The ash hearts of opium orphans

In Canada, nearly 27,000 people have died from apparent opioid-related intoxication between January 2016 and September 2021. There have been more than 9,000 deaths in British Columbia.

From 2019 to 2020, deaths have doubled to more than 6,000 per year, or 17 people who lose their lives every day.

On June 9, Montreal’s regional director of public health, Mylène Drouin, also called on the federal government to decriminalize simple drug possession in her territory.

If Quebec was once relatively safe from this scourge, now the province is overtaken by grim statistics, particularly due to the COVID-19 pandemic. In the past two years, some 1,000 people have died there from drug overdoses.

An overdose victim receives first aid.Photo: Radio-Canada

Break taboos to get out of isolation

Alexandra invites me to meet her at the Saint-Jérôme boarding house where she has been living for a few months. Le Dispensaire’s drug addiction counselor, she has been using opioids for more than 25 years.

Some are going to buy a bottle of wine with their friends, says the fragile woman with the tattooed chest. Me, my pleasure is to make a little hero.

He also agreed to inject me with a dose in front of me, to break, he says, the taboo surrounding opioid use. The overdose crisis is above all because of the stigma, he denounces. People hide. If we could talk about it, there would be a lot less people using alone.

Before beginning her ritual, she gives me a brief training on naloxone, the antidote to respiratory depression caused by opioid overdose. In case it goes wrong. Then, Alexandra takes out a small bag from her bag that contains a purple stone. It looks like candy. I’m pretty sure there’s fentanyl in there.she says.

Journalist Simon Coutu watches Alexandra test her dose for fentanyl using a small device.Photo: Radio-Canada / André Perron

To be sure, test a small amount with a strip that reacts to the presence of the opioid. The device looks like a rapid test for COVID-19. After a few seconds of waiting, the result is unequivocal: Fentanyl, definitely. she says.

She decides to consume it anyway, paying attention to the dosage. And anyway, there is almost no heroin that is not contaminated with fentanyl in Quebec for two years. She is aware of the risks. I’m ready to step in with my vials of naloxone, in case anything goes wrong. She has also had two overdoses that have landed her in the hospital in recent years.

Alexandra begins her drinking ritual. She heats her drug in a spoon to liquefy it and then sucks it up into the syringe. She wraps a tourniquet around her arm to pull out her veins and injects herself with the powerful opioid.

The interview is over. And, fortunately, I will not have had to apply my new resuscitation knowledge.

Alexandra prepares a dose. Photo: Radio-Canada

Distinguishing right from wrong to stop overdoses

After a year of waiting, the Dispensary, the Saint-Jérôme community organization for which Alexandra works, has just obtained an exemption from the federal government to be able to handle drugs for analysis.

Cactus Montreal, an organization that works with people who use drugs, has been offering the same service called Checkpoint for nearly a year. Its CEO, Jean-François Mary, is convinced that this initiative has saved lives.

Recently, heroin has been identified that contains etonitazene, a very strong opioid that cannot be detected with test strips, he says. People had to reduce the normal dose by 20 in order not to overdose. Surely we avoided deaths with that.

Cactus reaches more than 70,000 people each year in downtown Montreal, thanks in particular to its supervised injection service. Knowing what is circulating on the street, almost in real time, is an invaluable tool for workers in community organizations.

A drug addict on the street, in front of a subway entrance.Photo: Radio-Canada / André Perron

Between July 1, 2021 and March 31, 2022, more than 320 people participated in the exercise of analyzing their medicines. According to Mr. Mary, the initiative also reassures consumers. Most of the time they get exactly what they pay for. For example, of the approximately 140 cocaine samples tested, less than 3% contained fentanyl.

The biggest surprise we have had since the start of the program is the overall good quality of the substances. Nearly pure cocaine is not uncommon in Montreal. Rather, low-quality cocaine is the exception.

On the other hand, the scourge of counterfeit medical pills, such as the one consumed by Marie-Francis MacEachern, is confirmed in light of the results of this first year of analysis. It’s nonsense and the doses are random, denounces the director of Cactus Montreal. And they are so well made that we no longer had the ability to visually differentiate a real one from a fake one. With substance analysis, we can do that.

The ravages of the overdose epidemic

Photo: Radio-Canada / André Perron

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