Deadly drug wave ahead

Get ready for the worst, in­ter­ven­tion coun­sel­lor warns prov­ince

The Aurora (Labrador City) - - FRONT PAGE - BY TARA BRAD­BURY TC ME­DIA

Andy Bhatti has spent the ma­jor­ity of his life sur­rounded by hard drugs.

As an in­ter­ven­tion­ist, he can talk to you elo­quently about the dan­gers of drug use, quote Cana­dian sta­tis­tics, and of­fer his ideas about what pro­grams and ser­vices are needed in or­der to help drug users and stop over­doses.

He can just as eas­ily slip into the lan­guage of a drug user, call­ing drugs by their slang names, giv­ing you a list of his ac­quain­tances who have died, and talk­ing like liv­ing in stolen cars and dirty mo­tels while com­mit­ting crimes in or­der to sup­port an ex­pen­sive ad­dic­tion is a reg­u­lar fact of life.

Bhatti, who’s from B.C., has seen both sides: he was once a 15-year-old spend­ing $800 a day on heroin and rack­ing up dozens of crim­i­nal charges. After time in jail, he turned his life around: he got clean, got cer­ti­fied as a drug an al­co­hol in­ter­ven­tion­ist, and started his own char­ity, rais­ing money for or­ga­ni­za­tions sup­port­ing vic­tims of child sex­ual abuse.

Through this work help­ing drug ad­dicts, Bhatti has been across the coun­try, in­clud­ing New­found­land and Labrador, hired by fam­i­lies to in­ter­vene in the lives of their loved ones and help them get clean. In the past two years, he has done five in­ter­ven­tions in this prov­ince, bring­ing each of the clients to B.C. for treat­ment. Of the five, only one re­turned here. All of them are still sober, and one is still in treat­ment.

Bhatti knows Cana­dian drug trends travel from west to east, and he’s got a mes­sage for New­found­land and Labrador.

“Your prov­ince is not equipped to deal with what’s com­ing your way,” he says. “You’re go­ing to see a lot of deaths and a lot of over­doses un­less some­thing changes.”

It’s no se­cret that the drugs here are get­ting scarier. While co­caine was once the pop­u­lar drug of choice, now it’s opi­oids, both pre­scrip­tion and home­made. There’s a lot of talk about fen­tanyl, a syn­thetic opi­oid painkiller with a fiveminute on­set that’s set to be up to 100 times more po­tent than mor­phine. Last Novem­ber, pills seized by po­lice in the St. John’s area thought to be Oxy­con­tin proved upon test­ing to be fen­tanyl in dis­guise. Po­lice in Burin warned last week that the same type of pills have showed up in that area.

“Fen­tanyl is in ev­ery­thing out here,” Bhatti says. “Ev­ery­thing you buy on the street, Oxys, Ati­van, co­caine, ev­ery­thing. No­body out here looks for heroin any­more. Why would they?”

“Lean” is pop­u­lar, Bhatti says. It’s a drink made from pre­scrip­tion-strength cough syrup con­tain­ing codeine and the anti- his­tamine/ seda­tive promet­hazine, mixed with Sprite and Jolly Rancher candy, also of­ten laced with fen­tanyl.

There’s also W18, another ex­tremely dan­ger­ous opi­oid po­lice in Cal­gary warned after a drug bust a year ago was 100 times more pow­er­ful than fen­tanyl — 10,000 more pow­er­ful than mor­phine.

“You know what? It’s eas­ier to find some­one with a nalox­one kit out here than it is to find some­one with booster ca­bles,” Bhatti says. Nalox­one is an an­ti­dote to opi­oid over­dose that will sta­bi­lize a pa­tient un­til they can get med­i­cal at­ten­tion.

With its po­ten­tial for im­me­di­ate death, why would any­one take fen­tanyl? Bhatti says most peo­ple don’t know they’re tak­ing it. His most re­cent client from this prov­ince was shocked to test pos­i­tive for the drug on a urine test, Bhatti says, since he thought he was tak­ing Oxy­con­tin and co­caine.

“I know six peo­ple (in B.C.) who have died of over­doses in the past two weeks alone,” Bhatti says. “Half of them were very suc­cess­ful peo­ple with good jobs. I’d say five out of the six of them had no idea they were tak­ing fen­tanyl at all.

Fen­tanyl cheaper than heroin

“Years ago, we used to use pow­dered novo­caine or sugar to mix co­caine with. Deal­ing with heroin, we would use caf­feine pills or pow­dered methadone so the ad­dicts that smoked heroin wouldn’t know we buffed it. Now, fen­tanyl is cheaper than heroin and lasts longer. You only need a lit­tle bit to get you high. When drug deal­ers mix in fen­tanyl, they can make more drugs. More drugs equals more money.”

Of the 20 drug-re­lated deaths in New­found­land and Labrador in 2015, five were caused by fen­tanyl, with 18 of the peo­ple test­ing pos­i­tive for one or more opi­ates, ac­cord­ing to sta­tis­tics from the prov­ince.

In 2014, fen­tanyl was cited as the cause of three of the 14 drug-re­lated deaths. The pre­vi­ous year, two of the 14 dru­gre­lated deaths were linked to fen­tanyl.

“We’ve only heard of fen­tanyl a few times around, but it’s go­ing to get big­ger, this we know,” says Tree Walsh, co-or­di­na­tor of the AIDS Com­mit­tee of New­found­land and Labrador’s Safe Works Ac­cess Pro­gram (SWAP). She says while she hasn’t heard of any W18 in the prov­ince, fen­tanyl is be­ing added to “es­sen­tially ev­ery­thing” here.

Hap­haz­ard man­u­fac­ture, hap­haz­ard strength

A par­tic­u­lar dan­ger, both Walsh and Bhatti say, is the hap­haz­ard way in which the drugs are be­ing cre­ated. Bhatti uses a bak­ing anal­ogy: if you’re mak­ing choco­late chip cook­ies, not ev­ery one has the same amount of chips; the first one might have a dozen, while the next one could have five. The first pill in a batch might not have enough fen­tanyl to kill you; the next one very well could.

Walsh doesn’t think there’s any­one lo­cally mak­ing the drugs: “If there was, we’d know.” Those who are cook­ing them up are ab­so­lutely chemists, she says, able to change one mol­e­cule and make some­thing en­tirely new and po­tent.

There’s a dan­ger than once tighter mea­sures make it too dif­fi­cult to get pre­scrip­tion opi­ates here, the street ver­sions will slip right in.

“There’s no two ways about that,” Walsh says. “That’s the way they work.”

The pro­vin­cial gov­ern­ment has ac­knowl­edged opi­oid ad­dic­tion is a pub­lic health cri­sis at the mo­ment, and has es­tab­lished an ac­tion plan to ad­dress the is­sue. A num­ber of ini­tia­tives have al­ready been put in place: late Novem­ber, nalox­one kits were dis­trib­uted across the prov­ince and are avail­able free for any­one at risk of an over­dose as well as their care­givers.

At the Pro­vin­cial Opi­oid Ad­dic­tion Fo­rum in St. John’s in early De­cem­ber, Health Min­is­ter John Hag­gie an­nounced the prov­ince will be pro­vid­ing the drug sub­ox­one as an al­ter­na­tive to methadone for peo­ple un­der­go­ing ad­dic­tions treat­ment. Con­sid­ered safer than methadone, sub­ox­one is a mix­ture of a syn­thetic opi­oid and nalox­one that is avail­able in tablet form and is less likely to cause an over­dose than methadone.

Un­like methadone, which can only be taken when the opoids are out of a per­son’s sys­tem, sub­ox­one can be given to a pa­tient right away.

Methadone re­quires spe­cial au­tho­riza­tion to pre­scribe, and only 14 doc­tors in the prov­ince have a li­cense to do it. Sub­ox­one doesn’t re­quire au­tho­riza­tion, so any doc­tor can pre­scribe it.

The pro­vi­sion of sub­ox­one is an im­por­tant mea­sure, in Bhatti’s opin­ion, but it can’t come soon enough. A call Fri­day af­ter­noon to the Re­cov­ery Cen­tre, a fa­cil­ity in Pleas­antville run by the prov­ince for peo­ple look­ing to over­come ad­dic­tions, re­vealed a wait time of three weeks for an as­sess­ment, and a fur­ther two weeks be­fore methadone could be pre­scribed. Sub­ox­one isn’t yet avail­able.”

“That does noth­ing for an ad­dict,” Bhatti says. “What do they do in the mean­time? They keep us­ing. That wait time could mean the dif­fer­ence be­tween liv­ing and dy­ing.”

Hag­gie told TC Me­dia he doesn’t ex­pect to see the same sit­u­a­tion in this prov­ince that Bhatti sees in BC, reck­on­ing Bhatti’s views are likely coloured by a down­town east side Van­cou­ver con­text that is very spe­cific in terms of chronic drug use.

“I think you have to al­low for the fact that what’s hap­pened in Van­cou­ver will not trans­late to Grand-Falls-Wind­sor or Gander,” Hag­gie says. “It isn’t go­ing to hap­pen. It isn’t go­ing to be seen like that. But we are very much con­nected and peo­ple bring­ing in il­licit drugs that are street drugs, cer­tainly we’re go­ing to have a chal­lenge in fen­tanyl be­ing there.”

He pointed to­wards other i ni­tia­tives the prov­ince is i mple­ment­ing, i nclud­ing man­dat­ing a safe pre­scrib­ing course for new doc­tors, which will even­tu­ally be a re­quire­ment for physi­cians al­ready in prac­tice as well, as well as Phar­maNet, which links phar­ma­cies and al­lows for the mon­i­tor­ing of pre­scrip­tions. The sys­tem is up and run­ning, and all phar­ma­cies are ex­pected to be in­cluded by April.

“Once that hap­pens, what we can do is iden­tify peo­ple who are us­ing amounts of opi­oids that are way out­side the norm. That in­for­ma­tion can be fed back to their fam­ily doc­tor and (the pa­tient can) get en­gaged in a process by which other ther­a­peu­tic op­tions are looked at and their dosed are re­duced grad­u­ally,” Hag­gie says. “Ev­ery­one thinks that this is a puni­tive ex­er­cise and if you have more than X pills a month we’re go­ing to chop you off cold, but that’s not the case.”

It’s this mon­i­tor­ing pro­gram Hag­gie be­lieves will help pre­vent users be­ing pushed to­wards home­made street drugs, but he ac­knowl­edges a cer­tain per­cent­age of opi­ate users who may be ca­sual dab­blers without a pre­scrip­tion will only be tar­geted through ed­u­ca­tion and aware­ness.

Hag­gie, Bhatti and Walsh all speak of harm re­duc­tion — us­ing strate­gies to re­duce the harm of drugs in cases where a user is clearly go­ing to con­tinue do­ing them — but it’s a chal­lenge, since our popul ation doesn’t par­tic­u­larly em­brace the harm re­duc­tion phi­los­o­phy. When pub­lished in the me­dia, Walsh’s tips on harm re­duc­tion ( in­clud­ing di­vid­ing a pill in quar­ters and do­ing one quar­ter at a time to test for po­tency and us­ing clean nee­dles each time) are of­ten met with pub­lic com­ments and con­cerns about teach­ing ad­dicts to be bet­ter at do­ing drugs.

Hag­gie says the prob­lem rests with the pub­lic view­ing ad­dic­tions as a choice and not a dis­ease.

“Ad­dic­tions are a dis­ease. You don’t blame some­one for need­ing clean nee­dles to in­ject their in­sulin. Un­til you deal with the ad­dic­tion in the con­cept of a dis­ease, the same as any other dis­ease, you’re never go­ing to get past this idea that some­how ad­dicts are sec­ond class in some respects,” he ex­plains. “That’s to­tally in­ap­pro­pri­ate and it’s not some­thing that en­ables an ap­pro­pri­ate dis­cus­sion to be had.

“I think the man­age­ment of ad­dic­tions is the Cin­derella of men­tal health, and in turn, men­tal health is the Cin­derella of the health sys­tem. I think it’s been ne­glected for a long time and we do need to try and re­store that bal­ance.”

Bhatti, a sin­gle dad of a 10-year-old, does his best to en­sure the ed­u­ca­tion starts early.

“What do I tell my son? I tell him the truth,” he says. “I tell them that drugs will kill you.”

SUB­MIT­TED PHOTO

Andy Bhatti

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