The shadow of the opioid drug crisis, which has already devastated B.C., Alberta and Ontario, looms over Quebec.
A new study, published Aug. 6 in the medical journal Drug and Alcohol Review, examines the substances contributing to drug-related deaths in Quebec. The research highlights a sharp rise in opioid and stimulant-related fatalities in the province over the past decade.
Historically, stimulants such as cocaine have accounted for a significant portion of the province’s drug-related deaths. But opioids such as fentanyl are becoming increasingly prominent.
“In Quebec, traditionally, there has been a preference for stimulants over opioids,” said Sarah Larney, a co-author of the study.
But the new research makes clear Quebec is not immune to the shifting drug landscape.
“Quebec is not isolated against these problems, and what has happened elsewhere is coming in,” said Larney, who is also an associate professor in the Department of Family Medicine and Emergency Medicine at the University of Montreal.
On the rise
Across Canada, more than 44,500 individuals died from opioids between January 2016 and December 2023, according to the Public Health Agency of Canada.
The vast majority of these deaths — 87 per cent — occurred in B.C., Alberta and Ontario, which account for about 63 per cent of Canada’s population. About six per cent of deaths occurred in Quebec, which is home to 23 per cent of the population.
The Quebec coroner’s office examined data from 2,853 unintentional opioid or stimulant-related deaths between 2012 and 2021 and found 58 per cent were due to opioids and 42 per cent due to stimulants, the study says. By contrast, 82 per cent of the drug-related deaths recorded nationwide were due to opioids, according to the Public Health Agency of Canada.
The study showed opioid and stimulant-related deaths in Quebec have increased over time, peaking in 2020 and remaining high in 2021. In 2022, the province had 540 drug-related deaths overall, and 536 in 2023, according to the Public Health Agency of Canada. Data about the specific substances that contributed to those deaths is not yet available for those years.
“The situation of deaths related to the use of opioids and other drugs is worrying and is being closely monitored in Quebec,” said Marie-Claude Lacasse, media relations coordinator for the Ministry of Health and Social Services of Quebec in a written statement.
The study also found benzodiazepines such as Xanax and Valium were frequently present in opioid-related deaths, as well as newer, illicit formulations of this drug (commonly referred to as “benzos” or “benzodope”).
“The combination of opioids and benzodiazepines is particularly concerning as the sedating effects of benzodiazepines combine with opioid-induced respiratory depression to increase overdose risk,” the study says.
Benzodiazepine-induced respiratory depression continues even after naloxone — a fast-acting drug used to temporarily reverse opioid overdoses — is administered, complicating efforts to respond.
These challenges are further compounded by the emergence of synthetic tranquilizers, which are often manufactured in home-based labs and mixed in with other opioids. The inconsistent and haphazard production methods of these street drugs often result in strong and unpredictable reactions.
Learn from mistakes
“Hopefully Quebec can learn from the mistakes of B.C.,” says Larney. “The real issue [with decriminalization] in B.C. … was around not consulting with people who use drugs and not involving them in the process.”
Lacasse said Quebec’s response to the opioid crisis is guided by the province’s strategy for preventing overdoses. This strategy prioritizes seven areas, including harm reduction, addiction prevention and treatment, and housing support for homeless populations.
Quebec has offered drug users naloxone free of charge and without a prescription since 2018, Lacasse said. In 2021, it expanded distribution of naloxone through 91 community organizations. It also provides supervised injection and inhalation sites, needle exchange programs and drug verification services, including through mobile sites.
Larney believes city-led responses that prioritize community engagement could be a more effective way of responding to Quebec’s drug challenges than a one-size-fits-all provincial model. She also believes harm-reduction responses must address broader issues like housing, quality of life and cost of living to be effective.
“In the US, access to financial benefits during Covid was associated with decreased overdose deaths,” she said.
A recent study in the medical journal International Journal of Drug Policy found strong unemployment benefits can help reduce fatal drug overdoses and that social support programs can lessen the harm caused by drug use.
“People often think that if you give people who use drugs money, they’ll just spend it on drugs and die,” said Larney. “However, they use it to meet their needs. And when their needs are met, they don’t need to use as much.”
Editor’s Note: This article has been updated to include a response from the Ministry of Health and Social Services of Quebec, which was provided to Canadian Affairs after our publication deadline.
