Ken Chopee was walking down the street one day this winter when he came across what is a sadly common sight in downtown Oshawa, Ont. – a man sitting on a park bench with a needle in his arm. He stopped to check if the man was okay and noticed that his lips were turning blue, a classic sign of an overdose.
Mr. Chopee reached for a zippered black-and-red kit that he usually carries with him, hanging from a clip on his belt. He took out a syringe and gave the man a shot of naloxone, a drug that reverses overdoses. When that didn’t work, he gave him another shot. The man on the bench began to breathe again.
Mr. Chopee reckons he saved a life that day – and it was far from the first time. He says he has yanked about 20 people back from the brink of death over the past few years. Mr. Chopee is no paramedic. A grey-bearded 57-year-old who is on methadone – a prescription opioid – himself, he spends much of his time in downtown Oshawa, joining food lines and chatting with pals. Yet, with his naloxone kit at his side, he is ready to rush into action if he sees someone in trouble.
There are many like him in Canadian towns and cities these days. As the opioid crisis rages, people who use drugs have become their own first responders. Though no one documents how often they succeed, these sidewalk medics certainly save many lives every day, often arriving sooner than any ambulance – if an ambulance arrives at all.
“It’s like a war,” says Leslie McBain, who co-founded the advocacy group Moms Stop the Harm in 2016 after her son, Jordan Miller, died of an accidental overdose in 2014. “You drag other soldiers off the battlefield and give them some medicine.”
Drug users say they have no choice. Now that fentanyl, a highly potent opioid, has spread through the illicit-drug supply, users can die within minutes of taking their drugs, their breathing slowing to a stop.
Mr. Chopee says that though he always calls 911 when he sees someone overdose, he can’t afford to wait for the paramedics to get there. “It’d be too late – they’d be dead,” he says. “What do you want to do – save a life or wait for an ambulance? I want to save the life.”
Spend a few hours on the streets of Oshawa and you hear lots of stories like his.
The historic automaking hub lies an hour’s drive east of Toronto on the shore of Lake Ontario. Though it is booming in many ways, the city’s downtown is home to a floating population of struggling people who live in shelters, rundown apartments or clusters of camping tents.
Just about everyone in that group seems to have saved someone or been saved themselves, often multiple times. Many take turns saving each other, forming a kind of buddy system to stay alive.
Jesse Boudreau, 29, and Nelson Arnold, 38, live together in an apartment above a store on Oshawa’s main downtown thoroughfare, Simcoe Street. Ms. Boudreau says she has given her boyfriend naloxone up to a dozen times. He returns the favour.
“If it wasn’t there, I can’t tell you how many people would be dead,” he says. “She’d be dead. I’d be dead for sure.”
Both say they are trying to quit drugs, distracting themselves from their cravings by binge-watching medical drama series New Amsterdam.
Another local, Brian McMinn, 37 (nicknamed Chum), keeps a naloxone kit dangling from the bars of the BMX bike he uses to get around town. He thinks he may have used the drug on 100 people over the past four years.
“Some nights I can go out with a backpack full and won’t have enough. It’s wild. People are dropping everywhere,” he says. He himself was saved by the drug last November when he collapsed on the street after smoking fentanyl with a pipe. The naloxone left a bad taste in his mouth – “like you just swam across a swamp and drank half the water” – but he survived.
He says he’d rather be revived with naloxone than go to hospital, where “they just treat us like garbage” – a perception the local hospital is striving to overcome.
Stephen Mulligan, 57, a former woodworker drinking with friends down by Oshawa Creek, says some people get mad when he gives them naloxone because it throws them into withdrawal: “You’re ruining their high.” He does it anyway, giving them one or two shots and performing chest compressions to get them breathing again. He says he saved 10 people last summer.
Naloxone (pronounced na-LOX-own, and known on the street by the commercial name Narcan) was co-invented by American researcher Jack Fishman in the 1960s to deal with one of the unpleasant side effects of opiate use: constipation. Scientists found it also served to reverse overdoses by blocking opioids from receptors in the brain.
It has an almost miraculous effect. Overdose victims usually come to within minutes, sometimes uttering a gasp as they start to draw deep breaths again.
Health workers started handing it out in volume when the opioid crisis escalated in the 2010s. Along with clean needles and supervised drug use sites, naloxone has become an important part of harm-reduction strategy, which focuses on saving – rather than reforming – the drug user. The aim is to make it as routine to carry naloxone as it is for those who suffer severe allergies to carry epinephrine.
Hundreds of thousands of naloxone kits have been distributed across the country through pharmacies, health clinics and community centres. British Columbia alone gave out a quarter of a million kits last year – more than a third were used to reverse overdoses. The federal government says “naloxone has been used to successfully reverse thousands of opioid overdoses across Canada.” Even drug dealers sometimes give it out to their clients.
Many police officers, firefighters, paramedics and security guards now carry the drug in either nasal spray or injectable form. The Ontario Provincial Police says it has saved 210 lives with naloxone since its officers started carrying it in 2017.
But only a fraction of overdoses draw the attention of uniformed first responders. Most happen out of their sight – in washrooms, apartments, drug houses or parks. If anyone is there to render first aid, it is usually not a trained medic, but a fellow user.
At a clinic in London, Ont., that cares for local drug users, people often suffer overdoses nearby. By the time clinic staff get to the scene, says Andrea Sereda, a doctor at London InterCommunity Health Centre, someone has usually given the victim a shot of naloxone. The clinic has 300 clients on its safe-supply program, which prescribes opioids to registered users, and “every single one has a story about saving someone’s life like that,” Dr. Sereda says.
Outreach workers in Oshawa say they see it all the time: people reviving others before emergency services can arrive.
Adam McNeil, an outreach worker with Oshawa’s Welcoming Streets initiative, says the program received a call from a local business recently about a person collapsed outside because of an overdose. When program staff got there, someone was already administering naloxone. The ambulance had yet to arrive.
Another day, four people “went down” within half an hour on Simcoe Street, McNeil’s co-worker Lindsay Hannah recalls, saying one of them needed four shots of naloxone before being revived.
Some helpers prefer the injected version of naloxone over the spray, saying it works better and faster. Others try cardiopulmonary resuscitation. If someone collapses and no one has naloxone, companions will often sound the alarm by calling out for “Narcan, Narcan!” – a familiar cry in Oshawa. A federal Good Samaritan law enacted in 2017 protects helpers from being prosecuted for things like possessing drugs if police show up.
Saving others with the drug has become so much a part of life on Canadian streets that it has given birth to a verb: To “narcan” someone is to give them naloxone. Mr. McNeil says that people talk about the drama of saving a life as if it happens every day – which, in fact, it does. “It’s really just a casual thing now: ‘Oh yeah, I narcan-ed someone the other night.’ ”
But the offhand attitude is often a mask. “It’s pretty horrific to see,” says Don King, 55, a guitar-strumming musician who wanders the streets of Oshawa, hoping his songs will cheer the addicted, the homeless and the mentally ill. Some overdose victims lie in a pool of saliva. Others stare with unseeing eyes. Their skin is often deathly pale. As he gives them a shot of naloxone, he wonders, “Are they going to come out of this? It’s heart-wrenching. They are right on the border.”
If people come up to ask him about it afterward, “I just end up saying ‘Yeah, yeah’ and walking away, because I just don’t want to think about it,” he says.
Mr. King was once a heavy drug user himself and still struggles to keep himself on track. He became addicted after being prescribed fentanyl to soothe the pain of injuries from a serious car accident. His 25-year-old daughter, his youngest child, died of an overdose just last year.
So he tries to help whenever he can. He started using naloxone after he saw a woman collapse from overdose near the local library one day. He rushed over to give her chest compressions until an ambulance arrived, but felt helpless without a kit on him, so started making sure he always had one close to hand. For a while, he even stored a kit in a hollow tree stump in the main downtown park – a local hangout and the site of many overdoses.
Despite the efforts of people like Mr. King, the tally of overdoses continues to climb. It is a measure of the depth of the crisis that, despite the widespread usage of an effective first-aid drug, people are dying in rising numbers.
British Columbia, Alberta and Saskatchewan had their worst years on record for drug fatalities in the period since the COVID-19 pandemic began. Opioid-related deaths in Ontario were up 59 per cent in the first 11 months of last year. In Durham Region, which includes Oshawa, the number of overdose deaths quadrupled between 2013 and 2019. Early figures showed it jumped again in 2020, reaching a record 80 deaths by November. Health authorities say that the pandemic has worsened what is sometimes called “Canada’s other health crisis” by disrupting the supply of drugs and making users more isolated, raising the odds that they will be alone when they overdose, with no one on hand to help.
But health authorities say the toll would be even worse if other drug users weren’t around with Narcan in hand.
Mr. Chopee, who saved the man on the bench, wishes that even more people carried and used naloxone. He still grieves over the death of his best friend, Kevin, who died of an overdose last year after injecting himself with drugs at an Oshawa bus stop last April. Mr. Chopee found him lying on the ground.
Mr. Chopee didn’t have his naloxone kit with him, so he ran to a nearby Tim Hortons to get help. But it was too late. “If I had the Narcan, I could have saved him,” he says. “I think about him every day.”
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