The number of illegal drug samples containing fentanyl has doubled every year in Canada since dealers began smuggling a black market version of the prescription painkiller into the country, new figures show.
The figures, based on samples seized by police and analyzed by Health Canada's Drug Analysis Service, provide the first national snapshot of how rapidly illicit fentanyl has moved east from British Columbia.
Amid a dearth of national surveillance data on Canada's deadly opioid crisis, the lab results provide fresh evidence of a booming underground market in fentanyl. A Globe and Mail investigation last year revealed how China's chemicals industry has helped foster a market for illicit fentanyl in Canada.
As the death toll from illicit drugs climbs, more communities are sounding the alarm. Mayors of Canada's biggest cities plan to meet on Friday with federal ministers to discuss a "co-ordinated response to an unprecedented rash of opioid overdoses and deaths."
Unlike the United States, Canada does not have national systems tracking the number of overdose deaths or visits to hospital emergency departments – a gap federal Health Minister Jane Philpott has pledged to fill.
"In the absence of real-time monitoring, we are looking to seizure data, [emergency] calls and on-the-ground reports," said Michael Parkinson, a community engagement co-ordinator with the Waterloo Region Crime Prevention Council.
Laboratories operated by Health Canada detected fentanyl in 3,721 illegal drug samples in 2016, compared with just 231 in 2012, according to statistics obtained by The Globe.
While fentanyl accounted for a tiny portion of all drug samples, it is growing at a faster rate than other categories. Benoit Archambault, national director of the Drug Analysis Service, said the labs received 120,000 samples in 2016, up 2 per cent to 3 per cent a year.
British Columbia, the centre of the opioid crisis, accounted for half of all samples containing fentanyl in 2016 and saw its numbers triple from 2015, the statistics show. But every province and territory has been exposed to the powerful opioid.
The number of samples containing fentanyl doubled between 2015 and 2016 in Saskatchewan, Manitoba, Ontario, Quebec, Northwest Territories and Nunavut. Alberta bucked the trend, with a 27-per-cent rise in 2016.
The drugs analyzed by the labs do not indicate how much fentanyl is available on the street – a sample can range from a couple of pills to several kilograms, Mr. Archambault said. Nor do the samples represent all seizures by police.
Illicit fentanyl first appeared in Canada after the prescription painkiller OxyContin was pulled from the market in 2012. OxyContin was popular not only with people who became addicted after their doctors prescribed it but also with heroin users because they could easily snort it like cocaine or inject it like heroin for a quick high.
The Globe investigation found that demand for a replacement for OxyContin gave rise to a counterfeit version of the drug. Illicit fentanyl powder is smuggled into Canada from China and processed for street sale in clandestine labs, which typically put the powder through a pill press machine and dye the tablets green to mimic the 80-milligram OxyContin pills favoured by opioid abusers.
Health-care workers and police say a sharp spike in the number of samples containing fentanyl in Ontario reflects what they are seeing in their local communities. There were 903 samples containing fentanyl in the province in 2016, an eight-fold increase since 2012. Anecdotal evidence also points to the growing presence of fentanyl in several communities in Ontario, the country's biggest per capita user of prescription painkillers.
Police in Ottawa arrested a dozen people last week believed to be trafficking counterfeit pills containing fentanyl. The amount of illicit fentanyl in Ottawa has "grown in leaps and bounds" over the past year, said Staff Sergeant Rick Carey of the Ottawa Police Service's drug unit.
Michelle Klaiman, an addiction medicine doctor in Toronto, said fentanyl began showing up in the urine tests for many of her patients last summer. "We never saw fentanyl before and now we're seeing a lot more," she said.
Toronto's St. Michael's Hospital, where Dr. Klaiman works in the emergency department, expects ED doctors to use 30 per cent more of the antidote naloxone on overdose patients this year over last year, she said.
In Kingston, tests done recently on patients who use needle exchange programs and those being assessed for addiction treatment showed that eight out of 10 had unknowingly used drugs laced with fentanyl, said Kieran Michael Moore, associate medical officer of health for KFL&A Public Health, an agency representing Kingston and neighbouring communities.
British Columbia publishes the number of fatal overdoses linked to illicit opioids every month and Alberta is planning to release data on deaths linked to fentanyl every six weeks.
By comparison, the most recent opioid-overdose death figures for Ontario are from the end of 2015. However, as of April 1, hospitals in Ontario will be required to disclose the number of patients they treat in emergency for opioid overdoses, said Health Ministry spokesman David Jensen. The initiative is part of Health Minister Eric Hoskins's response to the opioid crisis.
But medical experts said much more needs to be done on the surveillance front. Dr. Moore is calling on Health Canada to publicize results of its drug testing, information he said is vital to help communities respond to the problem. "We are in an outbreak," he said. "We have to be more accountable."
Health Canada spokeswoman Rebecca Gilman said that "whenever potent substances are encountered for the first time in a community," the department shares those results with provincial and territorial health agencies.
"Given the ongoing opioid crisis," Ms. Gilman said, the department is "exploring opportunities" to share more information.
Overdose deaths in B.C. are at an all time high with 60% of cases involving fentanyl. We look at how that compares to other causes of deaths on a national scale