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There’s no question that there’s a lot of pain and suffering in the world.

When B.C. residents turn to health care professionals to help them deal with physical pain, they are all too often consulting someone with no formal training in the use of opioids.

That’s part of the reason that drug overdose deaths have been four times higher than COVID deaths over the past two years in B.C.

“I still think opioid prescribing is a bit of a taboo subject,” Dr. Seonaid Nolan, an assistant professor with the Department of Medicine at UBC in Vancouver and a clinician scientist with the B.C. Centre on Substance Use, told iNFOnews.ca.

“I definitely received no training around how to appropriately prescribe opioids, how to optimize non-opioid prescribing for pain management and so I do feel there are a lot of health care providers that are prescribing opioids but don’t feel confident in their prescribing practices,” she said. “Often we see, certainly where I work, people who are continuing to be abruptly discontinued or tapered off because physicians and other prescribers are really worried about being audited and being criticized for how they are prescribing.”

There is no requirement in medical school to take an addiction elective to learn to identify and manage substance use disorders.

“We see a large proportion of people who were the recipients of health care providers over-prescribing opioids with that strong push that happened from the pharmaceutical industry a number of years ago and the college cracking down on prescribing,” Nolan said.

That’s not something that happened just in the past. It’s still all too common today.

“Many patients are being discontinued off their opioid prescription altogether so, in order to meet either their pain or their withdrawal management needs, they had no choice but to turn to the illicit drug market,” Nolan said.

She estimates the majority of people she sees started out on opioids that way. The others are more likely to have come from the recreational use side then became addicted.

This is happening despite the highly publicized fact that illicit drugs are often laced with deadly fentanyl.

READ MORE: Illicit toxic drug deaths hit Thompson-Okanagan region hard in 2021

“Adolescents are a prime target group who really engage in risk taking behaviours,” Nolan said. “We all did, when we were younger, in terms of pushing the boundaries and almost having this sense of invincibility. As you get older and your brain is fully developed, I think that risk-taking behaviour is diminished.

"But a lot of people don’t have the necessary coping strategies to manage things like depression, anxiety, stress and so substances are a very common thing that they turn to to help with that. Certainly turning to recreational drugs is one aspect. If you look at smoking or alcohol, which are far more prevalent in terms of substance use disorders, people are using those substances for the exact same purpose, often.”

And it’s not that opioids are necessarily the substance of choice. Many are caught up in the deadly fentanyl side of the drug trade quite unintentionally.

READ MORE: Why you need to update your perception of who's dying of overdose in B.C.

“There’s a large proportion of people, I would say the vast majority, who really are not interested in accessing fentanyl but, because it is so prevalent in the illicit drug market, they’re exposed to it regardless,” Nolan said. “

Fentanyl is attractive to dealers for two reasons. For one, it’s not derived from opium so it does not have to be imported from oversees. It can be cheaply manufactured in drug labs and secondly, it is so potent that a little can go a long way.

It’s so good that some users actually seek it out. They often have built up a tolerance to opioids in general but can still die from poorly mixed drugs that contain too much fentanyl.

“Drug manufacturers aren’t intending to kill off people who are accessing illicit drugs,” Nolan said. “But, as you can imagine, a manufacturing plant or a lab is not a sterile environment. They may be manufacturing fentanyl but also manufacturing crystal meth and there’s going to be some degree of cross contamination.”

It can take fentanyl the size of a grain of sand to get a user high but that can also kill someone who thinks they’re buying crystal meth and have no tolerance for opioids, Nolan said.

And it’s not just crystal meth that can be dangerous. Grains of fentanyl can find their way into other illicit drugs like cocaine or ecstasy.

Because all these drugs are illegal, there’s no way to say how prevalent any one is on the recreational market at any given time.

“Where I practice in Vancouver, we’re seeing a change in the illicit drug market,” Nolan said. “When I started in practice five or six years ago it was predominantly heroin, and there was a lot of crack cocaine use. Now the more prominent drug of choice in the recreational drug scene, is fentanyl and crystal meth. The illegal drug market is an ever-changing drug market so staying on top of treatment can be particularly challenging.”

While she’s sure that things like magic mushrooms, LSD and ecstasy are widely used in some circles, she doesn’t see much of it in her practice.

“We just have a biased population around those presenting for management either to the emergency department or to our clinic,” Nolan said.

She’s also not seeing people substituting legal cannabis for opioids. It just doesn’t have the same kind of high or pain killing attributes.

“It really revolves around the fact that people who have an opioid use disorder have developed this degree of physical dependence,” Nolan said. “Often they’re not using opioids to get high. They’re simply using it to relieve their withdrawal symptoms and to fill normal.”

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