Investigation: Deadly fentanyl now B.C. addicts’ drug of choice

Jeremy Hainsworth and Albert Van Santvoort

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While governments warn of the threat of drugs contaminated with fentanyl, the harsh fact is that the synthetic opioid is increasingly the drug of choice for British Columbia’s addicts and drug abusers.

Fentanyl/Shutterstock

Yes, there are admitted fentanyl addicts. And it’s growing, a Glacier Media investigation has found.

“People get used to it and that’s what they want,” said Anne Livingston of the BC/Yukon Association of Drug War Survivors.

“They sell it separately, some of the dealers,” Livingstone said.

And, fentanyl’s involvement in the overdose crisis is driving both the federal life expectancy and mortality rates.

No one’s disputing that fentanyl and chemically similar drugs – or analogues – can be fatal. B.C. accounted for 1,510 of Canada’s almost 3,500 (final figures are not available) overdose deaths. Provincially, fentanyl and analogues were blamed for 87% of those deaths last year, up from 4% in 2012, 25% in 2014 and 67% in 2016.

And, with the ever-increasing chances of other drugs such as heroin, meth and cocaine being cut with fentanyl, users have been urged to have their drugs tested to make sure they’re getting what they expect —rather than a drug laced with something fatal.

However, it’s those test results from throughout B.C. that show it’s now fentanyl most drug users expected to get when they picked up from their dealer.

In April alone, of 610 drug checks detailed by the BC Centre on Substance Use, 261 people had bought what they expected to be fentanyl. That’s more than 10 times the rate of those hoping they’d bought heroin. Those ratios remain steady for the first four months of 2019.

“The most common drugs for people to check are opioids – because there’s been the most concern about them being contaminated – and it turns out that 90% of opioids contain fentanyl,” Vancouver Coastal Health medical health officer Dr. Mark Lysyshyn said.

That’s an apparent shift from 2018, where a B.C. Harm Reduction Program survey found meth was the drug of choice.

When users were asked what drugs they’d used in the past week at the time of the survey, meth clocked in at 69%, heroin at 49%, fentanyl at 43%, crack cocaine at 26% and cocaine at 22%.

As well, more than half of respondents reported preferring smoking or inhaling their drugs, while 34% preferred injection and 6% chose snorting.

In 2018, there were 17,679 fewer injections at Insite annually than there were in 2009.

Considering that, on average, each decline of 35 injections may equal one fatality in the general addiction death rate, it may be extrapolated that there has been an additional estimated 505 deaths connected to a decline in supervised injections since 2009. It must be heavily noted that this is not the fault of Insite.

Since 2009, other drug consumption sites of various forms have opened throughout B.C. The NDP government also established its Ministry of Mental Health and Addictions, which in turn set up the Overdose Emergency Response Centre. The centre’s two top people left last year and have yet to be replaced.

Data is difficult to collect as some sites do not gather it while others do not report it in a standardized manner. Cooperation between health authorities and delivery organizations seems tenuous. Some organizations even change their reporting methods over time, making comparisons even more difficult.

B.C. overdose death rates driving national averages

The overall effects of B.C.’s opioid crisis, however, remain staggering.

In fact, B.C.’s overdose death numbers are not only lowering the provincial and national average life span figures, but they are significantly boosting the national overdose death numbers.

Indeed, new Statistics Canada rates show B.C. is also driving the federal mortality rate as a result of the opioid crisis.

“By examining changes in deaths by age and cause, in 2017, it was possible to identify the main factor that was responsible for the recent change in life expectancy in Canada, and in particular in British Columbia: accidental drug overdoses among young adult men,” a May 30 Statistics Canada report said.

Glacier Media’s investigation found fatal fentanyl-related overdoses were increasing throughout B.C. while injections of drugs such as cocaine and heroin were decreasing. Use of meth appears to be steadily increasing at Vancouver’s Insite, Canada’s first supervised injection site.

But, cautioned Lysyshyn, it’s difficult to tell if people are using more meth overall or if the statistics indicate people are choosing to use it more at Insite due to contamination fears.

Indeed, many drug users are now identifying themselves as fentanyl addicts, which is perhaps a function of a lack of heroin on the streets coupled with the more powerful high of the synthetic opioid that has wreaked havoc. Some point to problems in the prescription of heavy-duty painkillers as being part of the problem.

Provincial health officer Dr. Bonnie Henry said in February that, with an average of four British Columbians dying of overdoses each day last year, the predicted life expectancy for all British Columbians has dropped.

Her predecessor, Dr. Perry Kendall, in April 2016 declared a public health emergency.

And, that dovetails with federal Chief Public Health Officer Theresa Tam saying in October that “the national life expectancy of Canadians may actually be decreasing for the first time in decades, because of the opioid overdose crisis.”

In other words, Canadians’ average life expectancy rate had been increasing – until the opioid crisis hit.

In a June 2018 commentary, Tam said, “Over the past two years, the epidemic of opioid-related overdoses has been the most significant public health crisis, demanding a collective response from all levels of government working with frontline responders and other partners.”

And, that, observers say, means its time Ottawa declare a national crisis in order to deal with the continuing fatalities.

March overdoses declined

Meanwhile, the BC Coroners Service recently released numbers offering a glimmer of hope. The monthly average for illicit drug deaths for the first quarter of 2019 (89 deaths/month) is down 32% from the same period in 2018 (132 deaths/month).

Fentanyl-rated deaths are down 40% comparing the same two months. January 2019 compared with 2018 saw a 29.3% drop while February 2018 over 2019 was a 28%.

However, rises and falls both federally and provincially are not uncommon in the ongoing crisis, as Glacier data examination indicates.

Annually, the last decrease was in 2012, when deaths dropped 8.2%, compared with a national increase of 1.8%

In 2013, that switched. B.C. overdoses climbed 23.3% compared with a national drop of 6.3%. At the same time, Insite saw a decrease in its number of injections.

Federally, the next two years saw overdose death increases of 6.5% and 6.3%, partially driven by provincial increases in deaths of 10.5% and 44%.

Then the horrific 2015-2016 years arrived in B.C., marking fentanyl’s arrival. The death rate increased 44% and 87% in those years, respectively. In the latter year, that B.C. rate helped drive the federal overdose death rate up 24%.

Fentanyl was only seen in 4% of overdose deaths in 2012 but jumped to 25% in 2015 and then to an alarming 67% and 87% in 2017 and 2018.

Not all deaths were attributable to fentanyl, but its presence has been significant. Single or multiple drugs were found in the systems of those who have died.

Insite tracks what drugs users at the facility in the city’s poverty stricken Downtown Eastside are using.

It should be strictly noted here that no one has died at Insite since it opened in 2003. Also, fentanyl is not specifically tracked.

As well, Insite only handles injections. Overdoses also happen as a result of people smoking various drugs such as heroin, cocaine (and crack cocaine) and meth. Insite does not have an inhalation facility.

“Insite isn’t really a reflection of what people are consuming,” Lysyshyn said. “You can only consume drugs at Insite by injection. If you smoke crack cocaine, you can’t do it at Insite.”

“The most common drug is crystal meth,” Lysyshyn said. This is consistent with Glacier’s findings.

“Possibly, also, people are choosing to use the meth at Insite because they’re worried about overdose,” he said.

More than half of the 486 respondents to a BC Harm Reduction Program 2018 survey identified smoking or inhalation as the preferred method of drug use, while 34% preferred injection and 6% preferred snorting.

The survey also found 19% experienced an opioid overdose in the six months prior to the survey, 15% experienced a stimulant overdose and 57% witnessed an opioid overdose.

The question remains, however, whether or not drug use inside Insite represents drug use outside Insite, which is located half a block from the opioid crisis’ ground zero of Main and Hastings. Lysyshyn warns against drawing comparisons.

Indeed, research shows it’s the Downtown Eastside that is taking a heavy brunt of the opioid crisis.

A February BC Centre on Substance Use report said, “In 2017, the Downtown Eastside death rate in Vancouver’s neighbourhood was estimated at almost 250 deaths per 100,000 individuals — around eight times higher than the B.C. average. The centre notes the figures as unpublished Vancouver Coastal Health statistics.

The impact of overdose deaths has led to a drop in the average life expectancy of a man living in the neighbourhood by four years, a January report said.

Heroin statistics dropping, meth rising

Heroin injections at Insite had begun to drop after climbing to an annual high of 101,496 in 2014. There were several peaks and valleys before a steady decline, dropping to 74,021 in 2018.

The climb to that 2014 peak began in 2010 when cocaine injections peaked at 69,705 injections. Cocaine injections have dropped steadily since, hitting 6,636 in 2018.

The rise of crack cocaine

Lysyshyn said there was a lot of cocaine injection at Insite when it opened. That has dropped, however, as smoking crack cocaine became more prevalent.

People have transitioned from injecting cocaine to smoking crack, which they can’t do at Insite.

He said, “In general, there has been a bit of an increase in crystal meth use in B.C. but I can’t tell that from the Insite data, All I can tell is that people are using more crystal meth at Insite.”

Lysyshyn cautioned against extrapolating from Insite data to the province in general, but he added other data indicates there has been an increase in crystal meth use. He also cautioned against extrapolating from the data to say drug use outside Insite is rising or falling, because Insite is an injection-only facility.

Meth use, however, grew steadily from 2010. Insite reported 6,071 uses of meth in 2009, 7,185the next year and then a jump to 13,075 in 2011.

Those meth numbers from Insite are lower than those reported in the BC Centre for Disease Control (BCCDC) harm reduction client survey in 2015.

In December, the BCCDC said reported use in 2018 for B.C. was three times higher than in 2012. The change for Insite, though, was less than double. In 2012, there were 19,998 meth injections at Insite, while in 2018, there were 34,005 uses.

By 2015, the year overdose death numbers generally began rising dramatically, 39,433 uses were recorded. While those numbers declined slightly in 2016 and 2017, in 2018, 37,096 uses were reported, at about the same time opioid deaths had hit an alarming high.

More and more, anecdotal reports say, users are proclaiming themselves as fentanyl addicts, that being the drug of choice they seek out.

And that may be borne out in the BC Centre for Substance Use statistics, which show the largest number of people using drug testing to avoid overdoses are expecting to have bought fentanyl when they go to have it tested.

Back in 2015, 19% of respondents reported intentionally using fentanyl in any form, the BCCDC found.

By December, the centre was saying intentional fentanyl use has tripled over 3.5 years.

No national emergency

While B.C. has declared the public health emergency, there won’t be anything similar coming from the federal government – at least not yet.

Health Canada and the Public Health Agency of Canada spokeswoman Maryse Durette said the federal government is committed to addressing the opioid crisis and problematic substance use from a public health perspective.

“This includes supporting harm reduction initiatives, increasing access to treatment options and working to end the stigma about people who use drugs,” she said.

“A declaration of an emergency would not change our course of action.”

Prime Minister Justin Trudeau held up B.C.’s approach as a model for other Canadian jurisdictions.

“We support an evidence-based approach to countering this terrible opioid epidemic that is hitting not just in B.C. but right across the country,” he said. “We have been dismayed to see conservative governments stepping back from the harm reduction programs that have been so successful here in B.C. and elsewhere.”

Trudeau said Ottawa is working on making it easier for addicts to access prescription drug alternatives, and continue to look for supports for addicts to get help.

– With files from Ben Mussett