Ethical Policy and Regulations

There has been a surge in the number of fentanyl-detected overdoses in 2014 among people who use drugs in British Columbia. Provisional data indicates a constant increase in the number of fentanyl-detected overdoses over the past 3 years. A green pill, ‘fake oxy’ tablets, which resemble Oxycontin 80mg (oxycodone) have been found to contain variable amounts of fentanyl and not oxycodone. The physiological effects, symptoms and signs of fentanyl overdose are largely indistinguishable from that of heroin. This can complicate the management of overdoses in emergency settings. Emergency room physicians may find that the standard protocol dose of 0.4 – 0.8 mg of naloxone for heroin overdoses insufficient to reverse fentanyl overdoses. In such cases, in addition to investigations to rule out other potential use of other substances, larger doses of naloxone are often necessary to reverse the overdose. Take home naloxone programs are one harm reduction approach which is available in many jurisdictions in US1 and was initiated in British Columbia in 2012 and it is currently available at 62 sites throughout the province of British Columbia. Il y a eu une vague d’overdoses liées à la présence de fentanyl en 2014 parmi les personnes qui consomment des drogues en Colombie-Britannique. Des données provisoires indiquent une augmentation constante du nombre d’overdoses liées au fentanyl au cours des trois dernières années. Des comprimés verts, « fake oxy », ressemblant à des comprimés d’Oxycontin 80mg (oxycodone), ont été identifiés comme contenant des quantités variables de fentanyl et non d’oxycodone. Les effets physiologiques, signes et symptômes d’une overdose par fentanyl s’apparentent à ceux de l’héroïne. Ce tableau complexifie la gestion des overdoses en situations d’urgence. Les médecins en salles d’urgence pourraient faire face à des situations où la dose standard de naloxone (0,4 – 0,8 mg) pour overdose d’héroïne soit insuffisante pour renverser les effets d’une overdose de fentanyl. Devant pareilles situations, en plus de chercher à éliminer la présence d’autres substances, de plus grandes doses de naloxone sont souvent nécessaires pour renverser l’overdose. Les programmes de naloxone à emporter sont une approche de réduction des méfaits disponible dans plusieurs juridictions aux États-Unis1 et en Colombie-Britannique depuis 2012. Ils sont présentement disponibles dans 62 sites à travers la province. There has been a surge in the number of fentanyl-detected overdoses in 2014 among people who use drugs in British Columbia. In the first 8 months of 2014 provisional data show a total of 49 fentanyl-detected deaths were identified compared to 51 in all of 2013 and 15 in 2012. Although most cases in 2014 were reported in the more populated lower mainland of BC (18 cases in Fraser health area) and 12 in metro Vancouver); cases were reported throughout BC2. The BC Centre for Disease Control, Royal Canadian Mounted Police and Vancouver Police Department have sent out warnings to the public, people who use drugs and health care providers to raise awareness when overdoses have occurred3. Increase in Fentanyl-related death has been previously reported in the US. During the summer of 2005, multiple cities in the United States began to report outbreaks of fentanyl-associated fatalities among illicit drug users. Schumann et al4 reviewed the Cook County medical examiner findings for the 18 month period from April 1st 2005 to December 31st 2006 and identified 342 illicit fentanyl-related fatalities occurring during the study period. Fentanyl-related deaths rose dramatically between April and July 2006. Approximately 84% of the cases were men, 50.6% involved black men and most victims (70.8%) resided in the city of Chicago. In a similar study5 reported a surge in the number of fentanyl-related death in Wayne County between the period of July 2005 and May 2006. V O LU M E 6 N O . 1