Detailed reports from an agency conducting provincewide fentanyl-related testing confirm the presence of various other relatively new synthetic opioids, highlighting the rapidly changing nature of the local drug supply – and the futility of trying to control it with prohibition.
Coroner's reports show that illicit fentanyl has dominated the drug supply for some time, resulting in a dramatic surge in fatal overdoses. Detected in 4 per cent of overdose deaths in 2012, the synthetic opioid is now being found in more than 80 per cent of such deaths.
But weekly reports from laboratory testing service LifeLabs show that several other synthetic opioids are in the drug supply as well.
"If we were back to just heroin, we would be back to 250, 300 overdoses a year," said Mark Tyndall, executive medical director of the BC Centre for Disease Control (BCCDC). "But fentanyl and these new drugs are directly responsible for quadrupling, or more, the current number of people dying. It's changed this situation dramatically [and] it's unlikely that we're going back any time soon."
LifeLabs has operated in British Columbia for decades, but has taken on an elevated role in recent years because of the overdose crisis. It now issues weekly reports on fentanyl, fentanyl analogues and other synthetic opioids detected in urine samples of patients who are screened for fentanyl, usually from drug-treatment centres.
A recent report found that, in early June, carfentanil, the large animal tranquilizer that was suspected in a surge in overdose deaths, was detected in 20 per cent of tests in which fentanyl was also present. That dropped to a low of 3 per cent in late July, but is now back up to 13 per cent.
U-47700, another synthetic opioid that has been implicated in numerous deaths in the United States, was first detected in B.C. in July, showing up in 0.8 per cent of fentanyl-positive tests. That figure grew to 5.2 per cent by early September.
Furanylfentanyl, a fentanyl analogue, has been found in between 1 per cent and 4 per cent of tests in which fentanyl was also present since February.
Garth Graham, director of government contracts for LifeLabs, said the company has invested in high-powered equipment and scientific expertise that allows it to test for drugs not usually found in basic screening tests. But such compounds are still difficult to detect and scientists need to know what to look for.
"Are we two steps ahead? No, we're not," he said. "In my opinion, there's more of this coming … I think it is difficult. We're working with provincial stakeholders, we are tied into networks of law enforcement and medical officials. Two weeks ago, we asked someone from the [BCCDC] what else has been found out there. They mentioned another fentanyl analogue, and we are now trying to work that up so we can look for that."
Health Canada has made efforts to contain drugs such as these, and other synthetic compounds, by issuing alerts and adding them to Schedule 1 of Canada's Controlled Drugs and Substances Act – the same category as heroin and cocaine.
But health officials, including provincial health officer Perry Kendall, say it's a losing battle.
"If you can't get a legal supply of something because it's been listed, you then look for an analogue that hasn't been listed," Dr. Kendall said. "You can make tens of thousands of analogues of various compounds that are then technically legal until they get listed, and then you switch to something else. It's a game of whack-a-mole."
Dr. Tyndall called the enforcement approach "a fool's game."
"The strongest message is that this is not something that we should be focusing on: restricting formulations and putting money into finding these drugs and intercepting them," he said. "It's just never going to work. We really need to focus on helping people to get a safer supply of drugs."