Orphans of the “tonis” | La Presse

No one knows exactly how long little Noah* spent alone with his father’s corpse.

At least one night. Maybe more.

One thing is certain: the 3-year-old boy was hungry.

“In the early days [après le décès]he developed a stake in food. He was hoarding it,” says his uncle, whom we are not naming to protect the child’s anonymity.

Noah is an orphan of the “tonis” – the street nickname for nitazenes – synthetic opioids first identified in 2019 in Quebec. Some are more powerful than fentanyl.

Nitazenes may increase the risk of accidental overdose, especially when combined with other substances that reduce breathing and heart rates, such as other opioids and benzodiazepines, warns the Canadian Centre on Substance Use and Addiction.

In Quebec, nitazenes have been detected in 90 cases of fatal overdoses since 2020, it has been discovered The Press by analyzing reports from the Coroner’s Office.

The youngest, Mathis Boivin, was barely 15 years old. According to our analysis, the victims often combined multiple drugs. In several cases, they took nitazenes without knowing it.

This is what happened to Hugo*, Noah’s dad.

In the summer of 2022, the thirty-year-old is going through difficult times. The cabinetmaker owns a workshop that was working rather well until health problems linked to a chronic illness forced him to close it.

Around the same time, he split up. Things were not going well. He was taking prescription drugs to treat his chronic illness as well as depression.

But Hugo also self-medicated on the illegal market. “He really didn’t like being so sick,” says his brother. “That’s why he fell into abuse.”

On August 7, the father was alone with his son at home. Around 8 p.m., he had food delivered. The next day, he did not respond to text messages from a friend. The latter, worried, arrived at his house the day after, late in the morning. He then discovered the father, lifeless, lying on his couch.

The friend pulls the child away from the body to try to resuscitate the father. In vain.

The thirty-year-old is said to have consumed cocaine, speed, benzos sold illicitly under the name of Xanax and protonitazene, according to toxicological analyses.

His death was accidental. He did not intend to commit suicide, concluded the coroner, who recalled the “dangerous and unpredictable effects, regardless of the dosage found” of each of these street drugs, “all the more so when combined with other substances, prescribed or not.”

Hugo’s brother is “certain” that Hugo was unaware that “his pills” contained a drug more powerful than fentanyl.

“It just shouldn’t exist,” he says.

Noah, who is now 5 years old, has received psychological help. The little boy, “more intelligent than average” is doing “well”, assures his uncle.

The child has stopped storing food.

Russian roulette

Because of prejudices against drug users, there is a tendency to blame them for their recklessness, observes D^D Julie Bruneau, physician at the University of Montreal Hospital Center (CHUM) and holder of the Canada Research Chair in Addiction Medicine.

But the drug market has become so “erratic” that it is impossible for a user to be certain of what they are consuming, she describes.

“We have an extremely unpredictable and dynamic illicit market. New substances are added regularly,” confirms her colleague, Dr.^D Carole Morissette, medical advisor to the Montreal Regional Public Health Department in drug-related harm reduction.

“We see complex mixtures that include fentanyl, fentanyl derivatives, nitazenes, benzodiazepines that are not marketed,” explains Dr.^D Morissette: “That’s what puts people at risk of overdosing.”

The metropolitan DRSP published a notice last April to alert the population about the “significant” circulation of counterfeit tablets on its territory which contained nitazenes which could be “up to 25 times more powerful” than fentanyl.

Then in early August, this time in Drummondville, the Royal Canadian Mounted Police dismantled a clandestine laboratory producing hundreds of thousands of tablets imitating the appearance of a legitimate oxycodone tablet but instead containing protonitazepyne (also in the nitazene family).

The danger is that consumers who believe they are buying hydromorphone (Dilaudid), for example, end up with a much more powerful opioid, stresses Dr.^D Bruneau of the CHUM. If they have a naloxone kit with them, they can counteract its effects, although several doses may be necessary due to the potency of nitazenes.

“Another danger” is that nitazenes have also been found in stimulants such as cocaine and crystal meth, continues the CHUM doctor, so people do not have naloxone with them, unaware that their powder actually contains opioids.

Little information available

The effects of nitazenes are still little known, but the main one remains the reduction in respiratory frequency and amplitude which can lead to respiratory arrest and death, even at low doses. In many reports consulted, coroners emphasize with a certain helplessness “the little information available” on the subject.

Based on our analysis of these reports, some of the people who died took a pill that appeared to be a hydromorphone tablet (Dilaudid) that actually contained protonitazene.

In other cases, they believed they were buying counterfeit oxycontin (an opioid), in the form of blue tablets marked A/215, which actually contained isotonitazene. “Toni” is “often” presented in this form, says coroner Lyne Lamarre, who sounded the alarm after investigating the death of a 20-year-old from Granby in 2020.

In Quebec, there is an upward trend in the consumption of substandard and counterfeit medical products; “manufactured to resemble brand-name or generic prescription drugs,” writes coroner Lyne Lamarre.

Designed in clandestine laboratories, they contain neither the right dosage nor the right ingredients. The ease of access to counterfeit drugs (easy to buy on the internet) and the popularity of their consumption are worrying, insisted coroner Lyne Lamarre four years ago.

Since then, the “tonis” have continued to break up families.

On the way to school

It’s June 2023. It’s the end of the school year. It’s around 7 a.m. Jean-François’s* children try to wake him up before leaving for school. Without success. Worried, one of them calls out to an adult he meets on the way to class.

This relative will accompany them home. Arriving in the room of the 38-year-old father, he discovers the latter on his back, unconscious, lying in his bed. Emergency services will be called. But there is nothing more to be done.

A friend with whom he spent the previous evening will tell the coroner that the father of the family had consumed alcohol, cocaine and half or a quarter of a Concerta tablet.

Before leaving, he and his friend promised to go play tennis soon. He also told her that he was taking “rather strong pain pills”. The suicide theory was ruled out. A toxicological analysis showed no trace of Concerta in his blood.

The police discovered 19 blue tablets of unknown origin in his dresser. They were metonitazene (a powerful synthetic opioid from the nitazene family).

The father “had – in all likelihood – consumed falsified medical products (counterfeit medicines) which did not contain the correct ingredients,” the coroner concluded.

* Fictitious first names to preserve the anonymity of the children; their story is very real.

Read our major report “The invisible epidemic”