Despite government measures, the opioid crisis continues to wreak ever more havoc in Quebec. Researchers estimate that the magnitude of the overdose crisis experienced in British Columbia and Ontario is now occurring in Quebec.
In a study published in the medical journal Drug and Alcohol Reviewexperts from the CHUM Research Center and the University of Montreal analyzed data from the Quebec Coroner’s Office between 2012 and 2021.
During this period, there were 1,647 reported accidental deaths due to opioids and 1,206 cases where stimulants were involved.
Between 2012 and 2017, the annual number of deaths increased from 1.5 per 100,000 population to 2.2. Rates fell in 2018–19, reaching 1.8 deaths per 100,000 population, before rising to their peak in 2020 with 2.7 deaths per 100,000 population. The following year, the rate was 2.4 per 100,000.
“It’s huge because we’re in total populations, but we’re on a very small denominator of people who are at risk. In other words, if we had the real number of people who take opioids on the street illicitly, we would have a really frightening proportion of people who die,” explains DD Julie Bruneau, specialist in addiction medicine and co-author of the study.
She said data over long periods of time show that people who use opioids are typically 10 times more likely to die than non-users of the same age. “That’s for all sorts of reasons, including the fact that it’s illegal and the fact that they’re hidden. There are services, but the services fall far short of what’s needed,” D said.D Bruneau.
The study’s findings suggest that one of the key factors in the crisis in Quebec is the increased presence of fentanyl and new synthetic opioids in opioid poisoning deaths since 2020.
In addition, benzodiazepines have been consistently detected in cases of opioid poisoning. “There is a decrease in heroin and an increase in fentanyl and all sorts of opioid derivatives, but there is also a parallel increase in benzodiazepines, that is, sedatives or tranquilizers that are mixed with these drugs. And these tranquilizers are often mixed without the knowledge of the people who use them and who think they are just using opioids,” explains DD Bruneau.
The combination of opioids and benzodiazepines is particularly dangerous because the sedative effects of benzodiazepines combine with opioid-induced respiratory depression, increasing the risk of overdose.
A Parallel Stimulant Crisis
DD Bruneau says the opioid crisis in Quebec is multifactorial. “We have worse and worse drugs, more and more powerful, in a social structure that is increasingly difficult for the entire population. And with three years of COVID-19 that have exacerbated a lot of inequalities, distress and mental health problems in the entire population, including and if not more this population,” she says.
On the fringes of the opioid crisis, stimulants like cocaine continue to cause many deaths. Data show an upward trend in stimulant deaths, with rates higher for cocaine than for amphetamine or methamphetamine. The highest rates were also seen in 2020, when there were 2.2 deaths per 100,000 population.
Cocaine has historically been the most common drug detected in stimulant deaths, but it has dropped from being responsible for 80% of deaths in 2012 to 58% of deaths in 2021. Amphetamines and methamphetamines are gaining ground. These substances were detected in 30% of deaths in 2012, then after fluctuating over the years, they have climbed to 62% in 2021.
“We know that in Quebec, people who use drugs use cocaine and stimulants a lot. It is one of the provinces where there have been the most cocaine and stimulant epidemics,” says the researcher. She is therefore not surprised that there is an increasing number of deaths attributable to stimulants, even if opioids are more often involved.
Insufficient government action
As part of International Overdose Awareness Day, which takes place on Saturday, the Minister responsible for Social Services, Lionel Carmant, announced a $1.6 million increase in the Addictions Fund in order to prevent overdoses of psychoactive substances.
Since 2017, the Government of Canada has committed more than $1 billion to directly address the overdose crisis, including by enhancing harm reduction initiatives. The Government of Quebec has also made naloxone available free of charge in all pharmacies in the province.
DD Bruneau believes that these actions should be welcomed. “There has been an increase in concern about access to care for people who have problems with use,” she notes. The specialist also welcomes initiatives such as the injection equipment distribution program.
“But that’s not enough,” she said. “We can’t think that by warning today those who are at risk of dying because of their drugs that we will be able to act upstream on prevention, detection and care centered on the individual that is not stigmatizing.”
Stigma causes people with drug addiction to wait years before seeking help.
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