Risk of fentanyl in illicit drugs on the Coast is “extremely high”

(by Margot Grant) One hundred per cent of the users of illicit drugs who have their urine tested at the opioid replacement clinic in Sechelt test positive for fentanyl, the clinic’s addictions nurse Kendrah Rose said last week. “If you use drugs on the Coast, the risk is extremely high that you will encounter a potentially deadly contaminant.” 

The Sunshine Coast has been caught in the fentanyl crisis just like the rest of B.C., Rose said. “No small town is safe from it.”

“Fentanyl is definitely on the users’ radar. They are scared. There is not one person in that community who does not know somebody who has died or overdosed on fentanyl,” said Dr. Ron Mundy, a GP and anesthesiologist in Sechelt who also works in the mental health and addictions clinic and the ER at Sechelt Hospital.  “A year ago, one person a month would come to the addictions clinic because they were worried about fentanyl. Now, it’s two or three a week.”

Mundy estimates that six or seven people on the Coast have died from opioid overdoses, mainly fentanyl, in the past year.  “We have had a potential of 4 deaths since November 16 but we are still waiting for toxicology reports from the coroner’s office to confirm,”  Sunshine Coast medical health officer Dr. Paul Martiquet said today.

The total number of deaths may be higher because not every person who dies is autopsied, and testing for fentanyl is not routine, Mundy says. Hospital staff may not be aware that a patient with cardiac arrest has been using drugs.

Compared to the rest of the province, the number of deaths on the Coast is relatively low. There were 488 illicit drug overdose deaths in B.C. during the first four months of this year, according to the latest data released by the B.C. Coroners Service. The report says 136 people died of suspected drug overdose in April alone, a rate of 4.5 deaths per day.

The lower death rate on the Sunshine Coast could be related to the free availability of naloxone kits since January. Naloxone (also known as Narcan) is a life-saving antidote which reverses the effects of an opioid overdose. If injected immediately when the overdose occurs, the drug user recovers without side effects.

The addictions clinic at Sechelt Hospital gives naloxone kits to anybody who wants them. Family members and friends of drug users, caregivers, first responders or users themselves can pick them up and get training in how to use them. “We’ve done a pretty good job as far as that goes,” Rose said.

The kits are also available at the Sechelt Hospital ER, the hospital pharmacy, the Sechelt Indian Band health services, and the Gibsons health clinic.

Vancouver Coastal Health streetworker Brent Fitzsimmons has given kits and training for their use to drug users, social services in Gibsons and Sechelt, the homeless shelter, the public health nurses, Chapman house, all community services, transition houses, and visitor centres. Ambulances, fire departments and RCMP officers carry the kits as well.

Fitzsimmons also gives out kits to people who come repeatedly to give them to their friends. “We don’t judge people,” Fitzsimmons said. “It’s all about harm reduction. If people want training and a kit, they don’t have to give their name.”

The demand is brisk and steady, Fitzsimmons said. He estimates he has given the training to an average of eight people per week since January. The training is not hard, he says. “Anybody can do it.”

The Sunshine Coast is also taking part in a program called Toward the Heart which is administered by the B.C. Centre for Disease Control. It has online instructions for use of naloxone kits and aims to educate people about how to help someone who is overdosing in the time before paramedics arrive. www.towardtheheart.com

Fitzsimmons gives out cigarette lighters that say “236-999 DOPE (3673). Text ‘bad dope’ if you see an overdose. Text ‘alert’ to get overdose alerts.”

The emergency department at Sechelt Hospital sees an average of three people a month who have overdosed on drugs but survived, Dr. Mundy said. But at the (addictions) clinic, we hear about more people who have overdosed at home and been resuscitated with naloxone.”

Fentanyl causes the respiration rate to slow down and eventually stop. When that happens, the heart will stop, too. The brain is deprived of oxygen, causing severe and irreversible brain damage within minutes.

After the heart has stopped, it’s too late for naloxone. However, CPR and rescue breathing can resuscitate the patient to the point that naloxone can be administered.

All naloxone kits include a plastic breathing mask and CPR instructions. However, not everyone is trained in practising CPR and rescue breathing. The Gibsons fire department is looking at buying a new robot teaching aid so more people can learn how to administer CPR.

Dr. Del Dorscheid, a critical care doctor in the intensive care unit at St. Paul’s Hospital in downtown Vancouver, said in The Times Colonist of December 31, 2016 that he is seeing more cases of hypoxic brain injury linked to drug overdoses.

Dorscheid estimated that 90 per cent of drug overdose patients in the intensive care unit suffer some type of brain trauma, ranging from memory loss to complete loss of brain function.

It costs about $5,000 a day to care for someone with brain damage and some people require months of intensive care. Statistics on overdose-related brain injuries are not available.

The RCMP has not found fentanyl-laced marijuana on the Coast. Fitzsimmons does not rule out that it exists: “It is definitely possible. Illegal drugs can be processed with fentanyl at the premises. That means the marijuana can be contaminated as well.” You can’t be sure unless you grow it yourself, Fitzsimmons agrees.

A Victoria pharmacy offering free drug testing for users said that in the last two months about 70 per cent of the samples of the popular party drug MDMA (ecstasy) was found to contain traces of fentanyl. The pharmacists called the results “shocking.”

“It is of great concern that many people are still using illicit drugs in private residences where help is not readily available,” B.C.’s. chief coroner Lisa Lapointe said recently. “I strongly urge those using illicit drugs to do so only at a safe consumption site or drug overdose prevention site, if one is accessible.”

Provincial health officer Dr. Perry Kendall said recently that those dying at home are not stereotypical drug users, but professionals and people afraid to make their addiction known. “There’s a degree of stigma around dependence or use of illicit drugs, which I think prevents those people from wanting anyone else to know that they’re using,” he said.

In Vancouver, no overdose deaths have occurred at Insite, a supervised drug consumption site. Health Canada has recently approved three more supervised sites in Metro Vancouver.

At this time, there are no plans for a supervised drug consumption site on the Sunshine Coast. Addictions nurse Rose would not be opposed to one. “I don’t know that we have the staff here for such a site, but more safety for users can never hurt.”

The addictions clinic is open Monday to Friday, 8:30 am to 4:30 pm and can be reached by phone at 604-885-8678. The clinic offers methadone and suboxone substitution therapy, counseling, outreach and support.