GREATER SUDBURY, Ont. — Crystal Plume sits in the shade of a tree near a busy intersection in downtown Sudbury and carefully injects fentanyl into a vein on the back of her hand before licking the speck of blood left behind.
The 36-year-old who regularly panhandles in the northern Ontario city says her substance use disorder has worsened in recent years and she's lost many friends to opioid overdoses.
"Before there used to be the drunks, the winos, but you don't see those anymore," says Plume.
"Everyone is using drugs now. It's the fastest and easiest way to numb your pain. I was only smoking at first, now I smash it."
Plume says she turns to opioids as a way to deal with past domestic abuse and other personal trauma. She lives with a friend who also uses opioids and says they've both come close to fatal overdoses.
"I've almost died a few times," she says.
Local crisis workers and city authorities say that since 2019, some northern Ontario cities, such as Sudbury and Thunder Bay, have been ground zero of a drug overdose crisis that has become increasingly difficult to address.
Data from Ontario's coroner's office shows that from April 2022 to March 2023, the Sudbury and District public health unit had a fatal opioid overdose rate of approximately 50 per 100,000 population – the third highest in the province after the Thunder Bay and Algoma public health units, also in northern Ontario.
The provincial rate for that time period was 17 per 100,000 population.
Amber Fritz, the manager of Sudbury's only supervised consumption site, says the city has been going through "unprecedented times."
"People are dying at a rate that's hard to keep track of," she says.
"The level of disorientation and sedation that people who use drugs are facing is something that I've never seen in the 10 years that I've been doing this work."
The illegal supply of powerful opioids, particularly fentanyl, in the city has put a growing number of drug users at risk, she says.
"Everyone is doing the best that they can to catch up with the unregulated supply, but it's a beast," she says.
Crystal-Ann Grigg, a former homecare worker who lost her job during the pandemic and has been panhandling since, says she knows firsthand how easy it can be to obtain illegal fentanyl, and how hard it can be to stop using the drug.
"You get hot flashes, pain on the back of your leg for some reason, and your mood is so hard to control, you're angry, you can't focus on anything" says Grigg.
While Grigg no longer uses fentanyl, she knows many who do and many others who've died from overdoses.
"Some people ... I didn't realize that they had passed away, I thought maybe they're in jail, gone away for summer but then I find out and it's just shocking," she says.
"You don't know who's gonna pass away next."
Samantha Mortimer, a public health nurse in Sudbury, says there are several factors in northern Ontario that may help explain why its population is more vulnerable to the risks posed by opioids.
There are fewer social services in the north compared to the south and there is a higher percentage of Indigenous residents who may have trauma related to colonialism that's been known to lead to increased substance use, she says. Northern Ontario also has more mining, and studies have indicated young men working in trades disproportionately overdose on opioids, she says.
"It's a collection of different elements that, when combined together, create a perfect storm that really is impacting our communities, and putting our folks at a disadvantage, increased risks for overdose and increased risk for substance-use related harms," Mortimer says.
The City of Greater Sudbury will be hosting a summit in the fall to better understand the northern opioid problem and look at ways to address it.
Steve Jacques, general manager of community development for Greater Sudbury, says the municipality has been funding the city's supervised consumption site and has taken several steps to help address the crisis, including transitional housing for people with addiction, increasing the number of shelter beds and hiring outreach workers who connect drugs users with services.
But the programs haven't been enough and Sudbury is seeking support from the province, he says.
"It's not a badge of honour to have one of the highest per capita death rates due to opioid use in the country," Jacques said.
"It's a crisis in our community, it's a crisis in our province and it definitely needs to be dealt with. There needs to be some meaningful response from senior orders of government."
A spokesperson for Ontario's Ministry of Health said the province has invested $525 million in addiction treatment services and supports since 2019 but didn't specify how much of that has gone to northern Ontario.
"Additionally, in response to the pandemic’s impact on substance use, our government is implementing the Addictions Recovery Fund, a one-time investment of $90 million over three years to boost capacity in addictions services," W.D. Lighthall wrote in a statement.
The Greater Sudbury Police Service says it is looking to work more closely with other forces to combat the illegal drug supply.
"The difficulty is the majority of the drug trafficking seems to be by transient people who are coming to Sudbury for the sole purpose of distributing drugs and taking advantage of the people that are mainly at a vulnerable state," says Det. Staff Sgt. Guy Renaud.
"Then there's associated violence we're seeing involving firearms, more mental health calls, and it's just becoming more complex than it would have been years ago."
For Plume, the toll of the city's opioid crisis is all too clear as she sits near a collection of white crosses marking recent overdose deaths.
"There's so many people here I know," she says, pointing to the makeshift memorial.
"They're my friends."
This report by The Canadian Press was first published Aug. 25, 2023.
Fakiha Baig, The Canadian Press
