Pubdate: Tue, 02 Feb 2016
Source: Prince George Citizen (CN BC)
Copyright: 2016 Prince George Citizen
Contact:  http://www.princegeorgecitizen.com/
Details: http://www.mapinc.org/media/350
Author: Samantha Wright Allen
Page: A1

'PEOPLE ARE DROPPING ALL AROUND US'

Printed in bold block letters and taped to the door of the Needle 
Exchange on Third Avenue, a sign warns drug users to take extra precautions.

"There has been reports all drugs may contain fentanyl," it reads, 
the last word highlighted with bright green marker.

The warning sign has been up for more than a year, but since 
Christmas Prince George has seen a spike in overdoses that has the 
community again on high alert.

Fentanyl is a highly toxic narcotic that service providers and 
frontline workers suspect has flooded the illicit market. It can be 
mixed with opiates like heroin, making the drugs both cheaper and 50 
to 100 times more potent, according to the BC Centre for Disease Control.

Clinic coordinator Linda Keefe recalled a sudden overdose in their 
office right in front of a support worker.

"This person looked at her, rolled their eyes and dropped and they 
were in respiratory arrest. That was just before Christmas and that 
kick-started everything for us," said Keefe, who has been telling 
people not to use alone and to take small doses to test the drug for strength.

People have overdosed in the office's bathroom and in the building 
alcoves nearby.

"They like to use closer to us because we're safe," said Keefe, 
adding the clinic is operating under the assumption most of the 
opiates are contaminated.

"All of a sudden it was like people are dropping all around us.

"Certainly there has been a spike in overdoses and some deaths," she 
said. "Thankfully most overdoses aren't fatal."

Since then, the Needle Exchange has handed out more than 50 naloxone 
kits, a lifesaving antidote that reverses the effects of an overdose. 
The clinic opened up for longer hours at Christmas and started 
working even more with other service providers to respond to the uptick.

Meanwhile, the Central Interior Native Health Society said it ran out 
of its naloxone kits after handing out about 30 last year and has put 
in an order for more.

"Our patients are talking about it and they're concerned," said 
Margaret Coyle, CINHS manager. "We've had a bit of an increase in 
patients asking for the kits because they're aware that there's 
fentanyl in (the drugs)."

In the 14 years Dr. Lawrence Fredeen has worked in addictions, he's 
noticed patterns in overdose deaths, but the latest spike is 
something new and different.

"This rash we're seeing now is very dramatic and more than anything 
I've seen," said Fredeen, director of addictions for Prince George. 
"We've had overdoses coming in every day to a maximum of 12 in 24 hours."

Prince George fire chief John Iverson echoed that sentiment.

"We've experienced a very busy period with overdoses in the last 
couple of months," he said.

"We've gone through these periods before. For whatever reason there 
seems to be a spike in opiate overdoses. This is a fairly new but 
very concerning, very serious problem that we're seeing."

The antidote

Fentanyl has become a national problem and one that provincial and 
national agencies are scrambling to address. There were at least 655 
fentanyl-connected deaths in the country between 2009 and 2014. 
Provincially, the B.C. Coroner's service said 30 per cent of overdose 
deaths in 2015 had traces of fentanyl.

Two weeks ago, Health Canada said it planned to make naloxone 
available without prescription. In order to fast-track the shift by 
mid-March, it waived the usual six-month consultation period for such changes.

A prescription is one extra step that creates considerable barriers, 
said Coyle. As it stands, nurse practitioners and doctors can only 
prescribe to those at risk of overdose.

"Obviously they're in no position to administer to themselves," she said.

If family members, friends, and support workers can access naloxone 
without prescription, however, that leads to much better outcomes for 
those at risk.

"It is a step that creates tremendous barriers," Keefe said. "It's 
one of the few medications that has virtually no side effects or 
potential to harm."

In the meantime, local agencies have come up with creative solutions.

"We have prescribed prescriptions to some downtown organizations like 
the Fire Pit, like the shelters, so that they can then go to the 
pharmacy," Coyle said.

Blue Pine Primary Health Clinic can also prescribe naloxone, or 
Narcan as it's also known.

"It's really brought a lot of the service providers together quickly, 
just to strategize," Keefe said. "We do come together anyway but it 
really kind of got everybody on the same page because we're all 
having people dropping."

Last week the province said some Lower Mainland firefighters would 
carry the overdose-reversing drug to all emergency calls.

"This program recognizes that with the increasing number of overdoses 
we're seeing, we have to make sure the people on the front lines 
responding to emergency calls have the right treatment available to 
save lives," said Health Minister Terry Lake in that announcement.

That program could make its way north, but Iverson said he needs more 
information.

"They're ahead of us timewise because they're the first out of the 
gate with this. I'm going to find out more information and then I'll 
have a better idea if we can, and then, if we can, how long it will 
take for it to actually get on our trucks," he said.

'Her lips were turning blue'

As Theresa George watched her friend's lips turn blue, she knew 
something was different in this heroin high.

"She passed out," said the 33-year-old, her voice low while she 
remembered the overdose, her hand stroking up and down her right 
forearm. "She's incoherent. Like usually people would be able to talk 
to you and they'd wake up and they'd react right away."

George gave her mouth-to-mouth and then called for help as she got 
the naloxone kit out, one she'd picked up from the Needle Exchange 
just the week before.

Two doses later and her friend is alive today.

The kit, which looks like a sleek sunglasses case, comes with a mouth 
shield, which is one of the key pieces of equipment, according to Keefe.

"Even if you don't have a kit, do mouth-to-mouth," Keefe said. "You 
will keep them alive."

While George doesn't think that particular hit was laced with 
fentanyl, her sense is the drug is responsible for the spate of 
recent overdoses.

It's why she took the naloxone training in the first place.

"I've been around other people who have overdosed in the past and the 
ambulance didn't show up all that quick some of the times, so it's 
good the Narcan kits are here."

Many suspect the drug is coming to Prince George from the Lower Mainland.

George said fentanyl was off the streets for a time last year, 
interestingly, shortly after Prince George saw a rise in overdoses 
and deaths at the end of August.

"They took the fentanyl away for a little period of time 'till now," 
George said.

At the end of August, Northern Health sent out a press release after 
a rash of opiod overdoses in a 24-hour period.

'Be careful, it's really good stuff'

The way George tells it, no one in Prince George is caught by 
surprise when fentanyl is in the drugs they're buying.

"The people who do sell it to us they do let us know and they let us 
know to be careful and to make sure that we don't take too much," 
George said. "They tell us more than once."

Some, like Shawn Byers, seek it out.

"You get more bang for your buck as long as you know you're getting 
fentanyl so you can adjust in smaller doses," said Byers, who like 
George, is addicted to opiates and lives in shelters.

The 30-year-old can take about one point - or a tenth of a gram - of 
heroin per hit every six hours or so.

But he can stretch one point of a fentanyl mix much further. For him, 
it's six times as powerful.

Byers said it's a fine line between the nod - "that's pretty much the 
ultimate goal that a heroin addict tries to obtain" - and the overdose.

"(Drug dealers) say be careful it's really good stuff.

"Even though I know I'm getting fentanyl, I've overdosed a couple of 
times, not serious enough to require Narcan, but enough to alarm the 
people around me and by the way I was acting," Byers said.

"I don't know what's really stopping me from getting another (Narcan) 
kit, I guess just the fact that I'll lose it. After this discussion 
here it's kind of opened up my eyes.

"It's silly not to have it."

Fredeen said fatalities will never be enough to scare people off 
opiates and that means fentanyl as a health issue is not going away.

"Such is the nature of addiction," said Fredeen. "They tend to keep 
reaching out and taking it even though they know it carries 
potentially a huge risk."

Tracking fentanyl

Local data detailing the spike in overdoses is hard to come by. 
Neither Northern Health or the Prince George RCMP could produce the 
number of overdose deaths in August and December or whether any had 
traces of fentanyl.

The RCMP said it is working with the health authority, but lab 
results have not come back yet for the recent cases. In August, 
Northern Health reported two of the deaths that year were connected 
to fentanyl.

The B.C. Coroner's service also could not say whether any of Prince 
George's 13 overdose deaths last year contained fentanyl because with 
"so few deaths altogether the fentanyl numbers are likely to be too 
small to have been recorded."

While the majority of overdose deaths don't contain fentanyl, every 
year the percentage that have traces of the drug is increasing. Last 
year, 30 per cent of all overdose deaths in B.C. had fentanyl, 
compared to only five per cent in 2012.

In 2015, Prince George reported 13 overdose deaths, up from 10 in 
2014, seven in 2013 and 10 in 2012.

Northern Health could not provide the number of overdoses it 
responded to in August or in the last number of months. It also 
doesn't have a system that tracks the causes of overdoses, so it 
can't report whether there has been an uptick in overdoses with 
traces of fentanyl.

"When they come in for an overdose it's up to the patient whether a 
toxicology report (is done)," said spokesperson Jonathan Dyck.

In fact, it was only in the last few months that hospitals even had 
the ability to include fentanyl testing in its urine drug screens, 
Fredeen said.

"We don't know exactly how big the problem is, how much is solved in 
the community.

"It's so much by word of mouth, which is so tricky because it could 
be overreported or under-reported," said Fredeen, who has had the 
testing available at the methadone clinic he runs.

"The problem is, if you're not testing for it or looking for it, 
you're not going to find it. So how many have we had before but we 
just didn't recognize?"

Similarly, RCMP don't have on-site testing for fentanyl like they do 
for other drug seizures, said spokesman Corp. Craig Douglas.

"If we tested a baggie of heroin, it would come up positive for 
heroin, but there is a chance that fentanyl would be in there but we 
wouldn't be able to tell that," he said.

Officers send the drug off for testing and the results would be 
passed on the to Crown to prosecute.

"In the last couple years we've had a few rounds of fentanyl reports 
and clusters of overdoses," Douglas said.

"It's not that we don't want to know, we certainly do, but it doesn't 
change our duties. We're still doing everything we can to get illicit 
drugs off the street and fentanyl would be in that."

An education in overdoses

"In an ideal world, people would stop injecting drugs but we know 
that it's much more difficult and more complicated than that," said 
Central Interior Health's Coyle.

Health Canada's proposed changes to naloxone will make a difference.

"It's really just trying to educate people as much as possible, 
having these kits widely available, training as many people as 
possible in how to use them ... and talking to their clients about it."

Education comes down to repetition, Keefe said.

"We've talked to so many people and we just talk over and over and 
over again," she said.

"For some people an overdose is a turning point too. They'll access services."
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MAP posted-by: Jay Bergstrom