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‘They’re quicker than we are’: Inside the fight against the opioid crisis

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They call it the opioid crisis: a rapid uptick in the use of both prescription and non-prescription opioid drugs across Canada and the United States.

The phenomenon began in the 1990s but has peaked in recent years with increased restrictions on prescribed opiates and the appearance of fentanyl, a powerful synthetic painkiller that’s become the street drug of choice for many.

Highly addictive, cheap to buy, and lucrative to those who sell it, fentanyl has been responsible for thousands of deaths across the country.

The death toll is staggering. Since January 2016, more than 8,000 Canadians have died of an accidental opioid overdose, according to the Public Health Agency of Canada, and most of those deaths are from fentanyl.

  • This is the third instalment in a four-part series in conjunction with the Calgary Eyeopener about how the fentanyl crisis is affecting people in the city 

In Alberta, fentanyl deaths continue to rise. Alberta Health reports that in 2016, 348 people died of accidental fentanyl poisoning. In 2017, that number had grown to 569 people, and in just the first half of 2018, 330 people had died of accidental fentanyl poisoning — around two people per day in this province alone.

Fentanyl « is a more potent formulation than what years before was out there, » said pharmacist Amy Rego, owner of Beacon Pharmacy in the Sheldon Chumir Health Centre.

The centre is also home to the city’s only supervised consumption site.

Amy Rego is the owner of Beacon Pharmacy in the Sheldon Chumir Health Centre. (David Bell/CBC)

Fentanyl doesn’t discriminate

Fentanyl doesn’t discriminate, she said; her clients who receive opioid maintenance medication range in age from 14 to their 70s.

« [The drug is] a hundred times more potent than morphine. So that in itself — we’re talking a granule. You don’t need much. The second thing is the affinity for the drug to the receptors in your brain. It’s a very high affinity. So it attaches, and the euphora. They’ve made it such that it’s highly addictive that way, » Rego said.

That highly addictive quality of fentanyl has caused an « epidemic, » according to Calgary police Staff Sgt. Kyle Grant, who works in the Strategic Enforcement Unit.

« It’s very cheap for the manufacturers to bring in and produce, and highly profitable for them to sell. It’s thousands per cent profit, versus what they put out to get it, and when you’re making that much money, I don’t think it’s ever really going away. »

A fentanyl user prepares to smoke the drug in downtown Calgary. (Elizabeth Withey/CBC)

Calgary police and the RCMP say most of the drug comes into North America via China, though some is coming up through Mexico, with a small amount being made here in labs in Canada.

China is attempting to regulate exports, but with thousands of fentanyl analogues or recipes, banning export of particular analogues is akin to banning house designs instead of banning bricks.

« The illegal supply side of this problem, they’re quicker than we are, » said MP Karen McCrimmon, parliamentary secretary for Public Safety Minister Ralph Goodale.

« They’re quicker to finding a way around things. The exporters of this product out of China, they’re pretty quick on their feet. Sometimes we’re playing catch up. »

Crackdown on pill presses, imports

The federal government has taken some action to tackle the opioid crisis in Canada.

In May 2017, it passed Bill C-37 to tighten control of pill presses, which are being used in the drug trade to press raw fentanyl powder into pill form, often after being diluted with a cutting agent such as caffeine powder or baking soda.

The federal government also gave Canada Border Services agents the power to open international mail under 30 grams,to check for drugs being imported.

Fentanyl comes in small amounts and is easy to mail.

Over a one-year period between 2017 and 2018, border agents seized 14 kilograms of fentanyl, enough for potentially 15,000 fatal doses, McCrimmon said.

The RCMP also has 130 sniffer dog teams specially trained to detect fentanyl, she added, and border services is investing in more technology to detect the drug upon arrival to Canada.

Grant said that police in Calgary are doing what they can. Border agents alert local police when a package containing fentanyl is destined for a particular city and police then follow up with the addressee.

‘Overwhelming’

« We’re on top of it as much as we can be, » he said. « The subject itself is overwhelming. But there’s never a shortage of work. »

When investigators make fentanyl drug seizures, they’re « potentially saving lives. They’re saving lives they don’t even know about. »

He added that « any seizure is a success. Because as we know and see, it only takes a portion of a pill to kill somebody, right? »

Katherine Pederson and Matthew Faulds lost their daughter Angelina (Lina) to fentanyl in 2017. (CBC)

Katherine Pederson knows all too well how deadly the drug is.

Her daughter Angelina (Lina) developed a drug problem in her early teens; Pederson and her husband Matthew Faulds tried everything to help.

In 2017 when she was 16, Lina took a fentanyl pill at a Calgary Stampede party and died.

« Lina touched every single public service and a private centre and still we lost her. So there’s something wrong with that. Like, how do you think a parent feels when they’ve done everything they can? »

Lina was among 12 case studies reviewed in a June 2018 report on youth opioid use issued by the Office of the Child and Youth Advocate of Alberta.

Angelina (Lina) Pederson was 16 when she died after taking fentanyl at a Calgary Stampede party. (Supplied)

The report highlights that youth are particularly vulnerable to the opioid crisis and require special strategies to respond to their substance use. In Alberta in 2017, 71 youth between the ages of 15 and 24 died from fentanyl, and 35 more youth died in the first half of 2018.

In May 2017, Alberta set up the Opioid Emergency Response Commission. Made up of experts from diverse backgrounds including parents and frontline workers, the commission makes recommendations on how the provincial government can combat the opioid crisis.

This summer the commission made 32 recommendations, all of which are being implemented by government.

Dr. Elaine Hyshka, co-chair of the commission, said the crisis can be resolved but it’s going to take some unconventional strategies.

« No one would say that increasing rates of overdose deaths is success by any measure, » Hyshka said, but added that the government’s quick response to the commission’s recommendations is a sign of hope.

« We’ve seen a significant amount of progress in terms of building our system capacity to respond to the crisis in a relatively short period of time. »

[Pharmaceutical companies] were certainly the kindling that set the stage, but fentanyl was the match.– Dr. Elaine Hyshka

But until accidental overdose numbers begin to significantly decline, she said, « there is more work to do. »

McCrimmon agrees the problem isn’t unsolvable — but that international cooperation with China is needed to stop the flow of the drug across international borders.

Lawsuits may be coming to help pay for the toll fentanyl is taking on the healthcare system.

In early October, the British Columbia government tabled the Opioid Damages and Health Care Costs Recovery Act — legislation to fast-track a class-action lawsuit against players in the opioid industry, including drug manufacturers, drugstore chains, distributors and wholesalers.

Hyshka supports any efforts to garner more resources for the opioid response, but said the « issue goes deeper. »

Safer alternatives

« [Pharmaceutical companies] were certainly the kindling that set the stage, but fentanyl was the match, » she said.

« At the end of the day we have to get people off the illegal market. We have to get people who are struggling — even if they’re going to use — onto safer alternatives. »

Hyshka said Alberta is keenly watching how B.C. is handling the crisis; some of the plans, she said, are « promising. »

That province is considering implementing a low-threshold hydromorphone program, she explained, which would help get people off illicit fentanyl.

« If we’re willing to think outside the box and recognize that what we’ve been doing traditionally has not been effective, then we can get on top of it but it’s going to require significant willingness to move into uncharted territory, » she said.

Many Calgary drug users are taking advantage of Safeworks, the city’s supervised consumption site where clients who use illicit substances can receive clean needles and be monitored to prevent overdoses.

Many of Beacon Pharmacy’s clients access treatment services in the Chumir and use Rego’s pharmacy to « dose, » receiving daily opioid maintenance medications such as methadone or Suboxone — putting Rego’s pharmacy at the epicentre of the epicentre.

Some clients at Beacon Pharmacy receive daily opioid maintenance medications like Suboxone. (Sally Pitt/CBC News)

The Calgary Zone continues to have the highest rate of fentanyl deaths in Alberta (20.1 per 100,000 person years, according to Alberta Health’s Opioid Response Surveillance Report from Aug. 31, 2018, compared with the provincial average of 15.1).

The work at Beacon Pharmacy isn’t for everyone.They’ve gone through numerous staff.

While it’s not what she’d envisioned when she and Rich opened the pharmacy a decade ago in 2008, Rego finds the work rewarding, especially when she fosters solid relationships with opioid users in treatment who’ve been mistreated or demeaned at other pharmacies.

Of her work she said, « It’s great the way it is. I wouldn’t have it any other way. »



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Regina Pioneer Village resident says long-term solution needed now – Regina

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Regina Pioneer Village is Saskatchewan’s largest seniors complex, but the provincially run facility has been on life support for years.

Now, one longtime resident is speaking out and hoping the province will find a permanent solution to the complex’s infrastructure problems.


READ MORE:
Regina Pioneer Village not the only long-term care facility on life support

“This used to be my home. Now, it’s just a death trap,” said Cathy Girard, a resident of the complex.

Girard moved to the facility in 2007, but over the years she says the standard of care has deteriorated.

“We have mould, we’re overrun with mice — and the shortage of staff, especially nurses, housekeepers and doctors,” Girard said.

“A lot of people are complaining that their eyes are watering, and they have breathing problems.”


READ MORE:
Almost 100 Regina Pioneer Village residents being moved due to mould

The Pioneer Village facility was built in two phases – the first in 1967 and the second in 1972. Due to its age, the building has recently been plagued with ongoing infrastructure issues including weakening brickwork and ageing plumbing and electrical systems.

Back in April, the Saskatchewan Health Authority moved around 94 residents from the facility after a report showed an excessive amount of mould.

Since then, Girard says they’ve been left with more questions than answers.

“What’s going to happen? Are we going to get a new building, or a Band-Aid solution?” Girard said.

The Saskatchewan Health Authority says remediation is currently taking place.

“We have ongoing weekly monitoring and we have air quality monitoring so we feel comfortable with the steps that we’ve taken [and] that the environment remains safe for residents to remain in it and staff to work in it at this time,” said Debbie Sinnett, executive director of ongoing care at Pioneer Village.

In 2014, a provincial report indicated the facility needed around $60 million worth of repairs, but over the past four years, the province has invested just over $8 million.


READ MORE:
Regina Pioneer Village now dealing with water line break

“Every time it rains, there are tiles falling down on people’s heads, and in the summer there’s water leaks, cracks in the ceiling, cracks in the building,” Girard said.

The Saskatchewan Health Authority says it’s working closely with the Ministry of Health to come up with a long-term solution, but Girard says the clock is ticking.

“We can’t just be waiting and sitting on our thumbs; we’ve got to have help now,” she said.

© 2018 Global News, a division of Corus Entertainment Inc.



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Ontario government says cannabis stores to be phased in

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The Ontario government says it plans to take a « phased approach » to introducing retail cannabis stores, with only a handful of licences being handed out at first.

In a statement Thursday evening, the province says it will issue up to 25 licences ahead of the first day of private retail sales on April 1.

It says the Alcohol and Gaming Commission of Ontario will implement a lottery system to determine who is eligible for the initial licences, with the results announced in January.

The province’s Tory government says it was compelled to implement the phased approach due to « severe supply shortages » being experienced by cannabis outlets across the country.

The announcement comes on the same day councillors in Torontoand Ottawa voted to allow privately operated retail stores to open within their boundaries.

The only legal way for Ontario residents to currently acquire recreational weed is through a government-run website, the Ontario Cannabis Store, which has experienced its own shortages.



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Council agrees to talks with province about TTC subway upload

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Councillors have voted to enter into discussions with Premier Doug Ford’s government about the province’s plan to take ownership of the TTC subway system, even though they registered their opposition to the plan.

At a meeting Thursday, council voted 24 to 1 to approve recommendations in a report from City Manager Chris Murray to start talks with the province on a potential “upload” of the subway to Queen’s Park.

But they also voted 23 to 2 to in favour of an amendment from Mayor John Tory to “reaffirm (council’s) support for keeping ownership of the Toronto Transit Commission in the City of Toronto.”

Council passed a similar motion in May, after the Ontario PCs floated the upload in their election platform.

In a speech to council, Tory expressed skepticism about the upload, saying the Ontario PCs have never fleshed out the plan in detail and suggesting the proposal was “a solution in search of a problem.”

The PCs say the city has a poor track record of building new lines, and the province is better positioned financially to create an efficient regional transit network.

But city staff were unable to answer questions raised by councillors Thursday about what the plan would mean for TTC service or the city’s ability to co-ordinate transit with land use planning.

I think, in the end, the best way to protect the transit system … is to go to the table and get answers to the questions,” said Tory.

Staunch opponents of the upload agreed it was best to talk with Queen’s Park, given the legislative authority the province has over the city.

“As the largest city in this country, as the economic engine of this province and country, our ability to own and operate the transit system is central to our success,” said Councillor Joe Cressy (Ward 10 Spadina-Fort York). He said he saw “zero benefit” to Ford’s government taking over the subway.

“I believe we should use absolutely every tool that we have, every tool at our disposal, to fight this. And that includes, based on our legislative framework, being at the table.”

The recommendations approved by council authorize the city manager to enter into an agreement with the province under which the city would share information about the subway system that could help facilitate the upload.

Staff are expected to report back to council early next year with an update.

In a letter to Tory last month, Ontario Transportation Minister Jeff Yurek said he wanted the city’s written commitment by no later than Thursday that it would participate in the information-sharing agreement.

The minister said the goal of the exercise is to assess the value of the subway assets, the maintenance backlog, and the operating costs of the network.

A confidential legal opinion attached to the city report warned council effectively has no legal power to prevent the upload.

The legal opinion, which was obtained by the Star, said Queen’s Park could unilaterally take ownership of the network without compensating the city financially, and even leave the municipality on the hook for the billions of dollars of debt it has accrued funding the system.

Although the city manager’s recommendations passed with almost unanimous support, some councillors vowed fierce pushback if the province actually takes concrete steps to upload the subway. Yurek has said the Ontario PC’s could introduce enabling legislation early next year.

Councillor Krystin Wong-Tam (Ward 13 Toronto Centre) called the subway the “heart and the spine” of Toronto and argued it has to remain integrated with the bus and streetcar network in order to provide quality service. She urged council to block Ford’s plans.

“I think we’re about to get into the biggest fight in this term if (Ford) is successful in taking this away from us” she said.

In a statement released Thursday evening, Yurek said he was pleased with council’s decision.

“Our government was elected to get the people of Ontario moving and we are working towards that goal,” he said. Yurek claimed that the city “is not good at planning or building subways.”

He promised to carry out talks with the city “in good faith.”

In another significant transit decision Thursday, council voted 19 to 3 to extend the King St. streetcar pilot project until July 31, 2019. City transportation staff said they needed more time to collect and report on data from the pilot, which was set to expire on December 31. Their final report is expected by March, after which council will decide whether to make the project permanent.

Ben Spurr is a Toronto-based reporter covering transportation. Reach him by email at bspurr@thestar.ca or follow him on Twitter: @BenSpurr



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