Lessons From the Front Lines of Canada’s Fentanyl Crisis

lessons from the front lines of canada’s fentanyl crisis

A nurse at the Crosstown Clinic, a supervised injection site in Vancouver, British Columbia, handed out a syringe of medical-grade heroin to a patient.

A machine used for chemical analysis, with a slight resemblance to a printer, thrummed repeatedly as technicians at a drug testing site in Victoria, British Columbia, prepared to open its doors to local drug users.

Most of the samples handed to Substance Drug Checking, a lab led by researchers at the University of Victoria, were found to have contained fentanyl, the synthetic opioid driving fatal overdoses in the province to record levels.

Alarm about the spread of fentanyl is entrenched in how Canada and the United States talk about the opioid crisis. But in Mexico, the government has repeatedly denied that fentanyl abuse is spilling over its border and has asserted that the problem is exclusive to its northern neighbors.

Weak detection efforts, in public health settings or during drug death investigations, have meant that the extent of fentanyl’s reach in Mexico is largely an open question.

“We don’t know, because we’re not looking for it,” said Xóchitl Cárdenas, a forensic services chemist at the attorney general’s office in Sonora State, along Mexico’s northern border, where experts say the fentanyl crisis is acute.

Ms. Cárdenas was one of about a dozen Mexican forensic scientists, medical researchers and government workers who traveled to Vancouver and Victoria this week to learn how Canadian agencies are responding to the toxic drug supply. She watched as Pablo Gonzalez, a graduate student running the lab, listed the capabilities of the drug analysis software being developed by the university, which can spit out drug test results in under 30 minutes.

I traveled with the group this week as members visited some of the sites where drug users can receive services — including stalls they can use to inject substances under the supervision of health care personnel, group meetings that offer grief counseling and pharmacies that dispense therapeutic drugs for patients suffering from opioid use disorder.

The Mexican visitors’ trip to Canada was sponsored by the Bureau of International Narcotics and Law Enforcement Affairs at the U.S. Embassy in Mexico. In February, the bureau organized a similar tour to a “body farm” in Colorado, a site where Mexican medical examiners observed how decomposing cadavers can be tested for fentanyl poisoning.

Natalie Kitroeff, my colleague who leads the Mexico City bureau at The Times, reported on that visit, which U.S. State Department officials hoped would further their diplomatic goal of holding a mirror up to Mexico’s fentanyl crisis.

[Read Natalie’s story: How a ‘Body Farm’ Might Help Tackle Fentanyl Abuse]

Canada is an important partner in tackling the opiod crisis across the region, said Alex Thurn, the deputy director of the embassy bureau.

“The strides that Canada has made in this fight is very impressive,” Mr. Thurn told me, adding that his group hoped to bring its study tour full circle with an invitation for Canadian and American experts to visit northern Mexico.

lessons from the front lines of canada’s fentanyl crisis

Medical examiners from Mexico looked on as workers at the Denver medical examiner’s office prepared an autopsy on the body of a person who died of an overdose.

The trip came as political tensions in Canada erupted over British Columbia’s experimental approach to lowering opioid deaths by decriminalizing the possession of small amounts of the drug for personal use.

[Read: Canada Decriminalizes Opioids and Other Drugs in British Columbia]

Public health and policy experts we heard from in Vancouver’s downtown east side, a neighborhood viewed as ground zero of the opioid crisis, said de facto decriminalization had been in place long before it officially began in January 2023. They told us that the police often used their discretion in making arrests but still seized drugs, which commonly sent drug users racing to unsafe options to satisfy their addictions. For those arrested, withdrawal symptoms in prison could have dangerous results.

lessons from the front lines of canada’s fentanyl crisis

Protesters outside the Indian Consulate in Vancouver in September.

David Eby, the premier and leader of the New Democratic Party, has been under increasing pressure ahead of the October provincial elections to address public drug use and announced last week that he was looking to effectively shut down that experiment about halfway through its expected three-year run. Doing so requires authorization from the federal health department, which approved the experiment.

Pierre Poilievre, the federal Conservative leader, seized on the drug decriminalization issue this week to attack Prime Minister Justin Trudeau. He called Mr. Trudeau a “wacko” in a biting exchange during a question-and-answer period on Tuesday that ended with his temporary ejection from the House of Commons for using unparliamentary language.

Drug overdoses from toxic substances are the leading cause of death among the largest swath of British Columbia’s population, those from 10 to 59 years old. They kill more people than homicides, suicides, accidents and natural diseases combined, according to the coroner’s office, and have caused more than 14,000 deaths in the province since 2016.

Despite politicians backtracking on the issue, a main difference between the drug situations in the two countries is, as the Mexican visitors pointed out, the wide availability of Canadian government funding to address the dangers from opioids.

“We have no support from the government,” said Lourdes Angulo, director of Verter, a nonprofit organization that offers services for drug users in Mexicali, the capital of the northern border state of Baja California.

“We are sometimes afraid for our own safety because the government is always looking for something to stop our organization from doing what we do,” she said.

For experts like Ms. Cárdenas, the chemist from Sonora, the experience of walking through homeless encampments along the streets of Vancouver and Victoria, where outreach workers make their rounds with naloxone kits to reverse overdoses, gave new meaning to the results she would look for in the lab.

“It gives me a different perception of what drugs are like on the streets,” she said.

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Trans Canada

■ The police in Surrey, British Columbia announced the arrests of three men in the investigation into the shooting of Hardeep Singh Nijjar, a Sikh nationalist and temple president.

■ In a Guest Essay for The Times, the author Stephen Marche argues that public views of Prime Minister Justin Trudeau’s leadership have dimmed in the face of Canada’s growing polarization.

■ For the first time in a decade, three Premier League teams — Arsenal, Liverpool and Manchester City — are in the championship as it enters its final weeks. Shawna Richer, an editor working on coverage of sports in America, followed soccer fans to a bar in Toronto.

■ Scaachi Koul, a Canadian culture writer, reflects on how watching episodes of “Indian Idol” with her family helped bring some respite during her mother’s cancer diagnosis.

■ “Self-Portrait,” a documentary made using surveillance footage collected by the Canadian filmmaker Joële Walinga, is one of five international films to stream now, writes Devika Girish.

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Vjosa Isai is a reporter and researcher for The New York Times in Toronto.

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