I recently watched Heroin(e), a Netflix-produced documentary that follows three women (a fire chief, a drug court judge, and an outreach ministry worker) combatting the opioid crisis in Huntington, West Virginia, the “overdose capital of America”.
The outreach worker with the Brown Bag Ministry initially anticipated that she would be providing food and the words of Jesus to assist sex trade workers, but she was quickly confronted with the complex reality of their addictions and trauma histories. She observed that law enforcement overly focuses on the women engaging in the sex trade rather than the johns who are the impetus driving the sex trade.
Fire and ambulance services have seen a spike in the need for overdose treatment as the local drug supply has shifted from heroin to fentanyl and carfentanil. The city now sees 5-7 opioid overdoses every day. The number of deaths they witness is a significant occupational stressor for emergency personnel.
I live in Vancouver, British Columbia, the “overdose capital of Canada”. In 2017, British Columbia saw more than 1420 illicit drug overdose deaths, around 80% of which were attributed to fentanyl. In 2015 a dear friend of mine lost his life due to fentanyl, yet one more statistic in the opioid epidemic.
So what are opioids, and why is there currently an opioid epidemic/crisis? Opioids are substances that act at on opioid receptors concentrated in the central nervous system. Substances, both those produced in the body and those consumed, that stimulate opioid receptors have several different effects, including pain-killing. Morphine and codeine are examples of opioid agonists available by prescription, and heroin is an illicit example. While the painkilling effect is desirable, one of the undesirable effects is what’s referred to as “respiratory depression”, which occurs when opioid receptors are over-activated in the area of the brain responsible for the drive to breathe. This means the brain stops signalling to the lungs to breathe, which can quickly result in death.
People can potentially overdose on all kinds of opioids, but what’s really killing people these days is fentanyl. Fentanyl has been around for quite some time; outside of hospital, this has been in the form of a long-acting patch that is worn for 3 days, which is safe when used as prescribed. Back in the day, much of the illicit supply came from diverted prescription fentanyl patches. That has changed. Now there is a cheap, abundant supply of fentanyl pouring into North America from China. Fentanyl is extremely potent, and it hangs onto opioid receptors for dear life. Because fentanyl is cheap, it gets cut into a lot of other drugs, leaving the user no idea what they’re actually getting. Here in Vancouver, most of the “heroin” on the streets contains at least some fentanyl, which is far more potent than heroin. Even scarier is that carfentanil is making an appearance; it’s like fentanyl on steroids, and is used to tranquilize elephants. Every injection is kind of like Russian roulette; you must don’t know what you’re going to get.
How is an opioid overdose treated? Naloxone, also known by the brand name Narcan, is a rapid-acting opioid antagonist that temporarily shuts down activity at opioid receptors. The brain then can get back to its normal business of telling the lungs to breathe. Naloxone also throws the person straight into withdrawal, and they will be pissed off about it. If they aren’t monitored afterwards there is a very real possibility that once the naloxone wears off and the opioid receptors are back in business, there might still be enough of the opioid drug left in the body the person could go straight back into overdose.
A couple of years ago when I was having strong thoughts of suicide, I had come up with a plan of overdosing on fentanyl. I went down to skid row intending to buy some, but was put off by the presence of so many first responders; I hadn’t realized it was just after welfare cheque day, which is always accompanied by a spike in overdoses and resultant throngs of emergency personnel. I didn’t try again, thinking that even though there are all these people that are buying heroin and unintentionally killing themselves, it would be just my luck that I’d try to buy fentanyl and end up just getting garbage that would only make me sick. It makes me wonder, though, how many apparently accidental opioid overdoses may actually be suicides.
From the regular heroin user to the one-off experimenter to the suicidal mentally ill person, illicit opioids are playing with fire. There is help. Don’t be the next statistic.