Fentanyl and Synthetic Opioids- Awareness and the Enforcement Pillar. July-16-18

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1 Fentanyl and Synthetic Opioids- Awareness and the Enforcement Pillar

2 Opioid Situation-How we got here 2012 Oxycontin moves to the tamper proof version OxyNeo (Purdue Pharma) 2012/2013 Patch diversion and abuse becomes more wide spread as well as heroin in communities that never encountered it before 2014/2015 powder fentanyl begins to appear (first mixed with heroin to increase potency) 2016 powder fentanyl and counterfeit pills become wide spread across Ontario

3 Fentanyl Fentanyl is an extremely potent synthetic opioid currently prescribed for the treatment of acute and chronic pain, usually in patients already tolerant to high doses of less powerful opioids such as morphine or oxycodone. Fentanyl is 100 times more potent than morphine and 40 times more potent than heroin.

4 Fentanyl Powder In Western Canada (BC/AB) communities are experiencing an epidemic of fentanyl powder abuse and little or no fentanyl patch diversion Fentanyl powder can be purchased online and ordered from China for a little as $12,500 CDN per kilogram One kilogram can make upward of 500,000 fentanyl pills (@ 2mg powder per pill) Street prices $20-$40 per pill

5 Forms of Synthetic Opioids - Patches and Liquid Patches and Liquids- Fentanyl patches are the most popular type in Ontario. There are reports of fake patches. Patches can be cut into quarter or strips and can be smoked or taken orally. Synthetic Opioid powders have been dissolved in liquid form for consumption orally.

6 Pill Form Pills range in appearance from pharmaceutical grade to low quality pressed pills. Fake pills are being produced using imported pills presses and trademark stamps are produced to resemble popular prescription drugs like, OxyContin 80mg, Percocet and Xanax. These fake pills often contain heroin or fentanyl/fentanyl analogue and are mixed with caffeine or other cutting agents.

7 Powder Form Clandestine produced synthetic opioids are increasing in Canada. The powder can be any colour, any texture and any density. Traffickers are mixing cocaine and heroin with potent synthetic opioids to increase profitability. $12,500 for kg fentanyl compared to $45,000 for kg cocaine and $80,000 for kg heroin You can t See it, Smell it, Taste it!

8 Fentanyl/Fentanyl Analogues-Officer Safety Exposure to fentanyl powder is an extreme threat to first responders and police. Health Canada advises that the lethal dose of pure fentanyl for a non-opiate user is 2mg (1g =1000mg) which is comparable to 32 grains of salt or 7 poppy seeds The lethal dose of pure Carfentanil is 20 mcg (1 gram 1 million mcg) which is approximately 1 grain of salt.

9 FENTANYL and Analogues Fentanyl can also appear in a powdered form which is the illicitly produced fentanyl and its analogues made in clandestine laboratories. Powder fentanyl is used to increase the potency or to directly substitute heroin It is also used in the manufacturing of counterfeit prescription analgesics such as Oxycontin and Percocet as well as Xanax. Stronger more potent Fentanyl analogues have entered the Canadian illicit drug market such as Carfentanil, creating a serious health concern due to the rapid climb in incidents of drug overdose and death.

10 Routes of Exposure Routes of Exposure: Ingestion of chemicals Absorption of chemicals Inhalation of chemicals is the PRIMARY route of exposure

11 Fentanyl Dermal Exposure Myth----Touching even a small amount of fentanyl can cause overdose or death Recent studies have revealed that the likelihood of dermal absorption of powder is minimal. If contaminated with powder wash with soap and water and do not use alcoholic hand sanitizers.

12 Street Level Pricing* Powder on the street (similar to high grade heroin) $30-$40 a point (0.1 gram) $220-$240 a gram $ an ounce $20,000 for 9 ounces Counterfeit Oxy s $40-$45 a pill *The range of drug pricing is dependent on a number of factors including: Supply and demand Discount due to volume purchased Quality or purity of the drug Relationship between the buyer and seller Geographic location Proximity in drug distribution chain to the importation level

13 Health Canada Data Canada-2017

14 Health Canada Data-Ontario 2017

15 Federal Approach on Canada s Opioid Crisis

16 4 Pillar Approach The Ontario Opioid Strategy is led by the Ministry of Health. Police Services focus on the Enforcement Pillar but support the other three pillars. All pillars work collaboratively to achieve the collective goals.

17 Enforcement Pillar The goal is to reduce the supply of illicit opioids/opiates through a comprehensive enforcement strategy that targets individuals/organized crime groups by disrupting the production, supply and distribution of these illegal substances.

18 Enforcement Creation of the OCEB led Community Street Crime Units to investigate street level drug trafficking within all OPP policed communities. Investigative Priority for Opioid Organized Crime Groups who produce, import, manufacture and distribute opioids. Crime Stoppers Initiatives-Increased rewards for fentanyl trafficking. Support from Ontario Courts for high penalties for fentanyl trafficking.

19 OPP Opioid Working Group Established 2016 at the beginning of the Ontario Public Health Crisis. Developed internal strategies to support Frontline Officer Safety and Public Safety. Involves all aspects of the Organization and is led by the Organized Crime Enforcement Bureau- Executive Lead Superintendent Bryan MacKillop.

20 What has the Opioid WG Done? December 2016-Public Service Announcements in relation to Opioid Use. January 2017-Commissioners Committee approval for the distribution of Naloxone to all frontline members including training of new safe handling policies, implemented in Sept December 2017-Acquisition of 5 Electronic Presumptive Drug Testing Devices

21 What is the OPP Opioid WG Doing Now? Good Samaritan Act training initiative for frontline members in relation to responding to overdose calls. Comprehensive Overdose Investigations. Community Safety Services initiatives for Community presentations in relation to Opioid Awareness. Acquisition of 9 more Electronic Presumptive Drug Testing Devices.

22 Questions? Detective Staff Sergeant Lee Fulford #10299 Organized Crime Enforcement Bureau Operations/Program Coordinator OCEB Expert/Clan Lab Program Cell