The illicit drugs that users take with them to Vancouver's supervised injection site overwhelmingly contain fentanyl, according to early results from a new test that can quickly detect the drug, bolstering suspicions that the local drug supply is largely contaminated with the deadly synthetic opioid.
The test results were released Wednesday as Health Canada also announced measures to restrict six chemicals used to make fentanyl.
Anxiety about the growing prevalence of illicit fentanyl, and the opioid crisis in general, continues to spread beyond B.C. and Alberta, where the epidemic has been most acute. The crisis prompted more than 70 activist and harm-reduction groups to demand Wednesday that provincial and federal governments go much further to combat the problem.
Vancouver Coastal Health launched a pilot project at Insite in July offering drug users the option of testing their drugs for fentanyl as part of the authority's response to B.C.'s increase in illicit drug overdose deaths. From July 7 to Aug. 3, 173 tests were performed; 86 per cent of all drugs, and 90 per cent of heroin or heroin mixtures, tested positive for fentanyl.
Mark Lysyshyn, medical health officer for Vancouver Coastal Health, said test results at Insite confirm the suspicion that the local drug supply is "overwhelmingly contaminated with fentanyl." However, he noted the testing is voluntary, which may skew results: Those who suspect their drugs to be contaminated are more likely to test them.
The test, typically used to test urine samples, takes only seconds to produce results. Users mix a grain of their drugs with water in a cooker and then submerge a test strip into the solution. One line means it contains fentanyl; two lines mean it does not. The test does not detect the presence of any other drug.
Heroin is by far the most frequently injected drug at Insite, logging 48,462 self-reported injections in the first six months of this year. Methamphetamine, the second-most frequently injected drug, logged 17,821 in the same period. Fewer fentanyl tests were performed on less-frequently injected drugs.
Most users who learned that their drugs contained fentanyl used them anyway, Dr. Lysyshyn said. However, knowing that such a potent substance was cut into their drugs meant they knew to start with smaller and relatively safer doses.
B.C. declared a public-health emergency in April due to the rapid increase in fatal overdoses, while the Ontario Association of Chiefs of Police and the Waterloo Region Crime Prevention Council sounded the alarm earlier this week about an imminent crisis in that province.
A joint task force comprising B.C. health and justice officials is also working on a testing service to help a larger segment of people who use drugs determine if their substances contain fentanyl. However, the idea is still in its early stages and faces various hurdles: better technologies are expensive; testing sites would require exemptions from federal drug laws, which can be difficult to obtain; and doctors fear a negative test could lull drug users into a false sense of security.
More than 433 people in B.C. have died of illicit drug overdoses so far this year – a 74-per-cent increase from the same period last year. Fentanyl was detected in 62 per cent of these deaths. B.C. health officials have feared the final death toll for the year could be between 600 and 800.
As part of Ottawa's response to the issue, Health Minister Jane Philpott announced on Wednesday – International Overdose Awareness Day – that her government was proposing new restrictions on six chemicals used to produce fentanyl, a step originally proposed in a bill moved by Senator Vern White.
Sergeant Darin Sheppard of the RCMP's Federal Serious and Organized Crime Synthetic Drug Operations said anything Canada can do to help control access to fentanyl is a benefit. However, he noted that the majority of fentanyl intercepted in Canada is being imported already made.
A Globe and Mail investigation found that most of Canada's illicit fentanyl supply is manufactured in China, purchased online, smuggled into the country and then cut into a range of street drugs. Because of its high potency, only a small quantity is needed to turn a large profit; Canadian border guards cannot open packages weighing less than 30 grams without the consent of the recipient.
Also on Wednesday, activists and researchers from across Canada sent a letter to Ottawa calling for more access to the overdose-reversing drug naloxone, legislation that would protect from prosecution people who call 911 in the event of an overdose, better access to treatment programs, the suspension of Harper-era rules governing the establishment of supervised injection sites and a national task force on opioid overdoses.
Richard Elliott, the executive director of the Canadian HIV/AIDS Legal Network, said the federal government is wrong not to scrap the Respect for Communities Act, a Conservative-imposed exhaustive review process for new supervised injection sites.
"Why would you set the bar so high, particularly if, as the government says, you support having these health services?" he said. "We know that there is a need for them and we know that they save lives."
Vancouver Mayor Gregor Robertson, B.C. Health Minister Terry Lake and other B.C. health officials have also formally requested Ottawa repeal the legislation. They sent a letter to Dr. Philpott's office on Wednesday calling the act "a mean-spirited and ineffective piece of legislation" that "was a deliberate attempt by the Conservative government to create barriers that block people from accessing life-saving harm reduction services and medical care."
Harm-reduction advocates in Toronto, where council is planning to seek permission from the federal government for three new, small-scale supervised injection sites of its own, echoed the calls for change on Wednesday.
In July, Toronto City Council approved the plans for the sites, all slated for existing health clinics, after Toronto Police Chief Mark Saunders and Mayor John Tory expressed support for the move. Toronto Public Health officials are now in talks over funding from the province for the clinics, which need $400,000 to be set up and $1.8-million a year to run.
City Councillor Joe Cressy, chair of the city's drug strategy implementation panel, said if all goes well and both provincial and federal governments approve the plans quickly, the clinics could open next spring.
But all three levels of government need to do more, he said as the number of overdoses continues to rise.
For example, advocates say Toronto Police need to be given nalaxone kits and training on how to use them, as officers are often first on the scene of an overdose – when just minutes can make the difference between life and death. Mr. Cressy said the city's police force is examining the idea.
Firefighters in Vancouver and Surrey currently carry the overdose antidote; a recently-approved nasal spray version provides an easier-to-use alternative to the injectable formula.
Mr. Cressy also said governments need to track overdose deaths much more closely; Toronto health officials have been relying on official numbers from the coroner's office that are two years out of date. In B.C., the coroners service has been releasing updated statistics every month.
"The overdose crisis that is facing our city and our province is devastating," Mr. Cressy said. "It is killing people in our streets, our friends, our colleagues, our neighbours, every week."