Opioids: Preparation Could Save a Life

Opiate Users at Risk, Contamination Poses Threat in Street Drugs

Characteristics of an opioid overdose. Graphic Chris Michaud

The pain killing powers of opiates have been drowned out by recent reportings of rapidly rising overdoses and addiction to street drugs and prescription pharmaceuticals.

With overprescription of opiates by doctors from legal pharmaceutical companies, this has generated a vast market for resale of these drugs on the streets.

“I don’t plan on completely stopping,” said Nicolas Quijano. “[I’ve] been trying to stop for so long that I’m in more of a harm reduction mode.” Quijano is a full-time employee at Métâ d’Âme, a peer association that aims to improve the lives of opiate users. He is a long-time opiate user of almost 30 years, and also does work for Cactus, a supervised injection site near Saint-Laurent metro.

He said it’s not easy to control usage and maintain balance. Despite his use, he said he’s able to function well, currently holding two jobs. He’s now in harm reduction mode, taking low doses of methadone in order to stay off heroin. Since many non-opiate drugs can get contaminated with powerful opioids that can cause a fatal overdose those who experiment are not free from harm.

This is a result of dealers cutting their drugs with fentanyl, an opioid between 30 and 50 times more powerful than heroin, however, more inexpensive than most opiates. Dealers do this to make a larger profit off of stronger drugs. Initially in Montreal, fentanyl contamination was most commonly found in other opiates, like heroin and counterfeit oxycodone pills.

However, a test conducted by Cactus Montreal between April and August 2018 found fentanyl contamination in morphine, DMT, MDMA, crystal meth, speed, ketamine and cocaine. It has also been found in PCP. Public Health Montreal has also advised users to be cautious of crack, due to suspicion of fentanyl contamination.

Quijano first began his work for Méta d’Âme after moving into low income housing. He said the requirements to move into Méta d’Âme’s housing is that you must volunteer for a minimum of three hours at the organization each month. Quijano said he was blessed with a thorough education on drug use at a young age. When he first started heroin and riskier drugs, he knew what he was getting into, but was tempted by the romanticism of heroin use from such icons as The Rolling Stones and Sid Vicious.

“I’m giving back to the community when I’m alive and healthy,” he said. “I’m turning 50 in 2 years. If I’m still alive it’s because of organizations like Cactus.” While Quijano had the opportunity for proper education at a young age from his father, he wishes prevention messages were more straightforward to identify the difference between substances, since drugs like marijuana are not on the same risk level as other drugs.“If you are doing hard drugs—don’t do them alone, especially if you’re going to try opiates,” he said.

While using with others it is vital that one person remains sober, Quijano said, since, the sober person has the ability to react and take proper measures in case of an overdose.

“The most important thing to do is call 911,” said Quijano. “It’s not worth a friend dying because you are afraid of the police,” he said.

Quijano said the Good Samaritan Drug Overdose Act protects the person who calls from receiving drug charges. Before drug use, Quijano said it is vital to test your drugs and have a naloxone kit. Brain damage can occur within three to five minutes, as a result of lack of oxygen flowing to the brain.

Along with calling 911, it’s important to administer naloxone. For heavy opiate users, one hit of naloxone may not be enough, so it’s important for paramedics to arrive in case they revert back into an overdose.

“Naloxone has a shorter half life,” Quijano said. “Someone who’s taken a lot of opiates can go into an overdose an hour later again.”

The half life of naloxone is 60-90 minutes, but if the opiate the user has taken lasts longer in their system, they can go back into an overdose after the naloxone has worn off. Half life refers to the time in which it takes the concentration of the drug in one’s body to reduce by one half.

Fentanyl, an opiate originally intended pharmaceutically for aiding severe pain, can cause death from overdose with the consumption of 0.25 milligrams.

“It’s really good to get substances tested, but if it’s negative it doesn’t mean there isn’t fentanyl, [there] could be other substances.” Alexane Langevin

Fentanyl can be disguised as OxyContin, the brand name of oxycodone, which was removed from pharmaceutical markets in 2012. The removal of this opiate provided a demand for a replacement to OxyContin. They are often manufactured into pill form and dyed green to
resemble authentic OxyContin pills.

Carfentanil, an elephant tranquilizer, is 100 times more potent than fentanyl. Carfentanil was first publicly discovered on the streets of Montreal in February 2018. The drug was found in the home of a 59-year-old man, who was found
unconscious. He passed away three days later in hospital.

Quebec was the fourth highest province with opiate deaths in 2016, with 140 opioid-related deaths. Twenty seven of these deaths are attributed to fentanyl. The statistics from Quebec only account for closed cases and do not include cases still under investigation, also excluding those under the age of 19.

Alexane Langevin, project manager for GRIP Montreal, a charity and non-profit organization that provides education and harm reduction for psychoactive substances, said she is often asked about marijuana legalization and fentanyl. Her work focuses on school and community projects. Langevin said it’s important for users to know fentanyl isn’t the only concern. “If it’s not fentanyl, it doesn’t mean that [the drug] is pure,” she explained. Substances in the illegal market can be mixed, such as MDMA being mixed with methamphetamine or heroin, she added.

“More often when you use ecstasy in Quebec there aren’t many traces of MDMA,” Langevin said. It’s important to have substances tested for fentanyl, but if the result is negative it doesn’t mean it’s safe from contamination by other substances, said Langevin. Both Langevin and Quijano stressed that testing your drugs does not entirely confirm there is no contamination, so there should still be precaution when using drugs that have tested as safe.

Quijano said naloxone will not reverse an overdose for non-opiate drugs, such as ketamine or GHB which often display similar signs of overdose as an opiate overdose. However, there is no danger in administering naloxone to someone who is not
on an opiate.

“If in doubt, call 911, administer naloxone, start CPR and let the paramedics deal with the emergency,” said Quijano. Quijano said naloxone, and the training required to administer it, is obtainable for free at pharmacies or safe injection sites in Montreal.

Currently most paramedics in Montreal carry naloxone, but police do not. To find a naloxone kit go to: ACCM Montréal, Médecins du Monde, Méta D’Âme, PACT de Rue, Plein Milieu, RAP Jeunesse, Rézo, Spectre de Rue, STELLA, TRAC. These following organizations and safe injection sites provide not only naloxone, but the fentanyl strip test, as well: AQPSUD, Cactus, L’Anonyme, Dopamine, GRIP Montréal (GRIP only provides test strips in raves and festivals at the moment).