Opioid overdoses
Alberta finally tackles its fentanyl epidemic.
Every time I hear about another fentanyl death in Alberta, I have a morbid thought I should probably not write down: fentanyl i sn’ t even much fun as a drug — how sad to die from it. I’ve had both fentanyl and morphine ( in emergency rooms, so keep the smart remarks to yourself ). Fentanyl is the far stronger opioid of the two, milligramfor-milligram, but it also has a wider “therapeutic index” of safety. It burrows right into your central nervous system and knocks out pain like a champ.
But it doesn’t come with the surfing- on- clouds feeling of euphoric contentment that morphine gives you. I assume that heroin is even more amazing. When I got morphine, I knew I was probably very, very, very lucky never to have tried heroin.
The police tell us that most of the people who die from fentanyl overdoses, which have become a crushing public-health problem in Alberta, are not fentanyl addicts nor even intentional users. They are taking other drugs cut with or replaced by fentanyl, which is relatively cheap to both steal and smuggle. The fentanyl problem seems to be a result of regulatory efforts to rein in oxycodone abuse, and it is not clear that provincial governments, which replaced OxyContin with a crush-proof substitute a few years ago, have made a good bargain.
What is clear is t hat fentanyl is out of control, particularly in Alberta. The province’s health ministry recently reported that there had been 213 deaths from confirmed fentanyl overdoses in the province during the first nine months of 2015. Last year’s total for the whole year had been 120; 2013’s was 66; 2012’s was 29, and before that the numbers are essentially bupkis.
Two hundred and thirteen deaths in three quarters adds up to an expected 284 for the whole year. Statistics Canada publishes counts of causes of death broken down by province, so we can put that in perspective pretty readily. In a typical year Alberta will have about 500 suicides. Half that many or so people will die from all varieties of kidney disease or failure; another 250, give or take, will die from liver diseases, including cirrhosis. Pneumonia will kill about 400, and Alzheimer’s another 400. Parkinson’s disease, 120 or so. Mortality from fentanyl has, almost immediately, grown to the same order of magnitude as these more familiar plagues.
Fentanyl deaths have been rising in other provinces too, as the Canadian Community Epidemiology Network on Drug Use documented in an August report, but the increases elsewhere have not had the same excruciating exponential quality. Street- level social workers and health providers in Vancouver and Toronto spotted the problem earlier and took steps against it more quickly.
The good news is that Alberta has an NDP government now. And if you have a problem with street drugs creating heaps of dead, that is probably who you want in charge.
The best practical answer to deaths from fentanyl, a drug that can kill you quite easily in an unwitting first- ever en- counter, seems to be to spread lots of naloxone around. Naloxone is a safe, easily administered medication that snaps cyanotic victims of opioid overdose back to life in an almost magical fashion. Saving lives with naloxone is probably just about the easiest thing an emergency room physician does. And various pilot projects with “naloxone kits” incorporating nasal sprays or EpiPen- type intramuscular syringes have shown that paramedics, cops, and drug abusers themselves can use it to prevent overdoses and rouse people long enough to get them to the ER.
The evidence in favour of wide distribution of naloxone kits is still fairly circumstantial, but there has been no observable harm done by them in the cities that have tried it — mostly in answer to local heroin problems — and thousands of possible overdoses have been prevented. It is a question, frankly, of costeffectiveness. In Alberta right now, if naloxone can be made available to the few thousand people most likely to need it, the benefit side of the equation is likely to carry heavy weight.
That, at any rate, is the view on which our hippiedippy harm- reducin’ government is proceeding. It is making naloxone kits available to homes, for free, through addiction and HIV programs (you can look up the details at Drugsfool. ca). Last week, the health minister, Sarah Hoffman, issued a scope- of- practice order that will allow for more preventative prescribing of naloxone kits. Perhaps most importantly, the order permits administration of the drug by EMTs and EMRs as well as fully licensed paramedics.
I am betting that this will help — that the statistics will look less dire in 2016. By itself, simply making Albertans aware that opioid overdose deaths are almost all unnecessary might be a good thing.
Almost overnight, overdose deaths have gone from virtually nil to rivalling kidney and liver diseases, and are closing on pneumonia and Alzheimer’s toll