Carfentanil worries the Montreal health authorities. The regional public health directorate (DRSP) alerted on Friday organizations and professionals in addiction to the presence of this synthetic opioid in the metropolis. Public health is also investigating the potential presence of opioids in stimulant-type drugs such as crack cocaine.
In a letter sent on May 14, the DRSP said it was worried about the presence of carfentanil in Montreal, a situation “which is a first for us”, according to Dr. Carole Morissette, medical chief at the DRSP of Montreal, at the Integrated Center. University of Health and Social Services (CIUSSS) of Center-Sud-de-l’Île-de-Montréal.
The presence of carfentanil had so far never been documented in Montreal, according to the CIUSSS.
“This is a really worrying situation in that carfentanil is an analogue of fentanil which is 100 times more potent than fentanil. This can create an increase in severe overdoses in terms of deaths, ”says Dr. Morissette.
Two cases were reported to the CIUSSS of the Center-Sud of people admitted to the emergency room, in whom toxicological analyzes would have made it possible to detect the presence of carfentanil.
The synthetic opioid is associated with high risks of death from respiratory arrest, especially in consumers who could be exposed to it without their knowledge, explains the DRSP.
To reverse the effects of a carfentanil overdose, more doses of naloxone may be needed. Hospital management for medically supervised administration of naloxone or airway management may be required.
In addition to recommending not to consume alone, the DRSP of Montreal invites street drug users to be careful and encourages clinicians and workers to step up death prevention interventions with them.
The Service de police de la Ville de Montréal (SPVM) reportedly recently seized 2.2 kg of what was believed to be fentanil. But analyzes carried out by Health Canada would have established that there was a very large amount of carfentanil in this seizure, according to Dr. Morissette. This would be a very unusual phenomenon for Montreal.
Do not “demonize” carfentanil
Jean-François Mary, the executive director of Cactus, a community organization for the prevention of sexually transmitted and blood-borne infections (STBBI), which also works for harm reduction, argues that carfentanil should not be “demonized”.
“It’s been available for quite a long time. Both in the United States and elsewhere in Canada. In fact, well-prepared, well-diluted “batches” of carfentanil would be a little less dangerous, in fact, than fentanil. The therapeutic index of carfentanil is much broader than that of fentanil, ”he explains.
The therapeutic index is, for a substance, the ratio between the so-called “effective” dose and the dose which would cause death in 50% of individuals.
In short, the lower the therapeutic index of a substance, the less difference there is between the dose liable to obtain a therapeutic effect and that liable to cause death. And therefore more this substance is dangerous.
New survey
At the same time, public health is preparing to send a call for vigilance to the heads of emergency departments in Montreal hospitals. There have been reports of unusual effects from using crack or inhaled crystal, particularly from people with symptoms consistent with an opioid overdose.
An investigation was launched using various means, including toxicological analyzes carried out on deceased persons as well as the analysis of reports made by Urgences-santé.
“We are going to ask the emergency room doctors to report these situations to us and to take a urine sample to send to the Center de toxicologie du Québec so that we are able to make the link between these tables of unusual effects and the presence of opioids or other substances and have access to full toxicological results, ”says Dr. Morissette.
So-called stimulant drugs, such as crack and inhaled crystal, have effects that are normally different from those experienced following opioid use.
The DRSP is concerned about the unexpected effects that may be experienced by individuals who use opioids unexpectedly.
“For example, the user could be a naïve person with regard to opioids and who would not have tolerance for this type of drug. The person would therefore be really at risk of stopping breathing and dying from it, ”she maintains.
The call for vigilance should be sent to heads of emergency departments over the next few hours or days.
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