Carfentanil, COVID-19 creating deadly combination for Edmonton's opioid users

A spike in stronger-than-usual opioids on Edmonton streets, combined with a drop in the use of safe-consumption sites, has an addictions doctor braced for a significant increase of overdose deaths.

In the last week of May and first week of June, there were 16 deaths involving carfentanil, a dangerous opioid that is 100 times stronger than fentanyl. 

"It's alarming," Dr. Karine Meador told CBC Radio's Edmonton AM on Monday.

"The concern is that this is an early indicator — along with some other things that we've seen, including increased EMS calls — that in fact we are in a period of experiencing, or at least will experience, a significant increase in these deaths."

The Alberta Health Services bulletin, issued early last week, was the second one this month advising about worrying trends in opioid-related emergencies since April. It said that 14 of the deaths were in the Edmonton zone; the other two happened north of the city.

Meador, assistant director of the Royal Alexandra Hospital's inner city health and wellness program, said the COVID-19 pandemic has created an additional complication for the city's injection drug users.

Use of the city's four supervised consumption sites is down, partly because the sites themselves had to reduce capacity to comply with physical distancing guidelines, she said.

People may be steering clear of the sites or other support services — such as recovery groups or family and friends — to avoid potential exposure to COVID-19. That leaves them at a risk of relapsing or increasing their drug use, she said.

"We've been very effective in getting that messaging  across to people — including people who use drugs — that you need to isolate, you should be staying home you shouldn't be going out as much," she said.

"So they're really having to make that very difficult decision of, 'Do I risk going out and going to an SCS and being out in the public where I could be exposed to COVID? Or do I use these drugs in isolation at home?'"

Worrying statistics

In the first three months of 2020, Alberta saw 127 overdose deaths related to fentanyl, an increase from 105 in the last quarter of 2019.

Meador said that slight increase is concerning.

"We have, for the last year, seen pretty consistently those numbers coming down with some of the interventions we've done — increased access to supervised consumption sites, take-home naloxone kits, improved access to treatment and opiate agonist treatment," she said.

"So to see that number coming up is quite concerning to us."

Bulletins issued by AHS this month indicate that the upward trend is continuing in Edmonton.  

In May, there were 246 opioid-related emergencies, compared to 108 in May 2019. In the first three weeks of June, Edmonton EMS has responded to 184 opioid-related emergencies, compared to 133 for the entire month one year earlier.

April saw 676 overdose reversals — the highest number in more than a year — reported through the community-based naloxone program.

The appearance of carfentanil in the drug supply has in the past been associated with increased overdose deaths, she said. 

Most of the time, she said, people would have no idea that's what they are using.

"I would say right now people are expecting that what they're using is fentanyl or even heroin," she said. "You'll see people tend to use terms like 'dope' or 'down' to describe what they're using. ... Very few people come in and tell me 'I'm using carfentanil.' So for them it is merely accidental exposure."