Fentanyl, the powerful opioid responsible for causing a rise in overdose deaths in Alberta and BC, is now responsible for most opiate-related overdoses in Ontario, according to data from the Officer of the Coroner General.
In statistics obtained by the Globe and Mail, the government agency recorded one out of every four opiate deaths in 2014 as being caused by fentanyl—a rate that trails just behind the one in three ratio of fentanyl-related overdose deaths that currently exists in British Columbia.
Ontario's high opioid overdose rate is no secret: According to official statistics, almost 5,000 people died from opioid overdoses between 2000 and 2013. Last year, a collective of doctors and medical experts called the Municipal Drug Strategy Coordinator's Network of Ontario (MDSCNO) filed an official plea to the provincial government to take the opioid crisis more seriously—advocating for expanded access to safe injection sites and the life-saving, overdose-reversing drug naloxone.
According to Michael Parkinson, a member of the Waterloo Region Crime Prevention Council (WRCPC) and spokesperson for MDSCNO, the rise in fentanyl deaths is another example of how serious the opioid crisis is, but Parkinson notes that the new data—going back three years—is not as current as it should be.
"We simply don't know what those deaths attributed to fentanyl mean. Whether those are people using pharmaceuticals or bootleg fentanyl," Parkinson told VICE, noting that bootleg fentanyl—typically sold in pill or powder form—is more widely found on the west coast, while most cases of the drug appearing in Ontario have been from stolen or illegally sold prescription patches.
"What we have seen so far in 2016 in Ontario is a surge in opioid overdoses and alerts from Waterloo region, from Kingston, and from Toronto. From those overdoses, heroin is suspected, but the concern is that it [could] very well turn out to be bootleg fentanyl. The coroner data is three years old by the time it arrives, and no real time monitoring occurs in Ontario, so how would we know if opioid overdoses started to surge?"
Earlier this year, WRCPC launched the Overdose Monitoring Alert Response System (OMARS)—a dedicated third-party program for tracking opioid overdoses in the Waterloo region. Parkinson hopes that OMARS will be able to shed more light on what exactly is happening in the province, but he says that a more comprehensive strategy from the government is needed to cover all municipalities.
When asked by VICE for an interview, the Ontario Ministry of Health declined but said that it takes "the issue of opioid drug misuse very seriously." In response, the ministry pointed to its Narcotics Monitoring System (NMS)—a program that tracks the dispensing of opioid drugs for anomalies pointing to abuse or resale—and government-funded substance abuse treatment programs as examples of what the province is doing to respond to the crisis.
Dr. Philip Berger, medical director of the Inner City Health program at St. Michael's Hospital in Toronto, told VICE there needs to be more done on the issue of tracking prescriptions, specifically pointing to physicians that are either carelessly or maliciously prescribing painkillers as one of the reasons he believes overdose rates are continuing to rise.
Berger says that, in his recent experience, it's not uncommon for his patients to show up with fentanyl in their urine, but he believes the issue is a systemic combination of patients lacking access to both substance abuse services and the overprescribing of medication. While data on the Canadian side doesn't exist, correlation between the prescription of opioids in the US and the number of overdose deaths has been well documented.
Fentanyl first started making ripples in Canada when it began to replace OxyContin—the pharmaceutical opiate that was taken off the shelves in Canada in 2012 due to its high potential for abuse—as the go-to street drug. Due to fentanyl being 50 times more powerful than heroin, many users—especially in Alberta and BC—overdosed on the drug. Last year alone, the drug killed hundreds in the two provinces, prompting health agencies to start issuing take-home naloxone kits and convene about strategies on how to fight the spread of the substance.
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