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Fentanyl is a powerful opioid, multiple times more potent than morphine, that physicians typically prescribe to help people manage chronic pain.

A surge in bootleg fentanyl overdoses in western Canada and in northern U.S. states is now on Ontario's doorstep as the country's most populous province faces an imminent public health crisis for which it is woefully unprepared, organizations involved in drug issues are warning.

The Ontario Association of Chiefs of Police and the Waterloo Region Crime Prevention Council are among four groups set to issue an advisory on illicit fentanyl in Ontario's drug supply Monday.

The groups say all U.S. states bordering Ontario are reporting a significant spike in deaths related to fentanyl, with Cincinnati, Ohio, having an outbreak of 178 overdose cases over a six-day period earlier this month.

In Canada, the problem so far appears most acute in Alberta and British Columbia. Authorities in B.C. have declared a public health overdose emergency as deaths caused primarily by bootleg fentanyl have surged 74 per cent this year through July compared with the same period last year. But the illicit substance is also on streets in Ontario in growing quantities, with police reporting an increasing number of drug seizures this year. The groups warn it's only a matter of time before a wave of fentanyl fatalities occur in the province if government authorities fail to take the leadership necessary to save lives.

Related: How opioid abuse takes a rising financial toll on Canada's health care system

Ontario needs a more co-ordinated response, led by the provincial government, the groups say.

"We are watching a public-health crisis unfold in the Western provinces and all U.S. states bordering Ontario," said Michael Parkinson of the Waterloo Region Crime Prevention Council. "We feel it is critical that service providers and others in this province understand the very real threat to public health and safety … There is no reason to think that Ontario is immune from the disaster."

The warning ratchets up again the sense of urgency in dealing with the rise of bootleg fentanyl and opioid addiction more generally. A Globe and Mail investigation earlier this year found that Ontario, in addition to the other provinces and the federal government, is not taking adequate steps to stop doctors from indiscriminately prescribing highly addictive opioids or monitor the addiction crisis that has ensued within its borders.

"We have a growing concern that what's already happening in B.C., where they have a health emergency, will eventually wind up happening here in Ontario," said Joe Couto of the Ontario Association of Chiefs of Police. "It's sort of inevitable." The groups issuing the advisory also include the Municipal Drug Strategy Co-ordinators Network of Ontario and the Ontario Overdose Prevention and Naloxone Access Working Group.

Fentanyl is a powerful opioid, multiple times more potent than morphine, that physicians typically prescribe to help people manage chronic pain. But it has become a lucrative source of income for organized crime. The bootleg variant, made by clandestine laboratories, comes in many different levels of toxicity, with users having little to no way of knowing how much they're ingesting. An amount of fentanyl the size of two grains of salt can kill a healthy adult.

Related: How Canada got addicted to fentanyl

In Ontario, bootleg fentanyl has been detected in heroin and cocaine, as powder and as counterfeit pills manufactured to look like prescription opioids such as Percocet, according to the groups that put out the special advisory. They warn that the illicit substance might have health and safety implications for first responders, hospital staff and others given the potential for exposure via skin contact or accidental inhalation. The groups are urging authorities to put in place mechanisms to further expand access to naloxone, an antidote for opioid overdoses.

"What concerns us is a massive outbreak in a short period of time of overdoses," Mr. Parkinson said. "We should be engaging in a collaborative emergency preparedness planning and being prepared to roll out interventions that we know will save lives."

Eric Hoskins, Ontario's Health Minister, defended the province's action on fentanyl, saying Sunday the government has already implemented strategies to address its abuse and misuse. On the issue of illicit fentanyl specifically, he said the government is examining ways to prevent the drug from making its way into Ontario. And he noted Ontario moved with the Canadian government in June to expand access to naloxone.

"Our government takes the issue of opioid drug abuse and misuse very seriously," the minister said in an e-mailed response to questions.

More than 6,000 people have died of an opioid-related overdose since 2000 in Ontario, according to the groups that put out the special advisory. In 2014, one person died of an opioid-related overdose every 13 hours, surpassing the deaths on Ontario's roadways, they say.

"We do what we can at the local level," Mr. Parkinson said. "But in the absence of support from senior levels of government and elsewhere, we're doomed just to keep applying Band-Aids when we could be doing so much more to protect life and reduce injury."

With a report from Adrian Morrow

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