Illicit fentanyl: An emerging threat to people who use drugs in BC

Fentanyl-detected illicit drug overdose deaths in British Columbia increased dramatically from 5% of total illicit drug deaths in 2012 to over 25% in 2014.[1] While clusters of fentanyl-detected deaths have been reported in Canada and the US,[2] these recent deaths represent an emerging public health concern in BC.

Fentanyl is a synthetic opioid that is far more potent than morphine and heroin.[3] It is used to manage acute and chronic pain; however, both pharmacological and illicitly produced fentanyl may be abused. Pharmaceutical fentanyl is available in the community as transdermal patches; however, illicitly produced fentanyl may be sold as pills or powder, or it may be mixed with heroin, oxycodone, and occassionally stimulants. Fentanyl pills masquerading as oxycodone, known as “green jellies” or “street oxy,” are now available across Canada.[4]

While some people intentionally seek out fentanyl for abuse, others may consume it unintentionally. Given the potency of fentanyl and the highly variable doses in illicit substances, the risk of overdose is considerable, especially for those who are opioid naive.[1,5]

In response to the increase in fentanyl-detected deaths, the BC Centre for Disease Control (BCCDC) supported several strategies aimed at reducing harms. In February 2015 the BCCDC partnered with the RCMP and the Vancouver Police Department to initiate a public messaging campaign intended to increase awareness of fentanyl-related overdoses and recommend precautionary strategies (see Box).[6]

The BCCDC has also championed overdose prevention, recognition, and response training, including the use of naloxone to reduce severe harms from opioid overdose such as brain damage and death. The BC Take Home Naloxone program, initiated in 2012, is available at 70 sites throughout the province. Training is available for people who use drugs, as well as their families, friends, and service providers. However, as a prescription-only medication, Take Home Naloxone kits can be prescribed only to people at risk of an overdose. As of April 2015 over 200 out-of-hospital naloxone reversals have been documented in BC.[7]

In addition to the Take Home Naloxone kits dispensed through the program, naloxone can be prescribed by licensed physicians. Naloxone is covered by most private insurance plans. The College of Physicians and Surgeons of BC has also advocated the addition of fentanyl urine testing when investigating cases of suspected opioid misuse.[8]

Illicit fentanyl abuse represents a considerable health risk to people who use drugs in BC. While the increase in fentanyl-detected deaths is alarming, awareness and support of harm reduction strategies, including naloxone, can reduce fentanyl- and opioid-related morbidity and mortality.
—Geoff McKee, MD
—Ashraf Amlani, MPH
—Jane A. Buxton, MBBS, FRCPC
bccdc box

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This article is the opinion of the BC Centre for Disease Control and has not been peer reviewed by the BCMJ Editorial Board.


References

1.    Know Your Source. Fentanyl-Related Overdoses FAQ. Accessed 28 May 2015. http://knowyoursource.ca/questions-about-fentanyl.
2.     Centers for Disease Control and Prevention. Notes from the Field: Acetyl fentanyl overdose fatalities—Rhode Island, March-May 2013. MMWR Morb Mortal Wkly Rep 2013;62:703-704.
3.     Poklis A. Fentanyl: A review for clinical and analytical toxicologists. J Toxicol Clin Toxicol 1995;33:439-447.
4.     Canadian Centre on Substance Abuse, Canadian Community Epidemiology Network on Drug Use. CCENDU Drug Alert: Increasing availability of counterfeit oxycodone tablets containing fentanyl, February 2014. Accessed 28 May 2015. www.ccsa.ca/Resource Library/CCSA-CCENDU-Oxycontin-Fentanyl-Alert-2014-en.pdf.
5     Tanner Z, Matsukura M, Ivkov V, et al. British Columbia drug overdose and alert partnership report: BC drug use epidemiology, September 2014. Accessed 28 May 2015. www.bccdc.ca/NR/rdonlyres/360E0050-F939-4C0E-B627-854F0A7B346D/0/FinalDO....
6.     Toward the Heart. Fentanyl. Accessed 28 May 2015. http://towardtheheart.com/fentanyl.
7.     Toward the Heart. Take Home Naloxone: Frequently asked questions. Accessed 28 May 2015. http://towardtheheart.com/assets/uploads/files/THN_FAQ.pdf.
8.     College of Physicians and Surgeons of BC. Updates from the drug programs. Coll Connect 2015;3. Accessed 28 May 2015. www.cpsbc.ca/for-physicians/college-connector/2015-V03-02/07.

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Dr McKee is a public health and preventive medicine resident at the UBC School of Public and Population Health. Ms Amlani is harm reduction epidemiologist, and Dr Buxton is harm reduction lead at the British Columbia Centre for Disease Control.

Geoff McKee, MD, MPH, Ashraf Amlani, MPH,, Jane A. Buxton, MBBS, MHSc, FRCPC. Illicit fentanyl: An emerging threat to people who use drugs in BC. BCMJ, Vol. 57, No. 6, July, August, 2015, Page(s) 235 - BCCDC.



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