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By Christopher Curtis

A new batch of brown heroin hit the streets of St-Jérôme late last April.

Or at least, that’s what “Georges” thought when he bought a bag of brown powder off his dealer. As a precautionary measure, he injected an eighth of a gram of the substance into his bloodstream to see how his body would react.

He passed out and had to be taken to the hospital in an ambulance.

The tiny dose of what Georges believed to be brown heroin was, in fact, a cocktail of 13 substances — including cocaine, methamphetamine, morphine, ephedrine and three fentanyl-based synthetic opioids.

“There was a chemical in there that you find in hair dye,” said Dr. Jean Robert, who examined a urine sample provided by Georges. “He was rushed to the hospital where they treated him like he was ‘just another junkie.’ But he was a person and he could have died.

“People talk about a fentanyl problem like that’s what has been killing everyone. The truth is, aside from pot, most street drugs we come across have between two and 19 substances in them. And many of those substances are even more deadly than fentanyl.

“What we have is a drug supply problem.”

Like most major urban centres in Quebec, St-Jérôme’s drug supply is tainted.

The city is a 45-minute drive north from Montreal on Highway 15, a bedroom community and the last major stopoff before Laurentian ski resorts like St-Sauveur and Morin Heights. But just as this regional hub draws in college students from nearby farming towns and skiers from the city, it’s also a crucial waypoint in the North Shore drug trade.

Between 2009 and 2013, only five cities in Quebec had a worse crime rate than St-Jérôme. The drug trade, in particular, has hit St-Jérôme hard, according to two police sources. But somehow the city avoided the spike in mortalities related to Quebec’s opioid crisis last year.

That’s where Dr. Robert comes in. Robert is part of a team that’s reinventing the model of harm reduction in Quebec. For the past four years, the people at Centre SIDA Amitié (CSA) have used lab testing to better understand exactly what drugs users are putting in their bodies and how to slow the spread of tainted dope before it kills people.

Here’s how it works. The CSA distributes testing kits to hundreds of people every year: drug users, drug dealers, sex workers and a network of volunteers across the Laurentians, a region 40 times the size of the island of Montreal. But since the kits test only for the presence of 10 substances, they’ve also collected and analyzed over 1,000 urine samples since launching the project three years ago.

They call the campaign “Piss your buzz.” The results have been astounding.

There were 571 deaths related to an opioid overdose in Quebec in 2020 — more than any other year on record. When the COVID-19 pandemic forced Canada to close its borders last year, it disrupted the supply chain of heroin, cocaine and methamphetamines used by organized crime. To avoid a drug shortage, wholesalers began cutting their dope with the synthetic opioid fentanyl.

As a result, the rate of deadly overdoses jumped by 30 per cent across Quebec last year. But while the Laurentians also saw an influx of fentanyl and counterfeit drugs on its streets, there was just a 2 per cent increase in fatal overdoses last year, according to public health records.

“One of our users fell on hard times and he had to start selling speed,” said Hugo Bissonnet, the CSA’s executive director. “So he took his batch of pills to us and we tested them. They were laced with all kinds of substances, including fentanyl.

“Yes, he’s someone who uses drugs, and yes, he sells them. But he’s also a father, and when he saw how bad the drugs were, he didn’t sell them. Even in his desperate state.”

Naloxone goes mainstream

It all started with a $231 cheque.

“Four years ago, a patient came to me and said, ‘Doc, it’s September, and since June I’ve lost eight of my friends to an overdose,’” Robert said. “We need naloxone. And we need to find out what they’re putting in our dope that’s killing us.”

The drug naloxone counteracts the effects of an overdose, reversing the depression of the respiratory system. It has become one of the most indispensable weapons in the opioid crisis. These days, every pharmacy in the province is legally required to provide patients with naloxone for free, no questions asked.

But four years ago, it was something of a novelty in Quebec. So Robert picked up the phone and called a nearby pharmacy.

“All they had was one box of 10 vials,” said Robert. “They were $23.10 a dose. I wrote them a cheque for $231 and that’s how we got started. The box is up there on the wall (as a keepsake).”

Robert has a raspy voice and carefully sounds out each word. Though his white hair and glasses fit the part, he looks too relaxed to be a doctor. He wears a collared shirt with the kind of wavy, burgundy patterns you might see in a vintage bowling alley.

He pulls up a spreadsheet with comically large fonts, laying out the fruit of their efforts. Over 12,189 naloxone kits have been handed out since that $231 purchase less than four years ago.

The CSA has handed out 12,189 naloxone doses since then and trained over 1,000 people to administer the drug in an emergency. From cops who patrol the city to dime bag hustlers, their goal is to get as many kits on the street as possible.

“The police see what we’re doing, they’re on the front lines,”said Bissonnet. “They recognize this is helping save lives. It helps create accountability in the community.”

He says dealers come by to get their stuff tested all the time. Almost everything seems to come back with at least a trace amount of fentanyl.

“Dealers come to us because they have no idea what they’re selling,” Robert explains. “People can make better decisions when they know more about the drugs they’re buying or selling.”

Robert pulls up some lab results:

  • Amphetamine tablets with the word ICE pressed into them but cut with enough carfentanil to put someone to sleep.
  • “Purple heroin” that’s really fentanyl and benzodiazepine.
  • Speed laced with fentanyl, cocaine and morphine.

Robert, a microbiologist, was a pioneer of accessible healthcare in Quebec, running one of the province’s first major community health departments at Hôpital St-Luc for 20 years. But the community model was done away with as successive Liberal and Parti Québécois governments gutted healthcare spending to balance budgets in the 1990s.

In his book Médecin de Rue, he argues that by eliminating community healthcare, the system has become hostile to those who need it most — homeless people, sex workers, people with substance use disorders, and prisoners, among other vulnerable groups.

“They still use words like ‘junkie’ to refer to people who’ve overdosed. People are made to feel subhuman if they have an addiction,” Robert said. “That’s not healthcare.”

Despite overdose deaths jumping by nearly a third last year, the Quebec government did not increase funding to fight the opioid epidemic in the 2021 budget. In fact, the province allowed its national strategy on opioid overdoses to expire at the beginning of the year.

“The province wants nothing to do with us,” said Bissonnet. “We get a few dollars from public health but, for the most part, we fight just to stay alive."

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