Deadly drug wave ahead
Get ready for the worst, intervention counsellor warns province
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.”