Yukon doctors urge tough response to fentanyl 'crisis'

An emergency room doctor is speaking out for the first time about fentanyluse in Yukon, somethingthe territory's top doctor is calling an "opioid crisis."

Dr. Rao Tadepalli, an ERphysician at Whitehorse General Hospital,says doctors there are seeing an average of one to two fentanyl-related emergencies each week. He is raising the alarm, sayingmore needs to be done to protect Yukoners from the deadly drug.

Tadepalli's comments comein the wake of news earlier this monththat RCMP seized 535 fentanyl tablets in Whitehorse in April.

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Tadepallisays hospitalstaff are now regularly on the lookout for fentanyl overdose symptoms.

"It's akin to being a medical detective, in terms of suspecting fentanyl," he said.

"I can think of a particular situation where everybody thought it was a carbon monoxide poisoning, and it turned out to be a fentanyl overdose."

The drug, a synthetic opioidthat's 50 to 100 times stronger than morphine, is highly toxic. It can overwhelm the respiratory system and prevent breathing, leaving victims "basically comatose,"Tadepalli said.

Fentanyl has been linked to 525 overdose deaths in B.C. this year alone, more than twice the number over the same period in 2016.

'Not going away anytime soon'

Yukon's chief medical officer of health saysthe recent RCMPseizure in the territory should be taken seriously.

"It's another way to confirmfentanyl's presence in the territory, and its ability to make its way in unpredictably, and possibly in large numbers," said Dr. Brendan Hanley.

"It's another indicator thatfentanylis not going away anytime soon."

The Yukon Coroner'sService has confirmed five fentanyl-related deaths in the territory in just over a year.

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According to Tadepalli, the majority of people who overdose on fentanyl don't know they are taking the drug. He says they often think they're taking another street drug, which turns out to be laced with fentanyl.

Two milligrams of pure fentanyl the size of about four grains of salt is enough to kill the average adult.

Tadepallisays the volume of fentanyl-related overdoses has changed standard procedures at the emergency department.

"You're always taught to think about 'A-B-C': airway, breathing, circulation. Now, in unconscious patients, we're thinking of 'C' being the catheter, to get a urine sample to see if that is fentanyl," he said.

"That has dramatically changed the way we think about resuscitation."

A Band-Aid solution

One of the first courses of action when dealing with anopioid overdose is to administer the drug naloxone, which can temporarily reverse the drug's effects.

The Yukon government has made free take-home naloxone kits available at locations across the territory, including all pharmacies, community health centres, the Taiga Medical Clinic, the Blood Ties Four Directions Centre, and Alcohol and Drug Services in Whitehorse.

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Hanley says that about 40 per cent of those 1,120 kitshave been picked up by the public, and he's heard anecdotally aboutkits being used successfully against overdoses.

Tadepalli supports the "important public health program," but said naloxone alone isn't the solution.

"It's a good tool for awareness. It's a good tool when used immediately. But if you don't address the root cause of it, naloxone itself is a Band-Aid solution."

As a board member forthe Canadian Medical Association, Tadepalli has also had the chance to engage with colleagues from across the country on the threat of fentanyl, and he's heard about the limitations of naloxone.

He said doctors in Vancouver have discovered that above a certain dose of fentanyl, naloxone will not work.

Tadepalli said on one occasion he had to give 25 doses of naloxone to a single patient. On average, it takes about eight doses for naloxone to be effective, he said.

Hanleyagrees that naloxoneis not always the only or best solution. Heemphasizesthat calling 911 is the most important step when an overdose is suspected.

"The [naloxone] kit is a temporary stop-gap that can give a few more minutes of life in a life-and-death situation to allow definitive medical care through EMS, and ultimately hospital care," said Hanley.

"It's critically important that that's recognized."

Standards of treatment

The naloxone kits are just one aspect of a range of initiatives being implemented to fightwhat Hanleycalls an"opioid crisis" in Yukon.

Hanley says within the next few months, a territorial working group hopes to decide on consistent standards for treating chronic addiction at the primary care level. Thatwould include regular drug screening, managing addictions through methadone and suboxone, and funding for frontline fentanyl testing.

Evaluating the success of those programs will involvetracking the number of overdoses, and measuring the number and doses of opioids and opioid alternatives being prescribed.

Yukon's department of alcohol and drug services has also hired a new opioid overdose prevention coordinator who will start work in early September. The two-year position involves managing the distribution of naloxone and its appropriate training.

'A really scary situation'

Tadepalli wants fentanyl awareness to be taught at schools in the territory. He believes that experimenting with drugs is far more risky now that many could be laced with fentanyl.

"It's a really scary situation, one that can affect any one of us, especially our kids.And that's my worry," he said.

Hanley said there have been high-level talks between the departments of education and health to establish awareness initiatives for students and youth.

But Tadepalli said it's also important to realize that the impacts of fentanyl aren't limited to certain segments of the population.

"It affects rich and poor, every colour," he said. "It's not that one particular person is much more at risk than the other."

For Hanley,one key recommendation is that people never use drugs alone.

"If people have supervision or a sober buddy, if they do choose to do drugs, that can be the difference between life and death."

Federal law provides immunity from simple possession charges for people who call 911 for themselves or another person suffering an overdose, as well as anyone who is at the scene when emergency help arrives.

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