THREAD - I wanted to see if the opioid epidemic has escalated during the COVID-19 pandemic. The short answer is yes. Some of my findings were alarming - Ontario's chief coroner told me about 50 to 80 Ontarians are dying every week of overdoses, compared to about 44 a week in 2019

In B.C., about 28 people are dying every week of drug overdoses in 2020. Most of these are opioid overdoses. Both provinces set grim records for the most overdose deaths ever seen in a single month recently - in June, B.C. saw 175 deaths, a 130% increase from June 2019

Alberta has also been hit hard by the opioid epidemic, but unfortunately Alberta Health, Alberta Health Services and the Office of the Justice and Solicitor General (who oversees the coroner's office) said they could not provide me any figures in advance of the opioids Q2 report

That report is out in September. It will be interesting to see if Alberta follows the trend seen in B.C. and Ontario - the second quarter is when deaths have really been spiking. May, June and July seem to have been particularly bad.

It comes down to two main factors - more people using in isolation due to services such as supervised consumption sites having reduced capacity, and the ubiquity of fentanyl in Canada's illicit opioid market. There is evidence the market has become even more toxic post pandemic.

This is where things get really interesting for me. The B.C. Coroner's Office says they've been seeing "extreme levels of toxicity" in the fentanyl they've tested in recent months (more than 50 micrograms/L). They are also seeing high levels of cocaine and meth adulteration.

@dmwerb has observed significant amounts of benzodiazepines in Toronto's illicit opioids which puts people at much greater risk of overdose. They've been seeing a lot of etizolam, which is typically less common than popular benzos such as alprazolam (Xanax) or diazepam (Valium)

Over at @GYDTcanada in Vancouver, they observed a fentanyl shortage in the early stages of the pandemic. But it came back with a vengeance - they started seeing "stronger mixes of dope" in the second quarter of 2020 as well as more cocaine and meth adulteration as well.

They speculate this is a result of a transfer between Chinese pharmaceutical fentanyl coming into Canada to illicitly made fentanyl coming from Mexico and South America. This clandestine fentanyl is less consistent in its concentration and probably harder for dealers to mix

I find this really interesting - In 2020, CBSA has seized about one third of the fentanyl seized over the same period in 2019 (653 grams in 2020 versus 1,873 grams in 2019). It shows how even with borders closed, fentanyl will still find its way into the country.

It may also explain reports of higher drug prices and more toxic fentanyl concentrations. But right now it's speculative. What we do know is Canada's unregulated opioid market is completely contaminated by fentanyl, with the drug being detected in the majority of overdose deaths

Fentanyl is killing thousands of Canadians because people who are addicted to opioids often have no other choice but to use this dangerous substance. With numbers out of B.C. and Ontario, we are on track to hit 18,000+ opioid overdose deaths in five years https://www.thestar.com/news/canada/2020/08/14/in-the-shadow-of-covid-19-canadas-opioid-epidemic-has-suddenly-become-deadlier.html

The numbers are jarring. But as this crisis continues to cause carnage, I hope we never forget that behind every one of these deaths is a grieving family, dreams that were never realized, a human life that never met its full potential. Thanks for reading. https://www.thestar.com/news/canada/2020/08/14/in-the-shadow-of-covid-19-canadas-opioid-epidemic-has-suddenly-become-deadlier.html

Also, many thanks to @guyfelicella @matthew__bonn @dmwerb @gilliankolla @ChiefSerr @GYDTcanada @CanBorder and the coroner's offices in B.C. and Ontario for their help with this story.