Manitoba has spent hundreds of thousands of dollars for sophisticated equipment that will allow home-grown testing for drugs such as fentanyl, speeding up data on deaths and letting officials respond more rapidly to the opioid crisis.
Currently, Manitoba can't keep abreast of the problem because testing for suspected opioids must be done in other provinces and it can be months before results are returned.
An example involves the three people found dead Wednesday in the Inkster Gardens area of Winnipeg. They were found with drug paraphernalia and white powder suspected to be an opioid, but officials must ship samples of the powder away because Manitoba currently lacks the required testing equipment and laboratory software.
But, Manitoba's tardy testing time is about to improve.
"The software and the equipment and having the physical drug (carfentanil and fentanyl) present, it’s underway right now. But it probably won’t be operational until early 2017. That’s what I’m told," acting chief medical examiner Dr. John Younes told the Free Press on Thursday.
Manitoba will join provinces like Alberta and British Columbia, where the use of advanced equipment lets those provinces keep track of fentanyl and carfentanil overdoses and, as a result, roll out counter measures faster.
"We’ll be getting the results more quickly, my hope is within a couple of weeks to a month (per overdose)," Younes said.
It currently takes Manitoba from three to six months to get test results back on complex toxicology samples for drugs like fentanyl and carfentanil, two highly addictive and deadly synthetic opioids behind an epidemic of deaths in Canada and the United States.
Those samples are sent to location in western Canada that Younes wasn’t prepared to identify publicly.
Health Minister Kelvin Goertzen has flagged slow reporting of such deaths for improvement, telling mothers of victims behind closed doors that he can’t confirm the deaths when they’re reported to police. He told reporters on two separate occasions this week, in the lead-up to the Opioid Summit on the fentanyl epidemic in Ottawa Friday and Saturday, that he’d like to see a national standard on reporting such data. Such a national standard, along with the financing to pay for it, would help ensure all provinces are looking at the problem in the same way.
Delivering hard data on overdoses has been an ongoing problem but one Manitoba has not been able to correct up to now, Younes said.
"I want to be clear this isn’t anything out of the ordinary. There are jurisdictions in Canada and the United States where it takes months to get reports. Alberta and British Columbia are ahead of the curve," Younes said.
He said the cost of laboratory equipment is prohibitively high. He wouldn’t say how much it’s costing the province for the new gear, only that it is in the "ball park" of hundreds of thousands of dollars.
Beyond the price tag, it takes time to set up software as well as drug protocols to detect the presence of drugs like fentanyl and carfentanil, he said.
The current reporting lag explains why Manitoba can’t offer hard data on overdose deaths involving carfentanil or fentanyl beyond the end of May.
From January to May, fentanyl was confirmed as a primary or a contributing factor in nine overdose deaths. Preliminary results put carfentanil as the cause in another five deaths, according to numbers the CME office released Thursday. Carfentanil surfaced in Manitoba as a major concern only this summer.
Younes said the trend for the harder drugs is beyond troubling.
"It is true fentanyl is being mixed into other drugs, be it heroin, other opiates or drugs on the street. That’s the biggest concern about this. People don’t know what they’re buying," Younes said.
Fentanyl, including imports from countries like China, can be had in powdered, liquid and patch form, on the streets in Winnipeg.
"People are buying it from different places, different sources. They don’t know how much of it might be fentanyl. It’s almost like playing Russian roulette. You’re taking a hit of drugs which could have a lethal dose of carfentanil in it," the acting chief medical examiner said.
On the streets, meanwhile Winnipeg Fire and Paramedic officials say they’re still discerning fentanyl and carfentanil overdoses from the approximately 1,600 calls to 911 for all kinds of overdoses and poisoning from January through Nov. 16.
"If you look at the trend over the past five years, it’s been increasing. We’re going to see more people but more important than the absolute number is the severity of the calls," WFPS medical head Dr. Rob Grierson said.
Grierson, who also works half time as a doctor in the emergency department at Health Sciences Centre, said medical kits paramedics carry have stronger doses of naloxone than in the past. The bigger doses are needed to counter the potency of drugs like fentanyl and carfentanil.
"To give you an example, in years past, a patient might have required one or two doses. Now you’re giving people three or four or five times as much naloxone for the same effect," Grierson said. "If you look at the cases we had last week, the average dose of naloxone was 3.2 milligrams. In the past the norm might be 0.4 milligrams."
The WFPS head said naloxone kits are being distributed to the public, however, he warned they shouldn’t be mistaken for a cure and users shouldn’t be lulled into a false security just because they’re packing a kit.
"Just because you’ve got a naloxone kit, it doesn’t mean you’re going to save yourself or your friend if you start experimenting with things. Even if you’ve got three or four or five people, they can all be (impaired) rapidly and they’re not going to be able to help you," Grierson said.
Despite the rising volume of calls, Grierson said he’s suspects the epidemic in Winnipeg isn’t claiming more addicts; likely it’s hitting about the same number, only it’s hitting them harder.
"What I think is happening is that people who are using (illegal drugs) are getting themselves into trouble with fentanyl and carfentanil. The number of overdoses will increase in proportion to what we’ve seen in the past. And the percentage of people who require naloxone is probably going to grow," Grierson said.