Fentanyl is a powerful synthetic opioid that is similar to or could be compared to morphine. However, the potency of fentanyl is 50 to 100 times more potent, hence the opioid epidemic in Canada since 2016. Yet, it is the illegally manufactured fentanyl that is causing the ongoing surge in opioid-related deaths. Prescription fentanyl is different and produced legally but is also abused illegally for its euphoric effects. Like any other opioid, fentanyl causes tolerance, dependence, withdrawal symptoms, and addiction. Synthetic drugs like fentanyl are the most common drugs involved in overdose deaths in Canada.
According to Health Canada, during the first nine months of 2018, 3,286 Canadians lost their lives to apparent opioid-related overdoses. The data also shows that fentanyl and other fentanyl-related substances continue to be a major driver of the opioid crisis. From January 2018 to September 2018, approximately 73% of accidental opioid-related deaths involved fentanyl or fentanyl-related substances. Illegal fentanyl is smuggled into Canada from China.
How Does Fentanyl Affect the Body and Mind, and How is it Used?
Like morphine, heroin, and other opioids, fentanyl binds to the body's opioid receptors found in the area of the brain that controls pain and emotions. After using fentanyl, the brain adapts to the drug, diminishing sensitivity and making it harder to feel pleasure from anything but the drug. Prescription fentanyl is used to treat acute and chronic pain. Pain is one of the most common reasons for seeking health care in Canada. Prescribers commonly used prescription opioids as one of several approaches for addressing pain. According to the Canadian Centre on Substance Use and Addiction, a 2017 report found that between 2015 and 2016, about one of every seven people in Ontario, filled an opioid prescription. In Canada in 2018, almost one in eight people were prescribed opioids.
The purpose of the body's natural opioids is to trigger feelings in the body of relaxation and well-being. Opioids control the pleasure and reward center of the brain by producing dopamine throughout the body. However, fentanyl triggers these reactions at a much more intense rate and produces unnatural levels. Fentanyl affects the brain and body by creating extreme happiness, drowsiness, nausea, confusion, sedation, problems breathing, and unconsciousness.
Additionally, fentanyl is an addictive drug, whether it is a pharmaceutical grade or illegally manufactured fentanyl. The short-term and long-term use of fentanyl causes tolerance, dependence, withdrawal symptoms, and addiction. Finding treatment for fentanyl abuse is essential, and this may include medical detox, residential treatment, and aftercare support.
What are the Street Names and Legal Status of Fentanyl in Canada?
Illegal fentanyl is sold as a powder, dropped on blotter paper-like candies, in eye droppers or nasal sprays, or made into pills that look like real prescription opioids. The high potency of illegal fentanyl increases the risk of overdose, especially if a person who uses drugs is unaware that a powder or pill contains it. The illegal drug supply in Canada is being contaminated with fentanyl and other fentanyl analogs like carfentanil. Most street fentanyl found in Canada is produced illegally as a powder, and street fentanyl could be smoked, swallowed, snorted, or injected.
Fentanyl is only legal when a physician prescribes it. Purchasing, processing, and using fentanyl without a prescription is illegal. The Canadian government also continues to increase sanctions against people who traffic and sell fentanyl and is attempting to persecute traffickers. According to the RCMP, the possession of fentanyl without a prescription is illegal. The drugs and the precursors used to produce fentanyl are included in Schedules I to VII of the Controlled Drugs and Substances Act. Offenses range from simple possessions to possession for the purpose of trafficking, trafficking, importing, exporting, and possessions for the purpose of exporting and producing.
Some of the common street names for fentanyl include the following: apache, china girl, china town, china white, dance fever, friend, Goodfellas, great bear, he-man, king ivory, and perc-a-pop. Illegal fentanyl could be snorted, injected, swallowed, or commonly mixed with other drugs, increasing the risk of overdose. According to Health Canada, in 2016, there were more than 2,800 suspected opioid-related deaths in Canada. British Columbia has been at the forefront of the crisis, declaring a public health emergency in April of 2016. In 2016, just over half of all overdose death in Canada was associated with fentanyl or its analogs.
What Do Opioids Look Like?
HEROIN AND FENTANYL PILLS
FENTANYL LACED PILLS
FENTANYL IN POWDER FORM
The History of Fentanyl in Canada
Fentanyl was introduced more than 50 years ago and has become one of the most used opioids for analgesia purposes. Since the 1990s, the fentanyl patch has been used to treat chronic pain, and the legal pharmaceutical form of the drug has been used to treat varying levels of chronic pain. In 1959, fentanyl was first prepared and developed by Dr. Paul Janssen. The analgesic was developed to be almost 100 times stronger than morphine. In 1960, the drug was introduced as an intravenous anesthetic under the brand name Sublimaze.
Not soon after, other analogs were developed like Sufentanil, Alfentanil, Lofentanil, and Remifentanil. During the mid-1990s, the fentanyl patch was developed, and other delivery methods for fentanyl were eventually created. Overall, fentanyl is not a new drug, and it has been used for decades as a painkiller and anesthetic. As of 2021, fentanyl is a mail-order product marketed on the open internet and shipped directly to consumers and dealers in Canada and the United States. However, drug cartels still smuggle the drug in from Mexico, and much of it is made in labs in China.
Illegal fentanyl coming to Canada is coming from China, which is the key source of illicit fentanyl found in the country. Labs in China tailor custom variations of fentanyl, increasing the potency and lethality of the drug. Distributors sell the drug online with guaranteed delivery. Before the drug is shipped, it is hidden away in decoy packages, and the drug then comes into Canada through mail or courier. Larger quantities of fentanyl arrive in hidden cargo shipments, and traffickers range from organized crime to lone operators. As of 2021, police across Canada are seizing illicit fentanyl from China.
Unfortunately, much of the drug is processed in western Canada, and the white powder is cut or mixed with other drugs and fillers before it is sold. Most of the illegal labs dismantled by the police in 2013 operated in British Columbia and Alberta. Illegal drug labs dilute the drug with powdered sugar or baby powder. The drug is also mixed into other drugs like heroin or made to look like Oxycontin. Fentanyl is found across the country and is the direct cause of overdose deaths every year.
The Opioid Crisis in Canada (Including Fentanyl)
According to Health Canada, since 2016, more than 9000 apparent opioid-related deaths have occurred in the country. In 2017, approximately 11 lives were lost each day because of opioids, and the opioid crisis in Canada continues to grow. Approximately 94% of opioid-related deaths in Canada happen by accident. Young Canadians aged 15 to 23 are the fastest-growing population requiring hospital care from opioid overdoses. Drug and alcohol rehabilitation centers across the country routinely manage and treat people struggling with opioid addiction like fentanyl.
Addiction problems involving opioids in Canada begin with prescription opioids or illegal opioids. The street drugs found in Canada have been tainted with powerful opioids like fentanyl. Fake pills are being produced using unknown amounts of fentanyl, and other illegal drugs are produced on surfaces and equipment contaminated with fentanyl. Within Canada, illegal drugs with fentanyl in them are causing most of the opioid-related harm. One of the contributing factors to the current crisis has been the growth in the use of opioids for medical treatment.
During the mid-2000s, the rates of prescription high-dose opioid dispensing began to rise significantly in Canada. Unfortunately, prescription opioid use fueled the addiction problems during this time. According to Health Canada, Canadians are the 2nd highest per capita consumers of opioids in the world after the United States. The number of times fentanyl or an analog has been identified in samples by law enforcement has increased by more than 2000% since 2012. From 2016 to 2017, the number of deaths due to fentanyl more than doubled.
British Columbia has been impacted the most, yet communities across the country have felt the effects. The problem has impacted inner cities, suburbs and northern and rural communities, and First Nations communities across the country. Municipalities and local public health officials are all working on a solution to help each community. As of 2021, Canada's Government continues to take new approaches to address the crisis, public health considerations, and public safety.
The Long-Term and Short-Term Effects of Fentanyl and Related Health Risks
According to Health Canada, fentanyl is 20 to 40 times more potent than heroin and 100 times more potent than morphine. The risk of overdose along with long-term and short-term effects is high. The drug is odorless and tasteless and is mixed with other drugs. The risk of overdose increases with fentanyl mixed with alcohol, benzodiazepines, and heroin. Fentanyl leads to various short-term and long-term effects.
The short-term mental effects include the following:
- Being in and out of consciousness
The short-term physical effects are:
- Slow breathing
- Nausea and vomiting
- Constricted pupils
- Hot sensation of the skin
Unfortunately, life-threatening effects can occur within a couple of minutes of use, and in most cases, a person does not realize what they are taking until it is too late. The long-term mental effects include substance use disorders, depression and suicidal thoughts, and impulsive behavior. Long-term fentanyl use also leads to constipation, addiction, sexual problems, poor nutrition, and weight loss. Injecting fentanyl and sharing drug equipment leads to skin soars, HIV, hepatitis B, and hepatitis C.
Fentanyl use also leads to addiction because of its potency and addictive nature as any other opioid. Even prescription fentanyl has the potential to lead to addiction. Like any other addiction, someone addicted to fentanyl will continue to use the drug despite the consequences. However, some people may become dependent on fentanyl because of a prescription, while others become addicted through substance abuse.
There is no safe level of drug use, and fentanyl affects everyone differently based on size, weight, health, past use, whether other drugs are used, the amount that is taken, and the strength of the drug. Also, fentanyl affects everyone differently, and generally, it causes euphoria, reduced appetite, drowsiness, weakness, headaches, slow pulse and lowered blood pressure, and incoherent or slurred speech.
Fentanyl Overdose and Opioid Overdose Trends in Canada
Fentanyl overdose occurs frequently, and an overdose occurs when fentanyl produces serious adverse effects and life-threatening symptoms. Someone who overdoses on fentanyl experiences slowed breathing, or it may stop. When the brain experiences a decrease in oxygen, it is a condition called hypoxia, and this leads to coma and permanent brain damage or even death. Much of the illegal fentanyl sold in Canada is mixed with other drugs like cocaine, heroin, and MDMA.
Fentanyl is believed to act as an opioid agonist, which means it attaches to neurons in the central nervous system that regulates pain. The drug is considered to be a central nervous system depressant and slows down brain function and the central nervous system. The slowing brain function impacts the rest of the body, causing problems like a respiratory failure. A lethal dose of fentanyl is generally stated to be two milligrams. This dose would be lethal for someone who does not have a tolerance to fentanyl and even someone who does have a tolerance.
To add perspective, a lethal dose of morphine would be 200 milligrams, whereas a lethal dose of heroin is between 75 and 375 milligrams. A lethal dose of hydrocodone is around 90 milligrams, and a single dose of 40-milligram oxycodone may produce lethal effects in some individuals. Across Canada, fatal and non-fatal overdoses could potentially result in short-term and long-term damage. The chronic abuse of fentanyl drastically increases the risk of overdose.
According to Health Canada, the signs of a fentanyl overdose involves the individual being unresponsive, slow, shallow breathing, gurgling sounds or snoring, cold, clammy, or bluish skin, and severe sleepiness or loss of consciousness. If you suspect someone is having an overdose, it is important to call 911 immediately. Fentanyl overdose occurs across the country and affects every community. According to Canada's Public Health Agency, more than 10,300 Canadians lost their lives to apparent opioid toxicity between January 2026 and September 2018.
In 2016, more than 2,800 suspected opioid-related deaths in Canada, and many of these deaths were associated with fentanyl use. According to numbers recorded by Statista, there were 995 opioid overdose deaths in British Columbia in 2019. Within Ontario, the number of opioid overdose deaths reached 1,535, and in Alberta, it was 639 in 2019. Throughout the Maritimes, overdose deaths totaled over 100 among all Maritime provinces.
According to Canada's Public Health Infobase, approximately 75% of accidental apparent opioid toxicity deaths involved fentanyl in 2020. The majority of the fentanyl detected in opioid toxicity deaths was non-pharmaceutical. Also, approximately 85% of accidental apparent opioid toxicity deaths from January to June 2020 involved non-pharmaceutical opioids.
How Does Fentanyl Addiction Occur?
Fentanyl addiction could occur the same way as any other addiction. There are numerous reasons why someone becomes addicted to fentanyl and other opioids. Fentanyl is abused by fentanyl patches, powders, pills, intravenous use, and nasal spray. Some may become addicted to fentanyl because of a prescription that is taken too long or misused. Other reasons for addiction involve work stress, family stress, personal injury, and struggling with emotional or physical abuse.
There are physical and behavioral signs of addiction. The physical symptoms of fentanyl abuse depend on how long individuals have been using the drug and how much of the drug they have been taking. Some of the symptoms include injection track marks, poor dental health, poor hygiene, excessive weight loss, confusion, and dilated pupils. Fentanyl is a psychoactive drug and changes the chemistry of the brain leading to tolerance, dependence, withdrawal, and addiction. Typical behavioral symptoms include drug-seeking behavior, intense cravings, depression, anxiety, irritability, and social isolation.
Someone struggling with addiction also battles chronic relapse, which is a common issue for someone addicted to opioids. Stigma is another reason why the rates of substance use problems may be higher than some studies suggest. The stigma connected to addiction also affects families of people with addiction. According to the National Institute on Drug Abuse, addiction leads to compulsive drug use despite harmful consequences. It is characterized by an inability to stop using fentanyl, failing to meet work, family, and social responsibilities, and developing tolerance and withdrawal symptoms.
Fentanyl Addiction Treatment in Canada
No single treatment is appropriate for everyone, and treatment needs to be readily available. According to the National Institute on Drug Abuse, effective treatment attends to multiple needs of the individual, not just his or her drug abuse. Typically, for fentanyl addicts or any opioid addiction, a medical detox or withdrawal management is required. The purpose of medical detox is to ease withdrawal symptoms and manage a smooth transition into treatment. Generally, medication is administered to control withdrawal pain under proper medical supervision.
Opioid withdrawal usually begins within 12 to 30 hours of the last dose, and the withdrawal symptoms likely peak within the first few days and usually level off within a week. Some of the common withdrawal symptoms include yawning, sweating, restlessness, runny nose, chills, stomach cramps, muscle weakness, nausea, vomiting, elevated heart rate, hypertension, insomnia, and anxiety. These symptoms are managed in detox under proper medical supervision.
However, detox should not be considered the only approach to treatment because it will not provide adequate counselling or therapy. Following detox, the next phase of treatment involves attending inpatient or outpatient rehabilitation. Residential treatment is usually the better choice because more counselling and therapy services are provided to help the addict and their family. NIDA points out that behavioural therapies are some of the most effective options. These therapies are also incorporated with holistic treatment, 12-step facilitation, or non-traditional approaches.
However, some of the common therapies include cognitive behavioural therapy, contingency management, motivational enhancement therapy, and family behaviour therapy. Yet, a standard approach used to treat opioid addiction is a community reinforcement approach. This method of treatment aims to maintain abstinence long enough for patients to learn new life skills to help sustain sobriety. The process involves different counselling techniques focusing on improving family relationships, learning skills to minimize drug use, receiving vocational counselling, and developing new recreational activities and social networks.
It is also recommended to follow through with aftercare support, especially after long-term treatment. Aftercare support would include peer support groups, 12-step meetings, or even faith-based support groups. Sober living homes are also an excellent option because of the strong community and remaining connected to other sober people. Aftercare support can last as long as needed, and it significantly improves an individual's ability to maintain sobriety and a drug or alcohol-free life.
Fentanyl Addiction Statistics in Canada
According to the Canadian Centre on Substance Use and Addiction report mentioned earlier, in 2017, opioid pain medication was used by an estimated 11.8% of the Canadian population. Within this percentage are a number of people that are using fentanyl. Among the Canadians that used opioid pain medication in 2017, roughly 3% reported using them for non-medical purposes. Also, during 2017, the rate of hospitalizations due to opioid poisoning increased with an average of 17 hospitalizations per day. Between January 2016 and December 2019, there were at least 15,393 opioid-related deaths in Canada, with the number of deaths occurring in 2018.
Additionally, the rate of emergency department visits for opioid poisoning has doubled for younger adults aged 25 to 44, which was the largest increase among any other age group. The 2017 Canadian Guideline for Opioid Therapy and Chronic Non-Cancer Pain, as cited in this report, indicates that opioids are associated with a 5.5% risk of addiction. Per the 2017 Canadian Tobacco, Alcohol, and Drugs Survey as cited in this report, the prevalence of past-year use of opioid pain medication among the general population was 11.8%. In 2018, it was approximately 12.7% of Canadians were using opioid pain medication.
Among youth aged 15 to 19, approximately 8.4% had used opioids, and among young adults aged 20 to 24, approximately 12% were using opioids. The prevalence of opioid pain medication use among Canadian adults aged 25 and over was 12.1% in 2017. Also, among older adults aged 65 and over, it was 11.3%. Across Canada, the First Nation Communities were some of the hardest hit, and 24.9% reported use of a prescription opioid in the past year between 2015 and 2016. Unfortunately, prescription opioids represent the most frequently used substance relative to any other substance measured in the survey. Overall, among the general population, approximately 2.9% of Canadians reports using opioids for non-medical reasons.
According to the Public Health Infobase of Canada report mentioned above, between 2016 and June 2020, there were 17,602 apparent opioid toxicity deaths. Between April and June of 2020, there were 1,628 opioid deaths, and this was the highest quarterly count since 2016. Western Canada continues to be the hardest hit region of Canada. Individuals between 30 and 39 years old accounted for the higher proportion of accidental deaths where fentanyl was involved from January to June 2020. Also, 75% of accidental apparent opioid toxicity deaths involved fentanyl in 2020. Most of the fentanyl detected in opioid toxicity deaths was non-pharmaceutical.
Common Terminology Surrounding Fentanyl
|Fentanyl||Fentanyl is a powerful synthetic opioid similar to morphine, but it is 50 to 100 times more potent. Fentanyl is found as a prescription drug but is also manufactured illegally.|
|Carfentanil||Carfentanil is a structural analog of the synthetic opioid analgesic fentanyl. The drug is legally controlled in most jurisdictions and is used in veterinary medicine.|
|Synthetic Opioid||These are substances that are synthesized in a laboratory, and the drugs act on the same target in the brain as natural opioids.|
|Pharmaceutical Fentanyl||This is a fentanyl opioid pain medication approved for treating severe pain, typically advanced cancer pain.|
|Opioid||These are a broad group of pain-relieving drugs that work by interacting with opioid receptors in the body. Opioids are made from the poppy plant and are also synthesized in a laboratory.|
|Fentanyl Transdermal Patch||Transdermal patches are another way to administer opioids through the skin. Legal fentanyl is commonly used as a transdermal patch, and illegal fentanyl is also sold as a patch.|
|Morphine Milligram Equivalent (MME)||The amount of milligrams of morphine an opioid does is equal to when prescribed. Calculating MME accounts for differences in opioid drug type and strength.|