A spike in heroin overdoses has hit several cities across Ontario amid mounting signs that the scourge of bootleg fentanyl has expanded east from Western Canada.
Public health agencies in Toronto, Kingston and Waterloo Region issued overdose alerts over the past week citing heroin as the culprit. But health-care officials suspect that fentanyl, which is 40 times more toxic than heroin and often mixed with illicit street drugs, is behind many of the overdoses.
As health-care workers raise the alarm about a sudden surge in overdoses in Ontario, they warn that they are ill-prepared to address the problem because of a lack of a central database to provide up-to-date numbers on overdose deaths, and delays getting the results of toxicology tests.
"We have been in ignorant bliss," said Kieran Michael Moore, associate medical officer of health for KFL&A Public Health, an agency representing Kingston and neighbouring communities.
"You need real-time information at your fingertips to be able to have good active policies and effective intervention," Dr. Moore said.
Fentanyl was developed as a prescription painkiller, but gained popularity as a street drug after OxyContin was removed from the market. The Criminal Intelligence Service of Canada warned last August that the threat from illicit use of fentanyl is expanding eastward, "facilitated by organized crime groups."
The bootleg version of fentanyl that is often made in clandestine labs in China and smuggled into Canada has been linked to overdose deaths in British Columbia and Alberta. Health-care officials told The Globe and Mail that illicit fentanyl began showing up last fall as a street drug in several Ontario communities.
While British Columbia and Alberta have current statistics on fentanyl overdose deaths, the scope of Ontario's problem is largely unknown because the most recent numbers for the province are from 2013. And results of toxicology tests to determine what drugs an individual consumed often take months to get.
In the absence of timely information, health-care workers are gathering intelligence on drug misuse from community groups that have regular contact with users through such programs as needle exchanges.
Waterloo Region issued an alert last Thursday after six overdoses were reported in Cambridge and Kitchener over four days, including one that was fatal.
Heroin is suspected in five cases and fentanyl in one, the alert says. "The presence of bootleg fentanyl – an opioid – mixed in with substances including heroin, cocaine, crystal meth and/or pressed into pills is a concern," it adds.
Michael Parkinson, community engagement co-ordinator of the Waterloo Region Crime Prevention Council, said the council is planning to launch its own alert system next Monday to monitor the opioid crisis and the arrival of bootleg fentanyl, something that he said does not appear to be a priority of the provincial government.
"There are no adults in charge of this file in Ontario," Mr. Parkinson said.
Ontario Health Minister Eric Hoskins said in an e-mail response to The Globe and Mail that "he takes the issue of opioid drug abuse and misuse very seriously."
In Kingston, the public-health agency issued an alert the same day as Waterloo Region after a "highly unusual" number of heroin overdoses, Dr. Moore said.
"We immediately thought it might be spiked with fentanyl," he said.
The regional coroner's office expedited one toxicology test, which revealed fentanyl in one victim's urine. This confirmed that fentanyl is circulating in the community, Dr. Moore said.
Kingston had four overdoses in all, including one that was fatal.
In downtown Toronto, six people overdosed on heroin over a five-day period. "All cases reported the heroin to be more concentrated than expected," an alert from Toronto Public Health said on Monday.
Shaun Hopkins, manager of the needle exchange program at Toronto Public Health, said officials will not know what drugs were involved until they receive toxicology results.
"We are just going on word of mouth, on what people think they used. It's either very potent heroin or it's got something else in it," Ms. Hopkins said.
There are other indications that bootleg fentanyl has arrived in Ontario.
Rob Boyd, director of the Oasis drug treatment program at the Sandy Hill Community Health Centre in Ottawa, said he asked 16 patients last December whether dealers had offered them powdered fentanyl. Eight said yes.
Rosana Salvaterra, medical officer of health for Peterborough, Ont., said her region had a cluster of opioid-related deaths last fall.
"We have data from police telling us it's the bootleg fentanyl pills," Dr. Salvaterra said.
Canada has been in the grips of an opioid crisis since the early 2000s, when reports of addiction and overdoses first emerged. But health-care experts say the crisis attracts little attention from policy-makers because of a perception that those dying misused drugs even though people prescribed opioids by doctors have also suffered fatal overdoses. It is all too easy, they say, to stigmatize those addicted to opioids.
Donna May knows firsthand about the stigma associated with opioid use. Her daughter's life went into a downward spiral after she was prescribed OxyContin in her early 20s for the pain from a fall down a flight of stairs.
Ms. May asked The Globe to refer to her daughter by her nickname, Jac. After Jac became addicted to OxyContin, she said, her doctor cut her off and Jac turned to the street, using heroin and working as a prostitute to feed her drug habit. She was hospitalized for several weeks after contracting a flesh-eating disease.
On Aug. 21, 2012, Ms. May found her daughter in her bedroom in respiratory distress. She died later that day.
"She had just given up," Ms. May said. "The stigma that was put on her and me was enormous. We fought that every day."
Ms. May has founded a group called mumsdu (moms united and mandated to saving the lives of drug users) to help other families who have lost loved ones and to draw attention to the crisis.
"She left me with such a gift to fight for other families," Ms. May said.