Dear Harmy – In the spirit of the well known Dear Abby advice column, Harmy (nee Harmrietta Reductson) is on hand to answer questions and address staff concerns around harm reduction, drugs, sex and how to do them well. Well as in wellness.
I keep hearing about Fentanyl in the news. They say it’s a huge problem and that people are dying. What is it? Should I be worried?
Sincerely, Curious in Cabbagetown
First things first. It’s important to stay informed and up to date on drugs and how they’re used locally and around the world. However, I always encourage a balanced intake of information. The same sources of information detailing the ‘scary threat’ of fentanyl have a primary goal of generating more interest in their story, more clicks, more sales, more ad revenue etc. and fear always gets people reading. Not to say that there isn’t risk that people need to be aware of, but balance it with facts that acknowledge that it is not a new drug and it is used safely by many the world over, even recreationally.
Fentanyl is a member of the opiate (or opioid i.e. originally derived from opium poppy) sub category of drugs. It was developed as a synthetic pain killer and is most commonly prescribed as a pill or a patch. You may have heard more about it in the news over the last couple of years as it has become a popular recreational drug that has lead to highly publicized overdose deaths. Cheaper, more available and easier to use recreationally, Fentanyl is a popular alternative to Heroin and OxyContin use. The pills can be snorted, smoked, injected or ingested. The patches can be used transdermally (across the skin), chewed to release the drug, scraped off and injected, but most often are smoked from a heated piece of tinfoil.
The risk of overdose is high with Fentanyl for a number of reasons:
- Opiates in general cause a loss of consciousness very near the fatal level of respiratory depression. For example, when someone ‘passes out’ from alcohol, their respiratory system is still functioning at a healthy level that will keep them breathing through their sleep. However, the amount of Opioid pain meds such as Oxycontin and Fentanyl required to render you unconscious is "only slightly below" the level that shuts down your breathing. This means that many people lose consciousness (i.e. “on the nod”) and soon after stop breathing. Without anyone around to notice and arrange immediate medical attention, this too often results in preventable overdose death.
- Fentanyl has been most often diverted from medical prescriptions to illicit street sale for recreational use. This supply hasn’t met the demand and thus it is now being illicitly produced and/or imported from sources that are less reliable in providing consistency in dosage and ingredients. It is often disguised as “fake OxyContin” and used at levels suitable for OxyContin but lethal to Fentanyl.
- Users often smoke/inject Fentanyl squares cut from a patch designed to release the drug over a long period of time. The dosage of these squares is varying and unreliable and is being administered at a higher risk all-at-once versus more safely over time.
- Fentanyl and other opiates develop tolerance in regular users, requiring higher doses of the drug to achieve the same medicinal or recreational effect. First time or infrequent users are often using amounts prescribed to someone who has adapted to that higher dose over time. What may be safe for the prescribed user can be lethal for those using without their developed tolerance.
- It’s cheap and feels good. The barrier of cost and availability that exists for many other opiate drugs is less present with Fentanyl, making higher amounts more easily accessed to avoid pain and seek pleasure.
- It’s often hidden in other drugs. Given it’s low cost and availability, Fentanyl is often added to other powders like cocaine and crystal meth as a means of cheaply increasing the high of these drugs.
It may be important to note that the high street value of fentanyl patches and prescriptions alongside the low income of social assistance and disability pensions makes it very attractive to divert in the interest of meeting many people’s basic needs. The motivation behind Fentanyl’s widespread availability isn’t always insidious on the part of the dealer. Like other drugs, Fentanyl distribution and use are deeply connected to the socio-political realities that create the conditions we are facing today. Take this quote from this article:
“The going rate is anywhere from $150-$400 a patch—and if someone is on social assistance in Ontario their prescription is paid for, so the money they'd get on the black market is "pure profit," according to Wasson. Even the used patches have quite a bit of value, as the residue can amount to more than half the total dosage, according to Howell.
The "super expensive" value of the patches on the black market is a temptation that some legit users just can't resist, said Donald, who has 20 years of experience in Sarnia's ER. Experience has shown him that if a patient on a disability pension has a prescription, and if money's tight, he or she may think, "Do I put on the patch, or suffer through this and feed the kids," Donald told VICE. "When you have a script worth 6,000 bucks, it can be hard to resist."
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