Half of Patients Prescribed Fentanyl Patches in Canada at Risk for Overdose

A newly released study has found that half of those prescribed fentanyl patches in Canada were put at risk of overdose due to doctors failing to follow guidelines for prescribing the opiate.

"The findings are not surprising—it's consistent with the context of medicine being lulled into this false sense of security that chronic and high-dose opiates are OK and that they don't come with consequences that include overdose death," Dr. Hakique Virani, a specialist in public health, preventative medicine, and addiction medicine at the University of Alberta, told VICE. "One of the most concerning phrases that I see in the paper is that there is an 'inadequate exposure dose' that would require someone to be on fentanyl… that's the problem here." Fentanyl is supposed to only be given to patients in extreme situations such as for pain management in terminal cancer patients. More recently though, Virani said, chronic opiate prescriptions are being given out in Canada for "all sorts of conditions, and before they try anything else." READ MORE: Fentanyl Is Now Killing More Ontarians Than Any Other Opiate Because of its availability as a transdermal patch that distributes the painkiller over the course of several days, fentanyl serves a convenience that orally taken pills do not. "It's probably a factor with how pharmaceutical companies market their medications—marketing transdermal patches as a 'convenient' way of delivering opiates neglects to mention that this is an extremely toxic opiate," Virani said. "We've, as a profession, become quite ignorant of the consequences of chronic opiate-prescribing." However, the opiate crisis in Canada is more nuanced than what is present at the healthcare and pharmaceutical levels—counterfeit blue-green OxyContin pills (commonly referred to by users as "beans") containing fentanyl believed to derive from China have been the cause of many of hundreds of opiate overdose-related deaths in BC and Alberta in recent years. The proliferation of these counterfeit pills began at around the same time as when regulations around when OxyContin in its original form was pulled from shelves in Canada and swapped out for the tamper-resistant OxyNEO, which is designed to prevent users from crushing it up and snorting it. Michael Parkinson, community engagement coordinator at Waterloo Region Crime Prevention Council, also noted that Ontario has begun seeing bootleg fentanyl in addition to the abuse of fentanyl patches. "We can't subsidize and spend billions of dollars funnelling pharma-grade heroin via trusted health providers over fifteen-plus years and expect there will not be a deadly outcome of crisis proportions," Parkinson told VICE. "Opioid-related harms represent the worst drug safety crisis in Canadian history… the death toll will likely get worse before it gets better." The fentanyl study describes the shift from OxyContin to OxyNEO in Canada, which was introduced in 2012, noting that this is the same point when fentanyl prescriptions started increasing in some jurisdictions, showing a role in the broader scheme of the opiate crisis in Canada. "When we tried to address our opiate problem in a piecemeal type of fashion, it became very much like a bead of mercury—you try to cleave it off, and the bead of mercury just scurries into other locations, towards other drugs," Virani said. Follow Allison Tierney on Twitter.