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In America's opioid addiction crisis, alarm bells are now going off over Fentanyl. The synthetic opioid is stronger than heroin and is blamed for an increasing number of overdose deaths, including the late pop star Prince. But few places in the U.S. have been as hard-hit as the Canadian province of British Columbia, where a surge in Fentanyl-related overdose deaths has triggered the declaration of a public health emergency. NPR's Martin Kaste reports from Vancouver.
MARTIN KASTE, BYLINE: This is East Hastings Street. It's Vancouver's Skid Row, and it's the traditional capital of heroin culture here on Canada's west coast. Heroin use is so common here, so open, that you have to watch your step.
A guy on a bike bumps into me, and I hear something snap. He mutters a curse. Hugh Lampkin is my guide here, and he explains what just happened.
HUGH LAMPKIN: Oh, yeah. He was holding a syringe in his hands. And I guess when he bumped into you, the tip came off. Well, you shouldn't be riding around a bike with a syringe in his hands. Come on.
Lampkin is part of an organization called the Vancouver Area Network of Drug Users. It's exactly what the name says. It's a nonprofit run by drug users for drug users. And one of the group's biggest concerns right now is the fact that heroin isn't really heroin anymore.
LAMPKIN: It doesn't matter where you come from - from the suburbs, out of town or you're from here. If you go to buy heroin, you're going to get Fentanyl.
KASTE: Fentanyl - it's about 50 times stronger than heroin - so strong that the DEA warns police not to touch it with their bare skin. It's replacing heroin because it's cheaper to make and easier to smuggle from Mexico and China.
CLAYTON WILLIAMS: I overdosed...
UNIDENTIFIED MAN: Yeah. That's a good guy here.
WILLIAMS: ...Five times on Fentanyl.
KASTE: When people hear us talking about it, they come over to tell their stories. This is Clayton Williams.
WILLIAMS: I thought it was heroin, and I overdosed instantly. And I woke up in the hospital.
KASTE: So you were somewhere where someone found you, then?
WILLIAMS: Yeah. I was right - actually over in the bathroom on the corner of Main and Hastings over there.
KASTE: Fentanyl - I mean, how do you know it was Fentanyl?
WILLIAMS: That's what the hospital had said that they'd found in my blood system.
KASTE: This has been going on for a while now in Vancouver. Jane Buxton is with the British Columbia Centre for Disease Control.
JANE BUXTON: We did a study - it was a year ago now - where we asked people what they do - what drugs they'd used in the last three days and asked them to pee in a pot. And then we tested it. And we found 29 percent had Fentanyl in their urine. But of those, 70 percent didn't know they'd taken Fentanyl.
KASTE: And why does it matter? Well, partly because Fentanyl is so strong.
BUXTON: Heroin - often people, if they were having an overdose, it was being more of a slower process, whereas this can happen very, very quickly.
KASTE: And also because the drug can be so unpredictable. The street version can be poorly mixed, so a dose might contain deadly hotspots. But on top of all that, there's this - just as users are getting used to the idea that their heroin is actually Fentanyl, now maybe it's not even Fentanyl anymore. An even stronger synthetic opioid called W-18 has now appeared. The BC Centre for Disease Control's Mark Tyndall says it's just one of a whole family of compounds.
MARK TYNDALL: They're called W-18 because it goes from W-1 maybe past W-18. I don't even know.
KASTE: W-18 was invented in Canada but never approved as a prescription drug or tested on humans. It's thought to be circulating in the U.S., too, though its novelty makes it hard to detect. Doctors suspect that it's contributing to overdoses in places such as Philadelphia.
In Vancouver, public health officials are struggling with what they don't know about it. For instance, Dr. Tyndall was confronted by questions of whether W-18 responds to the medicine Naloxone. That's the medicine that's been used to revive victims of opioid overdoses. Did he think that Naloxone might now become useless?
TYNDALL: You know, I don't think so. They - what we need to get out there about Naloxone is we don't know any adverse reactions for Naloxone, so I can't see it being - it might be useless, but it's not going to make anything worse.
KASTE: This uncertainty has only strengthened Hugh Lampkin's sense of urgency back on East Hastings Street. Users have never really been able to trust that their drugs are pure. But he says, now, in this age of synthetic opioids, you don't even know what the active ingredient is. So he spends his time on the street preaching safer habits.
LAMPKIN: Don't use alone. Don't use it all at once; taste it. Have somebody there with you. Just try to stay as safe as possible. And remember those, and hopefully you'll stay alive.
KASTE: Martin Kaste, NPR News, Vancouver, B.C. Transcript provided by NPR, Copyright NPR.