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Fentanyl: Deadly drug Alberta’s No. 1 public-health problem

Negi

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http://www.theglobeandmail.com/news...s-no-1-public-health-problem/article27261009/

Justin Giovannetti
EDMONTON — The Globe and Mail
Published Friday, Nov. 13, 2015 7:55PM EST
Last updated Friday, Nov. 13, 2015 7:56PM EST




Dr. Hakique Virani has been on the front lines of Alberta’s battle with fentanyl. In the first half of this year, 145 Albertans died of fentanyl overdoses and Dr. Virani’s clinic in downtown Edmonton sees dozens of fentanyl cases weekly. A physician who also teaches at the University of Alberta, the 38-year-old specializes in addiction medicine. He spoke with The Globe’s Justin Giovannetti about Alberta’s leading public-health crisis.
What does the fentanyl crisis currently look like?
To use one word: bad. This is the worst problematic opiate use we have ever seen in Alberta. We are essentially seeing a death a day. The deaths are occurring in every socioeconomic demographic and every age group, you name it, people are using fentanyl and are at risk of overdose death. It’s urgent and the No. 1 public-health problem in Alberta.
On the front line, we see people who were formerly well-functioning and had jobs, such as professional athletes and bankers, as patients. For whatever reason, they were exposed to opiates, either after a prescription from a doctor for an injury or through from recreational use, and that use has escalated very quickly into dysfunctional use that is associated with social dysfunction: job loss, apprehension of children, criminal activity. The changes in the human brain that occur with chronic opiate exposure are such that there is a complete loss of control. I don’t think it’s banal to say that it really could happen to anybody.
Is there a possibility that this fentanyl crisis flames out over time?
If there was, I wouldn’t be so shocked to see the magnitude of the problem now. It’s predictable that fentanyl and heroin would arrive in Alberta because we’ve done a very poor job of addressing this problem with evidence-based intervention. I don’t think it’s natural that this has flared up or will flame out. It’s a function of our failure to address an issue that was simmering, bubbling and is now boiling over.
What do you make of the Notley government’s response so far?
I’m not going to say that it’s unfortunate that we have a new government, but what is unfortunate is that there is a delay in acting when you take over a file. You try to learn things, you have to trust your bureaucracy to inform you about the situation, but we’re at a [crisis] point now. We first saw this, ground zero, with the Blood Tribe, where this problem turned from insidious to overflowing. That was in January, we’re almost at the end of the calendar year now and we don’t have a great handle on the distribution of the antidote naloxone yet, we certainly don’t have access to treatment figured out and we don’t have supervised injection sites in Alberta, which might have tempered this problem.
I would characterize the government’s response as inadequate but I’m cautiously optimistic that their ideology is consistent with the evidence.
There is an argument for abstinence-based treatment in Alberta. How would you improve the treatment system as it currently exists?
Treatment must be evidence-based. Period. We must do more of what works. In a system where resources are always necessarily scarce and we are dealing with other medical needs, including needs in mental health and addiction, we should stop doing what doesn’t work and we should really stop doing what kills people. The evidence is very clear that an abstinence-only admission to care is the No. 1 factor associated with death. At the level of the President of the United States there has been recognition that offering abstinence-only treatment is not okay.
This is not someone’s failure to exercise conscious volition over drug use, but this comes after fundamental changes in their neurobiology. Their only fault is that they had a human brain. This isn’t something that they want to do. They have no control over the drug use and if they are exposed [to the drug] one time after an abstinence-based treatment they can die. It’s a science versus ideology debate, not a science versus science debate.
The antidote naloxone only works when a user has someone with them when they use fentanyl. You’ve raised a need for supervised injection sites. Do you think those sites are possible in Alberta?
I think after the federal election on Oct. 19 more things are possible in every province. There has certainly been a more open dialogue around the idea of supervised injection sites. The evidence around Vancouver’s Insite is not mixed; it’s clear. It works at reducing the dysfunction associated with injection drug use and it works with preventing death from drug toxicity.
This interview has been edited and condensed.


No mention of the form the fentanyl is being distributed in the article but a video linked on the page shows the pressed "oxycodone" pills that have shown up all over the place.
 
Yea there is no one out there clandestinely making thebaine and synthesizing oxycodone. It's always going to be fent or some rc opi or hell even codeine. I mean who has a poppy field with the special breed poppies than have really high thebaine and low morphine content? Besides pharma companies.

This crap is flowo g out of China like wild.
 
Fentanyl is getting unfortunately quite big here in Alberta but I seem to think that doctors are attributing many kinds of overdoses from unknown pills or opiates etc to fentanyl, after all there is no substance analysis performed if the patient doesn't die.
For example, me and my friend were at a show and he drank EXCESSIVE straight vodka before the show, and then dropped 0.2g of potent and tested MDMA.
Obviously he blacked out and was taken to the hospital, but already the security guards were blaming fent and had told the EMT's that he had taken fent without any evidence whatsoever
 
Not hard to tell if someone is on fent, really shallow breathing, head on chest. Super pinned eyes. Friend of mine almost died that way messingbwithba 10mg patch.
 
Some more coverage: http://www.theglobeandmail.com/news...on-to-combat-fentanyl-crisis/article27504544/

Bold is mine.

Justin Giovannetti
EDMONTON — The Globe and Mail
Published Thursday, Nov. 26, 2015 9:07PM EST
Last updated Thursday, Nov. 26, 2015 9:07PM EST

Alberta’s health minister is vowing that her department will do more immediately to warn the public about the dangers of fentanyl as medical experts say more Albertans could die this year from abusing the potentially deadly opiate than from car accidents.

The province’s medical authorities have declared fentanyl Alberta’s leading public health problem, and Health Minister Sarah Hoffman told The Globe and Mail she is assembling leaders from provincial and municipal agencies and First Nations for a roundtable on the drug. She has also directed the chairs of a review of the province’s mental health and addiction services to send her interim recommendations on fentanyl immediately.

“I don’t think Albertans understand the risk well enough yet, but I think it’s important for parents to talk to kids, and for kids to talk to each other, as well as staff and people they trust in their schools and community,” Ms. Hoffman said in an interview with The Globe.

Fentanyl is up to 100 times more potent than morphine, and was developed to treat extreme pain. The pills on the streets of Alberta’s major cities are mainly illicit tablets made by organized crime. Police say the pills are easy to make, readily available and cheap. Due to the haphazard conditions in which they are pressed, many contain amounts far above the lethal dose.

The province’s health authority has posted stark notices over the past year warning Albertans about the dangers of abusing fentanyl, but more will be done, Ms. Hoffman said.

“We need to make sure that we use every avenue that we can to increase awareness and have another outcome at the end of the day,” she said.
A graph showing the increase in emergency room visits over the past year due to fentanyl would be a vertical line, Hakique Virani said. The drug is toxic at amounts as low as two milligrams and can kill the average person in less than 15 minutes. It can create a sense of euphoria, but users can also quickly begin to slip in and out of consciousness and have trouble breathing. In the first half of the year, 145 Albertans died from using it.

“Based on exponential growth in the number of deaths involving fentanyl, about 400 Albertans are expected to die from fentanyl overdose this year,” said Dr. Virani, who specializes in addiction medicine and teaches at the University of Alberta.

Dr. Virani said fentanyl deaths will likely surpass the number of fatalities from traffic collisions. According to the Alberta Ministry of Transportation, 369 people died in car accidents in 2014.


The Alberta government provides an antidote known as naloxone and has asked the federal government to make it available over the counter. Alberta’s opposition parties have charged that Premier Rachel Notley’s New Democrats have responded with indifference as deaths increased rapidly.

Some people want safe injection sites to help combat overdoses, but Ms. Hoffman said that would happen only after she talks with communities.

“We need to take evidence into consideration, and if we’re going to make decisions around harm-reduction in a way that might impact a community, we have to do it in consultation. I’ve always been a big advocate of doing things with and for the people who have given you the opportunity of representing them,” she said.

Along with increasing public awareness, Ms. Hoffman has vowed to increase access to harm-reduction programs, improve addiction services and work with police to reduce the supply of fentanyl.

Staff Sergeant Martin Schiavetta, head of the Calgary police drug unit, announced on Thursday that three suspected fentanyl traffickers were arrested on Nov. 19. Some of the 61 tablets seized were sent for analysis and found to be three times the lethal dose. “Obviously fentanyl is posing a significant health risk,” he said.

I assume the high dose is to compensate for the shitty oral bioavailability? Really bad news if anyone decides to sniff or IV them.
 
How to solve the problem of people overdosing on fent or heroin in general? Make heroin legal and sell it in pharmacies. I doubt there would be many people playing around with fent and similar compounds when you can buy pharmaceutical diamorphine.
 
I assume the high dose is to compensate for the shitty oral bioavailability? Really bad news if anyone decides to sniff or IV them.

I'm highly sceptical of the "three times the lethal dose," not least because there is, for obvious reasons, no established lethal dose for fentanyl in humans. Are they talking about three times the lethal dose for rats? If so, are they assuming a human of a given weight? I feel like some cop pulled "three times the lethal dose" out of his ass.
 
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