Times Colonist

Dead­lier drug mix deep­ens cri­sis

Ex­pert: Nalox­one no match for sub­stances show­ing up here

- ROX­ANNE EGAN-EL­LIOTT Health · Pharmaceutical Industry · Medications · Pharmacology · Opioid Crisis · Industries · Medicine · Social Issues · Society · Vancouver · Vancouver Island · Vancouver Island · The University of Victoria · British Columbia

The il­licit drug sup­ply in Vic­to­ria is be­com­ing dead­lier due to higher con­cen­tra­tions of fen­tanyl and the pres­ence of other over­dose-caus­ing sub­stances that can’t be re­versed us­ing nalox­one, ac­cord­ing to a drug-check­ing re­port and harm re­duc­tion workers.

The Van­cou­ver Is­land Drug Check­ing Pro­ject re­leased a re­port based on 269 sam­ples that were tested be­tween April 1 and June 30. In 19 per cent of sam­ples ex­pected to be opi­oids, test­ing found other ac­tive in­gre­di­ents that would not re­spond to nalox­one in an over­dose.

Bruce Wal­lace, an as­so­ciate pro­fes­sor of so­cial work at the Univer­sity of Vic­to­ria who co-cre­ated the drug check­ing pro­ject, said the find­ing is alarm­ing, be­cause it means re­spond­ing to an over­dose with nalox­one may not re­vive some­one quickly or at all.

“If it’s not work­ing ... it’s ob­vi­ously a very, very stress­ful sit­u­a­tion al­ready. And then to add that, there might be some other in­gre­di­ent that we don’t even know and the nalox­one is not re­spond­ing, it’s just go­ing to re­ally add to the [over­dose] cri­sis.”

Harm re­duc­tion workers in Vic­to­ria say they’re see­ing an in­crease in over­doses on sub­stances that are not opi­oids. Ben­zo­di­azepine, which can be used to treat anx­i­ety, and xy­lazine, an an­i­mal seda­tive toxic to hu­mans, are among the most com­mon sub­stances.

Corey Ranger, a reg­is­tered nurse who is co-or­di­nat­ing a new safe sup­ply pro­ject through AIDS Van­cou­ver Is­land and Solid Out­reach, said the sub­stances have been around be­fore, but they are be­com­ing more per­sis­tent dur­ing the pan­demic.

Harm-re­duc­tion workers will still administer nalox­one to some­one who ap­pears to have over­dosed, but the over­dose-re­vers­ing med­i­ca­tion is only ef­fec­tive against opi­oids, be­cause it’s de­signed to re­move opi­oids from opi­oid re­cep­tors.

“So what hap­pens a lot of times is that people will ex­pe­ri­ence an over­dose, and then we use nalox­one on them, and they’re just not wak­ing up, and then their breath­ing isn’t re­turn­ing to nor­mal. Some­times it re­turns a lit­tle bit but it’s still in a de­pressed, ir­reg­u­lar state.

“People are get­ting a lot of doses of nalox­one, and that’s likely be­cause not ev­ery­thing that’s in the drug that per­son took con­tains just an opi­oid,” Ranger said.

The longer it takes to re­vive some­one, the greater their chances of brain in­jury as a re­sult of be­ing with­out oxy­gen.

Fred Cameron, op­er­a­tions man­ager at Solid Out­reach, said when people over­dose as a re­sult of a mix of opi­oids and non-opi­oids they can re­main semi-con­scious and at risk for hours.

“If some­body doesn’t breathe enough for five min­utes, some­times they come back with re­quire­ments of a ma­chine, and they’re es­sen­tially brain dead,” Cameron said. “That’s what hap­pens if we in­ter­vene too late into an over­dose, be­fore they die, but too late to bring them back.”

The drug-check­ing re­port also found a wider vari­a­tion in the con­cen­tra­tions of fen­tanyl in sam­ples that were ex­pected to be opi­oids than in pre­vi­ous quar­terly re­ports.

Wal­lace said the tech­nol­ogy is not able to quan­tify the con­cen­tra­tion, but sam­ples tested show greater un­pre­dictabil­ity and there­fore higher risk for those who use drugs.

“So that’s what can ob­vi­ously re­sult in an un­in­tended over­dose, be­cause the per­son was pre­dict­ing that the sam­ple was sim­i­lar to what might have been safely used in the past, and now it’s not all of a sud­den,” Wal­lace said.

Ranger said the av­er­age con­cen­tra­tion of fen­tanyl in the il­licit drug sup­ply was about eight per cent be­fore the COVID-19 pan­demic, but in re­cent months some sam­ples have been re­ported at 24 per cent. “That’s three times more toxic than it was pre-pan­demic.”

The COVID-19 pan­demic has wors­ened the over­dose cri­sis — B.C. has re­ported record numbers of over­doses in May and June — but ad­vo­cates say the pan­demic isn’t the prob­lem. They point to crim­i­nal­iza­tion of sub­stance use, the re­sult­ing stigma and a lack of safe sup­ply of opi­oids as the rea­son for the ris­ing num­ber of deaths.

“This is all very pre­ventable with an eas­ily ac­ces­si­ble safe sup­ply. If we’re able to get drugs that people want out there, they would en­gage with the sys­tem,” Cameron said. If it was pos­si­ble to reg­u­late the amount of fen­tanyl that some­one is get­ting in each dose, “the num­ber of over­doses wouldn’t be count­able on one hand, I’d as­sume.”

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