The year of the fentanyl crisis: How we got here

As the number of deaths linked tofentanyland carfentanilin2016 continue to rise in British Columbia and Alberta, the"unprecedented drug safety and public health crisis" is "spreading like a cancer" across Canada, a prominent drugexpert says.

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"There has never been a more dangerous time to source drugs on the street," said Dr. David Juurlink, head of clinical pharmacology and toxicology at Sunnybrook Health Sciences Centre in Toronto, and a researcherwith the Institute for Clinical Evaluative Sciences (ICES).

The federal government has acknowledged the threat. In November, Health Minister Jane Philpott, along with many of her provincial and territorial counterparts, jointly committed torespond to "a serious and growing opioidcrisis,"including anOpioidAction Plan in2017.

How did we get to this crisis point?

Juurlink, whois on a steering committee to change the guidelines for prescribing opioids in Canada, says a massive increase in prescriptionsfor narcoticpainkillersthat started 20 years agopaved the way for today'sfentanyl and carfentanilcrisis.

Opioids, including morphine, OxyContin and fentanyl, work by binding to receptors on cells in the brain and spinal cord, blocking the perception of pain. But up until the mid-1990s, Juurlink said, they were usually prescribed only foracute pain (such as a broken bone), pain caused by cancer or for palliative care.

That attitude changed when medical students and doctors were toldthat opioids could also be used to treat chronic pain, and that the risk of addiction for their patients was low.

But by the mid-2000s, when medication like OxyContin was being widely prescribed, it becameclear that many chronic pain patients were on a "spiral into addiction."

The sheer amount of painkillers being prescribed also "put a lot of opioids into medicine cabinets that otherwise wouldn't have been there," Juurlink said, which in turn led to teens experimenting with their parents' drugs, and "millions" of tablets also falling into the wrong hands.

When the medical community started to recognize the damage being done, the culture of prescribing opioidsbegan to shift and many doctors stoppedgiving them to their chronic pain patients.

In 2012, Purdue Pharmareplaced itsOxyContinpillsin Canada with a different formula approved by Health Canada thatwas supposed to make the tablets more difficult to abuse by crushing, injecting or snorting.

But making pharmaceutical opioidsless available didn't change the fact that thousands of people were addicted to them andthe withdrawal symptoms were unbearable.

"I can't tell you how many people I've looked after over the years who say,'I've tried quitting, I just can't do it,'" said Juurlink,an internal medicine physician. "Imagine the worst flu you've ever had, multiply it by 20 and you are miserable."

Desperate people turned to the streets to get their hands on whatever opioids they couldto avoid those withdrawal symptoms, hesaid and that option was often heroin.

The "sheer enormity of the market" of people addicted to opioidshas led drugdealers to maximize their heroin supplies as much as they can, Juurlink said, and that's where fentanyl and more recently, carfentanil comein.

Fentanyl is cheap and "incredibly potent," so drug dealers add it to heroin to multiply the effects and increase their profits, hesaid. But because "quality control isn't exactly their thing," how much fentanylthey add varies widely, and even a tiny bit too much kills.

Geri Platko saved her friend who had overdosed in a hospital bathroom

8 years ago

Duration 0:30

She injected her with Naloxone from her personal kit

In addition to contaminated heroin, there are reported cases of fentanyl-laced cocaine. Police have also started to find tablets that look exactly like OxyContin but really contain fentanyl.

People using street drugs "literally have no clue what they're getting," Juurlink said.

But what alarms him even more than fentanyl is the recently discovered presence of carfentanil, which was never intended to be consumed by humans, in otherdrugs.

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Carfentanil, also an opioid, is chemically relatedto fentanyl, but is 100 times more potent and used in veterinary medicine to sedate large animals.

It's "one of the most frightening drugs I can imagine in circulation," said Juurlink."It's only a matter of time before it is detected in every province in Canada."

Who is affected by this crisis?

When it comes to carfentanil, "nobody is safe from this stuff," Juurlink said. "This could literally kill anybody who comes into even just casual contact with the powder."

Both fentanyl and carfentanil pose enormousdanger not only to people with addictions, hesaid, but also to anyone including kids who might try a pill or drugat a party that isn't what they think it is.

"This happens. And those people fall asleep, and they stop breathing and they die."

How many Canadians have died?

Because the consumption of carfentanil by humans only became apparent relatively recently, some provinces have juststarted testing for it in post-mortem toxicology screens, so little information is available.

Some provincial chief coroners' offices have information about fentanyl-related deaths, but there is no national data. According to a British Columbia Coroners Servicereport,fentanyl was detected in 374 illicit drug overdose deaths in that province between January and October 2016.

A report from the Office of the Chief Coroner in Ontario cites fentanyl as a factor inmore than 150 deaths in that province in 2014.

Juurlink estimates fentanyl and carfentanil will kill at least 2,000 people in a year, and that the number will only go up without drastic action.

How can those deaths be prevented?

Experts, including Juurlink,are calling on the federal government to supportsafe consumption sites, where people suffering from addiction are supervised, and can be resuscitated if the drug they take is contaminated with fentanyl or carfentanil. In addition,those sites can provide a gateway to addiction counselling and anti-withdrawal drugs that can help someone stop using illicit substances.

• 60 days clean,fentanyladdictKatiMatherhas changed drastically since CBC last spoke to her

Juurlink also says people need to be able to easily accessnaloxone medication that reverses the effects of an opioid overdose in the same way that cardiac defibrillators are found in public places foruse on someone sufferinga heart attack. Naloxone isavailable in pharmacies, but Juurlink wants to see it inplaces like public bathrooms and nightclubs.

Kati Mather 60 days clean

8 years ago

Duration 1:07

In September 2016, 22-year-old Kati Mather was on the streets doing drugs. Now she has turned her life around with the help of long-term treatment.