Josiane, 30, and Nathalie, 38, were dying.

In a decade of drug use, Josiane had never overdosed before. But this time was different.

It happened a few weeks ago in August, and both women were lying on the ground in a Montreal alley, hovering between life and death, after a close encounter with a powerful drug. Both of their names have been changed to protect their privacy.

Passersby spotted their legs sticking out from behind a container and decided to investigate.

They got them the help the women needed and saved their lives.

Later, one of their rescuers told them what happened.

“They came to see and my lips were blue. We were unconscious. I was not responding to any stimuli," said Josiane, her voice still quavering with shock. "(The woman helping) pinched me and yelled but I wasn’t there. I was dying so they did CPR."

Josiane said she and her friend were lucky saved by Good Samaritans roaming the streets. But when the Montreal police arrived, away from their saviours' watchful eye, Josiane said her rights were violated.

The two women recounted their horrifying tale to National Observer on Aug. 31 during a vigil in Montreal for overdose victims who have succumbed to drugs like fentanyl. It was a sombre occasion, marked by tears, tributes to lost loved ones, and desperate calls from social workers and addicts for the provincial and municipal government to do more to tackle what they describe as a "crisis."

opioid crisis, Montreal, Quebec, fentanyl
People remembered their friends and family lost to drug overdoses during a minute of silence at a gathering in Montreal on Aug. 31, 2017. Photo by Clothilde Goujard

Fentanyl deaths rising in Quebec

Fentanyl, a powerful drug that can be up to 100 times more potent than morphine, has hit western Canada hard, triggering a "public health emergency" in British Columbia and calls for a similar declaration in Alberta. The deadly drug has infiltrated streets and homes, often disguised as a less potent opioid like oxycodone.

According to B.C. government statistics, fentanyl was detected in 706 illicit drug overdose deaths between January and July this year — an increase of 143 per cent from the number of deaths occurring during the same period in 2016. In Alberta, 241 people died from apparent drug overdoses related to fentanyl between January and June 2017, compared to 156 at the same period in 2016.

The numbers in Quebec have yet to reach such staggering heights, but the increase is still causing some alarm for health workers. Between 2005 and 2009, fentanyl was detected in 5.1 per cent of opioid-related deaths with eight deaths, compared to 19.3 per cent in 2016 with 27 deaths— an increase of 278 per cent.

When Josiane and Nathalie overdosed, they only had one Naloxone kit. Josiane says because she was in a worse state than her friend, she used the dose. But it was not enough and both women fell unconscious.

This is why Josiane describes the passersby as her and Nathalie's "saviours."

The woman who helped them happened to have naloxone — a medication that is used to help treat overdoses — on her person, and knew exactly how to use it. She holds workshops in Montreal to train people to use this medication and Josiane had attended one. She injected both Josiane and Nathalie. The women were brought to the hospital, provided with oxygen, and another dose of naloxone.

But their harrowing tale did not end there.

fentanyl, drug abuse, Alberta Law Enforcement Response Teams, mental health, addiction, opioids
Fentanyl is a potent, synthetic opioid pain medication, shown here in an undated police handout photo. Photo courtesy of Canadian Press and Alberta Law Enforcement Response Teams (ALERT).

Montreal police 'ready for war'

The Good Samaritan Drug Overdose Act, which came into force last May, offers legal protection to people who call 911 during an overdose. Its goal is to reduce drug users' fear of police by giving overdose witnesses and those who overdose, immunity from drug possession charges.

According to Montreal police guidelines for responding to overdoses, outlined in a document provided to National Observer, in the event of an overdose death, officers should seize drugs at the scene for analysis by Health Canada's Office of Controlled Substances. The guidelines also reminds officers of the Good Samaritan Drug Overdose Act.

But when Montreal police arrived at the scene where Josiane and Nathalie lay dying, Josiane said they took advantage of the situation. While unconscious in the ambulance, she alleges that officers opened her bag and ripped some papers up. She believes they were looking for any evidence that could point them to dealers.

“Right now, they’re ready for war because they’re worried the fentanyl crisis is getting as bad as it is in the West," said Josiane. "So I think they’re doing everything to get all the way up the chain to the dealers.”

Her alleged mistreatment, she added, extended into her hospital stay.

“I was at the hospital for four hours and for three hours, I had policemen by my bed who were pressing to make me talk and I was confused," she recalled. "The nurse came to bring me ice cream and a police officer said, ‘No she won’t eat before speaking to the investigators.’ The nurse told them off and said ‘No.’”

A Montreal police spokesman noted that Josiane has the right to file a complaint if she feels she was mistreated, but he declined to comment on her allegations. Josiane confirmed that she would proceed with a complaint, with support from a non-profit organization.

Hospital has no comment

Joëlle Lachapelle, a spokeswoman for Centre Hospitalier de l'Université de Montréal, a network of hospitals that includes the facility where Josiane was treated, also said she was not immediately able to comment on the specific case. But the hospital always puts the dignity of its patients and their families first, she added.

"We put our patients and their families before everything else and we make sure they are cared for humanely and respectfully," she told National Observer. "Yes, we collaborate with police forces but only when these conditions are respected and when they're not interfering with patient's care. These are very important conditions for us."

Josiane was seriously shaken by her brush with deadly fentanyl. Friends of hers have not been so lucky.

It's cases like these that have health care workers, social workers and addicts alike calling on the City of Montreal and the Quebec government to to respond to the escalating situation in their province before it’s too late.

opioid crisis, Montreal, Quebec, fentanyl
Concerned Montrealers attend a vigil for the local victims of drug overdose on Aug. 31, 2017. The increase in deaths is concerning, according to local advocates and health workers. Photo by Clothilde Goujard

Government 'watching bodies pile up'

The last two weeks in Quebec have been particularly deadly. On Aug. 25, two men were found dead in their car from a drug overdose possibly linked to fentanyl in Montreal. The week before, at least seven people in the Hochelaga neighbourhood overdosed from fentanyl.

They all survived, but a social worker who attended the vigil for victims in the square accused local governments of "watching the bodies pile up."

The issue at the heart of the overdose crisis is access to naloxone, which can block an overdose for between 30 and 90 minutes, according to the Montreal public health department's guide on the life-saving treatment. For a drug user who is struggling to breathe after an overdose, naloxone can give the brain temporary signals that there is no opioid in the blood and can stabilize someone until ambulances arrive.

Despite these life-saving capabilities, naloxone although now fully covered by provincial drug insurance when bought in its injectable version can only be found at four pharmacies in all of Montreal. The only first responders in the city who have access to and training for the medication are paramedics.

The Quebec government announced on Wednesday that it was working on a plan to make naloxone available for free in all pharmacies. It also announced other measures that would allow police and firefighters to administer the medication in an emergency.

In a statement, the government described the evolving situation as a "crisis" and that it would be investigating it formally through a provincial public health law.

In several major Canadian cities, other first responders like police officers are also equipped, prompting calls for Montreal to follow suit.

“The situation for us is dramatic, especially when we could have had tools at our disposition that could have allowed us to react a lot better and more efficiently so that people could have been and will be protected,” said Sandhia Vadlamudy, director at Cactus Montreal, one of three safe injection sites and community centres for drug users in the city.

Speaking at the vigil or in an interview with National Observer later, Vadlamudy said organizations on the ground have been asking for police officers to carry naloxone for months.

In September, Montreal Mayor Denis Coderre called for a municipal pilot project to train and supply police with naloxone kits.

Mayor anticipates a 'crisis'

Less than a week after the vigil, Coderre said the city is preparing for a crisis. Since August, Quebec's provincial coroner noted 12 deaths by overdose in the Montreal area alone, and the detection of fentanyl in the urine samples collected voluntarily from people who had taken cocaine and heroin. ​

Last Thursday, the city's public health department sent a a statement warning doctors and nurses in emergency rooms, intensive care units and clinics, along with those in charge of medical laboratories, that fentanyl-related deaths in Montreal are increasing. The statement called for vigilance and preparation.

At a press conference spoke after his meeting with members of a municipal working group on overdoses, comprised of first responders and health officials, Coderre said he has "asked for a diagnosis of the situation."

"We are living in an anticipated crisis," he told reporters. "It’s not a crisis but we are anticipating it and instead of waiting, we are putting in place a series of measures that we have already done for several months anyway."

He commended the work of the Montreal police, saying they reacted "promptly" in recent high-profile arrests and seizures of illicit drugs.

On Sept. 1, police conducted two operations to dismantle a network of heroin and fentanyl traffickers that resulted in 10 people and searches of five houses and two vehicles. Officers said in a news statement they found 13 grams of heroin, 19 grams of fentanyl and 225 grams of cocaine, among other drugs.

Montreal Police Chief Philippe Pichet, however, said he is wary of Coderre's proposed pilot project that would equip and train his staff with naloxone.

"We should look at other options with health respondents before asking the police to help with naloxone," Pichet said during the press conference. "Our priority is to investigate suppliers and dealers, but I’m not closed to the idea. I just really want to study it and put more efforts in being a partner in this initiative."

In recent weeks, Coderre said he has been in touch with federal and provincial health officials for advice on handling mounting opioid use in his city. Quebec's junior minister in charge of public health, Lucie Charlebois, with whom he has spoken, also confirmed that she is preparing a national strategy to address opioid overdoses, in addition to an inter-ministerial action plan on addressing addiction.

"Although Quebec is less affected by the opioid crisis than some other provinces, we are not less exposed to the risk of being confronted with this scourge," Charlebois said in a press statement on Aug. 30. "That’s why for several months, we’ve been preparing how to face it in a structured manner, through the adoption of efficient measures and the expertise of (social workers and healthcare professionals) who are well-prepared and have tools to react when necessary."

Denis Coderre, Montreal mayor, Barack Obama
Montreal Mayor Denis Coderre called in September for a pilot project that would arm police officers and firefighters with naloxone kits in anticipation of an overdose crisis. File photo by Elizabeth McSheffrey

'Enough with the studies'

At the vigil in August however, Manon Massé, co-spokesperson and Québec Solidaire MNA for the riding of Sainte-Marie-Saint-Jacques, called on Charlebois to speed up provincial response.

"Madame Charlebois, enough with studies," she told National Observer. "We know people on the ground know, and are pointing you to exactly where we need to go. But we’re already three years late.

"There’s too few pharmacies with (naloxone) and I can’t believe we have money to support oil development and to keep on making doctors rich, but not for human users (of drugs). So, hurry up, it’s urgent, because the day you lose control like in British Columbia, you lose it all. It will be too late."

A 25-year-old drug-user and community worker who wished to remain anonymous also said at the ceremony she has seen drafts of the provincial government's strategy, and it contains no concrete initiatives that will solve the problem.

“It’s not the time to do feasibility studies when people are dying. It makes me mad to see the lack of action from governments,” she told National Observer. “We know the solutions to the overdose crisis. It’s infuriating to see things aren’t moving forward while our relatives and us, we’re dying or, are at risk of dying.”

She said she's afraid she could be consuming fentanyl in illicit drugs without knowing it, but added that she tries to reduce risk by being open about her drug habits.

“My roommates, boyfriend and I have done the naloxone training and it’s a factor of reduction of risk that’s huge... On the ground, people are super active and do all they can in their power."

Editor's note: This article was updated at 11:30 a.m. ET on Thursday with new comments from the Quebec government.

Manon Massé, Québec Solidaire, Opioid crisis, Montreal

Manon Massé, Québec Solidaire co-spokesperson and a member of Quebec's National Assembly (left) speaks with a social worker about the opioid crisis in Montreal on Aug 31, 2017. Photo by Clothilde Goujard

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We need to understand why people become addicted and then change the conditions that lead to addiction. As I understand it from the research of Bruce Alexander in "The Globalization of Addiction" a major cause is a lack of social inclusion. This is the consequence of an extreme capitalist society in which some are winners and others are losers; this needs to be changed.

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