The Story of Fentanyl, Part 1: A prescription drug turned dangerous pill

This is Part 1 of a two-part web series on the facts behind fentanyl, the people it has affected and where to go from here.

Brigette Krieg sits by her daughter’s hospital bed, waiting for 16-year-old Ally to wake up. The Saskatoon teenager is in a coma after purposefully taking a pill to try and end her life.

The illegal tablet contained toxic amounts of fentanyl, a strong prescription painkiller. When used appropriately, fentanyl isn’t lethal. But its deadly effects have been felt across Saskatchewan, with a heightened awareness over the past year.

The Office of the Chief Coroner has confirmed six deaths related to illicit fentanyl pills in Saskatchewan since 2013. Five were in Saskatoon, one was in Kindersley and all of them were men.
 
But that only includes overdose deaths where victims accidentally took fentanyl thinking it was OxyContin, or “fake oxy.” Nineteen other people have died in Saskatchewan from overdoses involving pharmaceutical fentanyl, according to the latest government statistics obtained by CKOM News.
 

Louise Haugan’s brother Mark was one of them. The 43-year-old was living in Wynyard and working at Lilydale Foods when he was found dead on a cold floor in his home on Feb. 22, 2015. Haugan was told that an empty fentanyl package was discovered beside her brother’s body.

But Mark didn’t have a prescription for the potent painkiller, she said. Although he’d briefly turned to alcohol after losing his wife a few years ago, Haugan said he was not a known drug addict.

“I was completely stunned, and my sense is that I don’t know if he knew what he was taking,” she said. “We don’t know why he took it or who he got it from.”

“I was completely stunned, and my sense is that I don’t know if he knew what he was taking.” — Louise Haugan

All Haugan knows is that her brother had been taking oxycodone, a milder opioid painkiller, for a sore ankle. She wonders if he thought fentanyl and oxycodone were interchangeable.
 
“I didn’t even know what fentanyl was until I heard the reason for him passing; I didn’t even know such a thing existed,” she said. “That’s why I’d like to get the information out there so that this doesn’t happen to anybody else.”

What is fentanyl?

Dr. Peter Butt, an associate professor specializing in addiction in the family medicine department at the University of Saskatchewan, says it’s important for people to understand what fentanyl is so they can have a knowledgeable discussion about its dangers.
 
The synthesized narcotic was developed in 1960 and is worn as a patch to treat severe, chronic pain. But illegal pills made in unregulated labs have been popping up all over Canada.

The manufactured pills aren’t pure; there’s no way to know how much fentanyl powder is in each tablet, or if it is evenly distributed throughout the pill. That’s why some people have been hospitalized after taking only part of a pill. Insp. Jerome Engele with the Saskatoon Police Service said early last month, a 16-year-old boy nearly died after taking a quarter of a fentanyl tablet. His friend took the rest of that same pill and did not overdose.

Most painkillers are divided into two categories: opiates and opioids. Opiates, like heroin (illegal) and morphine (legal), are derived from the poppy plant. Opioids are synthetic and semi-synthetic substances that mimic opiates. They include oxycodone and fentanyl.

Fentanyl is the strongest opioid on the market for human use. While oxycodone is 1.5 times stronger than morphine, fentanyl is up to 100 times more potent.
 
The problem is, many dealers aren’t telling buyers that their product contains fentanyl. Instead, they’re often passing it off as OxyContin—a type of slow-release prescription oxycodone that people crushed and snorted in order to attain a quicker high. The “fake oxy” pills are designed to look the same as prescription OxyContin pills, Butt said. They even have the number “80” stamped on them, like a real Oxy 80 tablet.
 
But OxyContin hasn’t been prescribed in Saskatchewan since it was pulled from shelves in 2012. It was replaced with OxyNEO, a type of tamper-resistant oxycodone. Although Health Canada still recognizes generic forms of OxyContin, meaning it could still be floating around, the chances of someone selling the prescription drug in Saskatchewan are slim.
 
That means it’s safe to say if someone is offering to sell you OxyContin, they’re probably lying, according to Dr. Butt. He said if more young people knew that OxyContin is now a rarity, they may be less inclined to believe a dealer who claims to be selling it.

 A drug being sold by another name
 
Drug dealers pass fentanyl off as oxy for several reasons, Butt said. First off, most people have never heard of fentanyl. But they have heard of OxyContin.
 
“Organized crime saw a marketing opportunity to come out with something that they very vaguely produced, it was a similar colour to the OxyContin,” he said. “Fake oxy is simply a way of getting fentanyl onto the market into a particular niche.”

He believes the tablets were designed for existing drug users wanting to feed an addiction to painkillers. But as a result, he said young people who think they’re experimenting with OxyContin are also getting caught in the deceitful trap.

Although some addicts know that fake oxy pills contain fentanyl, Butt said in his line of work, urine screening will show that others mistakenly think they’re taking a form of oxycodone when they come in to see him.
 
“I would have to explain to them ‘no, that’s fentanyl. It’s much more potent.’ So initially I think they believed what the dealers were telling them.”

Butt said it’s “a bit of a stretch” to tie the increase in fentanyl-related overdoses directly to the lack of OxyContin on the market. He admits it did create a surge in other opioid prescriptions, but addicts were still searching for their old drug—OxyContin—and dealers were looking to capitalize.

“The familiar one. It’s no different than alcohol as it is with opioids. They like a particular brand, generally.”

Why sell fentanyl when oxycodone is still available?

According to Butt, it comes down to dealers wanting to get people hooked on a stronger drug so that they can push more product.

“If (users) survive the transition, they just became more and more dependent upon a much more potent drug than they were before, which would have led them to use more,” he said, explaining that opioid addicts aren’t so much looking to get high as they are trying to keep from going into withdrawal.

Those people would then start to seek out fentanyl rather than oxycodone because they get more drug for their money. Butt said he’s seen addicts who, once they have built up a tolerance to fentanyl, take up to 20 tablets a day. And those who don’t overdose will do whatever it takes to get the drug, he said.

“It’s a huge drive towards criminal involvement: property crime, break and enters, vehicle thefts, the sex trade, you name it. It’s driving crime in our communities.”

Here’s a look at fentanyl since it first became news in Saskatchewan last September:

Sept. 22, 2014– Saskatoon police report fake oxy pills linked to two men’s deaths in Saskatoon.
 
Jan. 3, 2015– Kelly Best, 19, from Saskatoon dies after taking counterfeit OxyContin pill.
 
January 2015– Sudden death of a 45-year-old man in Weyburn is suspected to be fentanyl after finding the green pills stamped to look like OxyContin at the scene. A Coroner’s report finds the death involved fentanyl but did not involve fake OxyContin.
 
Jan. 15, 2015- A giant drug bust involving 18 businesses across Saskatchewan. There are 14 people charged with drug and gun related offences. Thousands of fentanyl pills are seized.
 
Jan. 26, 2015– Two more men charged with dealing fentanyl in Saskatoon.
 
March 25, 2015- Alberta police believe drug traffickers are sending fake OxyContin pills to Saskatchewan and B.C. using hidden compartments in SUVs. Alberta police arrest five people after finding custom-made hidden cubbyholes in three vehicles.
 
April 5, 2015– Moose Jaw police warn about fake OxyContin pills after a 27-year-old man overdoses.
 
April 10, 2015– Regina police warn about fake Oxycontin pills after investigators seize a small quantity.
 
June 7, 2015– RCMP receive a call about the sudden death of a man in North Battleford where counterfeit OxyContin is found at the scene.
 
June 24, 2015– Saskatoon police charge two men accused of selling fentanyl.
 
July 6, 2015– Melfort RCMP find a man dead in a home in Pleasantdale. They suspect his death is related to fentanyl.
 
Aug. 2015- A 16-year-old boy in Saskatoon nearly dies after taking a portion of a fentanyl pill.
 
Aug. 13, 2015- A 27-year-old man is arrested in Calgary after police find $348,000 dollars worth of fentanyl at his home. A Canada Border Services Agency officer intercepted the parcel which was declared as a muffler and was being sent to Calgary.
 
Aug. 22, 2015– Ally Krieg, 16, of Saskatoon overdoses on fentanyl and falls into a coma.
 
Aug. 26, 2015- A 17-year-old in Saskatoon is charged after he is found to be in possession of seven fentanyl pills.

Part 2 of this web series will be published on Thursday.. In it, CKOM reporter Bre McAdam brings us the story of a Saskatchewan woman who legally uses fentanyl, and explores some of the solutions to the illicit fentanyl crisis.