Drug overdose deaths in Canada are dropping. So why is Quebec nearing a record high?
Province aligning with trends rest of country has faced for past decade, expert says
While overdose deaths are declining across much of North America, Quebec is experiencing a sharp rise, with new data from the province's public health institute indicating that deaths could reach a record high this year.
According to new data released on Dec. 20 by the Institut national de santé publique du Québec (INSPQ), the number of deaths linked to suspected opioid or other drug poisonings has surged by 33 per cent compared to last year, with 485 deaths reported between January and September. That's up from 363 during the same period in 2023.
The INSPQ predicts that 2024 will be the worst year on record for overdose deaths, with a rate of 7.3 deaths per 100,000 people.
"This year, it was worse than during the pandemic," said Dr. Marie-Ève Morin, a family physician with 20 years of experience working with people with addictions.
"People are suffering, people are hungry, there are more people on the streets, there is a bigger gap between the rich and the poor."
Urgences-Santé, the paramedic service covering Montreal and Laval, says it has observed a rise in overdose cases and calls for intervention.
"What we're noticing is that a lot of people just don't know what they're getting," said Vanessa Grillo, the supervisor of interventions for Urgences-Santé.
"They're buying something, they're thinking it's product X, but it's X mixed with several other substances that can make a pretty lethal cocktail."
In 2024, Urgences-Santé administered naloxone, a drug that can help reverse an opioid overdose or poisoning, in 1,000 cases. Grillo says in the last month, the service had 529 calls for intoxications, 225 of which mentioned the powerful synthetic opioid fentanyl.
"A lot of the drugs that are on the streets right now are cut with different things and it's really aggressive substances." she said.
While the situation continues to worsen in Quebec, the trend is moving downward in British Columbia, Alberta and Ontario — the three hardest-hit Canadian provinces — though they are still significantly more affected by the crisis in absolute numbers.
Data released from Health Canada last month showed opioid-related deaths dropped nationally by 11 per cent in the first half of 2024 compared to the same time period in 2023. Hospitalizations, emergency medical services responses and emergency department visits were also down.
Recent figures from the U.S. Centers for Disease Control and Prevention also showed a sharp drop in overdose deaths across the States.
Quebec 'catching up' with drug trends, expert says
While drug poisonings have steadily increased across North America for the past decade since fentanyl hit the streets and began tainting drug supplies, Quebec was sheltered from the worst of it until around 2020, according to Sarah Larney, a researcher and associate professor in the faculty of medicine at Université de Montréal.
Larney, who is also an expert in drug use and drug-related harm, attributes Quebec's recent surge in overdose deaths to the province "catching up" with drug trends that have affected other parts of Canada for years.
"Drug overdose deaths are very much driven by local markets so a national trend might not necessarily reflect a more granular level," she said in reference to Canada's declining numbers, which she views with cautious optimism.
While Quebec has traditionally had a cocaine market, opioids are now contributing to a rise in deaths, driven by the increasing availability of potent drugs like fentanyl and illicit benzodiazepines, Larney says.
She says the crisis calls for more supervised consumption sites in Montreal and in Quebec's regions, where a large number of these overdose deaths are occurring. There's also a need for more harm reduction strategies, such as safer supply programs and drug checking services. Addressing some of the root causes of the crisis, such as poverty, housing instability and mental health issues is also important.
"These deaths are increasing at the same time that housing affordability is becoming a bigger issue," Larney said.
She is calling for a shift away from a prohibitionist drug policy, advocating for alternative legal frameworks and improved social services.
In the meantime, Larney anticipates a continued rise in deaths in 2025, noting "the trajectory that we're on is not one that bends downward very quickly."
Written by Sabrina Jonas with files from CBC Montreal's Daybreak, Sharon Yonan-Renold and Radio-Canada's Thomas Gerbet