Fentanyl is killing Albertans. A stark reality that is becoming increasingly harder to ignore. According to information provided by Alberta Health Services (AHS), in 2015 the drug was associated with the deaths of 274 Albertans and 90 of those lives lost were in Calgary. Of the 338 Albertans who died from all opioid overdoses in the first nine months of 2016, 193 were specifically related to fentanyl, according to Health Canada data.

In the first 6 months of 2015, fentanyl claimed 139 lives in Alberta.

In the first 6 months of 2016, the number of deaths rose to 153.

It has come to be recognized on provincial and federal levels as a true health crisis. British Columbia declared fentanyl use a state of emergency, with many here in Alberta advocating for our government to do the same in order to rally all involved forces to create a solution to the problem.

Fentanyl is a synthetic opioid used as a pain medication first developed by a Belgian chemist in 1960. Available for highly effective palliative treatment in many different forms including tablets, patches, sprays and even lollipops, the drug began to be abused recreationally with increasing popularity since the early 2000s.

Across the country there have been numerous conferences addressing the issue, involving professionals from various fields coming together to work on tackling the health crisis. This bringing together and unification of different levels of government, health care, law enforcement, border control and many others, is a real step towards combating this crisis.

In November 2016, a conference was held at the Alberta Adolescent Recovery Centre (AARC). Staff Sgt. Martin Schiavetta of the Calgary Police Service and Dr. Mark Yarema, clinical associate professor at the University of Calgary and medical director of the Poison and Drug Information Service (PADIS) for AHS both provided expert information. In addition to their professional wealth of knowledge on the subject, another important voice in the fentanyl crisis was heard – that of someone who experienced addiction first-hand.

Dr. Jackie Smith of the Alberta Adolescent Recovery Centre opens the floor to a Q&A with her guest speakers (from left to right) Tessa Johnston, Martin Schiavetta, and Dr. Mark Yarema. Photo by Paul Rodgers.

Tessa Johnston, originally from Vancouver, was 19 when she started using fentanyl, progressing from partying with alcohol and cocaine into opiate addiction. She courageously shared her story with the crowd of more than 150. The conference room was packed with people from many walks of life, eager to hear what the speakers had to say. The three speakers took turns addressing the stage, sharing valuable information about the drug and the history of the epidemic, inciting meaningful discourse with the attentive audience in the Q&A forum at the end.

“I loved the drug,” Johnston, now 23, said in a phone interview a few days after her speech at AARC. She started using one pill every couple of weeks, but as her addiction grew so did her tolerance and her habit evolved to 8 to 10 pills a day.

“It was just a relaxing feeling and I felt like I didn’t have to impress anyone, I was just high,” she remembered. “I had no idea what I was even doing in reality, but I was just very relaxed on it. But then as I got more into it and more addicted to it, I pretty much used it to just cover up any kind of emotion because I didn’t want to feel emotion. So it numbed me, like it numbed my whole body, it numbed my head, it numbed everything.”

Her parents offered her an ultimatum: seek treatment, or lose their financial support. Considering how deep into addiction she was, that could have meant winding up on the streets. So on Jan. 20, 2016, Johnston, with her parents’ support, enrolled at AARC. Although she was over the facility’s age limit of 12 to 21, she signed herself into the eight-month program, which ended on Sept. 16, 2016.

Though she initially struggled with the strict rules and group discussions where she and other users had to share their feelings, she knew these things were set in stone for good reason.

“When I went to doctors and when my family would send me to counsellors, a lot of the doctors and counsellors I didn’t care to listen to – they hadn’t been through addiction, they had no idea what they were talking about. So the good thing about AARC is every single one of the staff members have been through that program or another program so they get it …So it was a really comforting feeling to go in there with.”

Johnston said she feels that there needs to be more support for adult long term treatment centres, as AARC is for adolescents. After her speech, heard by addicts, ex-addicts and parents of addicts, many commended her through tears for sharing a story which is all so near to their own hearts.“It numbed me, like it numbed my whole body, it numbed my head, it numbed everything,” – Tessa Johnston says. 

An opioid conference was held in Ottawa on Nov. 18, while in Alberta, similar conferences were held in October in both Edmonton and Calgary.

Mike Ellis, MLA for Calgary-West and former Calgary police officer provided opening remarks at the conferences in Edmonton and Calgary. Ellis recently passed private members Bill 205, which aims to regulate pill presses, restricting access to those who use them as a major tool and component in the creation of fentanyl tablets. Some presses can churn out 20,000 pills an hour.

It’s disconcerting considering one pill can be fatal. The pills are generally made in clandestine labs across the country with precursor chemicals easily imported from China. The lack of regulation or accountability creates risky drugs. Just two milligrams can be a fatal dose, equivalent to a couple grains of salt. A commonly used analogy is baking chocolate chip cookies. Although there is one cup of chocolate chips in the batter, not all the cookies will contain the same amount of chocolate chips. It’s hard to know if your pill has two milligrams or six.

In a phone interview, Ellis said his bill is the first of its kind in Canada and is, “really the first piece of legislation to tackle the fentanyl crisis.” He believes these types of conferences that bring together a mosaic of expertise are a step in the right direction.

Ellis proclaimed he is an advocate for long term care beds for addicts and a platform of education, prevention and intervention, a policy preached by former police chief Rick Hanson.“It’s only together that we can collectively tackle this issue,” Ellis said. “And when I mean together I don’t just mean police. This is not a police problem, this is a societal problem.”

During his 12 years on the police force throughout the early 2000’s Ellis remembers the oxycontin crisis well. Crime rates skyrocketed, with people going to drastic lengths such as robbing pharmacies to get their drugs.

“Oxy was really messing people up and causing them to do armed robberies, (things) that typically normal people don’t do,” Ellis recalled. “But fentanyl is like Russian Roulette, literally you’re going to live or you’re going to die, that’s how dangerous the stuff is.”

A former fentanyl addict, Tessa Johnston courageously shared her story of addiction and choosing to get clean with the help of AARC. Photo by Paul Rodgers.

Ellis hopes Alberta will recognize the crisis as a public health emergency and is hopeful that with increased action, including the implementation of Bill 205, the problem may be combatted.

“I’m optimistic,” he said, “but it needs to be done, like now, because people are dying today. It’s not debatable as far as I’m concerned.”

Schiavetta was also involved in the provincial opioid conference in addition to the seminar at AARC in November. A supporter of Bill 205, Schiavetta has faced the opioid crisis, like Ellis, since before fentanyl reared its ugly head.

“When oxycontin was pulled off the market in 2012, I think a lot of people in law enforcement thought heroin as an illicit drug would sort of step up and fill that market,” Schiavetta said. “Obviously fentanyl did.”

Schiavetta also believes that this issue must be approached with a “balanced strategy” at a collaborative level, and frequently uses the phrase, “we’re not going to arrest our way out of the problem” in interviews and speaking appearances.

“There’s a direct relationship between drug addiction and rising crime rates,” he said. “… and if we don’t deal with the root causes of addiction, you’re not going to affect crime.”

He believes a part of the strategy needs to involve the restriction of access to illegal drugs, but also to work on lowering the demands for drugs, including prescription drugs stating Canada is either the number one or number two country in world for prescription drug consumption, a statistic confirmed by the Canada Institute for Health Information.

“But fentanyl is like Russian Roulette, literally you’re going to live or you’re going to die, that’s how dangerous the stuff is,” – Mike Ellis.“So we have to change practices in regards to that, but on the legal side it’s about restricting access, lowering demand and building partnerships in our community that support rehabilitation and treatment and AHS is obviously looking to expand their capacity in a number of those areas. If a person wants help you have to be able to provide that help now, you can’t tell them to come back in eight weeks, it doesn’t work.”

Kathy Christiansen is the director at Alpha House, a free detox clinic in Calgary. In her 24 years there, she has seen people severely affected, not only by fentanyl or other opioids, but alcohol and crack cocaine and methamphetamine, which is very prevalent today as well.

“Over time we always have to adjust our practices, our work, and based on what we’re seeing in the community it does change over time,” Christiansen explained over the phone from a busy Friday shift at Alpha House.

Part of the provincial response to the new crisis is the introduction of naloxone kits, which stop opioid overdoses. These are inter-muscular injections that block the opiate receptors in the brain, stopping the fentanyl overdose and are available for free from pharmacies and various public health agencies such as the Sheldon Chumir. There have been some in Alberta that have pointed fingers at the former Conservative Government for its unsupportive stance on harm reduction and drug addiction.

“Well I don’t know if the government can be held accountable,” Christiansen said. “But it made it very challenging for those types of programs, operation-wise, to be funded.”

She said naloxone kits could have been introduced in the community earlier as a response to opioids in general, but the glaring death toll associated specifically with fentanyl spurred them into production, which is in a way, a silver lining.

“That’s a positive thing, but it came to us, perhaps not in a way that it could have,” she said. “But I would say there wasn’t a lot of support for harm reduction types of programming and they [the Harper Government] were more conservative in their views. They didn’t necessarily follow the evidence in terms of practice, and that’s always a concern.”

Dr. Mark Yarema shows an attentive audience at AARC some sobering statistics about the fentanyl crisis in Alberta. Photo by Paul Rodgers.

In addition to implementing evidence based practices that save lives such as naloxone kits, Christiansen said the Good Samaritan legislation, which is being reviewed currently, allows people to report a potential overdose without being prosecuted; which is crucially important.

However, her bottom line is more health care responses for people struggling with addiction.

“Responses that address all the social determinants of health like housing — all of those pieces are really important for people who are struggling with substance misuse. When you have more of those available for particular populations the outcomes are better for that particular individual, but also for the community overall.”

Across all levels, the main solution for combatting the opioid crisis is working towards tackling the roots of addiction in society. Of course that is a complex task and is easier said than done, but one of the ways to approach it is to listen to those who have experienced addiction themselves like Johnston. She was an ordinary girl that grew up loving dance and spending time with her friends. Her gradual foray into drug use is not so unusual and hearing the numerous concerned parents of addicts at AARC proves that it can happen to anyone.

So while the end may not be anywhere in sight, there is a collective hopefulness, that through working collaboratively, engaging all levels of society and fostering support, awareness and education, the fentanyl crisis may become a thing of the past. Additionally, we will be better prepared to prevent or mediate the severity of future drug epidemics.

prodgers@cjournal.ca

The editor responsible for this article is Mary Yohannes and can be contacted at myohannes@cjournal.ca