While scholars debate where “first do no harm” originated, most people associate it with the medical profession. But what happens when medical professionals do one thing to “first do no harm” that has ramifications far beyond what they could ever have predicted? Such is the case with fentanyl.

OxyContin, First Drug of Choice

In the last decade, OxyContin became the drug of choice for many, and the effects of this drug were horrific. There was widespread abuse and addiction, and many users turned to crime to feed their habit. OxyContin was originally designed to be a slow-release pain relief tablet, but users quickly found that if they crushed the tablet, the effects were immediate and the rush that users experienced was very similar to heroin.

But heroin has a reputation for being a street drug, whereas OxyContin is available by prescription, so many users figured it was safer. But the public outcry around the abuse of OxyContin continued and eventually, the pharmaceutical companies listened, partly because pharmacies were regularly being robbed, even when they posted signs claiming they had no OxyContin on site. In March 2012, OxyContin was pulled from pharmacy shelves. The crushable pill was replaced by a tamper-proof painkiller called OxyNeo, designed specifically to discourage misuse.

But here is where the unintended consequences come in. There was no plan in place to ramp up treatment for those addicted to OxyContin, leaving dealers with a large and lucrative pool of people who desperately needed something. And so the current crisis was born.

Fentanyl More Potent Than OxyContin

In 2011 there were 6 fentanyl deaths in Alberta; in 2012 there were 29; in 2013 the number rose to 66, and then 213 in 2014. In the first six months of 2015, there were already 145 deaths, with police predicting the number could reach 300 by year’s end.

But why so many deaths? Fentanyl is the most potent opioid available by prescription, but that’s not what is on the streets. Instead “green beans,” “shady eighties” or “fake oxy,” as it is known, is made in backroom labs with no controls, overdosage or contents. Real fentanyl can be lethal in very small amounts; an overdose shuts off oxygen to the brain and heart, killing the user in minutes. With backroom fentanyl users have no idea what they are actually taking. And, according to police, the drug is now as easy to get as pot.

Drug Use and Abuse

There is a need for a shift in how we think about drug use and abuse. From the controversies surrounding safe injection sites to providing free methadone to opiate abusers, there is a long-held belief that addiction is a character flaw or a choice. We think of it as a criminal matter rather than a health matter.

Health officials know that naloxone reverses the effects of opioid overdoses and saves lives. It’s an injection that revives users when fentanyl cuts off oxygen to the brain and heart, allowing them to live. Currently, naloxone is available in emergency rooms and for use by paramedics, but health officials recommend that naloxone be put into the hands of users, their friends and their families so that the next overdose doesn’t have to end in tragedy. This has not happened yet in Alberta.

In other provinces where the antidote has been widely available, deaths caused by fentanyl overdose are decreasing, whereas in Alberta they are increasing. Perhaps it’s time to rethink our province’s drug policy. Perhaps it’s time to do no more harm.

Shelley L Magnusson

Executive Staff Officer, The Alberta Teachers’ Association