More training for physicians key to fighting fentanyl addiction, B.C. doctor says

According to a B.C. fentanyl addiction expert, Manitoba doctors need to consider the long-term consequences before they prescribe opiates.

Dr. Seonaid Nolan is a clinical assistant professor at the University of British Columbia who studies opiate addiction. She said fentanyl is an especially dangerous drug, because it is 50 to 100 times more potent than morphine.

"Because it's so highly potent, that increases the risk of opiate overdose, as it has significant respiratory depressing effects," she said.

A Winnipeg fentanyl addict agrees with Nolan. The person, who we're calling "Amanda," told CBC News the difference in strength is "why people are dying."

"You never know what strength you're getting," Amanda said. "You could go from getting a very, very diluted form, to the next batch, which can be super, super strong."

According to Amanda, several of her friends have died from fentanyl, and she has "almost died a handful of times.

"I was resuscitated … and woke up on my kitchen floor," she said.

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In fact, Amanda nearly died just a couple of days before she spoke to CBC News.

"Unknowingly, I injected something that I thought was fentanyl, and it wasn't," said Amanda.  

"I believe it was acid [LSD], mixed with fentanyl," she continued.

Fentanyl deaths on rise in B.C.

According to the B.C. coroner's service, the number of fentanyl-related deaths in that province has gone up ten-fold since 2012.

Nolan said fentanyl's potency is one of the reasons it is being seen more often in Canada, since a smuggler can carry 50 to 100 times more doses than for a similar-sized shipment of morphine.

According to Nolan, some of the danger is also because fentanyl is a synthetic opioid and its production is not dependent on poppies. Because of this, "a small mistake in preparing or manufacturing or preparing the drug may result in a product that's highly toxic or lethal when that may not be the intended outcome."

Nolan also said, from her experience in hospitals, a significant number of patients didn't realize they were taking fentanyl.

"They believed that they'd taken heroin or some other drug and they actually had no intention of consuming fentanyl," Nolan added.

Fentanyl taskforce

In January, Manitoba announced a new fentanyl taskforce.

"To provide an opportunity to share information, increase knowledge of and capacity to respond to fentanyl use in Manitoba and implement strategies aimed at reducing fentanyl-related overdoses and deaths," said a provincial spokesperson.

According to Nolan this a process B.C. has also undertaken, and they've identified several strategies, including convincing doctors that prescribing opiates should not be taken lightly.

"The emphasis should really be on ensuring [doctors are] knowledgeable about the potential for adverse outcomes, the development of addiction that may occur as a result of their opiate prescription, and really placing the onus on the physician," said Nolan.

Nolan believes part of the increase in the use of fentanyl, and other opiates, can be blamed on the increase in opiate prescriptions written by physicians. When the opiate prescription runs out, she said some patients may turn to street drugs, like fentanyl, to satisfy their addiction.

Wait-listing addicts not appropriate

Nolan also said "recognizing an on-demand treatment approach is required" is important for treatment of opiate addicts. She emphasized that if an opiate addict is asking for treatment, being placed on a waiting list is not appropriate.

Nolan added B.C. has also "developed a remarkable infrastructure in terms of educating healthcare professionals," and is turning out several more addictions-trained physicians each year. According to Nolan, the goal of this approach is to eventually educate enough doctors to  be able to meet the demand for addictions treatment.

Amanda said after her recent near-overdose, something changed inside of her.

"It's just like this giant light bulb just went off and I just decided this is it, I need to seek treatment and finish it and do this," she said.

"I have lost too many friends and I don't want to be a statistic."

If you would like to add anything to this story, please contact the author at leif.larsen@cbc.ca.