synthetic opioids in counterfeit pharmaceuticals and other illicit

www.ccsa.ca • www.cclt.ca

Synthetic opioids in counterfeit pharmaceuticals and other illicit street drugs: The situation in

Canada

Matthew M. YoungNDEWS Webinar

July 20, 2016

About CCSA

www.ccsa.ca • www.cclt.ca 2

• CCSA is Canada’s only agency with a legislated national mandate to reduce the harms of alcohol and other drugs on Canadians.

• Created by an Act of Parliament in 1988, CCSA has provided national leadership and expert advice, advanced knowledge, and prepared information and resources based on the latest evidence in order to inform policy, practice and programs that bring forward solutions.

• Together with our partners, we help mobilize individual and collective efforts to achieve collective impact on the major health and social issue of problematic substance use.

• Ensuring access to a range of quality services to address alcohol-and other drug-related harms is at the core of what we do everyday.

We believe that hope and recovery are real

Why CCSA’s Work Matters

www.ccsa.ca • www.cclt.ca3

Health• Substance use disorder is a disease and should be treated like other

chronic diseases and health conditions• Contributes to the co-occurrence of mental health conditions, family

violence and suicide• Major contributor to 60+ diseases like cancer, heart disease, diabetes,

HIV/AIDS• Illicit drug dependence directly accounted for 20 million disability adjusted

life yearsPublic Safety• Significant factor in the commission of crime; as many as 80% of federal

offenders have a history of problematic substance use issues• Impaired driving accounted for 9,000 deaths in Canada from 2000–2010 Economics• Substance abuse costs over $40 billion per year in Canada

National Priorities and Areas of Action

Canada’s National

Framework for Action

Children & Youth

Problematic Substance use & Co-occurring

Issues

Canada’s Indigenous

People

Monitoring & Surveillance

Workforce Development

Treatment & Recovery

Impaired Driving

Alcohol

Prescription Drugs

Cannabis

4

National Framework for Action (2005): Collective action for collective impact

www.ccsa.ca • www.cclt.ca

How we got here

www.ccsa.ca • www.cclat.ca 6

1990s – 2010s - Increase in opioids prescribed and dispensed in Canada

- Many people became dependent

2013 - Pan-Canadian Strategy to address problem

2013 to present - A great number of interventionsintroduced to respond to crisis

- decreased availability of diverted opioid pharmaceuticals available in the illicit market

- unintended consequences

Deaths Involving Fentanyl


Between 2009 and 2014, there were at least - 655 deaths in Canada where fentanyl was determined to be a cause or a

contributing cause. - 1,019 drug poisoning deaths in Canada where post-mortem toxicological screening

indicated the presence of fentanyl

Seizures and anecdotal reports suggest overdoses occurred among individuals who thought they were using - oxycodone- heroin- cocaine or another substance

9

British Columbia

Alberta

ManitobaToronto

Nova Scotia

Newfoundland and Labrador

Saskatchewan

Montreal

Quebec

Ottawa

CCENDU is a sentinel surveillance network made up of representatives from sites across Canada. Each site coordinator collects quantitative and qualitative information on drug harms from: • Local data sources (e.g., poison control centres,

coroners); • Anecdotal reports from those directly

working with drug-using populations (e.g., law enforcement, harm reduction programs) and people who use drugs.

This information is then collated and assessed for risk at the national level. If warranted, CCENDU issues alerts to:

• Law enforcement • Harm reduction programs• First responders• Healthcare practitioners • Treatment providers • People who use drugs • Others

These bulletins and alerts provide information regarding new drug trends and

advise what can be done to prevent and reduce harms.

2012 201520142013 2016

# downloads since release 2,866

Alerts and Bulletins

2012 201520142013 2016




W-18U-4770

Fentanyl and fentanyl analogues

AH-7921MT-45

Implications…


For public health and harm reduction:

• The presence of these synthetic opioids in tablets and powders dramatically increases the risk of overdose because people using them do not know

• what substances they are using or• how much is included

Information provided by CCENDU members

Implications…


For public health and harm reduction:

• When warning people who use drugs about novel synthetic opioids it should be made clear that it is the variability of the dose from one tablet or powder to the next that increases the risk of overdose not simply the potency or toxicity.

Information provided by CCENDU members

Implications


For those with access to naloxone:

• Although the efficacy of naloxone has not been evaluated for all the novel synthetic opioids, in theory it should temporarily reverse the effects and so it should be administered immediately if an opioid overdose is suspected

• administering naloxone when not indicated will not hurt the person

• Higher or repeated doses of naloxone might be required to reverse the toxidrome

Information provided by an emergency physician from The Ottawa Hospital and the Canadian Association of Emergency Physicians

Implications


Bulletin also includes implications for:

• Poison Control Centres

• Laboratories

• Law enforcement

Contact Information

www.ccsa.ca • www.cclt.ca 26

Adjunct Research Professor,Department of Psychology, Carleton University, Ottawa, ONwww.carleton.ca

Senior Research & Policy Analyst500–75 rue Albert Street, Ottawa, ON K1P 5E7Tel / Tél : 613-235-4048 x 222 | Fax / Téléc : 613-235-8101 Email / courriel: [email protected]

Matthew M. Young, Ph.D.

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