Confronting Canada’s Opioid Crisis

Between January 2016 and June 2022, a total of 32,632 opioid toxicity deaths were reported in Canada. While the opioid crisis was reported to be most severe in the provinces of BC, Alberta, and Ontario, Montreal has observed a 50 per cent increase in opioid-related deaths from 2019 to 2021. In addition, the pandemic exacerbated existing factors that contributed to a high opioid overdose rate such as an increasingly toxic and unpredictable drug supply, feelings of isolation, and a limited access to health and social services.

Opioids exist in both prescribed and illegal forms. Medical opioids, such as codeine, morphine, and oxycodone, are prescribed most often to treat pain.

The prescription of opioids in Canada has declined in recent years in an effort to reduce the harms associated with prescription opioid use. Still, Canada is one of the world’s largest consumers of prescription opioids.

High rates of opioid-related harm result from unregulated drugs that can be tainted with alternative substances without the user’s knowledge, leading to a high rate of overdoses and deaths. Fentanyl, for instance, is an especially insidious synthetic opioid that is nearly impossible to detect without a test kit. Fentanyl’s high potency is often able to exceed a habitual user’s tolerance of other opioids, such as morphine or heroin, when consuming a similar dosage.

The opioid crisis disproportionately affects Indigenous communities. While there is a lack of national statistical data, provincial data reveals the particular harm that Indigenous peoples face. Reports published by the governments of BC and Alberta in 2018 highlight that First Nations people were five times more likely than their non-First Nations counterparts to experience an opioid-related overdose and three times more likely to die from one. Despite composing 2.6 per cent of the total population in 2018, Indigenous peoples accounted for 10 per cent of overdose deaths. Furthermore, in Alberta, First Nations people were twice as likely to be dispensed an opioid as non-First Nations individuals, and they tended to be at least five years younger at the time the drug was dispensed. Mechanisms of ongoing colonial violence – including but not limited to the residential school system, poverty, child apprehension, and involvement in the child welfare system – increase vulnerability to drugrelated harms for Indigenous peoples. Health care in Canada fails to care for the needs of Indigenous patients, as demonstrated both by cultures of racism and discrimination as well as a lack of Indigenous-specific health initiatives. Ontario Regional Chief Glen Hare noted, “governments need to correct the underfunding that has been occurring for years to make effective progress on addressing the overdose crisis in First

Nations communities.” Unhoused people – some 20 to 50 per cent of whom are Indigenous – are especially at increased risk of opioid-related harms.

From June to October 2020, Montreal saw a steep increase in opioid overdoses, as well as an increase in the number of interventions with naloxone – a drug that temporarily reverses an opioid-related overdose – by paramedics as compared to the summer of 2019. Jean-François Mary, executive director of the harm reduction organization CACTUS Montréal, told CBC that he doesn’t believe the province is taking the crisis seriously, advocating for greater support to drug users through decriminalization and increased regulation of opioids. In contrast, this past summer BC decriminalized the possession of up to 2.5 grams of opioids, cocaine, methamphetamines, and MDMA. Montreal’s public health director, Dr. Mylène Drouin, has noted that decriminalization is also needed in Montreal. Drouin stated, “we believe that [decriminalization] could allow consumers to use drugs in much safer contexts and avoid all the prejudice associated with judicialization.” Drouin and Mayor Valérie Plante agree that Legault’s opposition to decriminalization goes against Montreal’s public interest. Louis Letellier de St-Just, an advocate with CACTUS Montréal, which offers a supervised injection site for drug users, also supports decriminalization. He noted that “it will lower the pressure on drug users. It will give us much more impact on services and help that we could give to drug users here in Montreal.”

The provincial and federal governments must adequately respond to the opioid crisis by decriminalizing drugs and ensuring safe supplies. Support Indigenousled organizations like the Black and Indigenous Harm Reduction Alliance, Toronto Indigenous Harm Reduction, and the First Nations Health Authority promoting Indigenous-centred approaches to harm reduction. In Montreal, resources are available at organizations like ConsumAction, a McGill student-led organization that promotes safe drug use education and awareness. CACTUS Montréal, a community-based harm reduction organization, provides programs such as Checkpoint that provide free and confidential drug testing. Further, naloxone kits are available for free and without a prescription at any pharmacy. A step-by-step instructional video by the Montreal Gazette explains the physical signs that can indicate a potential opioid overdose, how to administer naloxone, and provides information on naloxone kits. Finally, attend naloxone training workshops to learn how to administer the drug in case you ever need to prevent an overdose. Check the Facebook page for McGill Nurses for Community Service for information on any future harm reduction and naloxone training workshops.

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