On Alberta’s Fentanyl Crisis

If you want to understand why Fentanyl has become a big issue, one has to look at the history of fighting other legal and illegal drugs including the fight against Opioids, Methamphetamines and OxyContin. About a decade ago, many opioids started appearing through illicit channels, or put another way, on “the street”. Drug syndicates were able to illegally obtain – either through synthesis or purchase – new and highly powerful addictive substances. These substances, including Methamphetamines and OxyContin, were largely derived from new medical knowledge.


At first, drug experts/analysts felt they could control the problem by making it more difficult to synthesize these very same drugs. They changed some drugs formulation, controlled precursors or actual drugs themselves. However, that didn’t work. As noted by Camille Bains of Canada Press, when the Canadian Version of Oxycontin was reformulated and the old version pulled off the shelves, addicts switched to heroin or fentanyl. (Canada’s move to control fentanyl chemicals not enough to stem crisis: expert, by Camille Bains, The Canadian Press, Published by the National Post, Sept. 1, 2016 10:49 AM ET).


Consequently, any politician who claims that there is a quick fix is probably wrong. The solving of the Opioid Addiction issue will likely require much cost and effort due to the endemic nature of the problem. The question for most of us is where to start. My solution is simple: don’t recreate the wheel & adopt solutions that already work.


While, I agree with Dr. David Swann on the need to declare this problem a Medical Emergency, I also recognize that under present law such a declaration will not add many resources. For, to date, the term has been used to describe policy and governmental responses to pathogens which are virulent and not addictive or problematic substances. Accordingly, as the New Democratic Government headed by Ms. Notley has said, at this point, a Medical Declaration is more about sizzle than steak. With that being said, let’s not forget that sizzle is an essential part of the experience of eating steak. In this case, the “sizzle” of declaring a Medical Emergency is important because it announces to the public that the Opioids issue is not just one of those concerns a government might have. In this case, the declaration says we are about to spend more money and might even raise taxes so we can help our Province through this difficult time.


In saying that, it is also in the power of the Notley Government to change the term or the powers of the Government of Alberta. As Dr. David Swann has suggested, we need to have an effective response.  Consequently, if calling it a Medical Emergency is problematic, let us use the term “Medical Drug Emergency”. With the addition of this new status, let us add a new set of tools to the Government of Alberta and AHS to deal with this situation. In my opinion, three come to mind.


In terms of effective strategies, let us start with borrowing from Ontario and BC. Firstly, we could adopt a Fentanyl Patch-for-Patch Exchange Programme. While, this might seem like a needless excess, it is a simple way to start. Since 2015, it has been a part of the way that Ontario has controlled access to Fentanyl. As it was noted in the article “Fentanyl patch-for-patch law passes in Ontario”, published by CBC in December of 2015, “Fentanyl patches sell for $400 to $600 on the street, and are often sold in pieces because of the high cost.” Given that the patches could be used in many ways including smoking and ingesting, Ontario decided to control access to Patches.


However, it doesn’t end there. Given the problem with all Opioids in Alberta, the Government of Alberta could have a drug return programme. Pharmacists or public health workers could accept all forms of drugs – legal and illegal – to be destroyed. While, at the same time, the Province could have an advertising programme and maybe even pay a small reward for the turning in of unused drugs. Such an effort will likely not be a silver bullet, but it might be enough to save some lives and reduce the scope of the opioid addiction issue.


Secondly, the Government of Alberta, the city(ies) of Edmonton and/or Calgary should look at setting up  Safe Injection Sites. Insite, in Vancouver’s Downtown Eastside, has had amazing success at preventing deaths and taking Fentanyl off of the street. Given Insite has an exemption to Canadian Illicit Drug Laws, many users can have their illegal or illicit drugs tested and/or use those same drugs onsite. It is through this type of innovation that Insite’s manager – Vancouver Coastal Health – was able to find out that, “86 per cent of drugs checked so far contain the powerful opioid”. Such efforts in Alberta could equally stem the tide of the Opioid tsunami which we are experiencing.


Lastly, the final and most important step is to change our health care system. It is clear that a part of the problem is the “overmedication”/“over-prescription” of our society. Or put differently, too many patients are taking and becoming addicted to pain medication. Once these patients become well, they are then addicted. We are creating addicts. Accordingly, Doctors, Pharmacists, Nurses, Nurse-Practicioners and other medical professionals have to come up with better practices. If you want evidence for this contention, just look towards our media. As CBC and the Globe and Mail have noted, “Prescriptions for dangerous alternatives to OxyContin are soaring, showing that a crackdown on the popular painkiller has failed to curb Canada’s opioid crisis”. (Prescriptions of opioid drugs skyrocketing in Canada, by Carly Weeks & Karen Howlett, The Globe and Mail Last updated:  Apr. 05, 2016; Canada must examine why it tops opioid-consuming countries: Health Minister Jane Philpott, by Kristy Kirkup, The Canadian Press, Published by CBC.ca, Last Updated: Jul 26, 2016 3:56 PM ET)


It becomes clear that this is a start. While, no one would condone breaking the law, we know that addiction issues are less costly, when we deal with them. The more they fester, the more addicts are consumed by them, the more expensive it is to deal with those same people. It is also less expensive on our hearts. For no one wants to see their loved ones’ consumed by violence or criminality to get their next hit. No one wants to waste the capacity of our citizens’ because of a chemical dependency. No one wants to pay for the extra medical trips or the costly lifesaving procedures which will be attempted to save the body which has been addicted to chemicals for twenty or thirty years.  It is less costly to send someone to rehab, then to send someone to jail. So let us work to break the cycle today. Let us work to control drugs but also provide institutions which can save lives. Let us provide the most benefit to the most people, by looking after the least of us. In doing what is right, we can lessen the effect of Opioid addiction and we create a better world.


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