Public health officials in Quebec’s Eastern Townships issued a warning following a spike in overdoses caused by a synthetic opioid in the region.
Substances are being contaminated with nitazene — a synthetic opioid 25 times stronger than fentanyl, says Dr. Mélissa Généreux with the regional health authority.
While overdoses in the townships are fortunately rare, Généreux says a single dose of the drug which has become more widespread across the country has lethal potential.
There were 30 overdoses in 2022, 57 in 2023 and, as of July 31, 37 overdoses so far this year in the Eastern Townships. The health authority did not indicate how many of the overdoses were fatal.
“What worried us most in this situation was that these were users who, according to their history, didn’t know they were taking opioids,” said Généreux.
“Possibly they thought they were consuming cocaine, for example.”
Contrary to fentanyl, Mélanie Perrier with the RCMP’s drug and organized crime awareness services says protonitazene, a type of nitazene, has no intended medical use.
“We barely have any information actually on the substance itself,” said Perrier.
“It is a substance that can only be analyzed with special equipment. So it adds on to the issue that we’re having with the substance being on the streets.”
Users are ‘just the guinea pigs,’ says RCMP
She says most of the time, dealers selling drugs “don’t even know the substance they’re selling.”
“We have no information at all in terms of the quantity of the substance that is in every pill,” she says.
The amount of protonitazene laced in any particular drug could also differ, even in the same batch.
Perrier compared it to making chocolate chip cookies.
“Let’s pretend that the chocolate chips are the substance, the drug. Some cookies will barely have any chocolate chips in there, but others will have many chocolate chips,” said Perrier.
“The ones that are going to get the chocolate chip cookies that have way too many of the chocolate chips are the ones that will overdose.”
The RCMP recently seized over a million tablets containing protonitazene. She says the substance can also be detected in counterfeit medication and has popped up across the country — tending to be more widespread in bigger cities.
“It’s everywhere. No one is protected from that. It’s all over,” said Perrier.
“People that are consuming drugs are just the Guinea pigs.… Unfortunately it’s those people that are paying the price.”
Naloxone means ‘difference between life and death’
Responding to calls of people who have consumed opioids has become “very regular” for first responders, says Jean-Pierre Rouleau, spokesperson for paramedic service Urgences-santé in Montreal and Laval.
“It’s a situation that is extremely worrying for our emergency responders,” said Rouleau
When arriving at the scene to a person exhibiting signs of an overdose, Rouleau says paramedics aren’t privy to what drugs were consumed.
“We really act on the signs and symptoms that the patient presents in order to administer the drug or antidote,” said Rouleau.
Naloxone, which can be administered by nasal spray or injection, is used to treat overdoses of opioids such as fentanyl, heroin and morphine. The number of naloxone kits distributed free at Quebec pharmacies has increased tenfold in six years, according to the latest numbers from the province’s health insurance board, the Régie de l’assurance maladie du Québec (RAMQ).
Available at pharmacies, Rouleau says the antidote treats both natural and synthetic opioid overdoses.
Although Urgences-santé responded to 74 cases of opioid consumption in June, Rouleau says in 32 cases, naloxone kits were already administered before paramedics arrived on the scene.
“Clearly the fact that antidote kits are in circulation or available to people makes the difference between life and death,” said Rouleau.