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Changing the face of addiction Fentanyl forces doctors to rethink addictions strategy Wednesday March 2 2016 15 HEALTH WELLNESS ADDICTION By CRAIG GILBERT For the past five years Yellowknife family practi- tioner Dr. Jennifer Harris has been one of a handful of doctors providing addic- tions medicine management services including the pre- scription of methadone or suboxone for people strug- gling with an addiction to an opioid like heroin or oxycodone. The new kid on the block is so powerful however it has prompted Harris and her colleagues to alter their approach. Synthetic opioid pain- killer fentanyl which is about 100 times as strong and therefore more toxic than its naturally occur- ring cousin morphine has altered the way she and other Yellowknife doctors approach treatment. The influx of fentanyl sort of changed the nature of opioid addiction in Yellow- knife she told the Journal. Prior to that it was more of a prescription-based type of addiction and we werent treating too many people. I would say a year or two ago with that influx we also saw an increase in requests to see physicians to provide opioid mainte- nance therapy. Initially it looked to Har- ris like those getting hooked on fentanyl were mostly from the 20-something crowd but use has spread to all age groups. Now I would say its kind of inltrated all of the peo- ple who are struggling with addictions she said. Most people who are struggling will end up trying lots of dierent things as they try to manage their demons. I have patients who used to have alcohol as their pri- mary issue but with the in- ux of fentanyl that turned into an opioid addiction. I would say people who have longstanding alcoholism end up using lots of substances in their episodes of intoxica- tion so they end up trying everything. Clinically fentanyl is available as a skin patch lozenge pills shots a film that dissolves in your mouth nasal spray or by IV intravenous and is intended for severe pain management for example for people suffering from chronic pain or undergo- ing cancer treatment. On the street in Yellowknife it is sold primarily as pills referred to as greenies or fake Oxys. People who are strug- gling with cocaine addic- tion would use them as a downer Harris explained. Generally most people have their drug of choice but Ive found with the fen- tanyl it has created more opioid-specific addiction versus trying it once or twice because of the nature of what it is. It has this fast onset and a short duration so its like the difference be- tween cocaine and the more addictive crack. It tends to push people more into the behavioural aspects of addiction because theyre Continued from Page 1. NWT chief coroner Cathy Menard told the Journal to date in 2015 there has been one overdose death where fentanyl and another drug were in the deceaseds sys- tem. In 2014 fentanyl was blamed directly for one fatal overdose in the NWT. By comparison 272 peo- ple were killed in fentanyl- related overdoses in Alberta in 2015 prompting the NDP government to make nalox- one more accessible to emer- gency workers and easier to administer for healthcare professionals like nurses. They also allow Albertans to take free naloxone kits home from a pharmacy with a pre- scription from their doctor or a participating pharma- cist so friends or loved ones will have them at-hand if they overdose. By the time Mounties seized fentanyl in Yellowknife for the rst time in the spring of 2014 the next-generation painkiller was well-estab- lished in the capital reshap- ing the drug scene in a way not yet seen in the Northwest Territories. chasing their next high and going into withdrawal more severely because fentanyl is so strong. For the same reason the drug is incredibly danger- ous to use. Overdoses can occur when just a few grains of fentanyl are contained in a pill. There is a variety of dif- ferent ones on the street de- pending on the batches that come through Harris said. There is heroin in them hydromorphone a variety of opioid and non-opioid substances in them. I think at times there might be co- caine in them. Certainly for somebody who thinks they are getting an oxycodone fentanyl is much much stronger so if their body has no tolerance to that level its very dangerous for them to take it. For the same reason it is harder to treat with opioid addiction therapies. What youre doing is re- placing the opioid but when your tolerance is driven up that much its hard to help people settle out on doses of methadone and suboxone she said. So Im finding it more diffi- cult to treat people with a fentanyl addiction but its not impossible. We do get new requests for treat- ment regularly so it has been well-received. What I was able to do be- forejustaspartofmypractice I found became harder in terms of numbers and stabi- lization Harris said. Cer- tainly that kind of correlated to fentanyl arriving in the city which I think was one of the primary reasons we got thisprogramupandrunning. In the last two years most people say their primary issue is the street fentanyl. Now about two months old the official opioid main- tenance therapy program run through Yellowknife Health and Social Services offers other facets of treat- ment including counselling and crisis management. Its a more standardized approach that hopefully is more accessible. HEALTH WELLNESS ADDICTION Less pan-NWT data Evidenceofthedrugsprev- alence elsewhere in the terri- tory is harder to come by. The GNWTdepartmentofHealth RCMP and chief coroners oce each told the Journal digging down into incidents of emergency room admis- sion overdoses or deaths or criminal charges directly related to fentanyl would be time-intensive. For example an officer may record that a person was charged with possession of fentanyl or write simply that they issued a generic Con- trolled Substances Act in- fraction. To conrm whether it was fentanyl they were ac- cused of carrying an ocer would have to open every drug charge le and check it manually. Likewise for toxicity results from Stan- ton Hospitals emergency department. Media relations officer Constable Elanore Sturko said the RCMP has made several seizures of personal amounts of fentanyl and has also laid trafficking charges against at least four people in Yellowknife since 2014 including William Castro who was charged with co- caine and fentanyl traf- ficking after police seized nearly 600 counterfeit Oxy- contin pills and other drugs in April 2015. He was sen- tenced to six years in prison on Dec. 21. The inux of fentanyl sort of changed the nature of opioid addiction in Yellowknife. Prior to that it was more of a prescription-based type of addiction. Dr. Jennifer Harris By the time Mounties seized fentanyl in Yellowknife for the rst time in the spring of 2014 the next-generation painkiller was well-established in the capital.