The number of fatal overdoses linked to opioids increased sharply in 2020 in Quebec and then decreased slightly in recent months. But the statistics continue to be high, reveal the most recent data from the National Institute of Public Health of Quebec (INSPQ), released Friday.
“In 2020, we really saw a sharp increase in overdoses. There, it is less marked. But there are still more than in 2019 ”, notes the DD Marie-Ève Morin, family doctor who works in addiction in Montreal.
Since 2017, the INSPQ has closely followed the evolution of the opioid crisis in the province. In the first months of 2021, the number of deaths caused each month by suspected drug or opioid poisoning declined compared to last year, when a particularly high number of cases were reported. But it started to increase again during the summer.
Number of deaths caused by possible drug or opioid poisoning from July to September (average per month)
- 2021: 42
- 2020: 56
- 2019: 35
- 2018: 34
Source: INSPQ
The INSPQ also documents the number of emergency room visits linked to poisoning possibly caused by opioids. From January to September 2021, an average of 109 visits per month was recorded. This is the same number as in 2020, and a little more than in 2019 (104 visits per month).
The reality of the opioid crisis varies slightly from region to region. In Montreal, there was a 25% increase in deaths probably linked to drug poisoning over 12 months, between March 2020 and March 2021. A sign that the situation is increasingly tense, emergency services have been called. to intervene 58 times in supervised injection sites in Montreal in March 2021. A peak never reached since the opening of these sites in the province in 2017.
Visits with emergency intervention in supervised injection or consumption sites in Montreal (average per month)
- January 2020 to August 2020: 8.6
- January 2021 to August 2021: 36.9
Source: CIUSSS du Center-Sud-de-l’Île-de-Montréal
In Montérégie, 45 deaths have so far been reported to be suspected of being linked to opioids for 2021 against 75 in 2020 and 39 in 2019. In Laval, the number of reports of severe overdoses from January to June rose from 6 in 2019 to 14 in 2020 and 12 in 2021.
Increased distress
According to experts, several factors may explain the increase in overdoses observed in 2020, the first year of the pandemic, and which remains worrying in 2021.
The mental and physical stress caused by the pandemic may have pushed some to increase their consumption, indicates the CISSS de la Montérégie-Center. The DD Morin explains that 50% of people addicted to opioids suffer from chronic pain. The pandemic, and the resulting confinement, has increased social isolation and distress for many, in addition to complicating access to health care, she said.
When we are in pain, we want to relieve ourselves. During the pandemic, some have turned to food, alcohol and gambling. Others have turned to drugs.
The DD Marie-Ève Morin, family doctor who works in addiction
Jason (not her real name), a 26-year-old Montrealer, was the victim of an overdose in the spring of 2020. After various personal and financial problems that upset his routine, Jason had consumed that day in the company of a person he knew little. “This person possibly saved my life by calling the ambulance. I woke up in the hospital. I had overdosed, ”he says.
The young man who has been using opioids for nearly 10 years says it is “more and more easy to find fentanyl” in Montreal. The INSPQ data seems to prove Jason right. Since 2017, the proportion of opioid-related deaths with the presence of fentanyl, a drug 40 times more powerful than heroin, has continued to increase.
Number of deaths with the presence of fentanyl or its analogues
- 2018: 44
- 2019: 43
- 2020: 71
- 2021 (January to September): 60
Source: INSPQ
The DD Morin explains that with the closure of borders linked to the pandemic, the supply of substances has been disrupted. “Some substances cost twice as much as before,” she says. Consequence: producers use other substances in what they sell. Like fentanyl.
A reality that is also observed by Catherine Boucher-Rodriguez, planning, programming and research officer at the Direction de santé publique de Laval.
We are seeing the emergence of new synthetic opioids with greater lethality.
Catherine Boucher-Rodriguez, planning, programming and research officer at the Laval public health department
Fentanyl is also found mixed with other drugs, such as counterfeit benzodiazepines, sold on the street, explains Mme Boucher-Rodriguez.
She adds that during the first months of the pandemic, certain treatment, prevention and risk reduction services declined across Quebec. In particular, there has been a decrease in the distribution of naloxone, a life-saving antidote in the event of an overdose. However, these services resumed in 2021. In November, the Quebec government launched a major campaign to promote the use of naloxone.
In the field, seven regions are currently working on the deployment of overdose prevention sites. In Laval, we want to use a bus where drug users can come and consume in a safe environment. A drug analysis service would also be offered.
If the public health authorities of Quebec remain on the alert with the opioid crisis, it is however clear that the province remains less affected than British Columbia, in particular (see table).
On November 29, the Chief Coroner of the Yukon reported 21 opioid overdose deaths since January in her territory, for a rate of 48.4 deaths per 100,000 inhabitants. The highest rate in the country.
Crude rate (per 100,000 people) of total deaths apparently related to opioid poisoning from January to March 2021
- Canada: 19.4
- British Columbia: 40.4
- Alberta: 31.9
- Saskatchewan: 16.6
- Manitoba: nd
- Ontario: 19.6
- Quebec: 4.6
- Prince Edward Island: 2.5
- New Brunswick: 3.6
- Nova Scotia: 5.3
- Newfoundland and Labrador: 3.8
- Yukon: 48.4
- Northwest Territories: 8.9
Source: Health Canada
Overdose crisis: new substances on the streets
PHOTO ARCHIVES THE PRESS
Isotonitazene often comes as an imitation of a 30 mg tablet of oxycodone, a medicated opioid normally sold by prescription.
New, lesser-known substances make street drugs in Quebec even more toxic, leading to increased risk of overdose, warns the Royal Canadian Mounted Police.
“What we see, mainly in terms of opioids, is that there are a multitude of new psychoactive substances which are present in the street, either in the tablets of counterfeit drugs, or in the powders”, explains Corporal Mélanie Perrier of the Drugs and Organized Crime Awareness Service of the Royal Canadian Mounted Police.
The pandemic has heightened fears that drugs are increasingly contaminated, according to the 2020 report on drug analysis by the Canada Border Services Agency, that Press got under the Access to Information Act.
There is an increase in encounters with combinations of polydrugs in Canada, particularly those contaminated with synthetic opioids, such as fentanyl.
Extract from the 2020 report on drug analysis by the Canada Border Services Agency
The year 2020 saw an increase of 1,636% in the quantities of fentanyl in solid form intercepted at the Canadian border, and of 2,975% in the quantities of fentanyl in liquid form, compared to the year 2019, also details the report. In addition, the interception of chemicals used to manufacture drugs, including fentanyl, also increased by 70% between 2019 and 2020, from 14 kg to 512 kg.
PHOTO PROVIDED BY THE RCMP
Counterfeit hydromorphone tablets
Risk multiplied
However, fentanyl is no longer the only drug to watch on the market. In 2020, isotonitazene, an even more potent synthetic opioid, hit the streets. And since then, other little-known chemicals have proliferated. “There are a multitude of them,” says Mélanie Perrier, “and they are all in the“ tonitazenes ”family, which are substances on which we have very little information, whether in terms of their effects or their strength. ”
This lack of data increases the risk of overdose among drug users.
For example, if a person is used to injecting a certain amount of heroin, and eventually ends up with that substance, there may be overdoses.
Corporal Mélanie Perrier, Drugs and Organized Crime Awareness Service, Royal Canadian Mounted Police
The other risk is the mixing of several substances, without the knowledge of consumers. “It is not uncommon that we find tablets or powders that contain two, three and even four different substances,” maintains Corporal Perrier. It’s really a problem right now on the street. ”