This story is part of A Killer High: A Globe examination into the rise of fentanyl in Canada
Two people in Winnipeg nearly died this weekend from apparent fentanyl overdoses, adding new urgency for a task force set up by the Manitoba government to tackle illegal use of the toxic opioid.
Just after 4 a.m. on Sunday, police officers found a man and a woman unconscious in a vehicle in the city's north end. A second man was in stable condition outside the vehicle.
Constable Robert Carver of the Winnipeg Police Service said it appears the three consumed cocaine cut with fentanyl powder.
"It certainly looks highly likely at this point that it was fentanyl," he said.
Paramedics revived the couple with an overdose antidote. But the near tragedy highlights the alarming speed at which illicit fentanyl is moving east from British Columbia and Alberta, where overdoses linked to the drug claimed 418 lives in 2015 – a 10-fold increase over three years.
The toll in Manitoba has been much smaller, with 29 deaths linked to fentanyl last year. In January, the government created the task force – the only one of its kind in Canada – in an attempt to head off a crisis.
Joss Reimer, medical officer of health for Manitoba, said in an earlier interview about the task force's work that heroin and other illicit drugs typically first appear on the West Coast, giving her province time to prepare.
"We're hoping fentanyl follows the heroin trend and doesn't actually make it here in any large quantities," Dr. Reimer said.
However, the incident on the weekend in Winnipeg suggests it has arrived already.
Illicit fentanyl, largely a product of organized crime, has its roots in Canada's epidemic of prescription painkiller abuse.
A Globe and Mail investigation found that neither Ottawa nor the provinces are taking adequate steps to stop doctors from indiscriminately prescribing highly addictive opioids to treat chronic pain. In 2015 alone, doctors wrote enough prescriptions for one in every two Canadians.
Fentanyl was developed as a prescription painkiller, but gained popularity as a street drug after OxyContin was removed from the market in Canada in 2012. OxyContin was popular not only with people who became addicted after their doctors prescribed it, but also with heroin users, because it could be snorted like cocaine or injected like heroin for a quick high.
The illicit version of fentanyl is manufactured in China and smuggled into Canada, where the white crystalline powder is diluted with buffing agents, cut with other drugs and sold on the street as heroin or pressed into tablets and sold as fake OxyContin.
Rob Grierson, medical director of the Winnipeg Fire and Paramedic Service, audited every case in which paramedics responded to overdoses involving fentanyl between January and November of last year.
Of the 96 calls, 41 overdose victims were close to death when the ambulance arrived, he said. The victims ranged in age from 20 to 51.
"The severity of those calls is extraordinary," Dr. Grierson said in February. "They are getting massive doses that basically take somebody from walking and talking to unconscious and not breathing in a matter of minutes."
Fentanyl is up to 100 times more potent than morphine. The equivalent of two grains of salt can kill a healthy adult.
Dr. Grierson said on Monday that he believes that the 96 cases he found understates the problem, because they involved only people who had used illegally obtained pharmaceutical fentanyl patches, not the illicit version cut into other street drugs.
His review did not include calls to paramedics in which overdose victims thought they took crack cocaine or crystal meth.
"I don't think the average user has any concept of how dangerous these drugs are when they are laced with fentanyl," he said.
The goal of the task force – made up of members of several professions, including health care, law enforcement and regulatory colleges for physicians and pharmacists – is to educate the public about the risks of illicit fentanyl.
The task force is setting up surveillance systems to identify quickly where drugs are trafficked and abused. Dr. Reimer said the group is looking at sharing information currently housed in different locations: overdose deaths, emergency department visits due to overdoses, prescription painkiller patterns, and drug use in the community.
Chief Superintendent Scott Kolody of the RCMP in Winnipeg, which is part of the task force, said in an interview in February that fentanyl involves a huge learning process for police, but is not just a law-enforcement problem.
The task force he said, is trying to "get ahead of the curve before it comes in a more significant wave."