Fentanyl pills are shown in an undated police handout photo.Handout/The Canadian Press
Canada has a massive and spreading problem of fentanyl addiction. As a Globe and Mail investigation has revealed, it happened quickly, little noticed by the wider public, and left largely unaddressed by those government officials who could see what was happening.Canada is now believed to be the world's largest per-capita consumer of therapeutic opioids. Until the mid-1990s, these powerful painkillers were rarely used by doctors, reserved for cases such as cancer patients suffering debilitating pain. But in 1996, Health Canada approved OxyContin, and physicians began widely prescribing the new painkiller. Stories of its power, its dangers and its addictive quality were soon widespread.
A few years ago, steps were finally taken to get OxyContin off pharmacy shelves. But other legal opioids continue to be prescribed in massive numbers by Canadian doctors. There were 19.1 million opioid prescriptions in Canada in 2015, up from 18.7 million the year before. Unfortunately, all of those legal, powerful opiate-based analgesics – usually prescribed with the best of intentions – appear to have opened the door to widespread addiction.
When the scrips run out, as they must, former patients may turn to the streets. Heroin is the old-school substitute. Fentanyl, a synthetic prescription opioid 100 times more powerful than morphine, is the even more dangerous new wave. It is easier to produce and transport illicitly – one kilogram, the size of a cantaloupe, and it sells on the street for $20-million. Only the tiniest amount is required to get someone very high, making it easy to package, distribute and smuggle.
That also makes the drug vastly profitable, which has created a robust global underground trade. Much of the black-market stuff now comes from China, often via mail order. And users now extend far beyond the community of people who were once prescribed a legal opioid.
All of which explains why Canadian overdose deaths from these drugs have become, in a relatively short time, remarkably common. In British Columbia and Alberta, the two hardest-hit provinces, there were 418 fatal overdoses linked to fentanyl last year – a tenfold increase since 2012.
What to do about it?
Conventional wisdom says to pour money into policing and prohibition. As The Globe discovered, it's easy to buy the stuff from black-market labs in China, with massive quantities of drugs of unknown provenance and quality shipped here under the noses of police and the Canada Border Services Agency. Obviously, the authorities have to do a better job of figuring out how to keep fatally dangerous illegal substances from being imported into Canada.
But we also have to consider this public-health emergency as more than just a police matter. The people using the drugs, and dying from them, did not set out to become addicted. This is something that happened to them, not something they chose. And it happened because the pharmaceuticals are to a large extent acting as intended. They are designed to be stronger than the human brain. That's what a painkiller is, after all.
In a hospital, the person who dulls their pain with fentanyl is called a patient. On the sidewalk, the same patient with the same substance becomes a criminal.
The case for treating drug addiction as a public-health issue, and people addicted to drugs as victims, is solid. And on this, the current federal government thankfully appears to be breaking with its predecessor, which favoured a punitive approach.
Studies validate the importance of supervised-injection facilities like Vancouver's Insite. Montreal, Ottawa and Toronto are making plans for similar installations; the federal government and the provinces should facilitate them.
We also need better-funded rehab counselling and wider access to methadone, buprenorphine and opioid antagonists like naloxone to help wean people off fentanyl and similar substances. One of the street's newest arrivals, W18, is orders of magnitude stronger than fentanyl.
Prescription guidelines are tighter than a decade ago, when the OxyContin wave first prompted attempts to thwart overprescribing. But continued high rates of legal opioid use suggest that more has to be done to prevent people from getting hooked in the first place. But that won't help those who already are.
An evolution is needed in the way we view drug addiction. Nobody gets blamed for having, say, a broken arm or a sprained ankle. They are treated as medical issues of the body, not moral failings. But medical issues related to the brain, particularly those involving addiction, are still characterized in our culture as a personal shortcoming, an absence of moral strength or a lack of willpower. To beat this growing epidemic, Canadians have to recognize how wrong that is.