Long sheltered from worst of overdose epidemic, Quebec seeing a surge in opioid poisonings

Five years ago, the Old Brewery Mission had to use naloxone on clients about once year, but since opioid toxicity skyrocketed during the pandemic, workers at the Montreal homeless shelter have had to use the life-saving medicine every day.

Sometimes, they don't make it in time. Just this week, two of the shelter's clients were found dead in suspected drug poisonings. 

"That's hard. That's really hard," said Vincent Dubois, the shelter's training co-ordinator, who teaches colleagues how to use naloxone and what to do when they find someone overdosing. 

"We're nowhere near the end of this crisis. I'm telling you, it's far from over." 

While drug poisonings have been on a steady incline across North America for the past decade since the powerful synthetic opioid fentanyl hit the streets and began tainting drug supplies — the number of yearly opioid-related interventions in Quebec was nowhere near the statistics out of British Columbia, Alberta and Ontario.

That appears to be changing.

Last week Urgences-Santé, the paramedic service covering Montreal and Laval, released data showing it used naloxone on patients 291 times in 2022, twice as many as in 2018 (137) and four times as many as in 2015 (71). 

According to data released earlier this year by Quebec's Institute of Public Health (INSPQ), more than 500 people died of suspected poisoning with opioids or other substances from October 2021 to September 2022.

In comparison, in 2017, there 181 deaths. In 2018, there were 424.

This year so far, Montreal Public Health has tallied 87 deaths from Jan. 1 to July 25 in the city, compared with 72 for that same period last year. 

The epidemic is becoming more visible in the Montreal area, as it coincides with a severe housing shortage. 

"These are intersecting crises that are highly related," said Jayne Malenfant, an assistant professor at McGill University's department of integrated studies and education. 

Increased pressure on the housing market has made it harder to afford rent, leading to a rise in visible homelessness, coupled with a poisoned drug supply. 

Merchants and residents in the city's Chinatown neighbourhood held a news conference Friday, decrying a rise in violence in the area and calling on the city to intervene. Business owners in the Village, east of downtown, have made similar requests this summer.

Malenfant says the crises' visibility is also a product of people trying to keep each other safe. Using drugs alone and in private can prove fatal if an overdose occurs. 

Amplifying the voices of those with lived experience

Various levels of governments have changed their approach to a harm-reduction one over the past decade, funding supervised injection sites. Individual shelters that traditionally only accepted clients when they were sober are also becoming more tolerant of clients using drugs on their premises. 

But Malenfant would like to see officials make more efforts to include users and homeless people in their decision-making. 

"Thinking of how do we conceptualize people who use drugs and people who are experiencing homelessness as members of our communities, as citizens who also are deserving of having a voice and shaping our responses," said Malenfant. 

James Hughes, the president and CEO of the Old Brewery Mission, said he'd like to see more medical staff at shelters in the future. 

"We're seeing people coming in with a bigger baggage of problems than we have before," Hughes said. "There's obviously a lot of pain and loneliness out there."

Hughes said he welcomes the funding announced earlier this month by Lionel Carmant, the minister responsible for social services in Quebec, for supervised injection sites — but that other tactics are necessary to tackle the issues, such as safe supply: a harm-reduction strategy that aims to separate people from the increasingly toxic and unpredictable drug supply by providing regulated versions of some criminalized drugs.

"Drug poisoning is everywhere but it is getting increasingly present in the shelters and so these medical issues have to be dealt with by medical people," Hughes said.

"We're a great community organization with great community workers, and we're a housing organization — but we're not a medical organization."