A new batch of brown heroin hit the streets of St-Jérôme late last April.
Or at least, that’s what “Georges” thought when he bought a bag of brown powder off his dealer. As a precautionary measure, he injected an eighth of a gram of the substance into his bloodstream to see how his body would react.
He passed out and had to be taken to the hospital in an ambulance.
The tiny dose of what Georges believed to be brown heroin was, in fact, a cocktail of 13 substances — including cocaine, methamphetamine, morphine, ephedrine and three fentanyl-based synthetic opioids.
“There was a chemical in there that you find in hair dye,” said Dr. Jean Robert, who examined a urine sample provided by Georges. “He was rushed to the hospital where they treated him like he was ‘just another junkie.’ But he was a person and he could have died.
“People talk about a fentanyl problem like that’s what has been killing everyone. The truth is, aside from pot, most street drugs we come across have between two and 19 substances in them. And many of those substances are even more deadly than fentanyl.
“What we have is a drug supply problem.”
Like most major urban centres in Quebec, St-Jérôme’s drug supply is tainted.
The city is a 45-minute drive north from Montreal on Highway 15, a bedroom community and the last major stopoff before Laurentian ski resorts like St-Sauveur and Morin Heights. But just as this regional hub draws in college students from nearby farming towns and skiers from the city, it’s also a crucial waypoint in the North Shore drug trade.
Between 2009 and 2013, only five cities in Quebec had a worse crime rate than St-Jérôme. The drug trade, in particular, has hit St-Jérôme hard, according to two police sources. But somehow the city avoided the spike in mortalities related to Quebec’s opioid crisis last year.
That’s where Dr. Robert comes in. Robert is part of a team that’s reinventing the model of harm reduction in Quebec. For the past four years, the people at Centre SIDA Amitié (CSA) have used lab testing to better understand exactly what drugs users are putting in their bodies and how to slow the spread of tainted dope before it kills people.
Here’s how it works. The CSA distributes testing kits to hundreds of people every year: drug users, drug dealers, sex workers and a network of volunteers across the Laurentians, a region 40 times the size of the island of Montreal. But since the kits test only for the presence of 10 substances, they’ve also collected and analyzed over 1,000 urine samples since launching the project three years ago.
They call the campaign “Piss your buzz.” The results have been astounding.
There were 571 deaths related to an opioid overdose in Quebec in 2020 — more than any other year on record. When the COVID-19 pandemic forced Canada to close its borders last year, it disrupted the supply chain of heroin, cocaine and methamphetamines used by organized crime. To avoid a drug shortage, wholesalers began cutting their dope with the synthetic opioid fentanyl.
As a result, the rate of deadly overdoses jumped by 30 per cent across Quebec last year. But while the Laurentians also saw an influx of fentanyl and counterfeit drugs on its streets, there was just a 2 per cent increase in fatal overdoses last year, according to public health records.
“One of our users fell on hard times and he had to start selling speed,” said Hugo Bissonnet, the CSA’s executive director. “So he took his batch of pills to us and we tested them. They were laced with all kinds of substances, including fentanyl.
“Yes, he’s someone who uses drugs, and yes, he sells them. But he’s also a father, and when he saw how bad the drugs were, he didn’t sell them. Even in his desperate state.”
Naloxone goes mainstream
It all started with a $231 cheque.
“Four years ago, a patient came to me and said, ‘Doc, it’s September, and since June I’ve lost eight of my friends to an overdose,’” Robert said. “We need naloxone. And we need to find out what they’re putting in our dope that’s killing us.”
The drug naloxone counteracts the effects of an overdose, reversing the depression of the respiratory system. It has become one of the most indispensable weapons in the opioid crisis. These days, every pharmacy in the province is legally required to provide patients with naloxone for free, no questions asked.
But four years ago, it was something of a novelty in Quebec. So Robert picked up the phone and called a nearby pharmacy.
“All they had was one box of 10 vials,” said Robert. “They were $23.10 a dose. I wrote them a cheque for $231 and that’s how we got started. The box is up there on the wall (as a keepsake).”
Robert has a raspy voice and carefully sounds out each word. Though his white hair and glasses fit the part, he looks too relaxed to be a doctor. He wears a collared shirt with the kind of wavy, burgundy patterns you might see in a vintage bowling alley.
He pulls up a spreadsheet with comically large fonts, laying out the fruit of their efforts. Since that $231 purchase less than four years ago, the CSA has handed out 12,189 naloxone doses since then and trained over 1,000 people to administer the drug in an emergency. From cops who patrol the city to dime bag hustlers, their goal is to get as many kits on the street as possible.
“The police see what we’re doing, they’re on the front lines,”said Bissonnet. “They recognize this is helping save lives. It helps create accountability in the community.”
He says dealers come by to get their stuff tested all the time. Almost everything seems to come back with at least a trace amount of fentanyl.
“Dealers come to us because they have no idea what they’re selling,” Robert explains. “People can make better decisions when they know more about the drugs they’re buying or selling.”
Robert pulls up some lab results:
- Amphetamine tablets with the word ICE pressed into them but cut with enough carfentanil to put someone to sleep.
- “Purple heroin” that’s really fentanyl and benzodiazepine.
- Speed laced with fentanyl, cocaine and morphine.
Robert, a microbiologist, was a pioneer of accessible healthcare in Quebec, running one of the province’s first major community health departments at Hôpital St-Luc for 20 years. But the community model was done away with as successive Liberal and Parti Québécois governments gutted healthcare spending to balance budgets in the 1990s.
In his book Médecin de Rue, he argues that by eliminating community healthcare, the system has become hostile to those who need it most — homeless people, sex workers, people with substance use disorders, and prisoners, among other vulnerable groups.
“They still use words like ‘junkie’ to refer to people who’ve overdosed. People are made to feel subhuman if they have an addiction,” Robert said. “That’s not healthcare.”
Despite overdose deaths jumping by nearly a third last year, the Quebec government did not increase funding to fight the opioid epidemic in the 2021 budget. In fact, the province allowed its national strategy on opioid overdoses to expire at the beginning of the year.
“The province wants nothing to do with us,” said Bissonnet. “We get a few dollars from public health but, for the most part, we fight just to stay alive.”
‘I’m not there to judge’
Behind the wheel of his white pickup truck, Sebastien Doyon looks like someone who decided to skip work and hit up the beach on a sweltering Tuesday morning.
He sports a baseball cap with aviator sunglasses and camouflage shorts. His school bag is never too far out of reach. It’s packed with safe injection material, drug testing kits and an old pill jar filled with vials of naloxone.
For the towns on the north shore of Lac des Deux Montagnes, he’s the closest thing to a street clinic anyone will ever see. Doyon spends his time in skateparks and boat launches, places where kids go to smoke weed and drink king cans of beer. Places where some of them might graduate to harder drugs like MDMA or speed.
“I’m not there to judge them, I’m just there to let them know that if they do ingest drugs, they should be safe about it,” said Doyon, a street worker who acts as a liaison with CSA. “Truth is, if I’ve tested 40 drug samples, about 30 to 35 have come back with traces of fentanyl, not just heroin. This is showing up in everything. I’ve never seen anything like it.”
If you work with Doyon, odds are you’re going through a rough patch. He takes clients to court dates, helps find them an apartment if they’ve been on the streets and, if someone tells him they’re ready to go into detox, he’s ready to work the phones on their behalf.
“Because almost everything has fentanyl in it, it’s changing the way people try to quit drugs,” he said. “It used to be, weaning yourself off of crack or meth wasn’t that bad. It was rough but it lasted a few days and it was over.
“Now, if someone tells me they’re going to stop using crack, I suggest we find them methadone to help with withdrawal. Because even someone who only smoked crack is also ingesting opiates every time they take a puff. So when they stop, it’s like going through heroin withdrawal but worse because fentanyl is so much more powerful.
“Imagine the worst flu you’ve ever had and the worst gastro you ever had and you’re going through both at the same time for a week. Everything hurts, you’re sweating, you’re vomiting and if you take just one puff of crack, it can all go away.”
As a street worker, Doyon says he’s the “cheap labour” holding things together for about 60 clients in and around Pointe Calumet. There are no safe injection sites here or walk-in clinics that help an intravenous drug user get treatment for conditions like hepatitis.
Instead there is a patchwork of trailer parks and lakeshore mansions, a biker bar, waterslides that draw in screaming children from the city every summer, suburban housing developments and produce farmers still clinging to the old ways.
Doyon navigates this changing world with his truck and his school bag.
“People are buying in, people take the test kits, even pushers take the test kits,” said Doyon. “What they’re doing at CSA is changing everything. It’s a hell of a lot of work with not many resources but there’s something so fulfilling about it.
“If people can stay alive for long enough, they can get themselves out of the cycle of addiction. Our job is to buy them more time.”
Making the streets a little safer
Urine was just the beginning.
The CSA paired with two Montreal-based safe injection sites this year to buy lab equipment that can determine what substances are in a drug but also break down how concentrated each substance is.
In the absence of leadership from Quebec, CSA and organizations like CACTUS Montreal and L’Anonyme have banded together to make the streets a little bit safer.
“Whether it’s naloxone or test kits, we purchase them in bulk, together, so everyone gets a break on the price,” said Bissonnet. “Our own distribution extends from the North Shore all the way to Mont-Laurier 200 kilometres north. What really helps keep us going is the patients.”
In the lobby of the CSA — a bungalow-sized building between the railroad and Highway 15 — the walls are covered in art. Light from the street filters through a stained-glass garden that hangs in the storefront window. There are paintings, carvings and photos of people “graduating” from hepatitis.
“When someone is free of hepatitis, we give them diplomas because it was a struggle and it’s an achievement to get healthy again,” said Bissonnet. “A lot of the people we work with, they become like a family to us. Some don’t have the best relationship with their own families.
“We celebrate these victories together because, I guess, what’s the point of making progress if you have no one to share those moments with?”
“We’re proud of our little family.”