The Opioid Crisis In Canadian Drug Culture

Matt Owczarz – Mississauga, ON

Canada is in the midst of an opioid crisis and nobody is really safe.

Fentanyl, a painkiller that is stronger than both heroin and morphine, has spread across the provinces and caused a dramatic spike in fatal overdoses. The Canadian Centre on Substance Abuse reported at least 655 deaths were caused by fentanyl nationwide between 2009 and 2014.

“It’s now morphed into something completely monstrous. It is poison this stuff,” said Joe Couto, director of government relations and communications for The Ontario Association of Chiefs of Police, or OACP. “There are no redeeming qualities to it.”

Fentanyl first started to make its impact in Canada in 2012 after Oxy Contin was discontinued because of widespread abuse and crippling addiction. At that time, fentanyl was being prescribed in patches by physicians to treat patients suffering from intense, chronic pain. The pharmaceutical fentanyl was quality controlled, and as long as patients took it under the guidance of their doctors, they would be fine.

“My mother, for instance, had a hip replacement surgery. She was prescribed fentanyl to control her pain,” said Couto, “and as soon as the doctor felt that she could come off it, she came off it.”

On the streets now, cheap yet deadly fentanyl has become very difficult to trace or detect because it’s transforming and constantly changing, said Couto. While fentanyl first became available in patch form, the synthetic versions of the opioid soon hit the streets in pill, liquid and powder forms.

It’s the potency that makes illicit fentanyl so devastatingly dangerous. A dose that’s equivalent to one grain of sand can send the user into a bliss-like high similar to heroin. A dose that’s equivalent to two grains of sand can kill both hardened addicts and first-time buyers alike.

The opioid is very addictive so drug dealers quickly seized the opportunity to get people hooked. Doctors began prescribing fentanyl illegally and people were stealing doctors’ prescription pads in order to obtain fentanyl, said Couto. The drug dealers would get their hands on the patches, cut them up, and then sell them on the street to people who would then smoke or inject the gel inside the patches. People would then abuse the fentanyl patches to the point of overdose.

Now, drug dealers are getting their hands on this synthetic fentanyl – some of it made inside the country, most of it imported from places like China – and peddling it on the streets. This bootleg version of fentanyl is less pure but more potent. One pill of synthetically-made fentanyl, for example, may contain a small dosage of the drug, but the next pill may contain two doses, or three, or four or more, Couto warned. “Unlike medical fentanyl, which is regulated, you don’t know what you’re taking (with synthetic fentanyl). Essentially, you could be taking poison,” he said.

Worst of all, drug dealers are secretly cutting fentanyl into drugs like cocaine, heroin, and ecstasy in order to increase potency. “The problem with using a drug that’s addictive is you reach plateaus. After a while the drug doesn’t do what it originally did for you,” said Couto. “That’s why they (drug dealers) are always trying to be creative about cutting drugs like fentanyl into heroin, cocaine, ecstasy. It just gives it the extra edge.”

If the bootleg fentanyl is cut into another drug, it can’t be seen, smelled, or tasted. People may be going out with the intention to do cocaine but end up also doing fentanyl. Before they can realize something is wrong it’s too late. Drug dealers aren’t trying to kill their customers, but because they can’t control the quality of the fentanyl they’re selling, their buyers end up overdosing, mourned Couto.

Most of the synthetic fentanyl in Canada is being manufactured in chemical labs mainly in China. The manufacturers acquired a recipe to make fentanyl but, as said, there is no quality control.

It’s dangerously easy to get.

People, who know where to look, can go online and order fentanyl like they would order books from Amazon, moaned Couto. It’s never explicitly advertised as fentanyl. Usually, the package will be labelled as traditional Chinese medicine.

“A lot of the times it’s just coming across as a personal package, and it arrives at your doorstep,” Balked the director of OACP.

Criminal organizations in Canada typically buy legal pill presses and then order pure fentanyl from China to produce their own pills to sell on the street. A pill making machine requires a small investment of about $5,500 and then one batch of fentanyl can net around half a million dollars, confirmed Couto.

The war on illegal opioids is difficult to fight because the fentanyl in its pure form is even more dangerous. Officers’ and first-responders’ lives are at risk when dealing with pure fentanyl. Raw fentanyl is so dangerous, even physical contact or inhaling it can cause someone to have adverse health effects or to die. “Our officers, if they suspect that there is fentanyl in a vehicle for instance, will not go near it. They will call a hazmat team,” Couto said. Then again, battling the opioid crisis on the frontlines when the drug is so cheap and easy to obtain isn’t the best course of action. “We can’t arrest our way out of this problem. It’s just not possible.”

Karmik, based in Vancouver, B.C., is a harm reduction organization that provides support services from a non-judgemental perspective mainly to festivals and nightlife events. “Karmik was originally founded as a younger generation harm reduction initiative so we focus on the nightlife setting,” said Gareth Crawford, communications director from Karmik. “Our ethos is ‘we do not condone or condemn’ substance use and we think that education and self-care are the ways to improve because you can’t care for others until you care for yourself.”

“Originally the intent wasn’t to get into this whole crisis that’s going on. The crisis began and we started to see the wreckage that it was causing and the opioids made their way into the nightlife scene so they became an issue we really had to address,” he said. British Columbia was the first province to declare a public health emergency over the drastically increasing number of fentanyl overdoses in April of last year. From January through September of 2016, there were 332 illicit drug overdose deaths connected to fentanyl, according to the B.C. Coroners Service.

Karmik routinely hosts naloxone training sessions and offers harm reduction advice to prevent as many overdoses as possible, but it’s been an uphill battle inside a province so devastated by the powerful opioid. “There is the old saying ‘know your source’ but you know what, it doesn’t matter how well you know your source, they (dealers) can’t even detect it themselves lots of the time,” Crawford said. Karmik has begun advising anyone experimenting with drugs to always test their supply, never use alone and always have naloxone on hand. “Everyone needs to carry naloxone now,” he said. “It’s not like if you’re around someone who has an opioid dependency then carry it, because you just don’t know what could happen anymore.”

“A friend of a friend loses someone every weekend and it’s not just people who were heavy substance users or opioid addicts. It can really be anyone,” Crawford said. “People are just dropping dead.”

Inside the Downtown Eastside of Vancouver, medical responders have been dealing with an alarming rate of overdose related calls. Firefighters – usually the first on the scene for medical emergencies – have revived numerous men and women who were sprawled out on the ground, not moving, and suffering from an overdose. “It’s always been bad but it breached another threshold and its spread to people you wouldn’t expect to drop dead that weekend,” he said.

The opioid crisis is a complex monster of an issue with no quick-fix solution. “Government has started to move but a government can’t react fast enough,” said Couto. “This is going to take money. It’s going to take significant resources. It’s going to take some political courage.” Provincial and Federal governments have only recently taken efforts this past year to readily expand access to naloxone – an emergency medication that reverses an opioid overdose. Medical experts have been urging Canada to declare a public emergency over the opioid crisis but only recently has public discussion been opened on a federal level at a summit in Ottawa on Nov. 17 and Nov. 18, 2016. Canada’s Health Minister Jane Philpott said that legislative changes will come in the next few months and will require cooperation from multiple departments. In Toronto, Health Minister Eric Hoskins confirmed that the province of Ontario will fund supervised injection services at three sites – located at Yonge and Dundas Sts., near Queen and Bathurst Sts., and near Queen St. and Carlaw Ave. On top of that, in March, the Toronto Public Health brought an Overdose Action Plan to the Toronto Board of Health. The plan aims to reduce the rates of fatal overdoses by petitioning for the provision of free naloxone, addressing the stigma about drug use, and increasing the access to substance abuse treatment programs, as well as the aforementioned supervised injection sites.

Only time will tell if the changes can stop this epidemic, but until then Canadians, their kids, family and friends will continue to be at risk, more than ever, of simply dropping dead without warning, and without any idea as to why.

The following instructional and educational information was provided by Toronto Public Health spokesperson Shaun Hopkins, manager of the Needle Exchange Program. How to spot a fentanyl overdose People experiencing a fentanyl overdose will exhibit symptoms of an opioid overdose. These symptoms include:

 Extremely small pupils

 Cold, clammy skin

 Extremely pale face

 Blue fingernails and lips

 Breathing is slow, irregular or has stopped

 Deep snoring, gurgling or wheezing

 Doesn’t respond to yelling, touching or light

 Limp body

What to do next?

 Call 911

 Stimulate victim with pain by rubbing their breast bone

 Inject a dose of naloxone into a large muscle including upper arm or leg

 Perform CPR

 If the victim isn’t waking up, administer a second dose of naloxone

 Turn the victim onto their side so they don’t choke if they vomit

 Stay calm and remain with the person until help arrives

What is Naloxone?

Naloxone is an emergency medication that reverses the effects of an opioid overdose. Naloxone kits are essential for preventing an overdose death and they are increasingly available in pharmacies across Canada. Each kits contains two units of Naloxone, two syringes, two alcohol swabs, two latex gloves and a one-way breathing mask with instructions.