A constant demand from drug addicts and steady access to prescriptions has made the illegal trade of powerful prescription opiates in the National Capital Region both widespread and profitable, according to an Ottawa-area drug dealer.
Ottawa law enforcement officials, addiction specialists and family members of those dealing with addictions have for more than a year issued warnings in the community about the rising epidemic of the illegal prescription drug trade, which can have fatal consequences.
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From 2002 to 2011, an estimated 3,757 deaths in Ontario were linked to opioids, many of them prescription drugs, according to the Office of the Chief Coroner.
Watch the full TV report tonight
CBC Ottawa videojournalist Steve Fischer will explore the extensive problems with opioids on Ottawa streets all week. Tonight he looks at the street-level prescription drug trade through the eyes of a local dealer. Watch on CBC TV starting at 5 p.m.
More recently, from 2009 to 2011, in Ontario the two most deadly drugs were available through prescriptions: oxycodone (491 deaths) and fentanyl (253 deaths).
But if more people are dying from prescription opioids, it is in part because there are more of these drugs out there.
According to a study by the Canadian Centre on Substance Abuse, about 16.7 per cent of the general population in Canada used opioid pain relievers at least once in 2011.
Drug dealer started with his own injury
None of this is a surprise to Dave, an Ottawa-area drug dealer who has asked that we not use his real name.
For Dave, his road to dealing in fentanyl patches and other prescription drugs began 15 years ago when he himself had a prescription for percocet because of a back injury.
In fact, he agreed to meet CBC News at a doctor’s office where he’s receiving treatment for his own addiction to prescription drugs.
As Dave’s tolerance for the drug grew, so too did the dosage of his prescriptions — from one a day to eight a day.
That's when he discovered Oxycontin, the brand name of the drug oxycodone, which became notorious in the last decade for its popularity among drug addicts.
"[The] same thing happened with the Oxycontin. Your body develops a tolerance and then your prescription grows from there. Then you find out that these pills have a good value on the street,” he said.
“Then like a lot of people, your pain gets fabricated to be a lot stronger and a lot more painful than it really is and it's just a ploy to get more out of the doctor so that you can sell some.”
Dave said at its height, once OxyContin became known among drug users and before health authorities became aware of the epidemic, it was easy to acquire a prescription.
"It seemed like everyone was trying to find doctors who would give out prescriptions and whatnot and doctors were a lot more lenient before the epidemic hit. Then something had to be done because people were (overdosing)," he said.
He said it is more difficult to find a doctor who will prescribe narcotics, but not impossible.
One thing that hasn't changed, he says, is demand.
‘People just don't know how strong fentanyl really is’
Once Oxycontin disappeared from the market after the makers replaced it with a drug that is supposed to be harder to abuse, Dave said people seeking stronger opioids moved to fentanyl. Fentanyl is a drug often sold in a slow-release patch but which drug abusers chew or smoke for an immediate and extremely powerful high.
"I have a list of about 21 people that I know to buy fentanyl patches from, that will sell their patches, or come across patches that are for sale," he said, adding those people often get drugs for next to nothing if they’re covered by an insurance plan.
"Because fentanyl is a lot stronger they're getting... the result is achieved a lot quicker and they don't have to take as much, and that's where the dangers lie," he said.
"People just don't know how strong fentanyl really is and once they inject it or even just smoke it, if your body hasn't reached the tolerance for the level you're taking, it suppresses your breathing and they just nod off and stop breathing."
Ottawa police said the reason prescription opioids have become popular is the idea they’re safer.
“If I was to hold a bag of crack cocaine and a couple of patches and ask what's worse, they would automatically say the crack because there is that stigma around crack and heroin use,” said Staff Sgt. Kal Ghadban of the Ottawa police’s street crimes unit.
“In fact, fentanyl is just as addictive — maybe more so — and much more dangerous.”
Dave said the risk of a fatal overdose is why he only sells fentanyl to experienced drug users he says are aware of the dangers, making between $80 to $240 for a single “one hundred” patch which can be divided into pieces.
"They're not going to first-time users. They are going to people who have been on heavy opiates for years," he said.
But he admits should the drug be resold and leave the city, he doesn't know what happens to the drug.
People seeking opioids can give ‘Hollywood’ performances
Addiction specialist Dr. Mark Ujjainwalla said some doctors wrongly prescribe opioids because they haven’t kept up and don’t realize how addictive those drugs can be.
He said other doctors can be fooled.
“You have to remember that drug dependant, drug seeking individuals or entrepreneurial drug-seeking individuals who are trying to get the medication from the physicians can be very persuasive,” he said.
“They can give Hollywood performances.”
Ottawa Public Health said they’ve issued an alert to doctors about over-prescribing fentanyl and similar drugs.
“We wanted to provide physicians with some tips on how to deal with patients who may be misusing fentanyl and how to identify these patients early so they may be able to intervene,” said Pam Oickle, a public health nurse with Ottawa Public Health.
Heroin could be next local problem drug
Dave said he thinks it's only a matter of time before the medical community and provincial governments move to curb fentanyl abuse.
He said he thinks if that happens, drug addicts will either move onto another prescription drug or go onto heroin.
"Heroin... has always been a closet drug in Ottawa ...not a lot of people know someone who sells heroin," he said.
“I find in the last little while there's more mention of it and I think once fentanyl gets harder for people to buy I think it's going to be replaced by... you'll see heroin sales go way up."
But that's one drug Dave said he has no plans to get involved in.
"I'm not going to resort to selling heroin," he said.
The signs of opioid use
What others observe in users of opioids:
- Drowsiness or "the nod."
- Constricted or pinpoint pupils.
- Slurred speech.
- Impairment in attention or memory.
Early signs of a fentanyl overdose
- Severe sleepiness
- Slow heartbeat
- Trouble breathing or slow, shallow breathing
- Cold, clammy skin
- Trouble with walking or talking
Opioid withdrawal signs:
- Dilated pupils.
- Anxiety, irritability, anger (drug craving).
- Agitation (cannot sit still).
- Appears to be ill: nausea, vomiting, diarrhea, sweats and chills, watery eyes, runny nose.
- Yawning and Insomnia.
(Sources: The Royal, Ottawa Public Health)