The fentanyl addiction crisis in Canada has become a threat to public health and safety.  This particular opioid has evolved into a highly prevalent & dangerous drug on the streets, posing fatal consequences all across the country.  More people become addicted to this illicit substance each day, causing thousands of Canadians to overdose each year.

Fentanyl is a human-made opioid that is sometimes used to treat patients with chronic pain. It is similar to morphine in the way it works, but fentanyl is up to 100 times more potent. This powerful drug binds to the brain’s opioid receptors to block pain and cause a state of euphoria.  A single dose Fentanyl can be compared to taking 500 to 1000 codeine pills at once.  It is typically administered intravenously (IV), intramuscularly (IM), or as a skin patch (transdermally).

Canadian Statistics on Fentanyl:

According to the Canadian Centre for Substance Abuse, the number of deaths from fentanyl is on the rise each year all across the country. Reports show staggering numbers of misuse and overdose deaths occurring at regular intervals. British Columbia declared a public health emergency after overdoses killed 200 people in the first three months of 2016.

Between 2009 and 2014, there were at least 655 deaths in Canada where fentanyl was determined to be a cause or a contributing cause. This represents an average of one fentanyl-implicated death every three days over this time period.  Within the last six years, the number of fentanyl-related deaths has increased markedly across Canada’s four largest provinces.

Since the removal of OxyContin from the Canadian pharmaceutical market, fentanyl reached a high in 2012.  Prescriptions for fentanyl have heightened over the past 15 years making this drug easily accessible.

Some facts about Fentanyl:

• Canada has the largest rate of prescriptions for Fentanyl
• The illicit version of fentanyl is manufactured in China and smuggled into Canada
• It is typically laced with heroin, cocaine or oxycodone exponentially boosting potency by 50-100x
• Opioid carfentanil (Veterinary opioid) is now making its’ way on the streets & is up to 100 times more toxic than fentanyl
• It’s sold in pill or powder format and the average user is spending $300+ per day

The Dangers of Fentanyl:

Fentanyl can be absorbed into the body via inhalation, oral exposure or ingestion.  It is not known whether fentanyl can be absorbed systemically through the eye, so proper precaution should be taken.  Evidence suggests this drug can also be easily absorbed through the skin with very little contact.  If the compound contains carfentanil, the outcome can be life threatening.

All opioids can be dangerous because of the way they affect the brain. This class of drugs slows down breathing, and too much of it can easily cause an overdose to be fatal. What makes fentanyl particularly dangerous is its potency and prevalence.

Some symptoms of Fentanyl overdose include:

• Slowed or stopped breathing
• Blue lips and nails
• Choking on vomit or gurgling sounds
• Unable to regain consciousness
• Cold, clammy skin

Substances laced with Fentanyl:

Several of the popular street drugs, particularly heroin, have been found to be laced with fentanyl leaving this substance potentially undetected.  This poses a tremendous concern for addiction rehab as treatment and diagnosis are negatively impacted.

According to Health Canada, Fentanyl is often combined with substances such as heroin, cocaine & MDMA to increase potency. Fentanyl is easy and inexpensive to manufacture, making it convenient for drug dealers to spike other substances and create counterfeit versions of drugs.

Unfortunately, recreational drug users are completely unaware that they are ingesting the potent painkiller, resulting in overdose and death.  Additional danger lies in those who are not regular opioid users & inadvertently abuse the drug, as this creates a much greater risk of overdose or death.  A relatively small amount is considered potent and users are essentially playing Russian roulette with the laced substances.

Potential Impact on Treatment:

Opioid overdose deaths continue to rise across Canada, forcing federal and provincial authorities to respond to this growing epidemic.

Despite the exponential rise in abuse, workplace policies still do not include Fentanyl as part of a preliminary screening panel.

Although a standard drug screen for opiate could potentially detect fentanyl, the chances of this substance being missed on a urine screen is quite high.  The opiate test is not specific to Fentanyl therefore the negative impact could be alarmingly severe.  Being proactive with screening and educating staff members on the signs and symptoms of fentanyl abuse will enhance patient treatment and minimize risk and liability.

With the recent launch of Naloxone, the potential risk fentanyl overdose can be mitigated.  Naloxone binds to the same places in the brain that fentanyl does. However, because Naloxone creates a better bond, it takes the place of fentanyl and kicks the dangerous drug off the receptor. This process can occur even after the fentanyl has begun to take its toll on the person.  Since Naloxone can work in as little as five minutes, it can quickly reverse overdose and save lives.  Paramedics now carry Naloxone to treat suspected overdose patients, and it is also being used in hospitals across the country as an effective antidote.

While all of the facts surrounding fentanyl addiction may feel disheartening, new programs and treatments are proving to be effective in minimizing overdoses. Naloxone is the antidote to fentanyl and governments are using this drug in revolutionary ways to end this crisis.

The first step to treating fentanyl addiction and ending the crisis is by acknowledging it.

With education and awareness, the potential of fentanyl overdoses and death can greatly be minimized.   Employers, Physicians & Addiction treatment centres can incorporate more comprehensive drug screening programs to further enhance patient treatment.