British Columbia has become the first province in Canada to declare a public-health emergency because of fentanyl-related deaths. Dr. Perry Kendall, the provincial health officer, took this step after fatalities associated with the prescription painkiller surged.
In just one week last December, Greater Victoria recorded eight overdose deaths. Provincewide, 76 people died in January.
If these fatality rates remain constant, as many as 900 British Columbians could lose their lives in 2016.
It’s not clear how many of those deaths were due to fentanyl. Some varieties are difficult to detect.
But the crisis is real. Fentanyl deaths have spiked countrywide, and the trend is sharply upward.
The solution is another matter. The drug is so powerful, just one grain produces an instant high. Two grains can kill.
And that presents a massive logistical problem. Fentanyl is cheap to produce — roughly $70 a gram. But the street value of that amount is $20,000 — a drug dealer’s dream.
And because it’s so potent, small quantities are sufficient to sustain a black market. Most of the packages smuggled into B.C. come from China, and often weigh less than 30 grams. How do you interdict illicit shipments that arrive in such tiny amounts? And the 30-gram limit is no accident.
The Canada Border Service Agency, which polices ports of entry, is not allowed to open packages weighing less than that amount without the owner’s permission. If a suspicious package is found, and that permission is not forthcoming, they simply send it back where it came from. No doubt the sender tries again.
There is an antidote to fentanyl, called naloxone. But it only works if administered quickly. And that is one reason for declaring a public-health emergency.
With this provision in place, Kendall is authorized to collect drug-overdose information from multiple sources in real time. Emergency responders, physicians, hospitals and pharmacies can all be tied into a provincewide grid.
The hope is that data gathered in this way will identify “hot spots” — locations where fentanyl users are grouped.
Naloxone kits can then be distributed in those districts and training offered in their use. So far, between 6,000 and 7,000 people have received the training, many of them fentanyl addicts or family members. Several hundred kits were used last year, certainly saving lives.
Nevertheless, this is an uphill battle. Fentanyl is merely the latest in a long line of illicit drugs to hit the streets.
It was preceded by another prescription painkiller, oxycodone, which left a trail of fatalities in its wake.
And already there is talk of a next generation. Calgary police have warned about a drug called W-18, which is 100 times more powerful than fentanyl.
The only long-term solution — not without its difficulties — is to offer drug users a safe alternative. Island Health is currently in discussions with the City of Victoria and law-enforcement agencies about a proposal to set up one or more supervised sites for drug users.
Yet even if the talks are successful, sites such as these will not provide safe drugs. They will only offer a place to consume whatever drugs people bring in from the street.
The dilemma is all too obvious. We don’t want people dying of dirty drugs. However, having government provide cleaner but still life-diminishing drugs at supervised sites raises serious moral issues.
Some European countries have been willing to seize this nettle. Britain and Switzerland, among others, provide heroin to addicts if methadone — a less potent alternative — doesn’t work for them.
Giving addicts fentanyl at supervised sites would be in keeping with this policy, though it would be a gut-wrenching decision.
But that is what the war on drugs has become — gut-wrenching.
