Montreal's CACTUS safe-injection community group sees more overdoses amid pandemic

With COVID-19 having forced three out of four of Montreal's supervised injection sites to temporarily shut down, CACTUS Montréal says it's been dealing with a different kind of public health crisis in recent months: an increase in opioid usage.

Jean-François Mary, executive director of CACTUS, North America's oldest needle exchange program, said he has witnessed more drug overdose interventions since May, and it's only gotten worse in the last three weeks. 

"People were telling us they were taking more than usual, and so we knew something was up," Mary told CBC Montreal's Daybreak.

In Ontario, the provincial coroner's office has reported a 25 per cent increase in overdose deaths over the past three months, compared with the same three-month period last year. And British Columbia saw a 39 per cent jump in overdose deaths in April alone, compared to the same month in 2019.

However, in Montreal, Urgences Santé said only about 20 patients received naloxone, the antidote for opioid overdoses, in May — on par with the number of overdose cases paramedics have treated over the same period in last two years.

The regional health board for Centre-Sud-de-l'Île-de-Montréal also said it has not seen the kind of spike B.C. and Ontario have reported. It recorded 15 drug-related deaths last month. 

"There is no crisis related to opioids right now," said Dr. Carole Morissette, medical director at the regional health board. "But that could change any time."  

Mary said on the ground at CACTUS, the picture of drug overdoses in the city looks very different. At CACTUS's safe-injection site alone, the organization has counted 10 overdoses since the start of the pandemic. 

"We see our folks dying, and nothing changes. This is a public health crisis that nobody wants to answer to," Mary said. 

Mary said the discrepancy in the numbers may be because drug users often feel too ashamed or afraid of legal ramifications to call for help when they overdose.

CACTUS is the only one of Montreal's four supervised injection sites that remained open throughout the pandemic. The other three had shut down but have since reopened.

Even at CACTUS, they've had to cut their capacity in half, in order to respect physical-distancing regulations. 

Impact of border closures

Mary said the closing of the Canada-U.S. border has greatly impacted the supply and quality of certain drugs.

Because it's now harder to import drugs, sellers are cutting them with more fentanyl, he said. If the drug is more potent than what the buyer is used to, there is a higher risk of overdosing.

"It's a strange mix of capitalism and prohibition. Prohibition, because it's regulating the market, so there [are] no rules in terms of quality," Mary said. 

Also as a result of the difficulty importing products, dealers are raising their prices, so buyers turn to cheaper products they may be less familiar with.

"In the past, the pills used to be pretty much real, and now we see more and more fake pills popping up on the market, and it's problematic because people used to use those pills for safety," Mary said.  

On top of that, people who usually rely on prescription opioids may have issues accessing them during the pandemic, pushing them to less reliable and higher risk street drugs. 

"When you have fake opioid pills, then you never know even the substance you have inside," he said. 

The arrival of more potent street drugs on the market has not gone unnoticed by the region's health agency, the CIUSSS du Centre-Sud-de-l'Île-de-Montréal. Last week, it issued an alert warning the public that a new purple heroine powder has been found to be laced with fentanyl. 

Mary is calling on the government to open more supervised injection sites and to fund more resources for drug users in the province. 

If the Quebec government doesn't act quickly, he fears Montreal could end up in the situation that B.C. and Ontario are already witnessing. Although a lot of people on the street carry naloxone and know how to use it, he said the city is not prepared for a huge spike in opioid overdoses.

"The only thing we have is that our folks," he said. 

"We just have four safe injection sites. We should have one in each neighborhood, at least. We should have access to a safe supply of drugs, as is the case in many places across Canada."