Trying to stop a ‘tidal wave’

The region now sees about two overdoses every day

WATERLOO REGION — Five years ago, local paramedics responded to one opioid overdose a week.

Now the rate is almost two overdoses every day.

“Where does it end?” says Robert Crossan, deputy chief of the Region of Waterloo Paramedic Services.

The drug at the core of the crisis is fentanyl — a painkiller 80 times stronger than morphine.

It’s a pain medication prescribed and taken by patients through patches.

But bootleg fentanyl is coming in from China, and trace amounts — as small as grains of salt — are being mixed with heroin and cocaine sold on the streets.

“It’s a beast with many heads,” says Kelly Grindrod, a University of Waterloo pharmacy school professor and pharmacist.

“Fentanyl just came out of left field … doing anything with fentanyl can kill you.”

The influx of the drug into Canada has the Royal Canadian Mounted Police and other police groups such as the Ontario Association of Chiefs of Police working together with border security to try to stop packages of the drug being sent here.

“It used to be you had a trunk load of heroin, but now you can get on a plane with six tablets in your luggage and you have 2,000 doses,” Crossan says. “How do you stop that?” he says. One person dies every 13 hours from an opioid overdose in Ontario, compared with one death every 18 hours on the province’s roadways.

British Columbia has been hardest hit, with 914 drug overdose deaths last year, and 142 people dying in December alone.

Locally, the statistics aren’t as dire, but they are sobering.

According to the Office of the Chief Coroner of Ontario, 26 people in Waterloo Region died of all drug overdoses in 2013; 27 died in 2014 and 31 in 2015.

Police, paramedics, emergency room doctors and public health officials say the number of overdoses that are laced with fentanyl has been steadily increasing since 2013.

The Waterloo Region Crime Prevention Council has been issuing alerts and warnings on bootleg fentanyl. The words used sound astounding: “epidemic”, “crisis” and “tsunami”.

But indeed, 2016 saw a dramatic increase of emergency calls.

The opioid-related calls to Waterloo Paramedic Services began with an average of 28 in January. By September, the number had climbed to 47. In November it was 57. That’s nearly two overdoses a day.

“That sets off some alarm bells,” Crossan says.

The number of calls dropped to 31 in December. Crossan says it could have been a temporary dip or part of a new trend. It’s too early to say.

But on Jan. 8 this year, two young women in Cambridge died after taking opioids.

“This is a crisis,” Crossan says. “We saw it coming but it has eclipsed what we thought it could be at its worst.”

The user profile includes more than the transient population or addicts.

Paramedics are also going out to the suburbs. A recent call found a 45-year-old man who holds a regular full-time job in the midst of an overdose.

He had a prescription for opioids but when that ran out he wanted more and purchased it from a dealer.

“The prescription channel gets cut off, but the dependency doesn’t wear off,” Crossan says.

Waterloo Regional Police Chief Bryan Larkin says fentanyl is a “tidal wave” hitting Ontario and the opioid is a “game changer” because it’s more deadly than crack cocaine, meth or OxyContin.

In 2015, local police had 12 seizures of fentanyl. In 2016, it climbed to 69, with an additional 15 drug seizures sent to the Centre ofForensic Sciences in Toronto to determine whether the substanceswas, or contained, deadly fentanyl.

Most of the seizures were in powder form, says Det. Ian Young. On the street, it’s known as china white or popcorn heroin because when fentanyl is smoked it smells like burnt popcorn, says Young, who recently spoke at a conference on opioids.

And in December, police seized carfentanil after two people overdosed on the drug. It’s even more deadly than fentanyl — 10,000 times more toxic than morphine and 100 times stronger than fentanyl.

The concern for users is that those selling the drug often cut the opioid with other drugs and this causes “hot spots.” One dose can have more fentanyl than another, making it deadly.

One of the region’s major fentanyl busts occurred in October in Cambridge.

Crossan said paramedics responded to nine overdoses in two days and all the users had purchased the bootleg fentanyl from the house in the area of Victoria Street South and Grand Avenue South.

All survived the overdoses, with at least one person requiring naloxone, a life-saving drug that is being given to those on opioids and reverses the effects of the overdose.

Police received a 911 call from the Bridges shelter where a couple was overdosing on heroin laced with fentanyl. Police say the man might have died if someone at the shelter had not given him the naloxone.

Naloxone has been a miracle drug in tackling the region’s opioid crisis.

The antidote drug should be available to anyone who needs it, say social service providers.

“My belief is naloxone should be part of every first aid kit,” says Violet Umanetz, an outreach worker with the Sanguen Health Centre, which distributes naloxone kits from a mobile van twice a week.

They used to carry vials and syringes but naloxone is now available in nasal form.

“We have this perception that it’s ‘those people’ who use drugs,” Umanetz says.

But those people could be anyone, she says. Umanetz keeps a kit handy at home. She has children and she trusts them but “it’s a possibility for any parent.” “It keeps people safer.” The stigma around naloxone and opioid drug use — whether it’s a legal prescription or recreational — needs to change to deal with the opioid epidemic, Umanetz says.

“In my dream naloxone would be everywhere. It wouldn’t be a big deal.”

In a three-year period, the nonprofit agency handed out more than 170 naloxone kits.

Region of Waterloo Public Health started giving out kits in 2014. The number of kits distributed tripled by the end of 2016. Public Health recently switched to nasal naloxone, which is easier to administer.

Last month, the province announced it was implementing its first comprehensive opioid strategy to prevent addiction and overdose by enhancing data collection, modernizing prescribing and dispensing, and connecting patients with addiction treatment services.

One such initiative includes allowing Ontario pharmacies to distribute free kits. It’s been a viable option since June but only about 20 of the 150 local pharmacies are participating.

In December, Grand River Hospital joined in, giving naloxone kits to emergency room patients.

Waterloo Regional Police officers will soon carry nasal naloxone. Officers are being trained on its use and the service is in the process of purchasing nasal naloxone.

“I think as a region we’re pretty aware,” Grindrod says, but she wants to see more pharmacies stock the life-saving drug.