Fentanyl-related deaths have spiked in Canada's four largest provinces, with increases ranging from nearly doubling to increasing 20-fold in recent years.
That's one of the findings of a new bulletin by the Canadian Community Epidemiology Network on Drug Use (CCENDU), believed to be the first national report on deaths involving the powerful synthetic opioid.
The bulletin, expected to be released on Tuesday, comes as provinces grapple with the drug's growing prevalence not just among entrenched drug users but also among unassuming recreational drug users. In Vancouver, fentanyl is suspected in at least 16 overdoses on Sunday alone, including six within one hour, according to local police.
The bulletin found that fentanyl-detected deaths increased by nearly seven times in British Columbia, from 13 in 2012 to 90 in 2014. (There have been around 60 fentanyl-detected deaths in B.C. so far this year.) In Alberta, they increased more than 20 times, from six in 2011 to 120 in 2014.
In Quebec, they tripled, from seven in 2009 to 21 in 2013. In Ontario, data on fentanyl-detected deaths was not provided but cases in which fentanyl was directly implicated in the cause of death – rather than simply being detected in a person's body – increased more than 1.7 times, from 63 in 2009 to 111 in 2013.
Research lead Matthew Young said the alarming trajectory could be attributed to a crackdown on prescription opioid abuse in North America in the mid-2000s, when interventions were made to decrease the availability of prescription drugs and prescription opioids in particular.
"What's probably happening here is there's a decrease of available prescription opioids in the marketplace, and organized crime is filling that market with fentanyl," Dr. Young said.
It's also being cut into other street drugs. A recent B.C. Centre for Disease Control study found that nearly 29 per cent of drug users surveyed tested positive for fentanyl despite 73 per cent reporting not having recently used it, supporting the hypothesis that fentanyl is being mixed into other drugs.
Fentanyl is up to 100 times more potent than morphine and, in a medical setting, is used to treat severe pain. Fentanyl stolen from pharmacies typically comes in patch form, which some users either cut up and suck on or scrape off and smoke.
More common in B.C. is the illicit importation of fentanyl in powder form, which is then cut into other drugs such as heroin, oxycodone or crystal methamphetamine because of its high potency and relatively low cost.
In all, there were at least 1,019 drug poisoning deaths in Canada between 2009 and 2014 in which fentanyl was detected, according to the CCENDU bulletin. This includes at least 655 deaths in which fentanyl was determined to be either a cause or contributing cause – an average of one fentanyl-implicated death every three days.
These numbers are likely underestimates due to the different reporting measures from various coroners' services.
Dr. Young said the data underscore the need for widespread distribution of naloxone, a drug that has no abuse potential – naloxone taken in the absence of opioids produces no effect – but can reverse an opioid overdose within a few minutes. Health Canada recently announced that it would review naloxone's prescription-only status, opening the door to the possibility that friends and family members of severe opioid addicts can obtain and keep the drug on hand.
The bulletin also recommended that jurisdictions collaborate to standardize information reported for drug poisoning deaths in order to better understand what it calls a "rapidly evolving situation."
Editor's note: A previous version included incorrect statistics for deaths linked to fentanyl in Ontario and Quebec.