It took Alexandra de Kiewit a few seconds to come around.
The last thing she remembered was shooting purple heroin at a friend’s west end apartment. Now, de Kiewit stared at the ceiling as cops stood over her.
“When you overdose on opioids, you’re kind of missing a few bits,” said de Kiewit, recounting the recent experience. “So you start to connect the dots. The cops were trying to get me into an ambulance, I had bruises on my thorax from chest compressions and I could hear my friend crying.
“They started grilling me about who sold me the heroin. I’m pissed at the thought of going to the hospital. But the truth is, I fucked up. I could have died.”
De Kiewit says she should have known better than to buy “purple” from an unfamiliar source. Not only because she’s been using for the past 23 years but also because it’s her job to keep people from dying from an overdose.
The 43-year-old finds herself on both sides of Quebec’s opioid epidemic. As an intervention worker, she has helped bring people back from the brink. But she’s also a recreational drug user, who trains her peers to consume responsibly.
Most of what we know about a crisis that kills an average of nearly two people a day in Quebec comes from months-old coroner’s reports tallied on a government website.
Last winter, the Coalition Avenir Québec didn’t renew the province’s national strategy on opioid overdoses, nor did it increase funding for initiatives to reduce the fentanyl death toll. This despite a 30 per cent jump in opioid-related deaths in 2020.
“The government doesn’t have to look the crisis in the eyes,” says Dr. Jean Robert, a community health expert who works with opioid users. “Their job is to get elected and stay in power. They don’t see drug users as being worthy of their time because, they figure, no one cares.
“But we’re losing people every day. Families are being torn apart every day.”
In interviews with Ricochet, de Kiewit, Robert and other frontline workers offered a nuanced account of the epidemic from its earliest days — when COVID-19 measures disrupted Montreal’s heroin supply — to the new normal of nearly every street drug being tainted with fentanyl.
Fentanyl comes to Montreal
De Kiewit found him lying motionless in the backseat of a BMW.
He had overdosed on fentanyl and his friends drove him to the safe injection site in a panic. Neither had a driver’s licence, and they worried they’d be arrested if they took him to the emergency room.
So they raced into the cold night, slamming the sports car into park once they arrived outside CACTUS Montreal, east of downtown.
Now they watched helplessly as de Kiewit climbed into the backseat of the car with a naloxone kit in hand. She broke a glass vial and loaded the syringe as her colleague gave the man a nasal dose of the drug, which counteracts the effects of opioids.
“He made a ‘pishhh’ sound and his friends said, ‘It’s good, he’s breathing again.’ But I had to tell them, ‘No, that was the air leaving his body,’” said de Kiewit. “He was a big, beefy guy and it was just the two of us in the back of a two-door car, him slipping further away, me trying to prepare a dose and stick it in his arm.”
She injected him, set the needle aside and prepared another shot. It took eight shots of naloxone and about 20 minutes to get his lungs working again.
“Sometimes people wake up and scream at you for giving them naloxone,” de Kiewit said. “Because it blocks the opioids, you can get dope-sick from naloxone. So people start to panic, thinking they’ll go into withdrawal. And withdrawal is like an awful, awful cold; you’re puking, you’re sweating, you’re hot, you’re cold. Nobody wants that.
“So sometimes, people will scream, ‘I was just nodding off” after you’ve brought them back. And you have to tell them, ‘Dude, you were OD’ing.’”
Before the pandemic, overdoses were a rare occurrence at CACTUS Montreal. Because of Montreal’s status as a port city with an organized crime network that extends around the globe, access to pure heroin had largely kept fentanyl at bay.
“For a time, fentanyl was everywhere but here,” de Kiewit said. “I remember going to Ottawa — just across the river from Quebec — and all you could get was fentanyl. They nicknamed it fenty.
“Meanwhile, just a short drive from Ottawa, our dope wasn’t contaminated yet. That all changed when the borders closed.”
As the COVID-19 pandemic swept across Canada, the federal government closed its borders to contain the virus. With international shipping put on hold, drug suppliers worried they’d be hit with a shortage of heroin imported from Mexico. So they started cutting their dope with fentanyl — a synthetic drug that’s 100 times more potent than opium-based heroin.
Over the next 12 months, some 530 people across Quebec would die of an overdose.
For people like de Kiewit, this meant seeing users go into respiratory failure on a daily basis. But as a user, it also meant navigating a drug market where nearly every substance — from uppers like cocaine and speed to downers like dilaudid and morphine — was laced with synthetic opioids.
During one shift at the CACTUS safe injection site, eight people overdosed. Though none of them died because of the staff’s vigilance, de Kiewit said she could feel people starting to burn out. They may not have lost people at the site but when they went back into the world, there was little if anything staff could do to prevent the worst-case scenario.
“You had folks who would fill in at Montreal’s three safe injection sites working up to 80 hours a week,” she said. “They’re making life-or-death decisions and they haven’t had a good night’s sleep in weeks. To top it off, they’re constantly being exposed to trauma.
“It got so bad that we brought in an altar to CACTUS. We had a system where, when we learned of someone’s death, we would hang an origami bird above the altar. That way, you could emotionally prepare yourself for the news. I’ve lost a lot of friends, a lot of people I used with, a lot of people I formed committees with and who fought alongside me to change government policy.
“You start to get numb to everything. It’s incredibly dehumanizing.”
Buying heroin on the dark web
Like most brick and mortar retail businesses, the heroin trade has moved online.
With an encrypted browser, a Bitcoin wallet and a basic knowledge of how to navigate the dark web, users can log onto a site that sells every imaginable drug. In fact, dealers often come with a rating based on customer reviews.
“One guy advertised his product as having ‘no fentanyl,’” de Kiewit said. “But one reviewer summed it up as having ‘no heroin either.’ If there’s bad product floating around, whether it’s too weak or too strong, it gets flagged on the dark web.”
Though delivery can take weeks, the competitive nature of the drug trade means that dealers make up for delays by giving a free gram of dope or crediting a customer with a discount on future purchases.
The most pressing concern, de Kiewit says, is having access to a safe supply of drugs. To that end, she now works with Le Dispensaire, a clinic in St-Jérôme where users can get free kits that test for fentanyl and other contaminants.
If someone had a bad trip, they can provide the clinic with a urine sample to better understand what they ingested.
That was the case last March after de Kiewit’s boyfriend overdosed on what he believed to be brown heroin. In the end, a sample of his urine revealed that the dope was actually a compound of 12 substances, including three types of fentanyl, cocaine, amphetamines, methamphetamines and phenacetin — a fever-reducing drug most commonly used to manufacture crack.
“I found him on the bathroom floor,” de Kiewit said. “It was horrifying.”
‘I’m not holding my breath that things will change’
A poster depicting the brown heroin that nearly killed de Kiewit’s boyfriend hangs at the entrance of Le Dispensaire.
Under the caption OVERDOSE ALERT, the sign explains that the offending substance has been in circulation since March 30 and lists the 12 chemicals detected in his urine.
The clinic tests thousands of drug and urine samples every year in the hopes of catching a tainted batch of dope before it kills users in the region. Robert says he’s offered to share his data with the provincial government but has been rebuffed at every turn.
“They don’t trust our data but the information they’re using is years old,” he said. “The crisis is happening right now. We need as much information as we can get our hands on.”
On Tuesday, one of Robert’s regular patients travelled north from Montreal to provide a urine sample and tiny piece of crack cocaine in hopes that she can better understand why it’s been causing her skin to flare up.
“I think there’s probably morphine in the crack,” Robert said. “Itching is a common side effect.”
The patient, 56, was with her sister and a friend Monday when the friend nearly died of a fentanyl overdose. She says she’s seen five ODs in her circle of friends in the past two weeks.
There were times where she leaned on sex work to support her drug habit, but she’s managed to get financial stability back into her life. And since she has money, that means access to the most high-quality cocaine available in Montreal.
“But she’s still getting garbage in her drugs,” Robert says. “Everything is tainted now. Or at least we have to operate under that assumption.”
She says that in over 20 years of drug use, she’s never seen things this bad. So she keeps regular appointments with Robert, she tests her drugs and urine almost every week.
“Absent a reliable drug supply or better policy, this is the best we can hope for,” Robert says. “I’m not holding my breath that things will change.”
‘I don’t hide my drug use’
Over in her office, de Kiewit prepared crack pipes for Robert’s patient.
She used a wooden skewer to stuff metal filters into each glass tube, operating with surgical precision. This way, the patient wouldn’t inhale any resin from the crack or get an embolism in her lungs.
De Kiewit moved out of Montreal and stopped working at CACTUS because the sheer volume of misery became too much.
“I see fewer clients now but I can spend more time with them,” she said.
The evidence of de Kiewit’s drug use is carved into her flesh. It’s a bit jarring to look at the scars that run up and down her arms. She’s rail thin and her hands shake. But whatever slight discomfort that provokes is alleviated by her warm demeanour.
She keeps the dope sickness at bay with methadone and aside from her overdose a few months back, de Kiewit has never missed a shift because she was using.
“I remember calling into work that day, crying,” de Kiewit said. “And my boss, when I came back to work, he took me aside and said, ‘Alexandra, I never want you to apologize again. It’s okay to slip up.’”
The overdose came at a tricky time. She had just been in a fight with her boyfriend and her usual dealer had closed shop for the night. So she took a risk and nearly died because of it.
“What helps me remain accountable is that I don’t hide my drug use,” she says. “The stigma forces people to use in dangerous settings, when they’re alone, tucked away somewhere, when they feel shame. To encourage someone to be honest with you, to create that non-judgemental space, that can save someone’s life.”
It helps that de Kiewit owns her past. She’s been a sex worker, she’s living with HIV and there was a five-year period of her life where she didn’t particularly care whether she survived or died.
Things got better when de Kiewit took her restless energy and put it toward harm reduction. When she isn’t on the job, de Kiewet works with advocacy groups that lobby the government for better drug laws.
She co-founded the Canadian Association for People who Use Drugs, she worked with L’Injecteur magazine and she advocates for sex workers and people living with HIV to have a voice in shaping healthcare policy.
The dream scenario is for drug users in Canada to have access to untainted dope in the same way that alcohol and cannabis is subjected to government oversight.
“Once we let go of the judgement and see overdose deaths as a failure of government policy, people will stop dying,” she said. “Trying to turn this into a moral issue might make people feel better about themselves but it’s literally killing thousands of people in Canada every year.
“Fuck ‘Just say no.’ We need a safe supply of drugs.”