Fentanyl was responsible for the most deaths by overdose in British Columbia from 2019-2022. It’s not just our homeless population. Young professionals, our youth, and new parents have all been affected; in short, all those who choose to partake can fall victim.
This is terrifying but hardly surprising when you consider that a dose of only 2milligrams can kill you.
Fentanyl is a synthetic opioid: a man-made drug with effects similar to that of morphine and heroin. Fentanyl is 50 to a 100 times more potent than morphine and relatively speaking, frighteningly simple to synthesize. It makes sense then that it is used medically as both a pain reliever and sedative. In fact, it is on the WHO’s List of Essential Medicines.
It seems almost trite to remark here that fentanyl, like all drugs, has the potential for abuse.
Figure 2 shows the percentage of deaths attributed to a number of drugs between 2019-2022. Fentanyl clearly takes the cake here, and it’s not even close. Figure 1 below graphs the total deaths by illicit drugs per year, from 1996 to 2022. A truly disturbing, upward trend.
Figure 1: Deaths caused by illicit drugs from 1996 to 2022
Figure 2: Percentage of 2648 deaths in which fentayl and other drugs were found postmortem (Source: Government of Canada)
But why? Why are so many people dying? It’s not like people are purchasing fentanyl in droves. Surely they know how dangerous this is?
Fentanyl enters Canada in one of three ways: illegal import, illegal manufacture and theft of medical products.
The truth is, there are individuals who recreationally consume fentanyl. They have their methods; such as through transdermal fentanyl patches, lollipops or nasal sprays. These are all relatively safer options, all things considered, as they are all illegally sourced medical products going under brand names such as Actiq®, Duragesic®, and Sublimaze®.
Actiq, a popular orally bio available method of consumption.
These delivery methods first gained popularity in the 90’s, and soon after that, criminal organizations began making fentanyl analogues to avoid identification as an illegal substance. Even more potent than regular old fentanyl, analogues such as carfentanil and 3-methylfentanyl fueled the fire.
Most people are exposed unwittingly. The first illicit pills and laced drugs containing fentanyl and its analogues appeared in the market around 2013, and drug related deaths began to skyrocket at the same time (Figure 1) and a majority of these deaths are attributable to fentanyl (Figure 2).
But what can we do? While fentanyl test strips are certainly progress, there are limitations; false negatives, false positives, and the simple reality that most people probably won’t be bothered. We must first and foremost draw light to how pervasive and serious this problem really is. This should also be dealt with at the root. We must push for working with other countries including China, the US and Mexico to implement stricter drug measures and export regulations.
Drugs aren’t evil. They are neither good or bad, how could they be? But some drugs are worse than others. Much, much worse. We are left with a fire that we must put out while we still can. The good news is we have ways to deal with this. We have science and people who care.