British Columbia Drug and Poison Information Centre (BC DPIC)

29 May 2013

We have recently been informed by the police that fentanyl is being sold in BC as heroin.
The BC Coroners Service has identified more fentanyl-detected deaths in the first four months of 2013 than in all of 2012.

When fentanyl has been sold on the street in other jurisdictions, many people have died from unexpected overdoses. Please find attached a review of the 2006 fentanyl epidemic in Chicago in which 342 people died.

Fentanyl produces symptoms and signs that are indistinguishable from overdoses of other opioids and the treatment of patients with a fentanyl overdose is essentially the same as for other opioids.

However, fentanyl has a few unique characteristics to be aware of when managing patients:

• Larger doses of naloxone may be required for reversal of fentanyl overdoses. Although standard doses of naloxone should be given initially, up to 12 mg of naloxone has been required in some patients.
• When fentanyl is administered intravenously in therapeutic doses, the duration of action is relatively short with a range of 30 to 60 minutes. However, in overdose situations the duration is much longer, up to 24 hours.
• Fentanyl powder should not be handled without taking precautions to avoid unintentional exposure through inadvertent transfer to mucous membranes.
• Most conventional urine immunoassay drug screens are unable to detect fentanyl.

Please call the BC Drug and Poison Information Centre at 604-682-5050 or 1-800-567-8911 if you are managing one of these patients.

Link to Public Announcement