A powerful synthetic opioid called fentanyl that is up to 100 times as strong as morphine is suspected to be the culprit in a rash of overdoses that hit Abbotsford, B.C., over the past week.
Abbotsford police say a 38-year-old man died in hospital on Friday after possibly ingesting the substance. Officers suspect the drug was also involved in three overdoses last week in a tent city that has been erected near Gladys Avenue to protest against homelessness.
Health officials and law enforcement officers suspect unscrupulous drug dealers are sneaking the substance, which is being manufactured in illegal drug labs, into low-quality heroin in the belief that it will increase its potency.
"We do think that this is something that someone manufactured, much like people will manufacture ecstasy or MDMA," said Constable Ian MacDonald of the Abbotsford Police Department. "It probably was made by some home chemist as opposed to being ripped off from a pharmacy."
In one instance, an experienced drug user at the Gladys Avenue protest camp warned a younger man that the substance he was about to inject was likely fentanyl, not heroin, because of its light colouring. The man injected it anyway, overdosed and had to be revived by medical officials, Constable MacDonald said.
Fentanyl-related deaths are on the rise in the province, according to statistics the B.C. Coroners Service released in June. The drug played a role in at least 13 drug-toxicity deaths in the first four months of this year. The Fraser region had 12 fentanyl-related deaths in 2013; it had only six in 2012.
The B.C. Coroners service says the dangers are highest in the area covered by the Fraser Health Authority, including Surrey, Langley, Maple Ridge and Coquitlam.
In the spring of last year, Montreal police seized some 300,000 fentanyl pills from an illegal drug lab. The synthetic opioid, which does not come from a plant, has been implicated in a slew of fatal overdoses in Montreal in recent months.
Much of fentanyl's danger comes from the fact that it is 50 to 100 times more potent than morphine and 40 times as potent as heroin, said Mahyar Etminan, a drug safety expert and assistant professor at UBC.
Fentanyl is usually administered through a patch that is applied to the skin of patients who have chronic pain, such as those with cancer or in palliative care. It also sometimes given in hospitals by injection to help sedate patients before surgery.
The version of the substance that can be found on the street comes in a pill and is called desmethyl fentanyl.
"The patch and the injections are relatively well guarded in the stockpiles of hospitals, so the fact that there's so much of this new stuff out there in the street means they're producing it themselves," Dr. Etminan said.
Barbara Gobis, director of the UBC Pharmacists Clinic, said that in addition to its potency, fentanyl is much more likely than other opioids to cause sedation and breathing difficulties – but does not stimulate euphoric feelings.
"It's not actually going to give drug users more of a high," Ms. Gobis said. "It can sedate them and it puts them at risk of breathing problems. So a drug user who wants a high is not necessarily wanting fentanyl in their drugs."
Ms. Gobis said the increase in fentanyl-related deaths is likely caused by "shady dealers cutting low-quality heroin to try and pump it up."
It is concerning because all of the deaths were preventable, Ms. Gobis said. It also gives the drug a bad name and stigmatizes those who need it for therapeutic purposes.
"It is a legitimate drug that has a legitimate use for people with certain kinds of pain and certain kinds of needs," she said. "So it's a valuable contributor to the pain management choices that we have."