People who work with opioid users in Montreal say the city is well on its way to joining other parts of the country in seeing an overdose crisis.
Benoit Garneau, spokesperson for Urgences-Santé, the ambulance service for Montreal and Laval, told CBC News that paramedics started to notice a steep rise in overdoses at the start of the summer.
The increase began in June, spiking in July and staying high right through to last month, with 157 naloxone administrations in that period this year compared to 70 during the same period in 2019.
The numbers for October were especially troubling, with 40 naloxone administrations by paramedics compared to 10 for the same month last year.
“It’s a real crisis,” said Carole Morrisette, a medical director with Montreal public health.
“Montreal was one of the cities in Canada that was kind of in a stable situation, but now with the increase we are really concerned.”
Jean-François Mary, executive director of safe-injection group CACTUS Montréal, says even those alarming numbers don’t reflect the full scope of the problem.
Mary noted that many people who overdose don’t call 911 because they fear being arrested. And he said others administer naloxone themselves before paramedics arrive.
“This is only the tip of the iceberg, and if we see the tip of the iceberg that doubled, what’s happening below the surface?” said Mary.
Morrisette said the precise number of overdose deaths is hard to pin down, but she said it’s definitely on the rise. Mary said his group used to see about one death a month, and now it’s more like one every week.
Potent synthetics driving the increase
Morrisette attributed the increase to the transition among users from using natural opioids such as heroin to black market synthetic opioids such as fentanyl.
She said heroin is a more stable drug with predictable effects, whereas fentanyl is more potent and more addictive. And she said it’s impossible for users who acquire fentanyl on the street to be sure of the dosage.
Morrisette said before June, public health officials were generally seeing cases of people struggling with addiction using heroin cut with small amounts of fentanyl. Since then, users are increasingly seeking out pure fentanyl and other synthetic opioids.
Mary said he’s seeing the same thing.
He said organized crime groups have a higher profit margin when selling potent synthetic opioids.
“They don’t require a field to be grown, so people don’t need to grow vast fields of poppies. You just need a lab,” Mary said.
City looking at ‘safe supply’ solution
Mary said he doesn’t believe the province is taking the crisis seriously. He said the solution is to decriminalize and regulate opioids and to offer more support to drug users.
Morrisette said Montreal public health is working on a pilot project that would offer a “safe supply” of opioids to users in partnership with safe injection sites.
“That would give access to secure pharmaceutical substances instead of the black market,” Morrisette said.
She said the city hopes to have the pilot project up and running within six months.
In the meantime, Morrisette said the best thing people can do is make sure they’re never using opioids alone.
“They should have naloxone kits with them, and someone being able to call 911, because that could be a difference between life and death,” she said.
