The arrival of fentanyl in Bermuda is prompting warnings over the drug’s potential impact to public health and safety from representatives of the health, policing and government communities.

The message follows the arrest of two Canadians in December after allegedly smuggling the drug into the country.

A third suspect — a Jamaican national — was subsequently charged. The matter remains before the courts.

“This is an incredibly dangerous drug, and people can die very quickly from it,” Edward Schultz, director of Emergency Services for the Bermuda Hospitals Board, said of the synthetic opioid.

With a potency roughly 50 to 100 times that of morphine, the drug has been heavily linked to what Health Canada in November described as a “crisis of opioid-related overdoses and death across the country,” and which prompted a nationwide alert from the United States Drug Enforcement Administration nearly two years ago.

Widely used by physicians as a pain reliever, forms of fentanyl began to be sold for illicit purposes, most commonly as a cutting agent in other narcotics — primarily heroin — creating greater risks for those using the drug.

“I think there’s a huge issue with heroin use in Bermuda,” Dr Schultz said. “We’ve had a large number of people using heroin for the last 20 years.”

“There’s always been a very large heroin-using population,” Bermuda Police Services Detective Superintendent Sean Field-Lament said. According to Mr Field-Lament, the country’s heroin supply — traditionally sourced from either Mexico, via the eastern United States, or more recently The Netherlands, via London — has rarely been “stepped on”.

“We tend to get quite high purity,” he said.

The arrival of fentanyl, he said, would allow heroin to be cut down by importers and dealers to increase yields, and ultimately profits.

“My concern is that you’re going to see an expansion of heroin use by just adding amounts of fentanyl,” he said.

Fatal even in small doses, fentanyl’s infiltration into heroin elsewhere has put users at an increased risk for overdose and death. With a 10-milligram “deck” of heroin selling for $25 on the island, the amount of fentanyl needed to cut a single hit is minimal.

“The amount of powder that gets somebody feeling good from fentanyl and the amount that will kill you — you can’t eyeball that,” Dr Schultz said.

“The amount is even smaller to create a high-risk of toxicity, overdose and death,” Government of Bermuda analyst Nadine Kirkos echoed.

Prior to fentanyl’s recent arrival on island, Mr Field-Lament said the drug wasn’t really on “the radar” of police.

In fact, fentanyl was not technically illegal when it first showed up, and required fast tracking to add to the Government’s list of banned substances, he said.

Ms Kirkos, however, said that the Government had been tracking the issue for some time.

“Fentanyl has certainly been on our radar for a while,” she said. “But obviously we can only test what comes in.”

Testing of the drug, as well as identifying its effects, also presents a myriad of problems.

According to Mr Field-Lament, results on tests ordered into suspicious deaths have taken an “inordinate amount of time, from a policing perspective” to receive.

“The capacity on the island to do a very timely toxicology report is not there,” he said. “And that’s one of the things we’re trying to address.”

Test results can typically take six to eight weeks to be returned, Mr Field-Lament said. Results on tests ordered relating to three “incidents” in 2017 remain outstanding.

“The problem is we are an island,” Ms Kirkos said.

“You have a large bureaucratic pathway to go through to be able to ship something away.”

Samples dating back to 2013 are also being rescreened for the drug, she said.

Fentanyl also does not show up on standard tests, making the diagnosis of an overdose by the drug by first responders and health practitioners particularly difficult. After the death of 25-year-old Christopher Spencer in 2015, the use of Naloxone — a drug used to counteract the effects of an opioid overdose — was approved by all emergency medical technicians without a doctor’s approval following a coroner’s recommendation.

Naloxone, commonly sold under the brand Narcan, is now carried by all EMTs.

“The drug will save lives,” Dr Schultz said.

“What I advised all my colleagues in the emergency department when we found out fentanyl is on the island, is that if anybody comes in under this profile, we need to give large amounts of Naloxone and you’re not going to be able to test for it, so don’t be deterred by negative tests,” he added. A national strategy to address fentanyl is currently being developed, Mr Field-Lament said.

“Certainly if your loved one is an addict, you should be aware of the dangers,” he said.

Additional reporting by Lisa Simpson