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Fentanyl, overdoses, and the Fairview neighbourhood

March 12, 2015

idyllic-syringe

At least 29 of the overdose deaths in Vancouver from street drugs in 2014 have been linked to the increasingly common practice, on the part of some drug dealers, of cutting street drugs with fentanyl, a ridiculously potent synthetic opioid.

Vancouver police say they are finding fentanyl mixed into most if not all drugs that can be found on the street: heroin, cocaine, Oxycodone and even marijuana.

Health officials and police are especially concerned how fentanyl adulteration increases the risk of overdose for casual and recreational users of street drugs, because this group of users has nowhere near the tolerance to opioids that serious drug addicts build up.

When officials talk about recreational drug users, they don’t mean the drug addicts living in the Downtown Eastside or among the homeless population, they mean the regular folk, young and old, who far outnumber the addicts and live all over Vancouver.

To warn these users, the Vancouver Police, in conjunction with provincial health authorities, have launched a six-month fentanyl education campaign which includes both Facebook ads and a website called Know Your Source?

Fentanyl: a cut above other narcotics

Fentanyl is a synthetic opioid painkiller widely used in clinical practice as both an anesthetic and to manage chronic pain (usually in the form of a patch). It is fast-acting and much more powerful than natural opiods — maybe 100 times more potent than morphine and up to 20 times more potent than heroin.

It’s also odourless and tasteless, making it undetectable when it’s used as a filler to cut street drugs.

Earlier in March, B.C. Coroners’ Service data was widely publicized showing that fentanyl was a likely contributing factor in perhaps a quarter of the 300 illicit drug overdose deaths in British Columbia in 2014. And as a I mentioned at the top, in 29 overdose deaths in Vancouver.

Overdoses even seem to be more common on my side of False Creek — the south side, which is a distance removed from the Downtown Eastside.

I personally know of two overdoses in the Fairview neigbourhood within the space of the last week; well, one I’m almost certain was a methadone overdose in a Fairview McDonald’s and the other definitely was a heroin overdose in a Fairview back alley — heroin laced with fentanyl, I was told.

“I stopped breathing man!”

Two days ago this other binner in a Fairview back alley, homeless like myself, asked me what time it was, adding, seemingly apropos of nothing, that it sucked to lose your backpack.

Indeed.

It developed that during the previous evening, when paramedics had rushed him to a hospital, they had left his backpack behind in his shopping cart.

“Were you in medical distress or simply passed out?” I asked him, assuming he had been drunk.

“I stopped breathing man!” he declared emphatically before launching into a recitation of the controlled substances he had consumed, leading up to his doing a point (of heroin).

Next thing he knew, he said, he opened his eyes to the sight of a young kid (a paramedic) telling him that he’d stopped breathing.

He told me that he’d been told that the heroin had been laced with fentanyl.

A wake up call for the South Granville area

ambulance-responders-02

Last Friday, March 6, in the late afternoon, B.C. Ambulance Service paramedics were called to the McDonald’s in the 1400 block of West Broadway Avenue to attend to a man who couldn’t be woken up.

When I first noticed the man sitting towards the back of the sparsely occupied restaurant I was startled by the sight of him. He was sitting up but leaning far to his right side and his head wasn’t being held up by his neck, it was being held up by the back of a chair that someone had thoughtfully arranged for that purpose.

I went over to him and could see that he was clearly unconscious but that he was definitely breathing.

He had seemingly just nodded off at his table halfway through sipping his smoothie; his two cheeseburgers and one apple pie sat untouched in their boxes. His cowboy hat was sitting on the table; presumably placed their by the person who had positioned the back of the chair under his lolling head (unless he was the well-mannered sort who took off his hat before eating).

I went to the counter and asked a store manager what was going on and they explained that they had tried but that they couldn’t wake the fellow up. There was little concern though; the man was a regular customer who had fallen asleep in the restaurant several times in the past.

It was okay, the manager explained to me, the man was snoring.

It wasn’t okay I explained to the manager, not if they couldn’t wake him up. I asked her to please call an ambulance right away and she did.

Three of the other customers in the restaurant were also becoming very concerned about the man and one of them called 911.

Over the phone, an emergency operator asked the McDonald’s manager to double check the fellow’s breathing which she did and from then until the ambulance arrived I gently held the fellow’s head in an upright position.

I had time to reflect on his haircut and his cleanliness as well as the quality of both his tanned leather jacket and his cowboy hat (he certainly wasn’t living rough on the streets). I noted that he wasn’t snoring anymore and that his breathing was obvious but shallow and while he wasn’t ice cold to the touch he wasn’t particularly warm either and his face had a waxy, washed-out look to it.

And then a paramedic was by my side, reaching for the man’s head and two more paramedics were behind him.

In less than ten minutes the man was conscious enough to talk to the paramedics. He managed to tell them his name at least. And as the paramedics discussed his treatment the word “methadone” occurred at least once.

Ultimately the fellow was packed onto a stretcher and taken by ambulance to St. Paul’s Hospital in downtown Vancouver.

The paramedics were so calm that the incident hardly presented as the emergency.

Had the man suffered a methadone overdose? Some intravenous drug users I spoke to later said that it certainly sounded like he had.

He displayed many of the early signs of an overdose as listed on the Know Your Source? fentanyl awareness website:

  • Severe sleepiness
  • Slow heartbeat
  • Trouble breathing
  • Slow, shallow breathing or snoring
  • Cold, clammy skin
  • Trouble walking or talking

I later went over each of these early overdose signs with the McDonald’s manager who had been working on the Friday.

She was surprised that a drug overdose could look so benign; probably she expected blood and convulsions and perhaps foaming at the mouth but snoring? She had no idea.

To her, drug addiction and overdoses are other people’s problems, other neighbourhoods problems.

Not just a Downtown Eastside thing anymore

The McDonald’s in the 1400 bock of West Broadway Avenue is in a fairly prosperous part of Vancouver called Fairview.

Fairview also happens to be patronized by many street people attracted by the prosperity. There are panhandlers based in the area who are supporting heroin or crack cocaine drug habits and there is a steady stream of people commuting back and forth each day from the Downtown Eastside, some to panhandle, a few to try boosting things from the stores along South Granville Street, but mostly to bin and dumpster dive in the back alleys of the surrounding neighbourhood.

Another thing that draws drug addiction into neighbourhoods like Fairview are the new social housing towers popping up across the city. These are filled according to the inclusive Housing First philosophy, which says that drug addiction shouldn’t be a barrier to getting off the street.

And hardcore drug addicts and Downtown Eastside types aside, Fairview (like all of Vancouver’s neighbourhoods) has more than its share of the kind of casual and recreational street drug users that authorities say are at particular risk of fentanyl-related overdoses.

On a pleasant evening in the Fairview neighbourhood, there’s nothing uncommon about the sight and smell of marijuana use.

I would expect that for police and health officials, the worst-case scenario would have to be these sorts of casual marijuana users getting a batch of weed laced with fentanyl. That such users could unwittingly expose themselves to the head punch of a super-strong opioid just by smoking a joint is…so wrong.

Where people come to meet, eat and get off the street

If it’s true that Fairview has it’s own live-in casual street drug users and additionally plays host to plenty of visiting drug addicts from the Downtown Eastside then it equally true that the McDonald’s restaurants in the Fairview neighbourhood are a kind of crossroads for all of these people, young and old, rich and poor.

The same could probably be said of other McDonald’s locations and other popular fast food chain locations across Vancouver.

It’s time therefore for McDonald’s etc. to train all store managers to recognize the basic signs of a drug overdose and set down a clearly understood protocol to follow if those managers, or their staff, see these signs in a customer — such a protocol could be a simple as promptly calling 911.

This represents the simplest bit of education, with perhaps a reminder list taped up in a prominent place. It needn’t cost a dime to implement.

McDonald’s could start with the locations in the Fairview and Kitsilano neighbourhoods and up in UBC, which are conveniently all owned by the same franchisee and seem to share the same staff.

Got naloxone?

A TorontoHealth naloxone

A naloxone anti-opioid overdose kit distributed by Toronto Public Health.

Also I would like to see the South Granville Business Improvement Association participate in the Take Home Naloxone (THN) Program.

Naloxone is super-easy-to-administer medication that almost magically reverses the effects of an opioid overdose and, given the number of heroin addicts regularly panhandling on South Granville Street, I think it makes good sense for the two South Granville BIA Concierge/security guards to carry and be able to administer Naloxone, especially since both of the guards, I’m sorry, both Concierges, now have their first aid training.

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