The problem

Fentanyl and opioids combined with fentanyl have been implicated in a rash of drug overdoses in recent weeks, including four deaths in Vancouver and as many as eight deaths in Greater Victoria. All of the victims in Victoria were experienced drug users, according to the coroner. At least some of the fentanyl in circulation has been made to look like other more desirable drugs. A recent armed robbery at a pharmacy may have added to the amount of fentanyl in Vancouver’s recreational drug market.

The stats

The Canadian Centre on Substance Abuse says there were more than 1,000 drug poisoning deaths in Canada involving fentanyl between 2009 and 2014.

The quote

“Most of the addicts that I see who have fentanyl in their urine think they are using heroin or some other drug; they don’t know they are using fentanyl,” said Dr. Evan Wood, an addiction specialist at St. Paul’s Hospital. “That’s what makes it so dangerous.”

A knockout drug

Fentanyl is a potent synthetic opioid usually used in hospital settings for sedation during medical procedures when the doctor doesn’t want the patient to move. Because it is “fast on and fast off,” it doesn’t produce the same long-lasting pleasure that heroin does, according to Wood.

Dangerously potent

Although Fentanyl is 100 times stronger than morphine, it is not sought by addicts as a recreational drug.

“The nuance to that is no one is intending to take a drug 100 times stronger than morphine, so that conversation is irrelevant,” said Wood.

Fentanyl is frequently used to make counterfeit OxyContin or Percocet pills, which are sought by people addicted to prescription opioids. When fentanyl is manufactured or packaged in clandestine labs run by organized crime gangs, the dosage is difficult to get right.

“A difference of just a few micrograms can be the difference between a fatal overdose and the desired effect,” he explained.

Where it comes from

Fentanyl in the Canadian medical system is usually embedded in skin patches. The fentanyl distributed in the illicit drug trade is imported in powder form — probably from China — and pressed into pills, according to epidemiologist Jane Buxton of the BC Centre for Disease Control.

OxyContin was reformulated by the pharmaceutical industry to prevent abuse by addicts, which has given rise to a market for old-style OxyContin, which are often fentanyl-based fakes.