Quebec continues to wrestle with opioid crisis

As the opioid crisis wreaks havoc in Western Canada, Quebec is also grappling with an increase in drug overdoses.

According to data from the National Institute of Public Health of Quebec (INSPQ), more than 500 people died of suspected poisoning with opioids or other substances from October 2021 to September 2022.

While 90 per cent of about 32,000 Canadian deaths associated with opioids took place in British Columbia, Alberta and Ontario, unprecedented rates have also been observed in the Quebec City and Montreal regions since 2016.

"The first wave of street fentanyl was in Montreal in the summer of 2014. By chance, a batch of bad fentanyl ended up on the street, and there were several overdoses in those two weeks … But the crisis we are currently experiencing began at the start of the pandemic," said Christopher Kucyk, trainer and support officer at PROFAN 2.0, which offers training on overdose prevention.

According to data from the Bureau du coroner au Québec (BCQ), regions of the province experienced a total of 1,258 overdose-related deaths from January 2019 to July 2022. The majority of them were men between the ages of 40 and 59.

"It's not the drugs that make people die. It's the stigma," said Kucyk. "People hide to consume, they are alone, and so there is no one to intervene with them."

During the first year of the pandemic, the BCQ recorded an increase of about 25 per cent in deaths possibly or probably related to drug poisoning compared to the previous year.

Data from the director of Montreal regional public health (DRSP) show that emergency interventions in supervised injection services (SIS) are four times more frequent than in 2019-2020. The distribution of naloxone — a drug that temporarily reverses the effects of an opioid overdose — by community organizations has also increased by at least 63 per cent in Montreal between the pre-pandemic year and last year.

Some drug addiction services have improved in recent years, such as SIS. In Montreal, three fixed sites and a mobile unit allow injection drug users to dose safely.

Despite this, the current crisis requires an improvement in the services offered to the population, because they are still insufficient, according to Dominique Gagné-Giguère, a spokesperson for the Montreal organization Méta d'Âme.

"Even though there was a statistical lull in 2021 for fatal overdoses, it was almost the worst year for non-fatal accidental overdoses. 2022 promises to be the second worst year for fatal overdoses in Quebec," he said. "The situation clearly requires either an increase in funds or government initiatives that have concrete impacts, but that is not what we are seeing."

A silent crisis

In Quebec, more than one person per day dies from a drug overdose, according to Kucyk, an injection drug user himself.

"And again, we are talking about the deaths listed," he said.

But this problem remains relatively little addressed within the media space, Gagné-Giguère said.

"It is not stigmatizing to warm up a car, but it is very stigmatizing to inject or consume drugs at all," he said. "The public is aware that there is a crisis, but it affects a vulnerable and stigmatized population so much that in the end, it doesn't occupy much space in the public discourse."

While fentanyl has been associated with an increase in overdoses for some time, new psychoactive substances are increasingly circulating on the Quebec black market. This is the case of carfentanil, which is considered to be 4,000 times more powerful than heroin and 100 times more powerful than fentanyl.

"What has been exacerbated by the pandemic is the cessation of imports of foreign substances. People turned to local stock made with questionable mixtures, and it was really more complicated to know what was being consumed," said Gagné-Giguère, adding that substance analysis was not yet a very established practice.

Significant outreach work remains to be done to tackle this problem, he said, especially among the police. Although more patrol officers are carrying a naloxone kit, many of them don't have the appropriate training to intervene with users in crisis.

"The overdose crisis, unfortunately, is far from over. Until authorities act in a way that is commensurate with what we see in the streets, fentanyl is here to stay," said Kucyk.