Since 2015, the fentanyl crisis has taken Canada by storm: The Public Health Agency of Canada estimated that over 4,000 Canadians lost their lives to opioid-related overdose in 2017. On Jan. 12, Dr. Carole Morissette, Montreal Public Health medical chief, delivered a public health warning to recreational drug users, signalling that the crisis had reached Quebec.
In the face of this newly-arrived public health emergency, Quebec needs to take action now to prevent the situation from taking the same nightmarish toll as in Western Canada. Currently, safe injection sites are not stocked with naloxone, the antidote to counter a fentanyl overdose. Naloxone can temporarily reverse a fentanyl overdose by slowing down the user’s absorption of the opioid by 30 to 60 minutes, allowing time for emergency medical help to arrive. It is the only treatment for an opioid overdose. Support staff at safe injection sites must rely on emergency response teams to provide such medication.
If harm reduction is truly a priority in the Canadian government’s strategy against drug and substance abuse, oversights at the provincial level such as this one are unacceptable. Provincial policy makers must correct any holes in the system that put drug users at risk.
Fentanyl is 50 to 100 times more powerful than other opioids, such as morphine. This places its users at a high risk of an overdose; a dose the size of a grain of sand can be lethal. The lethal opioid is often found laced into other drugs, including counterfeit oxycodone pills and an increasing number of recreational drugs like cocaine, MDMA, and heroin. Consumers of street drugs, whether they are habitual or first-time users, have virtually no way of knowing that fentanyl’s been added: You can’t see it, smell it, or taste it. As the range of drugs that fentanyl contaminates increases, so does the scope of the population at risk of an overdose.
As of November 2017, naloxone is available at 1,900 pharmacies across Quebec to anyone over the age of 14—even without a prescription. As a part of Health Minister Gaétan Barrette and Public Health Minister Lucie Charlebois’s attempts to protect the province against the fentanyl crisis, police, firefighters, and ambulance crew are expected to carry naloxone kits on them at all times. Notably, the general public’s access to naloxone is only a very recent development in the response to the spread of the opioid crisis in Quebec.
Yet, these measures do little to protect those who are most at risk of a fentanyl overdose. More than 75 per cent of Montreal’s drug users regularly frequent community organization-run safe injection sites and needle exchanges to obtain their paraphernalia.
Shockingly, these institutions haven’t benefited from the wide distribution of naloxone kits like Quebec’s pharmacies have, despite Montreal Public Health’s expressed desire to equip any place where drug use might occur. Safe injection sites in British Columbia already benefit from their province’s wider distribution plan; Quebec should follow suit.
By rolling out naloxone in pharmacies and providing emergency response teams with the antidote, the Quebec public health system has merely done the bare minimum in combatting the fentanyl crisis. If drug users are at the same risk of a fatal fentanyl overdose when taking intravenous drugs at a safe injection site as anywhere else, they have less incentive to continue to use those spaces. Safe injection sites betray their primary purpose if they cannot guarantee drug users with protection against the ravages of the opioid crisis. The system is failing these users by cowering behind the pretense that naloxone is widely available to anyone who needs it.
Safe injection sites should be exactly what their name purports—safe. Public health services cannot wait for another onslaught of fatal drug overdoses caused by fentanyl to expand naloxone’s availability to those sites and finally make them safe again.