Ontario health-care workers struggle to track spread of fentanyl epidemic

Ontario cities struggling to gauge how often fentanyl is killing people are working with data as much as a year old, an overdose expert says.   

Determining what killed a suspected opioid overdose victim remains a time-consuming business for coroners. Ontario Health Minister Eric Hoskins said the ministry is working with the chief coroner "to accelerate that process and to make sure he's got the resources he requires to do that work as quickly but, of course, as completely and responsibly as possible."

The chief coroner's preliminary 2015 estimate is 707 opioid-related deaths, with 203 or 29 per cent involving fentanyl.

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An opioid epidemic in B.C. has led to an emergency being declared, and there are signs of a growing problem in Ontario. On the front lines, some cities have resorted to piecing together clues themselves.

"There's a range of activity on this issue happening in communities right across Ontario. It's at a fever pitch," said Michael Parkinson, a drug strategy specialist with the Waterloo Region Crime Prevention Council.

It's important to detect hot spots of bootleg fentanyl immediately because the overdoses tend to occur in clusters, Parkinson said. But Ontario lacks a standardized system across the province to track the overdoses. 

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An early warning, Parkinson said, can come from paramedics and service providers who make judgment calls as to whether an overdose is opioid-related. Their reports can be invaluable in spotting an overdose cluster quickly, health officials say.

B.C. was able to recognize and declare an emergency in April 2016 because the province was already tracking overdoses on a regular basis, said Dr. Bonnie Henry, deputy provincial health officer in Victoria.

'Eyes and ears of public health'

Ontario has had a challenge to understand the scope of the fentanyl problem in the province in part because it was slow to collect data in a systematic way, Henry said. Federal health officials and their counterparts across the country are now talking and sharing information.

"Yes, we've started that process. I would have liked to have seen it started several months at least earlier than it did," Henry said.

When B.C. declared its public health emergency, residents started to have an important conversation about opioids in a way that removed some of the stigma surrounding drug issue, Henry said. 

It's a message that the medical officer of health in Kingston, Ont., is also trying to spread.

Those on the front lines of the fentanyl crisis need to be on the lookout for anything unusual as the drug takes the lives of teens, said Dr. Kieran Moore, associate medical officer of health for Kingston, Frontenac and Lennox & Addington Public Health.

Earlier this week, Ottawa police confirmed that pills found near the body of Chloe Kotval, 14, tested positive for the deadly opioid. 

Parents in the Ontario community of Kanata have organized meetings to get the word out among families with teens struggling with addiction. Sean O'Leary worries about his daughter overdosing because "kids are dying and they're dying before they even realize they're addicts."

"I knew on January 1st there [were] children in Kanata dying by the dozens and being brought back to life," by paramedics, O'Leary said.  

Moore called on "the eyes and ears of public health" at emergency departments, urgent care clinics and family medicine clinics to report any overdoses from narcotics, especially if the victims didn't think they were exposed to a narcotic.

For instance, someone who takes cocaine but has no tolerance to opioids could crash if exposed to contaminated drugs, Moore said, becoming rapidly unconscious and turning blue. It's one of Parkinson's clues to identify hot spots in the province. 

When a hot spot occurs, public health officials need to communicate that information to drug users immediately and increase access to naloxone antidote kits.

Backup monitoring database

"We never want to see a young child, like the 14- or 15-year-old girls in Ottawa, die from fentanyl," Moore said. "We cannot afford as a society to lose any more people to this epidemic. We have to communicate more effectively with our children, family and friends about the risk. Have an antidote available if you're going to continue to use drugs."

While frontline health-care providers are the main surveillance, Moore also turns to a backup monitoring system. He looks for signals of a rise in overdoses based on daily emergency department visits throughout much of the province.

In addition, local provincial health units can turn to weekly counts of confirmed overdoses with demographic information. Ontario feeds data into the Canadian Institutes of Health Information's system, Moore said.

As of April 1, that weekly opioid data from emergency departments will also be used to fill gaps and strengthen surveillance, said Dr. David Williams, Ontario's chief medical officer of health.

In a statement, Williams said new tools to aggregate opioid overdose information are also being developed to identify trends based on geography, demographics and opioid type, alongside monitoring of narcotic dispensing and an early-warning system for carfentanil.