By Bre McAdam

The Story of Fentanyl, Part 2: The legal side of fentanyl and the battle against ‘fake oxy’

Sep 10, 2015 | 6:45 AM

This is Part 2 of a two-part series on the facts behind fentanyl, the people it has affected in Saskatchewan and where to go from here. Read Part 1 of this series.

Every three days at 9 p.m., Angela Bulbeck changes her three small fentanyl patches. She is on a pain management treatment plan so that she can do things like help her daughter get ready for school.

For Bulbeck, fentanyl is a necessity. The 33-year-old single mother who lives near Swift Current has a genetic connective tissue disorder and has been using the prescription patches for about four years.

She said her pain is overwhelming and the narcotic has made a world of difference. That’s why it’s hard for Bulbeck to hear fentanyl called a deadly drug that has no place in society.

“Yes it can be fatal when it’s not controlled; anything can be a fatal compound or medication if it’s not taken properly. I mean, if you drink too much water you can die,” Bulbeck said.

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“YES IT CAN BE FATAL WHEN IT’S NOT CONTROLLED; ANYTHING CAN BE A FATAL COMPOUND OR MEDICATION IF IT’S NOT TAKEN PROPERLY. I MEAN, IF YOU DRINK TOO MUCH WATER YOU CAN DIE.”- ANGELA BULBECK

“But when it is dealt with in a proper manner, it’s not only a safe medication, it’s very effective and it can give people a quality of life that they wouldn’t have otherwise.”

It’s frustrating to know that people are abusing something that she so desperately needs, Bulbeck said. She recalls how someone ripped a patch off her back while she was walking down a busy street. Her doctor told her people will extract the medication by either smoking it or chewing on what’s left in the patch.

“To hear about people that just go out and abuse it, it’s really hard because these medications are hard enough for chronic pain sufferers to get their hands on, and sometimes it almost seems like it’s easier for people to get it illegally,” she said.

There’s a big difference between dependency and addiction, Bulbeck points out. While she needs fentanyl to function, she said she always takes her prescribed dosage.

She doesn’t enjoy having to take such a strong opioid either. Bulbeck used to be on a different kind of transdermal painkiller called BuTrans. She said she had to switch to fentanyl because the Saskatchewan government wouldn’t cover her old medication under the Supplementary Health Benefits program.

“It kind of seems a little hypocritical, almost, that they would cover something that they consider to be this dangerous, lethal drug, and yet they won’t cover something that’s a more effective and safer alternative.”

FIGHTING THE ILLICIT FENTANYL BATTLE

The solution isn’t to take prescription fentanyl patches off the market because it would only hurt those who legitimately need the painkiller, according to Dr. Peter Butt, an associate professor specializing in addiction in the family medicine department at the University of Saskatchewan.

“The problem that we have is that this is illicit fentanyl; it’s not the fentanyl that’s being prescribed by physicians that’s causing the problem here,” he said, referring to the illegal “fake oxy” tablets in which unknown amounts of fentanyl powder are injected into pills and sold on the street.

Having said that, Butt acknowledges that people do abuse prescription fentanyl. But he disagrees with those who say the illegal pills are being made from the legal patches. He also doesn’t believe that all forms of fentanyl could realistically be banned because chemists would just create a new type of opioid.

“That doesn’t mean that we shouldn’t fight the good fight; I think that there is a place for law enforcement; there is a place to go after the dealers and the traffickers. Those are the people that should be in jail. I think the users have a medical problem and they need treatment.”

Ray Joubert, registrar with the Saskatchewan College of Pharmacists, said when it comes to the abuse of pharmaceutical fentanyl, banning the prescription patches is a complicated issue. In general, he said the organization supports the idea of tamper-resistant packaging, although he’s not sure how that would be carried out.

In the short term, however, there is a drug that can help reverse a fentanyl overdose. It’s called naloxone and it’s an auto-injector similar to an EpiPen. Take-home kits have become available in Alberta, but naloxone is not available in any form in Saskatchewan.

Joubert said the topic is on the association’s near-future agenda. He said legislative change would be required to allow pharmacists to prescribe naloxone in the first place, and then provide it in the kit form for administration by the patient.

“There’s quite a few steps that need to be taken here, but once the decision is made I don’t see any problem with proceeding with those steps in collaboration with our partners in the health system,” he said.

“We need to look at the role of a pharmacist in preventing prescription drug abuse in general, so that is an option that we need to consider very, very seriously.”

A take-home naloxone kit would be helpful for those with an addiction to opioids such as fentanyl, Butt said.

“There are families that are really, really struggling with this. They know their kids are using; they’re trying to get help (but) it’s a difficult process. I think that if they had kits at home it would be useful and perhaps save lives.”

A Saskatchewan group is petitioning the provincial government to bring naloxone in to the province. Supporters are also calling for the expansion of addiction treatment centres to reduce wait lists, and more overall education about fentanyl.

Butt agrees the focus should be on getting addicts proper treatment and teaching young people about the dangers of street fentanyl. Louise Haugan, whose brother Mark died from a fentanyl-related overdose in Wynyard on Feb. 22, also believes awareness is crucial.

“Especially the kids. The schools should make sure that before the sun goes down, (kids) know that Oxy80s (OxyContin) are no longer prescription. If you see an Oxy80, that’s a bad, bad pill.”

Illicit fentanyl pills are made to look like OxyContin, a prescription painkiller less potent than fentanyl that hasn’t been prescribed in Saskatchewan since 2012. Although Haugan said the coroner’s findings could not confirm the source of Mark’s fentanyl –or if the 43-year-old died from a fake oxy pill– Haugan believes it’s a possibility.

Remembering her brother as a huge Boston Bruins and Van Halen fan, Haugan said s he’s tired of hearing that the people who are dying are the only ones to blame.

“The laws have to get tougher, I mean, it can’t be appealing to sell this drug,” she said. “If we had people walking the street with a loaded gun, we’d stop them. This is the same thing.”

“IF WE HAD PEOPLE WALKING THE STREET WITH A LOADED GUN, WE’D STOP THEM. THIS IS THE SAME THING.” — LOUISE HAUGAN

 Email bmcadam@ckom.com
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