Horrors of Fentanyl Abuse Continue to Grow

Camões' tomb in the Jerónimos Monastery, Belém, Lisbon. (Dr. Noorali Bharwani)
Camões' tomb in the Jerónimos Monastery, Belém, Lisbon. (Dr. Noorali Bharwani)

Narcotics are the oldest (since 4000 BC) as well as the strongest pain-relieving drugs known to mankind. Narcotics or opioids (means the same thing) are drugs that act on the nervous system to relieve pain. Continued use and abuse can lead to physical dependence and withdrawal symptoms.

Is there a difference between narcotics, opioids and opiates? Opioids include opiates, an older term that refers to drugs derived from opium, including morphine. In some jurisdictions all controlled drugs are legally classified as narcotics. Now the term opioid is used for the entire family of opiates. 

Last year, almost 2,500 Canadians died from opioid-related overdoses. These are usually young and otherwise healthy individuals. There is no doubt we are in the midst of a drug crisis, with about 200 per cent increase in the rate of opioid overdose deaths in the last decade.

There are three kinds of opioid drugs. These are synthetic opioids (example fentanyl), semi-synthetic opioids (oxycodone, heroin), and natural opioids (opium, morphine, codeine). Natural opioids are from a natural source – opium poppy.

Fentanyl is a fully synthetic opioid, originally developed as a powerful anaesthetic for surgery. It is also administered to alleviate severe pain associated with terminal illnesses like cancer. The drug is up to 100 times more powerful than morphine. Just a small dose can be deadly. Illicitly produced fentanyl has been responsible in the number of overdose deaths in recent years. Fentanyl in intravenous form is 70 to 100 times more potent than morphine.

Comparatively, codeine is only about 1/10th as powerful as morphine. Opioid that is more powerful than morphine includes hydromorphone (Dilaudid) and others. But the strongest opioid in community use is fentanyl.

Doctors know their regular patients. Their relationship is based on trust and faith. When a person says he is in pain then the doctor has to decide what kind of painkiller would help. There are two main types of painkillers: non-narcotic analgesics for mild pain, and narcotic analgesics for severe pain.

Because pain is very subjective, it makes it challenging to prescribe appropriate painkillers. Patients with chronic pain are looking for quick relief of pain on a regular basis. Heroin is a faster-acting painkiller than morphine. Heroin is beneficial for those patients troubled by the adverse effects of morphine, like nightmares, nausea, constipation and hallucinations. With heroin the risk of addiction and abuse is high. Tolerance and dependence will develop with continuous use.

The biggest drug abusers are addicts who buy their fentanyl and other narcotics on the streets. The quality of these drugs is not good. Addicts are at a very high risk of dying from complications and overdose.

There is help for them. Alberta’s opioid crisis response team is available to help. Their website has all the details. Call 911 immediately if an overdose is suspected. Canada’s new Good Samaritan law can protect you, a relative, a friend or a bystander. Naloxone is an antidote can reverse an opioid overdose. This includes fentanyl. You don’t need a prescription and it is free at sites across Alberta. Find a naloxone kit near you. Keep it handy. Check with your doctor, health unit or pharmacist. You never know when you will need it.

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