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Part 1 of 2

Fentanyl: Niagara's silent killer

By Grant LaFleche, The Standard

Jon Jonhston at work at the Scapretta restaurant in Toronto. Photo by Susan Flores

Jon Jonhston at work at the Scapretta restaurant in Toronto. Photo by Susan Flores

Jon Johnston's life wasn't supposed to end. Not that soon. Not like that.

He was supposed to be a known and respected chef among known and respected chefs. His creations were meant to delight diners and make other culinary artists jealous.

Johnston worked three jobs to put himself through chef's training at  George Brown College. A year ago he was working at an upscale Toronto restaurant owned by Claudio Aprile, a judge on Canada's Master Chef television show. The future he worked so hard for was within reach.

But it would forever stay out of his grasp.

"He was very talented, very passionate about food," says Aprile. "I think he could have gone as far as he wanted to go in this business. Which is tragic really, because he made that one bad decision."

Johnston's road came to an end at age 25 on a patch of sidewalk on the corner of Yonge and King streets in Toronto with a lethal dose of fentanyl in his veins, and only his health card, a list of dishes he recently cooked and a needle in his pocket.

He was originally listed by police as a John Doe, and his death went unreported until his father filed a missing person report.

"People need to know," says Jenn Johnston, Jon's mother. "They need to know how dangerous this drug is. This has been a horror story for me and my family."

By the time her son died, Jenn Johnston knew he was using heroin.

It was a recent revelation. He'd kept his addiction secret from his family, but it had finally caught up with him.

After Johnston disappeared for two days, losing a good job as a result, his girlfriend called his mother.

Johnston's mother says she pleaded with him to get help. She warned her son about fentanyl.

"I told him, 'Please, please don't take that stuff. Don't inject that stuff,'" she said. "He said I didn't need to worry. He told me he wouldn't shoot fentanyl."

After he died last April, Johnston's mother was told the drugs in his system were 90 per cent fentanyl. The rest was heroin.

Johnston is one of hundreds of people in Ontario who died from an opioid overdose in recent years. Opioids - from Percocet to heroin - have always carried the risk of addiction and death. Many users, like Johnston, do not fit the stereotypical image of a shiftless drug addict. People from the streets to posh boardrooms use the drugs.

For years, public health officials, addiction specialists, drug companies and police struggled to combat the rise in opioid addiction, particularly through the widespread use of oxycodone.

The arrival of the fentanyl threw gasoline on that fire.

Cheap to make and easily accessible on the streets, fentanyl is more powerful, more addictive and more lethal than nearly any known opioid.

But it's ubiquitousness is more of a problem than pharmacological effects.

"It's everywhere," says Rhonda Thompson, co-ordinator of the Streetworks harm reduction program at Positive Living Niagara which provides clean needles and resources to Niagara drug users. "Fentanyl is being cut into just about everything."

Drug dealers have mixed their product with other substances for decades to extend their supply and make more money. But Thompson says fentanyl is different. It can be found in everything from cocaine to methamphetamine.

It is not just being cut into other opioids like heroin but is sold by dealers as heroin.

"It's used so widely because it is so cheap," says Niagara Regional Police morality unit detective Todd Waselovich. "It's cheap and easy to get. So you end up finding it in just about anything, usually without the user knowing exactly what it is they have."

Users often don't know they have fentanyl until it is in their bodies. By then, it could be too late.

"The people we deal with are genuinely afraid," Thompson says. "They don't know what they are getting, even from dealers they know. Someone might tell them it is heroin when it is mixed with fentanyl or just is fentanyl."

Those who use street level opioids know the risks, she says. They know, given the potency of fentanyl, their next injection could be fatal.

They take the drug all the same. "That is the nature of addiction," Thompson says. "They take it even though they know it could kill them."

The demand for naloxone kits - an antidote that can stop an overdose in its tracks - that Streetworks makes available has spiked dramatically in recent months by users attempting to protect themselves.

Glenn Walker of Streetworks said over the last year the number of kits the organization handed out went from a handful a month to 15, and is now over 30.

"We were concerned when we hit 15," he says. "We thought that was a lot. But now we are looking at 30-plus."

Thompson says many of the kits going out are to users returning to Streetworks for a new one, which usually means they used their previous naloxone doses.

Walker and Thompson say they are also seeing an increasing number of overdoses that appear to be related to the "wash," the small spoon used by opioid users to cook their drugs. They aren't sure why it's happening, but hypothesize fentanyl residue in the washes could be the cause.

Still, the numbers of overdoses and fatalities related to fentanyl are difficult to assess.

According to Niagara Regional Police, officers responded to 12 fentanyl overdoses in 2016, up from two in 2012. They responded to 12 fentanyl overdose deaths in 2016, up from four the previous year and only 1 in 2010.

Police record three fentanyl deaths already in 2017.

However, police data only reflects circumstances in which fentanyl can be confirmed as the source of the overdose or fatality, which can be difficult to ascertain when drugs are mixed together. Thompson and Walker say many users will use naloxone and not call 911, so there may be no police record of many overdoses in Niagara.

Even if someone who has overdosed goes to the hospital, neither Niagara Health System nor Niagara's public health department track the number of opioid overdoses or fatalities generally, nor those related to fentanyl specifically.

Data from the Office of the Ontario Coroner also show a rise in fentanyl fatalities.

The coroner recorded 86 deaths in 2010, and that number had risen to 167 in 2015, the last year the coroner produced data for.

Fentanyl deaths are not happening in a vacuum. The drug is exacerbating the already acute opioid addiction crisis in the province. According to the coroner's office data, there were 174 oxycodone-related deaths in 2010, a number that declined to 109 by 2015. When all opioid-related deaths are counted, the coroner says the drugs killed 543 people in 2015.

Fentanyl is only the latest in a long line of increasingly powerful opioids to reach the streets, something that has drug cops like Wasolovich concerned.

"Fentanyl is bad. But when you look at it, when you consider how much more potent it is than something like morphine, you start to worry about what is coming next. We know carfentanil (an even more powerful, if rare, opioid) is out there. What might be coming next?" Still, Waselovich believes there may be a ceiling on how powerful these drugs become.

"Drug dealers are in it to make money. They don't want to kill off their customers," he says. "To make money, they need repeat customers."

Considered in terms of supply and demand, fentanyl's risks, including fatal overdoses, aren't keeping customers away from the illicit opioid market.

Waselovich's division has been busy, with several major fentanyl busts in early 2017, which followed a series of fentanyl seizures the year before. The detective has no reason to believe the number of arrests will slow down anytime soon.

For Jenn Johnston, the tide of fentanyl moving into Ontario went largely unnoticed. It wasn't part of her life.

At least she didn't think it was. Her son Jon came by his passion for cooking honestly, watching his mother in the kitchen and cooking shows on television with his father. From a young age, the kitchen was his passion. By the age of 14, he was already cooking up a storm.

Determined to get the training he needed, Johnston worked three jobs to pay for classes at George Brown College.

That drive is what made Johnston special, Aprile says.

"To make it in this business, to make it in the food business, you need to have passion and absolute commitment to it," he says. "Jon had that, and like me, he started when he was 14. That is what you need if you want to make it."

There were no warning signs that he was headed for addiction, his mother says. She knew he drank alcohol when he went out with his friends and occasionally smoked pot. She chalked it up to teenagers being teenagers.

His mother said after he started getting jobs in Toronto restaurants, he delighted in coming home to take her out to dinner at some of Niagara's fine restaurants, ordering something exotic for her off the menu.

"He came home once to take me out to dinner at Queen's Landing (in Niagara-on-the-Lake)," Jenn Johnston says. "He'd point to something I never tired, I didn't know what it was and he'd say, 'Oh, you'd love this. I'm ordering this for you.'And he'd be right."

Jenn Johnston says her bubble was burst in the late summer of 2015 when her son's girlfriend called from Toronto. Jon hadn't been home for two days. He claimed he was going to Niagara, but hadn't been in touch since and he'd blown off his shifts at work.

"That was really weird because I had not seen or heard from him. Why would he come to Niagara and not visit me or his grandmother? That's wasn't like him," Jenn Johnston says.

She texted her son. He called shortly after to offer a tearful confession.

He was an opioid addict. To this day, Jenn Johnston isn't entirely sure how or when it started. She says he told her it started with Percocet pills. Over time, he graduated to more powerful drugs like oxycodone and heroin.

"I was just ignorant of all this stuff. I didn't know anything about it," she says. "I had heard about fentanyl though."

When she told him not to use fentanyl, he told her not to worry. Sometimes, it is in the cocaine he snorts, he told her, but he didn't inject it.

Hearing that from her son was soul crushing, she says.

"I didn't know what to do. I pleaded with him to get help. But he kept saying it was under control," she says.

From a distance, it appeared as though it was. Whatever demons Johnston was wrestling with, his talent in the kitchen couldn't be denied and he landed a job in Aprile's kitchen at Origins restaurant.

Aprile says Johnston was brought in to work as a sous chef for another chef at Origins. But Johnston wasn't the type of man to play second fiddle to anyone.

"This is such a great story," Aprile says.

"So the chef cooks a dish he wants me to take a look at and when he does he says to me, 'Jonny wants to show you a dish, too.'" What Johnston presented was a rabbit valentine, a dish Aprile says isn't easy to make.

"As soon as I saw it I could tell is was great," says Aprile. "He boned the rabbit himself, stuffed it. The dish was well balanced. It was great, but the look at the chef's face was perhaps not so great. He knew he has been upstaged and Jonny knew it, too."

Aprile says no one at Origins was aware of Johnston's drug habit.

"At work he was energetic and hardworking. Passionate about food. I certainly didn't know. None of the staff did," Aprile says. "Jon was very good at compartmentalizing his life."

That Johnston was working for a chef as accomplished as Aprile was a source of pride for his family, and taken as a sign that he was OK.

He wasn't. In April 2016, Jenn Johnston got another phone from her son's girlfriend. He was missing again.

There had been no word from him for 48 hours.

Jenn Johnston says her ex-husband, Jon's father, drove from Hamilton to their son's Toronto apartment. It didn't look like anyone had been there for days.

The missing person's report was filed.

Toronto police matched the name to the health card in a John Doe's pocket.

Jenn Johnston's world crashed down around her.

See Friday's paper for Part 2. 

 

Fentanyl in Niagara by Grant LaFleche on Scribd