Fentanyl: The king of all opiates, and a killer drug crisis

It’s stronger than heroin and more potent than OxyContin. It’s also cheap, ubiquitous, and incredibly deadly. Inside the rise of fentanyl.

              





 


Michael Morton and his friend had a plan, and they’d done their homework. It started with the opportunity for high school co-op placements at local pharmacies, and a favourite rap song that rattled off a list of drugs to abuse. “OxyContin, Xanax bars, Percocets and Loritab,” Lil Wyte rhymed in Oxy Cotton. “Valiums, morphine, patches, ecstasy. And it’s all up for grab.” Within weeks of starting their jobs, the two teens from Barrie, Ont., had pilfered enough prescription narcotics to start their own drugstore. And via the Internet, they researched how to best misuse them, right down to the dosages and the proper order in which to take them in order to build up tolerance.
Sitting in a coffee shop, with the history of his high school years neatly spelled out on pieces of foolscap before him, Michael, now 26, still gets a little misty about what he calls “the king of all opiates.” He and his friend had amassed a stash of more than 200 fentanyl patches, but kept away from them for months out of a healthy respect for a pain reliever that is 20 times stronger than heroin and up to 100 times more potent than morphine. But, just before Christmas of his Grade 11 year, Michael had been caught breaking into lockers at school and expelled. His bosses at the pharmacy—rightly suspecting him of stealing there, too—also dismissed him. Now sitting at home, grounded and alone all day, he had the motive and opportunity to push his limits. He unwrapped a patch, squeezed out a tiny amount of gel from between its plastic layers, and put it in his mouth. “I fell back in my seat and I fell in love,” he says. “It was the best high I ever had.”
Within a year, he was going through two of the patches—each designed to provide 72 hours of steady relief for people suffering from intense, chronic pain—every day, chewing them, or scraping out the gel to smoke or inject. He came close to overdosing on many occasions, and frequently passed out, as the drug slowed his breathing and pulse. “Every time I did it, my heart dropped to, like, 30 beats a minute,” he says, “but I thought I was invincible.” It took the deaths of four of his friends and fellow abusers—two of them still in their teens—to convince him to seek help. Six years later, he’s still on methadone, struggling to taper his daily dose and construct a future. “It’s hell, but it saved my life,” he says, “because the urge always comes back.”
Over the past few months, fentanyl has been making headlines across North America, as police discover more and more of it on the streets, and overdose deaths surge. Authorities in Alberta linked the drug to 120 fatalities in 2014, and 50 more in just the first two months of this year. In British Columbia, it killed almost 80 people in 2014, and was responsible for a quarter of all drug deaths, up from just five per cent in 2012. In Ontario, where 625 people died of opioid overdoses in 2013, fentanyl was involved in 133 of those cases and, each year, it now kills twice as many people as heroin.



(Photograph by Cole Garside)
Michael Morton. (Photograph by Cole Garside)
But the deeper story of the drug and its abuse is even more worrying. Police and health workers now face an unprecedented situation, with a burgeoning street trade in both the legitimate prescription patches and illicitly manufactured fentanyl—often sold in pill form and made to look like OxyContin, a far less powerful narcotic. The drug, also available in liquid and powder form, is increasingly being used to cut cocaine and heroin, dramatically boosting their potency, often with fatal consequences. Indeed, fentanyl seems to turning up almost everywhere you look. And it’s killing both inexperienced newbies and hardened addicts:

  • In Montreal, in the summer of 2014, there were at least 25 overdose deaths—six of them in just one week in June—linked to fentanyl-laced heroin.
  • Police in Moncton, N.B., found two dead men inside an apartment last November, with a package of fentanyl powder they had apparently purchased online.
  • In Durham region, east of Toronto, there were 11 fentanyl overdoses—eight of them fatal—in November and December.
  • Two major busts in Barrie, Ont., involved health care workers. One trafficking ring, in which false prescriptions were written with the help of a medical secretary, included two dozen people and 1,000 patches. The other involved an emergency-room physician, who was charged with 68 counts in connection to fraudulent prescriptions for 515 doses.
  • Since last summer, 16 deaths and dozens of non-fatal overdoses have occurred on the Blood First Nation reserve near Lethbridge, Alta., population just 12,000.
  • A Vancouver police raid in March netted 29,000 “fake Oxy” fentanyl pills and $215,000 in cash. Police in Alberta, meanwhile, have seized more than 20,000 pills in the last year.
Dr. Karen Woodall, a toxicologist with the Ontario Centre of Forensic Sciences in Toronto, regularly testifies as an expert in fentanyl cases. She first noticed the drug in 2005 in the autopsy files that cross her desk. She later traced deaths as far back as 2002, mostly via people overdosing after chewing cut-up bits of patches—a particularly dangerous practice, since there’s no way to predict the quantity of the drug in each piece. “The big problem with fentanyl is that a lot of people who aren’t tolerant to the drug are taking it. And if you’re not tolerant, it’s a lot more likely to cause serious toxicity and even death,” she says. “It severely depresses breathing and the heart rate.” Combined with alcohol or other drugs that slow the central nervous system, it becomes even more dangerous. “It’s a serious issue,” says Woodall. “We’re seeing more and more deaths.”
(Surrey RCMP)
(Surrey RCMP)
Kelly Best of Saskatoon died late in the morning of Jan. 3, 2015, the city’s third fatal fentanyl overdose in five months. The 19-year-old took half a “fake Oxy” pill, then lay down in the living room with his blanket and his dog, Kush. He placed his glasses and favourite blue ballcap on the couch beside him. He never woke up.
It was the second time he’d ever