patients identified as a possible risk of opioid overdose.
B.C.'s pilot take-home naloxone program, now in its third year, has also been credited with reversing hundreds of overdoses.
As of November, about 5,000 people have been trained to administer naloxone, 4,000 kits have been provided and more than 325 overdoses are reported to have been treated under the initiative, said Jane Buxton, head of the B.C. Centre for Disease Control's harm reduction office.
Andrea Woo