They were discovered unconscious on their bed, on a chair or even face down on the ground, sometimes several days after having suffered an overdose. Since January 2022, 329 Quebecers have lost their lives without anyone being able to call 911 or try to resuscitate them, reveals an investigation by the Duty.
“The stigma linked to consumption, the fact of hiding to consume – therefore, to consume alone – is the most important factor and which can lead to mortality when there is an overdose,” explains the DD Elisa Pucella, medical advisor to the overdose control team at the Laval Regional Public Health Department.
These are 81% of overdoses, between 1er January 2022 and April 5, 2023, which occurred while the people were using alone, shows the analysis of the coroner’s files carried out by The duty.
Analysis of overdose deaths since January 2022
Nancy has been a peer support worker for eight years at the Regional AIDS Action Bureau (BRAS) Outaouais, in Gatineau. The mother of two, who has been using drugs since the age of 12, particularly through inhalation, has chosen to give back to her community by supporting other users. She considers supervised inhalation centers essential for consumer safety, but above all to save lives.
“There are people who come here every day, seven days a week, because they have a routine. It allows them to socialize, to perhaps leave the house because they have no one. It also breaks the isolation,” specifies the helping pair.
Once there, users can also have their drug tested and decide if they still want to use it. “During my shifts, I have already resuscitated people with overdoses with responders,” says Nancy. “It allows you to have a safe place to consume. If you drop your pipe and pick one up on the ground and someone had smoked fentanyl with it, you could be contaminating yourself with a drug you don’t even want to use. It can be avoided [en consommant ici] “, she says.
In Quebec, there is no data on drug administration methods, but on the ground, community stakeholders consulted by The duty are unanimous: inhalation is a method increasingly popular with consumers.
Last July, the Mobile Intervention Unit and the Public Health Department of the CISSS de Laval set up Nomade, a bus which serves as an overdose prevention center by providing a space for injection drug consumption, orally, intranasally or by inhalation. A room with ventilation is set up inside the bus. The vehicle makes it possible to meet users in areas where they are most present, while serving those who are in more isolated corners of Île Jésus.
“The bus, the supervised consumption center, responds exactly to this important precaution [de ne pas consommer seul]. There are responders who are trained to intervene in the event of an overdose, and this is the great protection that is available,” indicates DD Pucella.
In addition to offering a place to consume under supervision, Nomade offers material distribution services, as well as testing for drugs intended for consumption. Since July 6, the bus has received 150 visits, and 75% of users have come to inhale stimulants.
According to Geneviève Cousineau, worker at the Nomade substance consumption and verification center, the mobile unit makes it possible to reach users who do not frequent fixed supervised consumption centers.
“We see people who have apartments and who do not have a consumption environment. There are some who do not want to be disturbed; others who don’t want their neighbors to know that they are using. There are plenty of reasons why people will call us to ask us to go to a specific location and who will come and consume on the bus,” explains the speaker.
A 24/7 line
However, a physical center is not the solution for all inhalant drug users: some will always prefer to consume in the comfort of their home. This is why, in the heart of the pandemic, Rebecca Morris-Miller, herself a drug user, launched the NORS (National Overdose Response Service) with a cell phone and a $1,000 donation to provide virtual support users and thus prevent possible overdoses. The latter has helped prevent around a hundred overdoses since its establishment in 2021.
“Last October, [Rebecca] died of an overdose. She would have kicked me in the kidneys if I had stopped what she started,” says her sister, Lisa Morris-Miller, now general director of NORS, on the other end of the line.
This entirely free national service, offered in French, is currently funded by the PUDS, Health Canada’s Substance Use and Dependence Program.
“Eighty-five percent of our calls are from people who are not visiting supervised centers. Otherwise, these are people who will consume outside the opening hours of a center. We are here 24/7. We also supervise by text message, because it is the channel favored by the youngest. And we offer bilingual service thanks to Wellness Center Canada,” explains M.me Morris Miller. Around 16% of calls to NORS came from Quebec, according to the latest available figures.
People think it’s street drug users who die from overdoses, but that’s absolutely not true. They are construction workers, stock brokers, health care workers. […] who took opioids and became addicted…
The profile of NORS users is also very different from that of supervised consumption centers, she notes. “Our clientele is predominantly female. People think it’s street drug users who die from overdoses, but that’s absolutely not true. They are construction workers, stock brokers, health care workers, bankers, athletes, people who have been injured, who have taken opioids and become addicted…”
Minimize the risk
The presence of supervised consumption centers also proves to be a reference tool for police officers, testifies Krisztina Balogh, file agent and commander of neighborhood station 21 of the Montreal City Police Service (SPVM). “It at least allows us to extend a hand, to provide information on the resources available. So, if we don’t have these resources, the police, no matter how much they redirect them, well consumption will continue to take place in outdoor places, in public spaces,” she emphasizes.
All stakeholders interviewed by The duty agree that supervised centers save lives. “Every person who walks through the door saves you from an overdose,” says Adrien St-Onge, safe consumption coordinator at BRAS Outaouais.
Marie-Christine Leclerc, head of the consumption center by injection and supervised inhalation Interzone, in Quebec, also advocates diversification of the service offering. “We really have to be able to reach people who can have functional consumption, who can come to work, go about their daily life, but who live with an addiction and who must have safe equipment, who are at risk of consume substances that will cause them major harm. We think of overdoses, we think of toxic psychoses [ou des décès parce qu’ils étaient seuls]. It’s a reality,” she notes.
In Montreal, people who inject drugs have had access to this type of service since the inauguration of the city’s first supervised injection center in 2017. Although they can test their drugs and collect equipment, consumers crack or crystal meth They still have nowhere to go to consume.
Beyond “not in my backyard”
The upcoming opening of the supervised consumption center at Maison Benoît Labre, about a hundred meters from a school in the Saint-Henri district, is, however, far from unanimous. Residents of the area have also organized several demonstrations and a press conference to oppose it. The future site would however be the very first to allow the consumption of drugs by inhalation to its users in Montreal.
The general director of Maison Benoît Labre, Andréane Désilets, underlines the complexity of setting up such a project, both from an administrative point of view and from a social acceptability point of view. She hopes to officially open the doors of her establishment this fall. “The last step we have left is the “stamp” of the Dr Luc Boileau [le directeur national de santé publique]which approves exemption requests” necessary for the opening of a supervised consumption center, she indicates.
How is it explained that no supervised inhalation service is yet offered in Montreal? “Because there are outcries. People are very, very animated, they are very afraid: we understand that. Then, as long as it all rests on the shoulders of community organizations, well, it’s always going to take a long time. We must also see to what extent we are capable of launching into a major social debate, then carrying it through to the end. I think that definitely slows things down,” replies M.me Désilets.
Prejudices are still well anchored when we talk about drugs, underlines the one who is nevertheless hopeful of undoing them. “We saw it [cet été], when we talked about “crack alley”. This terminology, unfortunately, stigmatizes. This space exists, unfortunately, because it lacks services and everything comes under the responsibility of a single organization. »
“At a given moment, it’s like the chicken before the egg, the egg before the chicken, as if we were accusing the organization of creating a problem,” illustrates Mme Désilets. “But the problem is the lack of investment in several small spaces like that, which would better meet the needs of these people, who would then not find themselves in public spaces. »
The general director of Maison Benoît Labre observes a real gap between the scale of the needs in terms of supervised consumption and the way in which the situation is managed by the government. “The fact remains that these spaces will have to see the light of day, whether the general population is happy or not. We will have to act, [les surdoses] are not going well, and not just on the street,” she notes.
In the next year, the community organization Dopamine, in the borough of Mercier–Hochelaga-Maisonneuve, also hopes to welcome an annex in the backyard of its establishment on rue Ontario Est that will allow inhalation under supervision.
Its general director, Martin Pagé, has observed the ravages of stimulants for many years, and he believes that the metropolis is far behind. “It took a year before consolidating services [d’injection] which have existed since 2017 and which have proven themselves, even scientifically. But there, we must leave with our pilgrim’s staff for stimulants and consumption by inhalation. How can you be so late and not have seen this coming? We are going to work in a hurry once again,” he laments.
Witnesses to the effectiveness of supervised injection centers, the stakeholders interviewed by The duty believe that more overdoses could be avoided if the service offering was improved.
“Currently, if there were no such services, consumers would be in the alleys, they would be elsewhere, […] then perhaps many lives were lost. […] One of the reasons why people consume in plain sight, in public spaces, is that if they overdose, they do not want to die: they want to be saved,” recalls police officer Balogh.