Canada is grappling with a “serious and growing opioid crisis” across the country that has caused an unprecedented rise in overdose deaths. With authorities slow to respond, some people are opening their own pop-up safe injection sites. Here’s the first of our two-part article looking into the overdose crisis.

A crisis that began at home

The overdose crisis ravaging the country is primarily associated with the drug fentanyl (an opioid that can be up to 100 times stronger than heroin, according to the Centers for Disease Control and Prevention).

A photo published by the New Hampshire State Police in the United States shows a fatal dose of heroin in the left vial, and a fatal dose of fentanyl in the right.

Opioids are a type of drug that work by binding to receptors in the brain and nervous system and essentially blocking or reducing the feeling of pain. Fentanyl can be smoked or injected, or patches with gel inside can be chewed or worn on the skin. To understand why fentanyl is at the heart of the drugs crisis, we have to go back to another opioid called OxyContin, the main ingredient of which is oxycodone — and the doctors that prescribed it.

Graffiti on a wall in Vancouver's Downtown Eastside.

OxyContin, the game changer

Opioids have traditionally been used to treat acute, severe pain such as in terminally ill cancer patients, but when OxyContin came on the market in 1996, it was a game changer. Pharmaceutical reps and pharma-sponsored medical conventions told doctors that because OxyContin had a slow-release component (it releases oxycodone more slowly over a longer period of time, so patients do not have to take it as often), it could be used to treat chronic pain. Doctors began to prescribe it for things like chronic back pain or headaches. What wasn’t known then was that it was both highly addictive, and lethal.

But soon reports were coming in of a huge spike in addiction and overdoses across Canada. When the effects of OxyContin began to be known, Canadian provinces delisted the drug, making it not covered by provincial health plans and harder to be prescribed by physicians. OxyContin was pulled from the market by its manufacturer, Purdue Pharma, in 2012, and replaced with another oxycodone drug called OxyNEO that was harder to abuse by snorting, crushing or injecting. This meant that addicts needed to seek that strong high elsewhere — which is where fentanyl comes in.

“If you were to drive through my town, you wouldn’t realise. But all of my friends are users”

Keera Roberts, 27, lives in Castlegar in British Columbia. She became addicted to oxycodone after a doctor prescribed OxyContin after an injury at work. Her prescription was cut off when the province delisted the drug in 2012. She then started chasing her high elsewhere, turning to buying illicit drugs on the street and eventually becoming dependent on fentanyl.

About two years ago is when it really came on the market. When I was younger and went to parties you didn’t find opiates, you found ecstasy or mushrooms – now it’s fentanyl. When it first came out people didn’t want it, but now they don’t want anything else.

I like the high from fentanyl; it’s way stronger [than OxyContin]. I have to take a lot less of it, a quarter of what I would normally take, and it knocks me out. That is why people are overdosing because they go to take the original amount. I inject it daily every four hours. I’m now studying for a diploma and have missed a few days due to withdrawal sickness. It really does control your life.

Just in the area where I live, I’ve had three friends die in the past year. When it was just regular opiates on the market I didn’t see any overdoses, and now I’m hitting friends with Narcan [the brand name for naloxone, an opioid antidote that can reverse an overdose], and watching people get buried.

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Vials of naloxone, the drug that can reverse an opiate overdose.

I was selling it at one point, but when I saw people were dying from it I stopped. When friends would ask me for it I wouldn’t get it for them because I didn’t want to cause their deaths.

There’s a hidden drug scene in my city, you don’t see people sleeping or shooting up on the streets like you do in Vancouver. It’s a nice town: if you were to drive through you wouldn’t realise. But it’s really rampant here. All of my friends are users. Everyone I know owns a Narcan kit.


Drugs coming from Chinese labs

After OxyContin was delisted, users would try to buy pills on the black market that were sold as OxyContin, but were actually fentanyl. Users buying heroin or even cocaine to allay their withdrawal were often unknowingly buying drugs that were heavily laced with fentanyl, because it is so cheap and potent.

And as demand for opioids increased, dealers began to source it as cheaply as possible, which meant it getting smuggled over the border from illicit labs as far afield as China.

This is what an injection naloxone kit looks like. There is also a nasal spray, which is easier to administer.

3.6 deaths every day in British Columbia

British Columbia is the province that is the hardest-hit, and was the first to declare a public health emergency in April 2016. There were the equivalent of 3.6 deaths every day in British Columbia in February 2017 alone: a year-on-year increase of 72.9 per cent.

It’s difficult to get a national picture of the crisis because death reporting and data-gathering amongst different public services like firemen and hospitals is organised at a provincial level.

On February 17, 2017, the Canadian government announced that it would disburse 65 million Canadian dollars over the next five years to implement national measures to tackle the opioid crisis. Ten million of that amount will be going directly to British Columbia emergency services.


But some community activists are sick of waiting for bureaucratic measures to pass, and have created their own pop-up medical tents to deal with the wave of overdoses happening on the street. Read more in 'Canada’s overdose crisis (Part 2): 'Pop-up' injection sites'.
Article written with
Catherine Bennett

Catherine Bennett , Anglophone Journalist

health /  crisis /  medicine /  drugs /  Canada