For information and resources:
Illegal drug overdose deaths in British Columbia
Source: Office of the Provincial
Health Officer BC
All overdose deaths
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
Kevin Flemen runs the drugs education and
training initiative, KFx. Visit www.kfx.org.uk for free
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.
• Encourage retention and submission of samples post OD for analysis.
June 2017 | drinkanddrugsnews | 9