Pubdate: Wed, 07 Sep 2016
Source: Ottawa Citizen (CN ON)
Copyright: 2016 Postmedia Network Inc.
Contact:  http://www.ottawacitizen.com/
Details: http://www.mapinc.org/media/326
Author: Kelly Egan
Page: A2

BOOTLEG FENTANYL CREATING OVERDOSE CRISIS IN TOWN

The number of calls to paramedics for overdoses in the city has more
than doubled since 2012, and one drug, fentanyl, is the main suspect
behind the surge.

And things might get even worse.

"I definitely think it is a crisis here," says Rob Boyd, director of
the Oasis clinic at the Sandy Hill Community Health Centre and a
leader in the harm reduction field in Ottawa.

"I said going into the summer that I had a bad feeling about it. I
really try hard not to be alarmist when it comes to this stuff, but I
think powdered fentanyl is a real game-changer."

The worrisome thing about fentanyl, first widely used in patch-form as
a painkiller, is its potency. Described as 50 to 100 times more
powerful than heroin, only a few grains can cause an overdose,
sometimes fatal.

In some jurisdictions, police officers have overdosed just by handling
the powder, among the shocking stories popping up all over North America.

Just last week, nine young people in a Vancouver suburb overdosed
almost simultaneously after sharing cocaine that was spiked with
fentanyl, with eight of them ending up in hospital.

The problem today is that fentanyl is widely available in powder form
and is being mixed - in uncertain dosages - with all kinds of street
drugs.

"From one dose to the next, you don't know what the concentration is,"
Boyd said.

Added Catherine Hacksel, a member of the addictions support group,
DUAL, and the co-ordinator of a weekly drop-in program:

"With fentanyl, you can buy enough to kill you in a dime
bag."

Boyd says data from the paramedic service suggests there may be as
many as 1,400 calls for overdoses by the time 2016 is over, up from
1,027 in 2015, while the use of naloxone, which neutralizes the
overdose effects, has doubled.

Once sourced via the medical route, availability is now wide open. In
an investigation published last month, a Toronto newspaper illustrated
how easy it is to order variations of fentanyl online, mostly from
China.

"It's quite frightening, really, when you think that all you need is a
mailing address and you get (fentanyl) shipped to you from China. You
don't need an elaborate supply chain to get it," said Boyd, who has
worked in the harm-reduction field for more than 25 years.

If there was any doubt about how widely it is being mixed with other
drugs, a recent sampling at the safe injection program, Insite, in
Vancouver found about 90 per cent of heroin tested positive for fentanyl.

At Oasis, the clinic has two key pieces of advice for intravenous drug
users: don't use alone and make sure a naloxone kit is available to
someone who knows how to use it.

The kits are now available over the counter and are offered free at a
number of Ottawa pharmacies.

Boyd and others are worried, too, that drug users are often reluctant
to call 911 when an overdose occurs for fear of criminal repercussions
to the illegal activity.

Last week, Health Canada announced it is making it more difficult to
import the constituent ingredients that are blended to make fentanyl.
But, like so many other regulatory prohibitions involving drugs, there
are questions about how effective this step will be.

"It feels very daunting about how you combat this," Boyd said. The
situation is made more difficult because Canada, per capita, is one of
the biggest consumers of legal opioids in the world, so misuse via
traditional prescription routes is common.

There are an estimated 1,500 to 2,000 intravenous drugs users in
Ottawa, and hundreds would be using fentanyl, Boyd estimated,
sometimes unknowingly.

Overdose deaths have soared in just about every major Canadian city in
the past five years. The Canadian Centre on Substance Abuse, in a
bulletin last year, reported there were 655 deaths linked to fentanyl
from 2009 to 2014. The number of police seizures over that same period
jumped 30 times. The drug is sometimes bootlegged in pill form and
disguised as a legal, safe product.

The centre also reported that a fentanyl death occurs in Ontario every
three or four days but admits those figures are probably low.

Boyd and others see the fentanyl scourge as just one more reason why
Ottawa needs a supervised injection site. An application to Health
Canada is expected to be submitted this fall.
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MAP posted-by: Matt