Organizations serving drug users in Montreal say they’re struggling to respond to an increase in overdoses, compounded by a lack of data from Quebec’s health ministry.
From April through June, 148 people in Quebec died from a suspected drug overdose, compared to 83 in the same period last year, according to data shared by Quebec’s coroner's office. The office also reported 23 people had died in Montreal in July after taking street drugs, with nearly half that number coming during one eight-day period.
“For us on the front line, we started to see that increase in May,” said Jean-François Mary, the general director of CACTUS Montréal, an injection site in the downtown area close to St. Laurent Street.
“We used to see one overdose every week, or every two weeks, a year ago,” he said. “Now this is a daily occurrence.”
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Since mid-June there have been 15 to 17 deaths per month that are suspected to be the result of a drug overdose, compared to 10 to 13 each month since 2014, according to Montreal public health.
“The deaths that have happened since July are more often believed to be caused by opioids, which is concerning to us,” said Dr. Carole Morissette, a medical director with Montreal public health.
Although the office receives routine updates about deaths from the coroner, they don’t make the figures public because the deaths are only suspected to be caused by drugs, she said. The coroner’s office typically takes a year to reach a conclusion on the cause of death, and has the final say on whether suspected overdose deaths can be made public. Morissette’s office also learns about the number of non-fatal overdoses from first responders and from the four injection sites that have been running in Montreal since 2017.
Knowledge about non-fatal overdoses would allow injection sites to get more outreach workers to neighbourhoods that are experiencing the most overdoses, advocates told Ricochet.
“The data isn’t available soon enough for us to intervene and provide help on the ground for those who need it,” said Kim Brière-Charest, who runs the intervention program at the injection site L’Anonyme.
Morissette says Montreal public health hopes to make some of the data available on a monthly basis. In contrast, the B.C. Centre for Disease Control shares data on overdose fatalities once per month, and data on the number of paramedic-attended overdoses once per week.
‘It’s not an opioid crisis, it’s an overdose crisis’
Many of the deaths appear to be caused by opioids and synthetic opioids including fentanyl and isotonitazene, a substance that has been making its way into street drugs since July, Morissette said. Stimulant overdoses are also common, and are believed to be responsible for 17 of the 23 deaths that happened in Montreal in July.
“It’s not an opioid crisis, it’s an overdose crisis,” Mary said. Stimulant overdoses are also more challenging to respond to since naloxone can’t be used to counteract the effects of the drugs, he said.
An analysis of 340 fatal overdoses in Quebec in 2017, recently made public by the school of social work at the Université de Montréal, suggests fatalities more often involve a combination of drugs.
It found 65 per cent of overdoses involved multiple substances, with alcohol, cocaine, and methamphetamines most often detected. When it came to opioids, 23 per cent of the deaths involved hydromorphone,19 per cent involved fentanyl and its analogues, and 15 per cent involved morphine. The findings only point to the drugs found in the body after death, not necessarily the ones responsible for the overdose.
To the researchers' surprise, a large number of fatalities included older adults, said André-Anne Parent, who contributed to the report. The average age of death was 46.
“While some years have passed, we nonetheless believe the portrait hasn’t changed, and that there are still a high number of overdoses happening,” said Parent, who presented the findings alongside an organization that promotes health among drug users, the Association québécoise pour la promotion de la santé des personnes utilisatrices de drogues. The research was made possible after the association received funding from the provincial government to study overdoses.
Deaths were mainly concentrated in Montreal, which saw 96 in 2017, compared to 36 in the Quebec City region. Those who died often had mental health problems, chronic pain and chronic illnesses, including heart, vascular and pulmonary problems, at a rate higher than the general population.
The association is calling for more funding so they can continue analyzing coroners’ reports from subsequent years. They also want a renewal of Quebec’s strategy to address overdoses in the province, which concludes this year and has only focused on opioid overdoses.
“There’s no new strategy, and there’s more overdoses now then there’s ever been. More resources need to be provided to the coroner’s office so they can speed up their investigations and we can act sooner,” said Chantal Montmorency, the general director of the association.
The analysis also suggests more can be done to educate people about what an overdose looks like, Parent said.
“More than 50 per cent of those who died were found by a family member or a friend, and many were using while in the presence of others,” Parent said. “This shows there are several avenues for intervention worth exploring, considering symptoms that appear in the hours and days leading up to an overdose are often trivialized by others, or assumed to be signs of simply being drunk.”
Morrissette said the province is studying the possibility of a “safe supply” pilot project that could supply opioids to drug users in Montreal, with similar pilot projects currently underway in Toronto and in B.C. She encourages people to carry naloxone and to avoid using drugs alone.
“The most important risk factor is using alone,” she said. “We believe more people using drugs alone without anyone around to intervene contributed to the spike we saw in July.”