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Fentanyl front lines: First responders going from ‘call to call to call’

The reality of the fentanyl epidemic is brutal, says Victoria paramedic Tamara McNay, describing the scene of a drug overdose: The person is unresponsive, covered in vomit, with a needle sticking out of their arm.
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Victoria deputy fire chief Dan Atkinson holds a bottle of opioid antidote naloxone at the Yates Street firehall.

The reality of the fentanyl epidemic is brutal, says Victoria paramedic Tamara McNay, describing the scene of a drug overdose: The person is unresponsive, covered in vomit, with a needle sticking out of their arm. Sometimes, their breathing has stopped for so long they are in cardiac arrest.

They are on the brink of death — and it is B.C. Ambulance paramedics’ job to bring them back to life.

But McNay, regional vice-president for the Ambulance Paramedics of B.C. union, said paramedics in Victoria do not have the resources to deal adequately with the spike in drug overdoses.

“We are literally going from call to call to call,” she said. “We go to overdoses every day, multiple times a day.”

> Read the other stories in this series here.

Between January and August of this year, B.C. Ambulance paramedics on Vancouver Island responded to 2,019 suspected overdose calls — almost as many as in all of 2015.

According to the B.C. Coroners Service, fentanyl, a powerful synthetic opioid, has been a factor in 61 per cent of the 499 overdose deaths that happened between January and August this year. The most recent numbers indicate there were another 56 deaths in the province in September, for a total of 555 — including 107 on Vancouver Island and 44 in Victoria.

Paramedics are seeing more patients who require higher levels of care as a result of fentanyl, said John Deakin, an advanced life-support paramedic with 27 years of experience, including 17 years in Victoria.

“We’re responding to a higher number of these drug overdoses, and they tend to be sicker when we’re attending to them.”

Sometimes, Deakin said, paramedics treat the same person multiple times in a day.

All ambulance crews and 46 fire departments across B.C., including Victoria Fire Department, carry naloxone. The life-saving antidote, sold under the brand name Narcan, reverses the effects of an opioid overdose.

Vancouver Island paramedics administered naloxone 488 times between January and the end of August — already four more times than in all of 2015.

While the province has dispensed thousands of naloxone kits, McNay said it’s like putting a bandage over a gaping wound.

“Narcan is great, but it’s temporary,” she said. “These people need intervention. They need hospital treatment.”

With a potency 50 to 100 times that of heroin, a few grains of fentanyl can kill.

Victoria firefighter Ryan Ayre recently had a call where it took eight shots of naloxone to pull a man back from the brink of death.

It typically takes one shot of the opioid antidote to reverse the effects of a heroin overdose. “But now it’s two doses or three doses or more,” Ayre said. “I just think people don’t know how much [of the drug] they’re taking and the strength of it is knocking them way down the ladder.”

Victoria deputy fire chief Dan Atkinson said overdose calls ebb and flow, and there’s no way to predict when or where they will happen.

The department responded to 368 overdose calls between January and the end of the September — an average of more than one a day.

In May, it responded to 20 calls in a 24-hour period, but March and July were the worst months, with 53 and 52 overdose calls respectively.

Front-line workers and social-outreach providers have raised concerns that people who see someone in the throes of an overdose might be afraid to call 911, for fear that a response from the police might result in criminal charges for drug possession.

“What we have noticed on our front lines is, perhaps, a reluctance from some individuals to place that call for help based on … that fear of possible repercussions, legally or otherwise,” Atkinson said.

Police officers typically respond to an overdose call only when B.C. Ambulance paramedics or firefighters aren’t immediately available, said Del Manak, acting chief of police in Victoria, but there are cases where officers walking the beat might come across someone overdosing. Victoria police recently started carrying naloxone, with 12 nasal spray kits distributed in supervisor vehicles, jail cells and police stations in Victoria and Esquimalt.

“Our goal is not about arresting people when it comes to people that are overdosing,” he said.

“It’s about actually helping people.”

Manak would not rule out criminal charges in such instances, saying calls are treated on a case-by-case basis. But making an arrest is not the primary focus, he said. “If we are there first, our goal is to help people to make sure they get the proper medical attention that they need.”

Fentanyl is difficult for drug users to avoid, because drug suppliers are cutting the cheap and powerful opioid into heroin and cocaine.

“Fentanyl is becoming commonly found in the traditional hard-drug substances … not in every case, but in alarming numbers,” said Victoria police drug expert Sgt. Conor King, adding that the danger of accidental exposure has changed the way police officers handle all illicit drugs.

Officers are advised to use much more rigorous handling techniques and are following safety tips from the RCMP clandestine-laboratory team.

“Any time we seize heroin, I would be very concerned that it also contained fentanyl,” King said.

Victoria police were not able to provide statistics on what percentage of drug seizures involve fentanyl because not all drugs seized are tested in a lab.

King said anti-drug police units across the country are grappling with how to stem the supply of fentanyl, which, because of its high concentration, can be shipped in small packages and easily smuggled into Canada.

“It’s a tough battle,” he said. “Once it hits the streets, we are essentially then left picking up the pieces.”

The focus should be on putting pressure on source countries — such as Mexico and China — to crack down on manufacturers, as well as on better interception at the Canadian border, he said.

Premier Christy Clark has called on the Canada Border Services Agency to screen all small packages for fentanyl. The agency cannot open packages weighing less than 30 grams without the consent of the recipient.

CBSA has not changed its policies, but said in a statement that it is “aware of the risk that fentanyl poses and continues to look at ways to enhance detection capabilities and tools to interdict illicit drugs at the border, including in the postal stream.”

King said while police try to target fentanyl traffickers, drug dealers who are arrested often face the revolving door of the justice system.

“And we all know that’s been a long, ongoing and difficult struggle for society to curb the availability of drugs.”

kderosa@timescolonist.com