London's opioid users say street drugs are getting stronger, cheaper and deadlier

People who use fentanyl on the streets of London say the deadly opioid is becoming ever cheaper and more powerful, delivering higher highs, while simultaneously raising the risk of overdose death. 

Without widespread testing, there's no way of knowing, but the city's drug problem has become more visible in the core, where strung out users lay in alcoves, doorways and on sidewalks where they remain sprawled in broad daylight, sometimes for hours, as passersby go on with their daily business in the city centre. 

If [fentanyl is] not strong enough to kill someone, it's not strong enough.- Joey, a London, Ont., street drug user whose name is being kept confidential by CBC News

Relief agency officials say while the problem might appear more visible, it's not because of an increased prevalence of drug abuse. Rather, the city's homeless population has recently doubled, making people who use the drugs to self-medicate for pain, mental illness, or sometimes just to catch some sleep, more visible.

"I really believe it's getting stronger," said Dave, a fentanyl user who spoke to CBC News on the condition his real name would not be used in order to protect him from the stigma of homelessness and drug addiction. 

Drugs becoming cheaper, more powerful, more toxic

He was one among a number of users who told CBC News the same thing — the drugs are not only getting stronger, but cheaper as dealers adapt their product to a changing marketplace. 

Dave said he believes dealers are cutting opioids with more additives to give users a bigger high, while federal officials say substances such as benzodiazapine, a highly addictive drug used as anti-anxiety medication, or xylizine, a muscle relaxant used in the veterinary care of animals, are becoming more common. 

The city needs to do more regular testing of street drugs to reduce the risk of more overdoses, said Dr. Andrea Sereda, a physician with Intercommunity Health and a poverty activist. Since the pandemic, users are taking drugs in ever-larger amounts to offset their increased tolerance to opioids, she added.

"Their tolerance has wildly increased," she said. "Before you might see an individual using maybe three times a day outside, now with that increase in tolerance they may be using every two or three hours."

Whether that means there are more overdoses is hard to tell. Figures on London's overdoses are hard to come by.

No single agency counts overdose deaths in the city and the most recent provincial overdose death statistics date back to last June.

While there are no hard numbers, there are anecdotes from users and outreach workers, and even a recent city hall report cites a rise in "overdoses and the toxicity of street substances" over the last 18 months.

Dave said he doesn't trust the drugs — just the naloxone kit he keeps with him, something that's become as common in the tents of London's homeless population as first aid kits in suburban homes. 

"You need to have narcan at your side, [and do drugs] with a friend," he said. 

Naloxone distribution has exploded in the last 5 years

According to figures from the Middlesex-London Health Unit, the rate at which the life-saving drug is being given out has exploded from 2,374 given out in 2018, to 9,965 last year. 

Pharmacies in the London area have also been giving out Narcan kits by the hundreds of thousands since 2019, with 339,110 kits distributed last year at up to 181 locations in Middlesex County, according to health unit data.

By distributing the free antidote, a drug that carries no health risks, critics of safe supply say it only encourages drug users by giving them a parachute, one that allows them to push their body to its limits for a higher high, knowing that if they do overdose, they can be instantly revived.

"You want to have the strongest stuff possible. In my eyes, if it's not strong enough to kill someone, it's not strong enough," said Joey, another homeless fentanyl user who CBC News has agreed not to identify. 

Dealers often advertise their product as the strongest because it's what users want, Joey said.  

"You want something stronger, you're also saving money. If you're homeless, money is hard to come by."