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Black-market forms of the powerful opioid fentanyl were responsible for nearly 80 per cent of fentanyl-related deaths in Ontario last year, according to the Office of the Chief Coroner.

And nearly half of the people who died from accidental opioid-related causes in the province from May to December, 2017, had been taking the drugs for at least five years, Chief Coroner Dirk Huyer said.

“We are seeing people who have used drugs for many years now dying, so something has changed,” Dr. Huyer said.

The figures are the result of new investigative techniques adopted by the office last year to better understand what is driving a spike in opioid-related deaths in the province and who is being affected. There were 1,263 such deaths in Ontario last year, compared with 867 in 2016, the coroner said.

Fentanyl, an opioid that’s up to 100 times more powerful than morphine, is responsible for rising rates of overdose deaths across Canada. Last year, 72 per cent of accidental opioid-related deaths in the country involved prescription or illicit fentanyl, compared with 55 per cent in 2016, according to a report released by the federal government last month.

B.C. and Alberta have been particularly hard-hit, with fentanyl linked to about four-fifths of all accidental opioid deaths in those provinces last year.

But Ontario is quickly catching up. Last year, 68 per cent of accidental opioid-related deaths were linked to fentanyl, compared to 45 per cent in 2016 and 21 per cent in 2016, according to Dr. Huyer.

Of those, 78 per cent were caused by non-pharmaceutical fentanyl, which Ontario’s coroner defines as fentanyl not produced in a medical facility for intended use by patients. Typically, that black-market fentanyl is made to resemble other prescription opioid tablets, or is mixed with other hard drugs. (Other provinces don’t distinguish between pharmaceutical and non-pharmaceutical fentanyl in the same way. In B.C., for example, the chief coroner’s office says that illicit fentanyl can include pharmaceutical products that have been stolen or otherwise obtained from the intended patient.)

Dr. Huyer said investigators are now examining details surrounding individuals’ deaths with greater scrutiny. For instance, looking at medical histories and previous drug-use habits help to paint a more complete picture. The office is also expediting investigations to allow for faster analysis of trends – instead of a year, most cases are being wrapped up in three months, Dr. Huyer said.

The next step is to figure out what is driving more people toward fentanyl and other opioids by examining their lives to better understand the growing crisis and how to prevent more deaths.