Fentanyl: only the lethal tip of the iceberg

Fentanyl: only the lethal tip of the iceberg

written by: Elysia Arseneau, staff writer


Fentanyl is a potent, synthetic opioid prescribed for pain, but also used as a recreational drug. It's getting increased awareness in the news because it tragically kills in microgram doses. But some experts believe that fentanyl is only the lethal tip of the iceberg, and that discussing its potency without addressing how we got into this crisis ignores the part of the iceberg that lies below the surface.


Kent MacLeod, Clinical Pharmacist at Ottawa’s NutriChem Compounding Pharmacy and Clinic, says that there’s much more to the fentanyl story. “You may more readily see people who accidentally overdose because it kills in such small amounts, but users didn’t get started with fentanyl. We don’t have a fentanyl problem: we have a narcotics problem, an opioid problem.”


Per capita, Canada is the #2 consumer of opioids in the world, with the United States occupying the top spot. In both countries, most people seeking opioids on the streets started from the legal, prescription pathway.


MacLeod quotes a 2014 study by Cicero et. al. which found shocking differences between todays’ heroin users and those of the past. Researchers found that of people entering treatment for heroin addiction who had begun abusing opioids in the 1960s, more than 80 percent had started with heroin. But of those who began abusing opioids in the 2000s, 75 percent reported that their first opioid was actually a prescription drug.


“Our culture has allowed opioids to be prescribed indiscriminately, even for conditions they’re not indicated for like fibromyalgia” says MacLeod. “We might not be able to stop all deaths from fentanyl laced with other drugs, but you can certainly reduce the number of users being prescribed opioids in the first place.”


MacLeod is involved with de-prescribing, where clinicians aim to either reduce a patient’s doses or stop certain medications altogether. Good candidates for de-prescribing are people taking medications that cause them harm, that are no longer providing benefit, or that may be considered inappropriate for them.


When they come to MacLeod, his clients are often taking a dozen or more prescription drugs, sometimes including narcotics, and often self-medicate using alcohol and other substances.


“The chemistry of an addicted brain is proven to be different than a non-addicted brain,” says MacLeod. “Addiction and cravings are a science-based problem, not a moral failing. People should see an expert in chemistry to help with the root of their addictions.”


To book an appointment with Kent MacLeod, please call one of NutriChem’s clinics, or book online at nutrichem.com.



[A version of this article appeared in Metro Ottawa on December 22, 2016.]

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