Everything you need to know to understand London’s drug-overdose crisis

A surge in drug overdoses across Southwestern Ontario over the past week, including nine fatal ones, has alarmed police and public health officials in London and across the region. It’s possible, some say, a “toxic” batch of fentanyl may be a root cause. But what is fentanyl? What are opioid drugs? How do they mix together? Why would anyone use them, or sell them? Our Jennifer Bieman dug into the details to help explain a burgeoning public health crisis:

WHAT ARE OPIOIDS?

• Highly addictive painkillers, also called narcotics, made from opium poppies or synthesized in a lab.
• There are many different kinds of prescription and illicit opioids with varying strengths, including morphine, heroin, hydromorphone, oxycodone and fentanyl.
• Prescription opioid pills, often prescribed as painkillers like OxyContin, can be abused by patients or diverted to the streets, where they may be smoked, crushed-and-snorted or injected by drug users.
• Opioids have been implicated in more than 2,000 deaths nationwide in the first half of 2018 alone.
• In the London-area, there were 42 opioid-related deaths between January and October 2018.

WHAT IS FENTANYL?

Fentanyl is a hyper-potent, lab-made opioid that is 100 times more powerful than morphine. As little as two milligrams of the drug, the equivalent of about four grains of salt, can kill a first-time user. It can be easily mixed into other drugs and is difficult to detect.

HOW DOES FENTANYL GET ON OUR STREETS?

• Prescription gel fentanyl patches used to manage severe chronic pain can be sold on the streets, where the drug is smoked, ingested or dried into a powder.
• Illegal powdered fentanyl, made in overseas labs and smuggled into Canada, can be cut into other drugs or pressed into tablets made to look like prescription pills.
• Organized crime plays a role in selling and distributing illicit fentanyl, Middlesex London Health Unit chief medical officer of health Dr. Chris Mackie says.

WHAT MAKES FENTANYL ATTRACTIVE TO DRUG USERS?

Sometimes drug users end up with fentanyl accidentally when it’s cut into another drug they want, other times they seek it out, said Ken Lee, lead physician at Canadian Mental Health Association Middlesex’s addiction medicine clinic. It’s powerful and cheaper, he says. “The people I see know that they’re using fentanyl,” Lee said. His patients report pharmaceutical-grade hydromorphone goes for $60 a point, one-tenth of a gram, on the street. “A point of fentanyl is much stronger and will last a lot longer. It’s cheaper than buying the known pharmaceutical-grade pills,” Lee said.

WHAT MAKES FENTANYL USEFUL TO DRUG DEALERS?

Non-users might wonder, why mix in a drug that could kill your customers? For dealers, the benefit is that slipping fentanyl into another kind of illegal drug can increase the high buyers get from using it, and mixing in fentanyl also lets dealers stretch out their supply of the far more expensive drugs — say, heroin — that they’re selling.

NOT ALL FENTANYL IS CREATED EQUAL

Fentanyl made in clandestine labs can vary batch-by-batch, Lee said. It can be weak or very strong and can even have other fentanyl-relatives including carfentanil — an elephant tranquilizer that’s 10,000 times stronger than morphine — mixed in. Some officials have openly wondered if this week’s rash of Southwestern Ontario overdoses, both fatal and non-fatal, may be linked by a “toxic” batch of fentanyl hitting the region.

THE RASH OF RECENT LOCAL OVERDOSES

Police and public health officials believe at least three of the five suspected overdose deaths in London over the past six days involved fentanyl, but the final coroner’s department reports will take months. Though it’s not yet possible to pinpoint what’s driving the string of deadly overdoses, Lee said the recovering drug users encountered through his work at the addiction medicine clinic have some insight. “What I’ve heard from users is that there’s some potent fentanyl out there right now,” Lee said. “There must be some new supply that’s come in that’s more potent than what people are used to.”