Fentayl is a prescription drug in Canada and the United States. It is a potent opioid pain killer similar to morphine, however fentanyl is 100 times stronger than morphine. As such, it remains a useful tool in the fight against pain when used and administered under the supervision of a physician. However the risk of addiction to fentanyl is real and its properties make it usable as a recreational drug similar to morphine or heroin. In 2016, the Canadian province of British Columbia declared a public health emergency over the number of overdose deaths from fentanyl. While not as common in Eastern Canada, fentanyl is surprisingly easy to transport, problematic to intercept, and as such is growing in popularity.

What makes fentanyl so dangerous?

Because it is 100 times more potent than morphine, it is also much more toxic, making it easier for accidental overdose to occur. Its toxicity also increases the difficulties that law enforcement officials have in intercepting illicit fentanyl shipments. When a law enforcement agency intercepts a suspected fentanyl shipment, the officers involved must use special gear and procedures in order to avoid toxicity from the shipment as even trace amounts of the drug can have a toxic effect. Additionally, because a large number of doses can be transported inside a container a small as a standard envelope, transporting the drug is easy. This makes it one of the most dangerous recreational drugs in use today, even for non users.

What is the plan for dealing with fentanyl?

Fentanyl has an antidote called naloxone. Naloxone is an injectable or inhalant drug which counteracts the effects of opioid substances such as fentanyl. Each dose of naloxone costs approximately $37 in the United States and $35 in Canada for generic versions. In a number of states, naloxone is available without a prescription. The government of Canada approved over the counter sales of naloxone in late 2016. In January 2017, the government of Nova Scotia announced the procurement of 5000 doses of naloxone to combat overdose deaths and to prepare for the arrival and increased use of fentanyl in that province. There, the province estimates at least 50 overdose deaths have been prevented since the roll out of this program. There are gaps in the approach to handling fentanyl however.

What are others doing?

The province of New Brunswick has not announced the procurement of naloxone, will not cover the cost of the drug at all, and has not announced any plans to deal with a fentanyl crisis. According to the provincial government, a preparedness task group has been assigned to formulate a plan. However this group has not consulted pharmacists, who in many cases will be dispensing life saving drugs to treat opioid overdoses.

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The provincial government has made two arguments for refusing to cover naloxone. One is that overdose deaths from fentanyl are uncommon and there is no need for it. The second is that many people in New Brunswick have private insurers who can cover the cost of naloxone for them.

This is rather disappointing news as it seems that the tax implications for providing naloxone seem to outweigh the benefit of saving lives. Many people who walk into drug treatment centers to deal with opioid addictions simply do not have the means to pay the $35 for a dose of naloxone and certainly cannot afford to hire a private insurer to cover it for them. Additionally, it would be interesting to see how many private insurers would actually cover the cost of the drug for a self inflicted accidental overdose. It seems the province is content to let drug addiction solve itself in New Brunswick, and this is a mistake.

What will happen in New Brunswick?

I do not have a crystal ball, so I can only make educated guesses based on my research and limited knowledge of the subject. However by not preparing for the arrival of fentanyl in New Brunswick, it could arrive more quickly than it would otherwise. Drug dealers often look for new markets in which to sell illicit drugs. The lack of preparedness in New Brunswick might mark it as a target for drug dealers. A sudden surge of fentanyl into New Brunswick’s black market can cause a crisis that does not need to exist.  The evidence for illicit fentanyl in New Brunswick has already been seized. The Royal Canadian Mounted Police in New Brunswick seized a pill which tested positive for fentanyl earlier this week.

This leads me to conclude that a fentanyl crisis is coming to New Brunswick. The province has been too slow to develop a plan to combat the drug, unlike the neighboring province of Nova Scotia. The province also refuses to cover the cost of naloxone, a life saving drug which can combat the overdoses of several recreational drugs. This refusal flies in the face of logic and shows just how unprepared the provincial government really is to handle an upcoming fentanyl crisis.

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