A man, lower right, injects himself outside the Insite supervised injection site on Wednesday in the Downtown Eastside of Vancouver, B.C., where a sign warns of heroin cut with fentanyl.DARRYL DYCK/The Globe and Mail
Hugh Lampkin was working late when he heard a knock at the door. "There's a guy down," the stranger said. "He's overdosed, and he's blue."
Mr. Lampkin, president of the Vancouver Area Network of Drug Users, grabbed a nearby supply of naloxone – a medication that can reverse the effects of overdose – and raced down the block to the scene.
The man who had overdosed did not have a pulse, or heartbeat, and wasn't breathing. Mr. Lampkin gave him a naloxone injection and began CPR. A minute and a half later, he gave a second injection. Less than two minutes after that, Mr. Lampkin said, the man's pulse and heartbeat returned and he took a massive breath.
"It was like when you see it in the movies," he recalled.
The use of the drug fentanyl – an opioid up to 100 times more potent than morphine that's increasingly being cut into other drugs such as heroin, oxycodone, or crystal methamphetamine due to its low cost – has made headlines across the country, following a long list of tragic deaths from coast to coast.
The Canadian Community Epidemiology Network on Drug Use this week issued a bulletin that said fentanyl-related deaths had spiked in the country's four largest provinces. In Vancouver, fentanyl was suspected in at least 16 overdoses last Sunday alone, including six within one hour.
Health Canada has said it's "deeply concerned." Though some arrests have been made by various police departments, a Calgary officer this week acknowledged that they "will not be able to arrest their way out of this problem."
Public awareness campaigns have been launched, but the calls for increased prevention and law enforcement have been joined in some quarters by calls for increased treatment – namely, wider availability of naloxone, the medication sometimes referred to as the overdose "antidote" that's only available through prescription and only for people at severe risk of overdose.
Health Canada announced three weeks ago it would review naloxone's prescription status. However, it cautioned the process could take 18 months.
Several cities and provinces have gone so far as to develop naloxone programs and take-home kits on their own. Edmonton was the first, in 2005. Toronto launched its program in 2011, with the rest of Ontario and B.C. following suit in 2012. The Alberta government earlier this year announced it, too, would roll out a provincial program.
Dr. Jane Buxton, harm-reduction lead at the B.C. Centre for Disease Control, which operates the B.C. naloxone program, said more than 4,000 people have been trained on how to respond to an overdose and 2,700 kits – which include two sealed vials of naloxone – have been dispensed. Naloxone cannot be abused and has no effect in the absence of opioids. She said more than 260 overdoses have been reversed, though the actual total is likely higher .
Dr. Buxton said program staff has been especially busy this week, given the heightened attention around fentanyl. She said the program has recently been handing out 500 kits a month but more than 500 were requested this week alone, along with training courses.
The current program does have some limitations, she said, such as the fact the kits can be dispensed only to people prescribed to use opioids. "[The naloxone] is not getting out to everybody who could be using it," Dr. Buxton said in an interview.
Mr. Lampkin said his organization is planning a naloxone training course for the next week or so. He said he'd like to make it a monthly occurrence.
"My personal preference is the weekend before welfare [cheques are issued]," he said in an interview. "Thursday, Friday, Saturday, those are usually the days with the highest overdoses."
Doug Nickerson, a homeless man in the B.C. suburb of Surrey who like Mr. Lampkin has been trained to administer naloxone, said he's likely used it on 20 people who had overdosed. He said the number of overdoses does appear to have increased in recent months.
Police have been unable to pinpoint where the fentanyl is coming from, but have suggested it's being smuggled from overseas. Health officials have said the majority of fentanyl deaths involve recreational drug users who were actually consuming other substances, such as heroin, oxycodone or crystal methamphetamine, into which fentanyl had been mixed.
Fentanyl stolen from pharmacies typically comes in patch form. The patches are applied to the skin of opioid-tolerant patients to treat severe pain.
Even those who knowingly take fentanyl are at risk of overdosing, given there's no way to tell how concentrated a given tablet is.
The numbers
- 1,019: Number of deaths in Canada between 2009 and 2014 in which post-mortem toxicological screening detected the presence of fentanyl, according to the Canadian Community Epidemiology Network on Drug Use.
- 655: Number of deaths in Canada between 2009 and 2014 in which fentanyl was a cause or contributing cause.
- 120: Number of fentanyl-detected deaths in Alberta in 2014, up from 6 in 2011.
- 90: Number of fentanyl-detected deaths in B.C. in 2014, up from 13 in 2012.
- 21: Number of fentanyl-detected deaths in Quebec in 2013, up from seven in 2009.
- 111: Number of deaths in Ontario in which fentanyl was directly implicated in 2013, up from 63 in 2009. (Data on fentanyl-detected deaths was not available.)
- $40 - $60: The price a fake oxycodone tablet containing fentanyl can sell from in B.C.’s Lower Mainland, according to Sergeant Lindsey Houghton, spokesperson for the Combined Forces Special Enforcement Unit – B.C.
With a report from Andrea Woo