Experts assess fentanyl risks for recreational drug users in B.C.

With exclusive data obtained by the Straight, stakeholders discuss what the spread of fentanyl means for the sort of drug user who enjoys an occasional line of cocaine

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      Since fentanyl arrived in B.C., it has obviously become more dangerous for someone to maintain an opioid addiction that requires injecting unknown substances multiple times every day. But what risk does fentanyl pose for, say, a Vancouver lawyer who uses cocaine two nights a month?

      In search of an answer, the Straight obtained B.C. Coroners Service statistics detailing fatal overdoses where both cocaine and fentanyl were detected as well as cases where both heroin and fentanyl were found.

      In 2012, cocaine and fentanyl were detected in four bodies where the cause of death was ruled an illicit-drug overdose. Then 21 in 2013, 51 in 2014, 57 in 2015, and 143 in 2016.

      For heroin and fentanyl, the numbers were 0 in 2012, then 6, 12, 37, and 119 in 2016.

      (These numbers—the first of their kind made public—only cover “closed cases” and are not directly comparable to data on overdose deaths presented in B.C. Coroners Service monthly reports.)

      Dr. Mark Lysyshyn is a medical health officer for Vancouver Coastal Health who specializes in substance use. In a telephone interview, he stressed that one needs to be very cautious with interpretations of the data. Despite appearances, Lysyshyn said, the numbers do not necessarily mean that fentanyl has contaminated a growing segment of B.C.’s cocaine supply.

      “We don’t know if those are people that took heroin that was actually fentanyl and cocaine, or if they took cocaine that was laced with fentanyl,” he explained. “We can’t tell the difference.”

      According to Lysyshyn, a likely scenario for many of the “cocaine and fentanyl” cases is that users ingested cocaine that did not contain fentanyl, then ingested what they thought was heroin but was really fentanyl. That would show up as a “cocaine and fentanyl” case, he said, where there was no fentanyl in the cocaine the individual ingested.

      At the same time, he said, the stats could indicate cocaine is cut with fentanyl with increasing frequency, but we can’t tell to what extent. “It’s very complicated,” Lysyshyn said.

      Another data source on fentanyl and cocaine is Health Canada’s Drug Analysis Service (DAS), which tracks seizures by law enforcement. According to those numbers supplied to the Straight, the percentage of heroin seizures across Canada found to contain fentanyl has ticked up from 8.7 percent in 2015 to 39.4 percent last year to 60.1 percent during the first nine months of 2017. For cocaine, those numbers are much smaller, at 0.3, 0.9, and 1.8 percent.

      But that sort of data also comes with caveats. “What police are seizing is not exactly what’s on the street,” Lysyshyn said.

      Travis Lupick / B.C. Coroners Service

      One thing that’s certain is fentanyl has contaminated B.C.’s illicit-drug supply overall. In 2012, the B.C. Coroners Service detected fentanyl in four percent of fatal overdoses, then 15 percent in 2013, then 25 percent, 29 percent, and then 68 percent last year. During the first nine months of 2017, fentanyl was found in 83 percent of overdose deaths.

      According to the agency’s latest monthly report on drug overdose deaths, B.C. is on track for roughly 1,470 fatal overdoses this year. That compares to an average of 204 deaths annually for the years 2001 to 2010.

      Munroe Craig is an outreach director at Karmik, which provides harm-reduction services to nightlife and festival events in B.C. She told the Straight that too many recreational users still believe that fentanyl is a “Downtown Eastside problem”. Craig argued that the statistics support anecdotal reports that fentanyl is finding its way into B.C. cocaine.

      “We are also talking about people who choose to use substances recreationally,” she said.