Opioids crisis deepens

By Rupert Nuttle

In the wake of dozens of deaths in Ottawa in recent years caused by the street drug fentanyl, the city’s paramedics are bracing for a new source of lethal drug overdoses — this time from the synthetic opioid carfentanil.

“We know it’s coming this direction,” said Darryl Wilton, president of the Professional Paramedic Association of Ottawa. “We know that those substances are now in Ontario.” To make matters worse, ambulances are running short on naloxone — the antidote that counteracts the effects of opioid overdose.

“The stock we’ve carried has been adequate for decades,” Wilton said, but in 2017, that’s no longer the case because of the increase in drug overdoses.

The issues arise in the wake of a series of drug raids and arrests on Feb. 16 in which Ottawa Police seized more than $100,000 in cash and large quantities of illicit drugs. In the same week, a 14-year-old Ottawa girl died of an overdose, prompting alarms among parents across the city.

Ottawa Mayor Jim Watson has also announced plans to confront the opioids crisis with other big-city mayors across Canada.

Carfentanil is 100 times more powerful than fentanyl and 10,000 times stronger than morphine. Deadly in even tiny doses, the drug has swept eastward over the past two years, with hundreds of overdoses occurring first in B.C., then Alberta and Manitoba.

It’s not yet confirmed that carfentanil has reached Ottawa, but in December counterfeit prescription pills laced with it were found in the Waterloo Region.  Local officials issued an “Overdose Alert” at the time, warning the public of the lethal green pills.

On Feb. 13, Ottawa Public Health and police issued a similar alert about “counterfeit prescription medications”  in the city.”

The pills are still being tested for the presence of carfentanil, but it is suspected they’ve been involved in recent overdoses.

There were 48 unintentional overdose deaths in Ottawa in 2015, two-thirds of which were due to opioids. Fentanyl alone was responsible for 14 of those deaths, and Wilton says that in 2016, that number might have doubled. (The 2016 data will be released next month.)

Wilton, who works night shifts as a paramedic, suspects carfentanil is already on Ottawa’s streets. He’s treated overdose patients who are “much more deeply sedated” than he’s ever seen in his decades-long career, and has had to use up to 10 times the normal dose of naloxone just to get them breathing again.

“Now the question I’m asking is: Why am I having to inject this patient multiple times?” he said. “Nobody should be receiving injection after injection. You don’t turn people into pin cushions.” Paramedics are “stuck playing a guessing game” as to what kinds of drugs they’re now trying to counteract.

Naloxone is usually administered by an injection in the arm — like a flu shot — but paramedics are turning to less invasive methods, such as a nasal spray, to deliver the much higher doses now required. In severe cases, patients are hooked up to an intravenous drip over an extended period.

Because paramedics need more naloxone to revive each patient, they’ve started running out of it in the middle of their shift, Wilton said, and they can’t respond to further overdoses until their ambulance’s supply is restocked.

To address this problem, the Ontario Paramedic Association sent a letter to the Ontario Association of Paramedic Chiefs on Feb. 10 recommending that ambulances in all of the province’s 52 jurisdictions be equipped with three times their current supply of naloxone.

According to the letter, this is “a critical juncture for patients and paramedics,” when emergency responders across the country “have documented administering recording-breaking doses of naloxone in order to achieve a therapeutic effect with patients.”

In most jurisdictions, including Ottawa, ambulances currently carry two vials — or 4 milligrams — of naloxone. The OPA letter recommends a minimum of six vials per ambulance. Wilton suggests that advanced care units should be provided with more.

“The next logical step, absolutely, is to respond by increasing the stock so that we have as many units in service as possible that can handle as many overdoses as possible,” he said.

According to a statement from the Ottawa Paramedic Service, each naloxone vial costs $28.43, and the cost is shared between the city and the province.

The statement said that the city’s paramedic service has partnered with several other agencies, including Ottawa Public Health and the Ottawa Police Service, “in preparation for the continual increase of fentanyl use … and the introduction of more potent analogues.”

“We’re all in this together,” Wilton said of cooperation between agencies, adding that the push to bring a supervised injection site to the city “is bang on.”

“It is exactly what you would expect from a medical system,” he said. “Addiction like that — use of recreational substances to that degree — is a disease, and as a medical professional you absolutely treat the disease.”