Fearing what will happen if they’re caught outside after curfew, hundreds of people have stopped using Montreal’s largest safe injection site, dramatically increasing the risk of fatal overdoses across the city.

The Quebec-wide curfew has also halted distribution of the life-saving drug naloxone and a needle exchange program that prevents the spread of HIV and hepatitis C.

Ordinarily, CACTUS Montreal serves 75 people a night, giving them a medically supervised space to use heroin and a clean syringe with which to use the drugs. Now there are about four people who use the site each night, according to Jean-François Mary, the director-general of CACTUS.

“This is incredibly dangerous,” said Mary. “Last summer, we would have about two overdoses on site every day. And lately it’s been about one a day. But these people wouldn’t die, our team would intervene and save their lives.

“Those overdoses are still happening but if it’s not here at CACTUS, they’re overdosing at home or on the street. We’re talking about one overdose a day. Now it’s potentially lethal.

“We’re going to start to see a lot more fatal overdoses, that’s going to happen.”

A new reality

The arrival of the COVID-19 pandemic in Quebec has coincided with a spike in overdoses, fuelled by the presence of fentanyl in heroin, cocaine and amphetamines. Whereas Quebec had largely been spared from the opioid crisis that’s devastated North America over the past decade, Mary says counterfeit drugs are a new reality in the province.

This was manageable when people used CACTUS and other safe injection sites — which see their peak hours between 8 p.m. and 4 a.m. But now that people are staying home, there’s a sense of panic among street workers in the city.

“I’m losing track of a lot of my clients and it’s getting harder not to worry,” said Emmanuel Cree, a street worker with the RÉZO community centre. “You worry that the last time you saw them was the last time you’ll ever see them. You worry they’re dead.”

Cree says CACTUS started giving his clients medical notes, in case they’re stopped by police after curfew. But ultimately, it’s up to individual officers to decide whether or not to ticket someone for breaking the public health order, which came into effect on Jan. 9.

Three sources told Ricochet that an officer ripped up a medical note from CACTUS and fined someone for being outside last week. The police could not confirm that claim.

But in a statement sent to Ricochet a Montreal police spokesperson wrote that all their officers are equipped with naloxone and trained to help someone in need of the medication.

“The fear is, if you give officers that note, you’re admitting you have drugs on you,” said Jessica Quijano, who works with the Native Women’s Shelter of Montreal. “At that point, you’re not just worried about a fine, you’re worried about a criminal record.”

A public health emergency

Over the holidays, a 24-year-old client of the Welcome Hall Mission died of an overdose, according to Sam Watts, the shelter’s CEO.

“It’s a tragedy, it’s a public health emergency. My understanding is there’s a problem with the drug supply,” said Watts. “We lost a life, a young man. He was struggling with addiction but his life had value.”

Late last fall, Resilience Montreal lost two of its clients to a heroin overdose.

“These were people living in the shadows but they were people who brought joy to a lot of other folks,” said David Chapman, who co-manages Resilience Montreal. “Things are worse now than I’ve ever seen them.”

Mary says that Canada’s decision to close the U.S. border to non-essential travel created a problem in the supply of illicit drugs on the streets of Montreal. Dealers began to either withhold drugs or cut them with fentanyl. But now he says it’s likely just “market forces” motivating traffickers to increase profits by cutting their product with cheap, dangerous synthetic opioids.

Public Health Montreal and CACTUS are working together to try to root out tainted drugs in the city through a pilot program that would test samples of opioids or other illicit substances.

Calls to decriminalize possession

Quijano is working with city councillor Marvin Rotrand to introduce a resolution to city council later this month, calling on council to implore Canada to decriminalize possession of narcotics.

Municipal governments in Toronto and Vancouver have adopted similar motions.

“When people are dying on your streets you have a problem,” said Rotrand, the longest-serving city councillor in Montreal. “We’re not just there to take away the snow, patch potholes and provide public libraries. The most vulnerable in our society are dying and if the municipality can help, it should help.”

There have been over 15,000 overdose deaths in Canada since 2016, according to Health Canada statistics. In Montreal, public health officials say there are about 15 fatal overdoses each month, an increase since the beginning of the pandemic. Not all of the overdoses are related to street drugs.
Last fall, Québec solidaire tried to introduce a motion calling for a debate on decriminalization in the National Assembly, but it was blocked by the Coalition Avenir Québec government.

Rotrand will unveil his resolution Tuesday with the support of a half dozen community groups working on the reform of drug policy in Canada.

“I’ve had at least 15 emails in the past 10 days from citizens worried about the curfew and how it affects the homeless and those struggling with addiction,” Rotrand said. “We’re in the middle of a crisis and we don’t have a strategy. There are all sorts of counterfeit drugs on the street, the numbers are growing every month, the number of interventions to resuscitate people are going up and we don’t have a plan.”