Pubdate: Mon, 10 Apr 2017
Source: Capilano Courier, The (CN BC Edu)
Copyright: 2017 The Capilano Courier
Author: Christine Beyleveldt

Deadly doping


Knowing the signs of an overdose can save someone's life, especially
with inconspicuous opioids like Fentanyl lurking in common street
drugs. It begins with high-like symptoms - euphoria, relaxation and
drowsiness, and cedes to shortened breath, a slowed heart rate and
unconsciousness. The effects of Fentanyl set in quickly. The trouble
is, anyone can fall prey because the opioid often goes undetected
until it's too late.

Fentanyl is laced into illicit street drugs to enhance their effect.
Originally a pain medication used as an anaesthetic, it's 50 to 100
times stronger than Morphine. Because it's so potent, the drug comes
in small doses, often concealed in silica gel sachets discreetly
marked that can't be seized at the Canadian border.

A sample of Fentanyl the size of a single grain of salt allows the
user to settle into a comfortable high; just twice that dosage can
cause death. "We know the war on drugs hasn't worked, so it's probably
not realistic to think our law enforcement agencies can stop Fentanyl
from getting into Canada. It's a huge business. Huge laboratories are
manufacturing it," said Capilano University Criminology instructor
Laurel Whitney. In British Columbia, where the opioid has had the
biggest impact, overdoses claimed the lives of 914 people in 2016.

Whitney compares the Fentanyl crisis to the public hysteria
surrounding Heroin and HIV/AIDS epidemic in the 1990s. "It's here to
stay," she said. "The population of people who are involved in this
behaviour is a continuing, existent fact, and so instead of using a
moralizing discourse and hysterical non-scientific approaches that
don't work, it's better to use harm reduction." Harm reduction begins
with the premise that behaviour - in this case, illicit drug use -
won't cease. So instead of criminalizing drug use or warning people
away from using, the harm it causes to users and those around them has
to be reduced.

Insite, which opened in 2003, was North America's first supervised
injection site. Even though nurses working at Insite can't prevent
accidental overdosing, the supervising nurses present are trained to
administer Narcan, the opiate antidote. By criminalizing the use of
illicit drugs, you drive it into back alleys and dark corners, and
then people end up sharing dirty needles and they end up transmitting
diseases to each other or they end up using a dose of heroin that is
stronger than the dose they used yesterday," Whitney explained. "If
they're lucky, a police officer happens to be walking by or a member
of the public or a health care worker who sees them and calls 911, and
they don't pass away."

Fire Hall No. 2 on the corner of Main and Powell is at the heart of
the Downtown Eastside. Although it's in one of the smaller precincts,
the rotating crews respond to more calls than any other Fire Hall,
with over 1,200 calls in March alone. 24-year-old firefighter Brandon
Davies reckons 75 per cent of their calls are in relation to drug
overdoses, since they're only minutes away from Insite and St. Paul's
Hospital. "These are the fastest response times in the downtown core,
but usually we still get there before the ambulance," he explained.
The crew was having a busy morning when the Courier paid them a visit
on Mar. 31, tending to four separate calls in the span of an hour and
a half. In January, the Fire Hall acquired a second medic truck to
keep up with the number of overdose-related calls they were receiving.

Davies led the way into the garage and hauled an oxygen tank and two
first-aid kits out of the back of the medic truck and opened up a
little black kit of Narcan. The tiny amber vials contain 0.4
milligrams of naloxone. On average it takes two doses to combat the
opioid, some victims take three or four or even five or six doses.
It's harmless on its own, he explained, snapping the cap off a vial
and inserting a syringe to draw out the liquid, but it's a lifesaver
if you've overdosed. The most he's ever needed to bring a person down
off a high was 11 doses. "We don't actually give Narcan as much as
when we started because everyone has their own kit," he said. "So
we'll get there and someone's already done it." Even though they're
not administering Narcan as much as they were when Fentanyl was
declared a public health crisis in Sept. 2015, they'll still carry
their own kits and prefer to use them because they know they're clean
and uncontaminated. Sometimes when they arrive th! ey'll open up the
victim's kit and discover the needles have been removed and used to
shoot up illicit drugs.

The first thing firefighters do when they arrive on the scene is look
for space. If they're in a cramped room they'll pull the victim out
into an open hallway where there's room to work, but nobody around
them ever seems to care that they're there or need space to work. Then
they'll check the victim's breathing. A person's oxygen intake should
be 95 per cent or higher, anything less and Davies will breathe
manually for them until the naloxone kicks in and the paramedics
arrive. He's seen oxygen levels as low as 17 per cent before. He
explains that breathing for a person until their levels have returned
to normal before administering the Narcan is important, otherwise
they'll panic when they wake up and aren't able to breathe.

After coming to, they'll either tell Davies to fuck off or they'll
want to go to the hospital where they'll be put on a naloxone drip.
"They're pissed off," he said. "They'll do their heroin and they've
spent all their money on it and we ruined their high." The naloxone
only lasts a short while, and after being revived if an overdose
victim wanders off they could be back on the ground and unconscious
again in a matter of 30 minutes. Davies recalled tending to a
250-pound man who had passed out after half a dose of heroin and his
girlfriend, who was sitting next to him, was trying in vain to wake
him up. As Davies prepared to start breathing for him she injected
herself with the needle, which had been rolling on the floor, and shot
up on the remainder of the dose of heroin. Minutes later, she too had
overdosed and fallen unconscious. "It does get frustrating at times;
you see the same person day in and day out and they say 'I'm never
doing this again, I'm saving myself,' but ! they never do," said Davies.

Perhaps the most heartbreaking aspect of the crisis is that it affects
the same people time and again. "A lot of people we go to often still
have their hospital bands on," Davies explained. "We know them by
name, it's a pretty small community."

But Fentanyl isn't the first public health crisis to devastate the
Downtown Eastside community. Whitney explains that Heroin and HIV/AIDS
were equally ruinous, although confined to one demographic. The only
reason Fentanyl is a crisis is because it can affect anyone. "If
you're a middle class person and you've always been a recreational
drug user but you [had] bad luck this time, your drugs were laced with
Fentanyl, then our society is concerned because, you know, it could be
my child next," she said. Whitney lives in the Downtown Eastside where
sharps are disposed of in the foliage near her building. It's a sign,
she says, that the problem won't relocate when the area becomes a
landed gentry.

Every life is worth saving.
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