DDN June 2017 DDN July2017 - Page 9

For information and resources: www.drinkanddrugsnews.com Illegal drug overdose deaths in British Columbia Source: Office of the Provincial Health Officer BC All overdose deaths Fentanyl related to end up as a component in another drug, usually heroin. This may be in the form of typical brown heroin, with fentanyl added to make it feel more potent. Fentanyl is sometimes referred to as ‘synthetic heroin’ or ‘China white’. It is therefore essential to stress that buyers offered ‘white heroin’ or ‘China white’ are at present very likely to be getting fentanyl rather than old-school white heroin. People seeking heroin are clearly the group most at risk of encountering fentanyls. However, they have cropped up in place of other products including benzodiazepines and stimulants such as MDMA or cocaine in the UK and Europe, and sold internationally mixed with crack cocaine. Becoming more widespread could impact not solely on heroin users, but people using any white powder drug – populations that are likely to be harder to reach with harm-reduction messages and less likely to have naloxone at point of overdose. Issuing warnings about fentanyls is a finely balanced judgement call, as premature warnings about ‘dangerous drugs’ can be counterproductive. On the one hand, they raise awareness and highlight the dangers; on the other, they risk publicising a high- strength, low-cost alternative to street heroin and can make it a sought-after product. However, the string of deaths in the north of England, more frequent reports from around the UK and increased police seizures have acted as a catalyst for the NCA and PHE to issue alerts about fentanyls. This has triggered a flurry of articles in the mainstream media, so the cat is well and truly out of the bag. This still doesn’t mean that fentanyls are widespread or have penetrated the market at all levels. We need to try and develop locally relevant messages that don’t inadvertently promote fentanyl: references to ‘super strong’ or ‘high streng th’ are probably phrases to avoid. Fentanyls need to be bulked out with a non-psychoactive filler agent, such as mannitol... Such mixing is at best prone to errors. When fentanyl is mixed with more granular substances, such as brown heroin, it is impossible to achieve a thorough mix, and so the risk of separation and ‘hot-spots’ is high. room provision is being expanded in Canada. Such measures are long overdue in the UK and in the context of escalating deaths in the UK and the advent of fentanyls, similar measures are required here. There’s no evidence that harsher legal sanctions for adding fentanyl to heroin will deter suppliers. However, fear of police action may mean that suppliers holding fentanyl supplies try to offload stock quickly, with the risk that the drug will crop up in a more random fashion. Ultimately, such measures are of course sticking plasters. We keep seeing the evidence that prohibition begets increasingly dangerous substances. The long- term solution is drug legislation reform, but until this happens we are obliged to wait for the next alert to flash up as a new, more potent substance enters the drug stream. Kevin Flemen runs the drugs education and training initiative, KFx. Visit www.kfx.org.uk for free resources. Harm reduction While all use of street opiates brings a risk of overdose, the potency and variability of fentanyls bring an unparalleled level of risk. Scattergun warnings can reduce their credibility, and so assessing what is going on locally is important: • Engage with people who are using to determine what is being offered, and if ‘white heroin’ or other potential fentanyl-laced products are appearing on the market. • Make bulletins up to date and locally relevant. • Ensure that facts are established before cascading information by developing a local drugs warning protocol in conjunction with user groups, police and public health. ‘Fentanyl=death’ messages are inadequate as, without access to licit compounds, people will still access the street market and so harm reduction is also essential. Core opiate harm reduction messages remain relevant, and need to be re-stressed: • Smoking represents the lowest risk of fatal overdose and this should be emphasised, alongside provision of foil. • Overdose risk increases when opiates are used alongside alcohol or other sedating drugs including benzodiazepines, z-drugs or gabapentin/pregabalin. • Sampling batches before use and injecting slowly can reduce risk. • Fentanyl overdoses can reportedly be very rapid. • Use with company who can respond in the event of an emergency; if using together don’t all use at the same time. • Ensure availability of naloxone and a phone that works. WHERE NEXT? • It is imperative that an ambulance is called in the event of an OD. We need to look urgently at the experience of North America, especially Canada, in the face of escalating fentanyl use. Experience in terms of detection, first response and educative messages will be invaluable. In response to rising fatalities, drug consumption • OD may require larger doses of naloxone than a heroin OD and distributors may need to review training and the number of kits distributed if fentanyl is a local issue. www.drinkanddrugsnews.com • Encourage retention and submission of samples post OD for analysis. June 2017 | drinkanddrugsnews | 9