Has Quebec entered a new era of drug-related deaths?

Newswise — Drug market contamination is now present in Quebec, and what happened in British Columbia and Ontario is now happening here, says expert Sarah Larney.

In a recently published study Drug and alcohol screeningThe researcher from the Université de Montréal analyzed data sets of accidental deaths between 2012 and 2021 in which coroners determined that opioids or stimulants were the cause.

And what she found is worrying: drug-related death rates in Quebec increased over time, peaking in 2020 and remaining high in 2021.

In addition, fentanyl and new synthetic opioids will soon be the most commonly detected substances in opioid poisoning deaths. These drugs often contain adulterants, which are pharmaceutical ingredients added to enhance or mimic the expected effects of the illicit substance consumed.

“In the recent past, people were buying heroin that contained cutting agents, but those cutting agents were not lethal,” said Larney, a professor in UdeM's School of Family Medicine and Emergency Medicine.

“Now the only thing you can buy is fentanyl, which is much stronger than heroin, and the adulterants are also much more deadly,” said the professor, a researcher at the Canadian Research Initiative in Substance Misuse (CRISM).

On the eve of International Drug and Medication Overdose Awareness Day, we asked Larney to tell us more about the results of her study.

The drugs (fentanyl and derivatives) currently offered on the illegal market in Quebec are not the same as in 2019. How do you explain this market shift when Quebec has traditionally been different from British Columbia?

It coincides with the COVID-19 pandemic, although there were signs of a rise in fentanyl before then. Canada's opioid overdose epidemic was exacerbated by this “major event,” which escalated from about 3,700 drug poisoning deaths in 2019 to over 7,300 deaths in 2022.

The pandemic caused disruptions in the pharmaceutical market and catalyzed and accelerated changes in people’s purchasing and consumption behavior.

A major change is the sharp increase in the number of deaths from opioid poisonings involving fentanyl and new synthetic opioids recorded in Quebec since 2020.

Toxicological findings related to drug deaths suggest that Quebec may be entering a new era of increased overdose mortality rates.

You have also found that deaths are often due to a combination of opioids and benzodiazepines. Why is this a concern from a public health perspective?

Most overdoses involve multiple drugs. For a long time, well-known benzodiazepines such as Valium were involved in overdoses in Quebec. But now we are seeing new, potent benzodiazepines (synthetic tranquilizers) being combined with opioids, whether intentionally or not.

This novel combination is particularly concerning. The sedative effects of benzodiazepines combined with the tendency of opioids to slow the central nervous system and respiratory system increases the risk of overdose and reduces the arousal effect of naloxone.

The risk of overdose is higher than before; the risk of not recovering from an overdose is also higher. It is a very scary situation.

Despite all the overdose prevention campaigns, the overdose death rate has increased. What do you think should be done to address this problem more effectively?

Canada continues to struggle with an epidemic of drug poisoning, with nearly 45,000 opioid overdose deaths recorded between 2016 and 2023.

Interventions are essential. Naloxone, safer supplies and accessible, supervised consumption sites are part of the answer, but they are not enough today, even though we know that harm reduction works.

Given the lethal nature of drug supply, we need to look at drug law reform, such as decriminalising or even legalising drugs. We can take inspiration from a fairly successful model in Portugal, which has reduced overdoses and HIV cases, and try it out at the city level in Montreal, for example.

Furthermore, the literature tells us that criminalization and punishment do not work. Instead, we should invest in social policy reforms that address the root causes of problematic drug use: poverty, income inequality, and the housing crisis.

Our study highlights what the latest data say: things have changed and we need to respond.