This article originally appeared on VICE Canada.
Amber Wasson remembers sitting with her brother David, watching his eyes roll back in his head, seeing his chin bob up and down in what she came to know as "the fentanyl nod." His head would flop down on his chest and then jerk back up as he tried to stay awake.
Fentanyl, a powerful painkiller that is 100 times stronger than morphine or 40 times stronger than heroin, produces "a feeling of peace and relaxes the whole body," Wasson explains. It was that high her brother sought when he died of an overdose in 2014.
In the "Chemical Valley" city of Sarnia, Ontario—a border town which sits about 100 kilometers north of Detroit—fentanyl abuse is a serious problem according to police and medical officials. The local death rate is four times the provincial average.
The painkilling patches can be cut up and sucked, heated on tinfoil and inhaled, or sometimes cooked in a spoon and injected.
But based on her experience watching her brother, Wasson says that abusers of fentanyl are "playing Russian roulette with themselves, hoping they'll wake up again."
While fighting for consciousness is what "the nod " is all about, what many users don't realize is that if they do pass out, they may not wake up. Passing out from fentanyl is not like blacking out drunk; it's actually bringing you staggeringly close to death, according to Dr. Del Donald, an addiction specialist and veteran of the Sarnia ER who has treated numerous fentanyl overdoses. Opioid pain meds such as OxyContin and fentanyl affect the human respiratory system, and the amount of drugs in your system required to render you unconscious is "only slightly below" the level that shuts down your breathing, the doctor explained.
Fentanyl turned up in Sarnia as a recreational drug "out of the blue" a few years ago, according to Donald, who added that it's become the drug of choice for opioid users in the area. After OxyContin was de-listed from the approved drug list in Ontario in 2012, addicts went searching for a replacement. He expected heroin would become the main replacement as has happened in other places, but the heroin coming into Sarnia was "lousy," and users are "more comfortable when something has a pharmaceutical stamp on it."
The numbers show the city has a major problem with fentanyl. Five deaths in 2013 may not sound like many, but for a city of 72,000 it's four times the province-wide rate, according to the Ontario coroner's stats. Sarnia police detective Mike Howell explained that, by comparison, London, Ontario, which has more than three times Sarnia's population, had the same number of Fentanyl fatalities that year. The drug appears to have disproportionately affected Ontario's smaller cities.
There's pretty much no way for an abuser or a dealer to get fentanyl other than from someone with a genuine prescription, according to to Donald, who is now medical director of the Bluewater Methadone Clinic in Sarnia. (There have, however, been reports of deadly illegally imported fentanyl making its way to Ontario.) As local police and the medical community are trying to get a handle on the problem, they've decided that, since the plastic backing on the patch is still in place after use by legit patients, it would make sense to require patients to bring the patches back to the pharmacy before getting new ones.
Call it the "Beer Store" solution if you like. But Constable Howell thinks a "patch-for-patch" system may help keep fentanyl off the streets. Howell, who's been heading up the campaign to bring the plan to the city, hopes the system will be up and running before the fall. If all goes accordingly, doctors will up their efforts to screen possible patients, and prescriptions will be faxed directly to the pharmacy, to avoid tampering with the prescription. (Adding a zero to the number of patches prescribed is a common trick, apparently.) Pharmacists will also give patients a paper to stick their used patches on before they come back for a prescription renewal. The returned patches will be examined carefully for signs of tampering.
According to Wasson, her brother David used to get the drug by abusing legit channels. A friend's father had a prescription, but didn't need it and "basically lied to the doctor," she told VICE. The father gave the patches to his own son to sell. The going rate is anywhere from $150–$400 a patch—and if someone is on social assistance in Ontario their prescription is paid for, so the money they'd get on the black market is "pure profit," according to Wasson. Even the used patches have quite a bit of value, as the residue can amount to more than half the total dosage, according to Howell.
Wasson's brother knew the dangers of fentanyl and once tried, unsuccessfully, to keep a girlfriend from using it. Watching him come down from the drug was terrible, his sister recalled. He would get very agitated, complain of headaches, constantly scratch himself, and hallucinate. Things could be very quiet, but he'd ask her to identify a sound that never happened. He sometimes even saw the non-existent bugs he could feel crawling on his skin. His death in March 2014 came as a shock to the family as David had been on methadone treatment for quite a while and "seemed fine," she told me. He had just stopped his methadone treatments, but returned one more time to the "old habit." It was truly his last time.
Even though she's not part of the drug culture and hasn't lived full-time in the city for several years, Wasson said she "easily" knows 20 people who are abusing the drug here in Sarnia.
Arriving in Sarnia from the Oshawa area in 2011, Constable Howell was surprised to see how the local drug scene was "all prescription opioids or meth," instead of coke, crack cocaine, or ecstasy. "It's hard to account for, and it doesn't have anything to do with it being a border town either," he said.
Searching local news turns up hit after hit for fentanyl, and some pretty wild stories, including several from just this month:
July 21, 2015 — A 33-year-old Sarnia man is handed a six-year penitentiary term for selling prescription painkillers worth $22,000 on the street. Last October, police raided his home and found none of the 42 fentanyl patches he had obtained on prescription the day before; just empty packages. He had convinced a doctor he needed the patches for pain from an injury and subsequent surgeries.
July 8, 2015 — Police bust a grow-op in the center of the city, find spent fentanyl packs. Again, the prescription had just been filled just the day before. The number of empty packages was "well above" the recommended one-day dose, a police news release said.
The "super expensive" value of the patches on the black market is a temptation that some legit users just can't resist, said Donald, who has 20 years of experience in Sarnia's ER. Experience has shown him that if a patient on a disability pension has a prescription, and if money's tight, he or she may think, "Do I put on the patch, or suffer through this and feed the kids," Donald told VICE. "When you have a script worth 6,000 bucks, it can be hard to resist."
There are high hopes the patch-for-patch system will cut Sarnia's Fentanyl problem, but there are still loopholes and some legit users say the system will just add a hassle to getting needed medicine.
Right now there are just a handful of Ontario cities running the patch-for-patch plan within their own boundaries. Donald thinks the province should be running this across Ontario.
"I don't know why we're waiting for something to be done. It's so obvious. A government agency could do this in a second," he said, his frustration obvious.
Making the system province-wide is the intention of a private member's bill introduced in the Ontario legislature by North Bay Conservative MP Vic Fedeli in October 2014.
While the bill passed second reading this May, it's now languishing in legislative limbo, waiting for the summer break to end.
While pharmacies are getting organized in Sarnia for patch-for-patch to start soon, Amber Wasson wonders if the plan will help prevent more Fentanyl overdoses, such as her brother's. The plan is a step in the right direction, she said, as long as doctors think more carefully before prescribing it.
"They need to be aware of people's addictive potential," she said.
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