Jac's problems with substance abuse started with a back injury and a prescription for OxyContin. She had anxiety and the opiate made her feel like she could deal with it. When she told the doctor that, he cut her off cold.
Without a steady prescription, the mother of three resorted first to family members, then to the streets of British Columbia to get her fix.
Eventually, she contracted a flesh-eating disease while injecting fentanyl and heroin. She died three years ago.
Her mother, Donna May, tells that story about Jac (who is pictured above) every chance she gets now. She's part of mumsDU, a group of mothers who travel across Canada raising awareness of substance abuse issues, especially fentanyl, a powerful opiate that gained prominence as OxyContin fell out of favor.
One of the mothers' main goals: to convince the federal health agency to relax access to naloxone, a substance that experts says is an antidote for opioids because it can reverse overdoses caused by them. Right now, only people with opiate prescriptions can access naloxone in Canada, although a number of cities and provinces have made kits with the antidote available to those individuals.
It's a campaign that has become all the more acute this year, amid a rash of fentanyl overdoses in Canada that has shown no signs of abating. Late last month, eight people in the Victoria, British Columbia area, all known drug users, fatally overdosed, with officials pointing the finger at a bad batch drugs that included methamphetamine, heroin, and fentanyl.
The Canadian Centre on Substance Abuse has said between 2009 and 2014, there were at least 655 deaths in which fentanyl was the cause or the contributing cause. And there were over 1,000 drug poisoning deaths in which traces of fentanyl were found in the person's system.
Roughly 50 to 100 times more toxic than morphine, fentanyl is cheap, hard to detect, and can be consumed in many ways — snorting, shooting up, ingesting, smoking or even touching it will get you high. These features make it incredibly popular for dealers, which is why it may appear hidden in cocaine, ecstasy, MDMA, heroin, and even weed. It started being used in hospitals about 20 years ago as a painkiller and is commonly administered via injections or patches.
The province of Alberta, in close proximity of Asian smuggling routes coming through British Columbia, has been among the hardest hit, with more than 200 people dying in 2015, a number that far outstrips past years. Officials have repeatedly called it a "public health crisis," with some observers saying the government has been too slow to react. Meanwhile, police forces across the country continue to bust alleged fentanyl traffickers and issue warnings for public vigilance every time a pharmacy is raided.
Health Canada says it is "working to support provinces, territories and law enforcement on responding to this issue. This includes reviewing the prescription-only status of the opioid overdose treatment naloxone on an urgent basis." The review was announced in the summer, and the agency expects to make a decision early this year.
"Health Canada is very concerned about the growing number of fentanyl overdoses and deaths, which is why it has taken the unprecedented step of initiating a review of the prescription drug status of naloxone," a spokesperson said in a statement sent to VICE News. Usually, reviews of a prescription status are initiated by the pharmaceutical industry in Canada.
"Not only is this the first time Health Canada has initiated this kind of review, but it has also been put through an accelerated timeline," the agency said.
The review time for naloxone isn't the only issue for advocates though. The government hasn't even found a way to consistently count the deaths.
Each province has been counting the deaths with a different methodology — BC, for example, is the only province that's just counting deaths that occurred in illicit circumstances, while Alberta casts a much wider net that includes people who were prescribed the drug.
"Our federal government should be charged with murder in my eyes," May told VICE News in an interview earlier this year. "And that's exactly what they're doing, they're murdering our children right before us because they're not giving us the tools that are available in order to save their lives."
According to one study, Canada and the US have the highest levels of prescription opioid consumption in the world — and that's expected to "dramatically" increase. In Canada, an average of 30-million tablets are dispensed every year.
But unlike Canada, naloxone can be prescribed in parts of the US, even if someone only thinks they might witness an overdose. Currently, 44 states have some sort of naloxone access law, although the specifics vary. Some states enable third parties to obtain naloxone prescriptions; some, like California, allow pharmacists to dispense the product without a prescription; and some, such as Oregon, require training or education before it can be obtained. Americans also have inter-nasal naloxone, which isn't yet licensed in Canada. It's carried by police in some states, and can be administered if they're the first respondents.
Vancouver's sudden spate of deaths is recent, but fentanyl has been around for much longer than most people realize, said Jane Buxton, harm reduction lead at BC's Center for Disease Control.
"What happened is that OxyContin used to be widely used. People would crush it and snort it and do all sorts of things with it," said Buxton. "But it was taken off the market (and replaced with a supposedly tamper-resistant version) so when something becomes unavailable, something else often steps in."
Anastasia Russell has seen it first hand. As a former heavy drug user, the youth counsellor is well aware of how common it is for drugs to be laced with something else. While laxatives and baking soda added to cocaine could cause nosebleeds and uncomfortable trips to the bathroom, fentanyl can literally kill you in your sleep. The Vancouver drop in center where she works keeps youth awake at night to ensure they survive until morning.
"We trust drug dealers more than we should," said Russell, noting that "all you need is a good compressor" in order to produce fake Oxy, as fentanyl is referred to. "Other than that, you could put anything in it as long as it keeps its form."
Making pills might be easy, but cooking fentanyl is not, which is why China-based pharmaceutical-grade producers of the synthetic drug could be the source for criminal purveyors, law enforcement suspect. Sometimes, the dealers might not even know their products contain fentanyl.
"The runners, or the people who are selling might not be aware because they just buy the product from their suppliers and they sell it. They don't care, it's all about the money," said Russell.
Watch the VICE News documentary: Back From the Brink: Heroin's Antidote
The human impact is real, though.
Deaths in BC rose from 13 in 2012 to 90 in 2014, representing close to a seven-fold increase, while Alberta saw a 20-fold increase from 2011 to 2014. In addition to the different ways they tally the body count, BC has a take home naloxone program that's been in circulation since 2012, while Alberta is just starting to roll it out. Opposition politicians have also seized on the matter in Alberta, calling for a "patch for patch" system that would require those who have a prescription for the drug to turn in used patches in order to get a refill.
According to Buxton, 270 overdose reversals have been reported by people using the BC kits since 2012. But because the substance can only be prescribed to someone who already has an opiate prescription, it hasn't been able to help the majority of drug users who are at risk.
"Unfortunately this is all part of having an unregulated drug market that functions under prohibition," explained Buxton. "We are working under that framework and it makes it hard to find solutions."
There is a broader discussion about drug use policy that both Buxton and mumsDU are pushing. But fentanyl users and dealers aren't going to wait for Health Canada to make any decisions, and the unpredictable nature of fentanyl has experts warning of more casualties to come.
"Just like I carry bandages in my medicine cabinet, I want a naloxone kit, If I see someone who's having an overdose I want to be able to save their lives," argued May. "It's not just recreational drug users or hardcore addicts that are dying from this, it's also our grandparents, or anyone that's prescribed an opiate."
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