In the first 9 months of 2015 fentanyl killed 215 Albertans. Public health officials, enforcement, and government have sounded the alarm , created task forces, and public awareness campaigns. The sudden spike in fentanyl related deaths has put pressure on the government to make naloxone more accessible, often described as the “fentanyl antidote” in media reports even though it is effective for all opioid overdoses. While it is nice to see new developments in regards to the accessibility of naloxone it is disappointing that government and policy makers dragged their heels until illicit fentanyl began ravaging Western Canada to act.

Opioid related deaths are not a new phenomenon in Canada. In 2011 my little brother was one of 53 opioid deaths in Nova Scotia.  In 2010 there were 421 opioid related deaths in the province of Ontario, this number jumped to 513 in 2013. Of those 513 opioid related deaths in 2013, 111 were fentanyl implicated.

What is a new phenomenon? Organized crime has identified there is a large market of opioid users in Canada and manufactured their own opioid products to supplement this market. Quite frankly I am surprised this had not occurred earlier. What perplexes me is the fact that government agencies have been very hesitant to acknowledge the risk of prescription opioids and their contribution to addiction and overdose over the past decade. However when organized crime produced their own opioid products there was very little hesitation in sounding the alarm about its danger and risk.

I fully understand that one of the dangers of illicit  fentanyl is that there is little consistency with these tablets and the potency is unknown. The fact still remains that pure does not equal safe. Although prescription opioids are considered pure they can have the same effect on an individual as illicit fentanyl.

I have seen opinions reported in the media that the reformulation of OxyContin to make it tamper resistant is one of the contributors to the Fentanyl crisis as people are turning to fentanyl to replace OxyContin. I have a hard time accepting this theory as there are dozens of prescription opioids without tamper resistant technology that could be supplemented. Opioid prescriptions have almost doubled and Hydromorph Contin prescriptions have tripled since 2009 in Alberta. Recently I spoke with Dr. Graham Jones, Chief Toxicologist at Alberta Medical Examiners Office where I learned that deaths where oxycodone was found have continued to increase in Alberta since the introduction of tamper resistant OxyNeo.

In a recent Edmonton drug bust enforcement seized illicit fentanyl pills being manufactured to look like Percocet (a prescription opioid painkiller still on the market). Fentanyl was also found in counterfeit Viagra and Cialis pills, which were pressed on the same machine as the fake Oxycodone and Percocet. Again this leads me to believe that organized crimes motive was not only to supplement the Oxycodone market but the opioid market as a whole which was created by big pharma and our healthcare system. Pressing the fentanyl into tablets resembling other prescription drugs is just an attractive way to distribute the fentanyl. In many parts of Canada the demand for prescription opioids is as high on the streets as illicit drugs, organized crime decided it would be much more profitable to manufacture their own products rather than divert pharmaceuticals.

I applaud the increased awareness created by government agencies, investigations by enforcement, and an effort to increase access to harm reduction since illicit Fentanyl hit the streets but lets not forget a very key part to addressing this epidemic which continues to sit on the back burner: reducing unnecessary exposure to opioids through more responsible prescribing practices. Government and policy makers need to acknowledge that prescription opioids are not always “safe as prescribed” with current practices.

In 2007 Purdue Pharma (an opioid manufacturer) pleaded guilty to criminal charges in the U.S. that they misled doctors, regulators, and patients about Oxycontin’s risk of addiction and potential to be abused. To resolve civil and criminal charges Purdue Pharma agreed to pay a fine of $600 million. Since then other U.S. states and counties have filed their own lawsuits related to OxyContin. Orange and Santa Clara counties sued five of the world’s largest narcotics manufacturers in May 2014. The lawsuit alleges the drug companies have reaped blockbuster profits by manipulating doctors into believing the benefits of narcotic painkillers outweighed the risks, despite “a wealth of scientific evidence to the contrary.” In December 2015 Purdue Pharma agreed to pay the state of Kentucky $24 million over 8 years.

Purdue Pharma marketed their product OxyContin in a similar fashion north of the border in Canada but the Canadian Government has not taken any legal action to hold them accountable.  It only seems logical to me that the pharmaceutical companies who helped create this epidemic be held accountable and any fines paid be used to fund treatment and prevention initiatives.

If the prescription opioid crisis was acknowledged and acted upon in a timely fashion hundreds of people would still be alive and organized crime might not have had the opportunity to capitalize off our societies opioid users, offering one of the most potent and dangerous opioids on the market.

It is easy to point the finger at organized crime for the fentanyl crisis but it is big pharma and our healthcare system who created this opioid monster, organized crime is feeding it, and people are dying.

-Amy Graves , President of GPDOTS
UPDATE: As of October 2016 Alberta Health confirmed there were more prescription opioid deaths than fentanyl in the city of Edmonton.