Jean-François Mary regularly uses a spectrometer to test street drugs in Montreal, checking for purity, potency and toxic ingredients.
"There is almost no heroin available locally. We've tested some samples of heroin, but it's very rare. Most of it is only fentanyl or synthetic opioids, in general," said Mary, who heads CACTUS Montréal, a community organization that offers a safe-injection site and other services to the injecting and inhaling drug users, sex workers, and trans people who are its clients.
Cocaine tends to be relatively pure, he said, but counterfeit pills are common, often containing different drugs than advertised.
Now his organization and others are being asked to keep an eye out for crack cocaine that has been laced with fentanyl.
The local health agency, CIUSSS du Centre-Sud-de-l'Île-de-Montréal, says six overdose-related deaths have been connected to people ingesting crack laced with fentanyl. It's possible, the agency says, that this crack is still circulating in the community.
Fentanyl is an opioid so powerful it is associated with a high risk of death — especially dangerous for crack users who could be unknowingly exposed to it, the CIUSSS says in a statement.
The agency is asking organizations to help build awareness about that risk.
The agency says users should be careful never to take drugs alone, and naloxone, the opioid antidote, may be needed to counteract an overdose if fentanyl is ingested. People should call 911 immediately if they suspect someone has overdosed, the statement says.
No supervised space to smoke
Alicia Morales, a site co-ordinator at Spectre de Rue, said her organization is asking permission to provide a place for people to smoke drugs safely, in a supervised environment.
As it stands, the organization's supervised safe-injection sites are only for drugs taken by needle or snorted. There's no place for people to go if they want to smoke a drug like crack cocaine that might have been laced with something else, she said.
Her organization is working to build awareness while providing a safe, supervised environment to snort or inject. If people could smoke, too, a nurse would be on hand to provide medical aid if needed, she said.
Jean-Pierre Rouleau, chief of services with Urgence Santé, said there is a protocol in place for responding to drug overdoses. When opioids are suspected, naloxone is administered.
He said there are specific signs to look for when it comes to opioid overdoses.
As far as the health agency's concern for crack laced with fentanyl, it doesn't change the way ambulance workers respond to such emergencies, he said. But the faster the ambulance service responds to any crisis, the better, and paramedics can respond faster when they know exactly what they are dealing with, he said.
People can help by providing as much detail as possible to 911 operators when they call for help, Rouleau said.
Law reform needed, advocate says
Rather than just keeping a vigilant eye out for laced drugs, the head of CACTUS Montréal said legal reform is needed to confront these issues because the current framework isn't working.
In fact, Mary said, it sometimes makes things worse. Recent police raids may have taken some drugs off the streets, but that means dealers are forced to dilute their supply, and this can lead to problems with users who don't know what they are ingesting.
When purer drugs are once again available, users may overdose because they take too much, expecting a weaker substance, he said.
He said users need more access to naloxone, better training in how to administer it and better education about drug use in general, to avoid potentially fatal mishaps.
Ultimately, illegal drugs are produced and distributed without any governmental control over what goes into them, meaning users don't always know what they are taking, he said. Enforcement is costing billions, he said, and being unlawful is exactly what makes it such a profitable, albeit illegal business.
"We need to change our drug laws," Mary said.
"It's totally inefficient. Because there's never been more drugs available, and there's never been such a diversity of drugs available, and they have never been more toxic-risky."