Suspected fentanyl overdoses worry public health

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Dr. Sunit Ranade, a medical doctor in Sarnia, says that a recent eruption of overdoses in Sarnia prison could force public health to consider opioids as an occupational hazard. (Tyler Kula / Sarnia Observer)

The main public health official in the region says it is bad news if the drug that sent three Sarnia detainees and two corrective agents to hospital last week proves to be potentially lethal fentanyl opioid.

Sunit Ranade, Lambton County health doctor, has been watching all the incidents related to the powerful opioid, including a traffic accident in the notorious Elgin-Middlesex detention center in nearby London last year. The incident at Sarnia prison, however, is unique and could potentially change the conversation around the powerful drug, he said.

"There are a number of opioids we have found, such as fentanyl patches, that can be absorbed through the skin and some of the formulations of these patches can be very powerful," Ranade said. "If someone is able to verify that it was fentanyl that the guards and other inmates were exposed to, then we need to start talking about how we view this as a professional risk."

"When it comes to second-hand exposure we are concerned about fentanyl and carfentanyl," said Joel Bissonnette, president of OPSEU Local 128, the union that oversees prison staff. "Here is where we consider the second-hand exhibition to be dangerous."

Both prison staff members were treated for exposure symptoms and released. All three detainees were released from the hospital, including a man accused of drug trafficking on Tuesday following a police investigation.

The police did not confirm whether the drugs found in prison this week – suspected of being fentanyl – were the same as those involved in overdoses. An Sarnia department official said the number of overdoses – "three people at the same time" – was rare.

"The police have warned for many years about changes in drug distribution and how different drugs might appear that we might see in other places, such as carfentanyl or very powerful forms of fentanyl (in Sarnia)," Ranade said. "This is one of the first places we think it might have. But still, I didn't see any confirmation."

The union representing the 80 odd staff members in Sarnia prison says that increased security could prevent the powerful drug from being smuggled into the facility. The union wants the province to also look at stronger security measures throughout the province, possibly in the form of expensive technologies such as ionic scanners capable of detecting small amounts of opiates such as fentanyl.

"Lambton's public health is also trying to address the opioid crisis in other ways," Ranade said. This includes working with the police and SME to develop in-community initiatives and offer free naloxone kits in local pharmacies.

"I think it's safe to use the word" epidemic "on this issue now. This is a very reasonable thing to say," Ranade said.

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FACTANYL FACTBOX

WHAT ARE OPIOIDS?

  • Opioids are very compelling painkillers, also called narcotics, made from opium poppies or synthesized in the laboratory.
  • There are many different types of prescriptions and illicit opiates with varying levels of strength, including morphine, heroin, hydromorphone, oxycodone and fentanyl.
  • Prescription opiates such as OxyContin can be abused by patients or diverted to the street, where they can be smoked, crushed, sniffed or injected by addicts.
  • Opioids have been implicated in over 2,000 deaths nationally in the first half of 2018 alone.
  • In the London area, there were 42 opioid-related deaths between January and October 2018.

WHAT IS THE FENTANYL?

  • Fentanyl is a hyper-powerful opioid, produced in the laboratory, 100 times more potent than morphine. Only two milligrams of the drug, the equivalent of about four grains of salt, can kill a user at the first experience. It can easily be mixed with other drugs and is difficult to detect.

HOW DOES THE FENTANYL GET ON OUR ROADS?

  • The fentanyl patches in prescription gels used to manage severe chronic pain can be sold on the street, where the drug is smoked, ingested or dried in powder.
  • Illegal powdered fentanyl, manufactured in overseas laboratories and smuggled into Canada, can be cut into other drugs or compressed into tablets made to look like prescription pills.
  • Organized crime has a role in the sale and distribution of illicit fentanyl, says Middlesex London Health Unit health manager Chris Mackie.

WHAT MAKES THE FENTANYL ATTRACTIVE FOR THE USERS OF THE PHARMACY?

  • Sometimes addicts end up with fentanyl accidentally when they are cut into another drug they want. Other times they look for him, said Ken Lee, principal doctor of the Canadian Mental Health Association, the Middlesex addiction medicine clinic. It's powerful and cheap, he said. "The people I see know they are using fentanyl," Lee said. His patients report that the pharmaceutical grade hydromorphone costs $ 60 a point, a tenth of a gram, in the street. "A fentanyl point is much stronger and will last much longer. It's cheaper than buying pills known for drugs," said Lee.

WHAT MAKES THE FENTANYL USED FOR PHARMACY AFFILIATES?

  • Non-users might wonder, why mix a drug that could kill your customers? For retailers, the advantage is that slipping fentanyl into another type of illegal drug can increase the high buyers they get from using it, and mixing fentanyl also allows retailers to extend the supply of more expensive drugs – for example the heroine – which are sale.

NOT ALL THE FENTANYL IS CREATED EQUAL

  • Fentanyl done in clandestine laboratories can vary from batch to batch, Lee said. It can be weak or very strong and can contain relatives of fentanyl including carfentanil – an elephant tranquilizer that is 10,000 times stronger than morphine – mixed into. Some officials have questioned whether a recent eruption of southwestern Ontario fatal or non-fatal may be the result of a "toxic" batch of fentanyl affecting the region.

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