One early morning in August 2015, a security guard found 43-year-old Brad Chapman lying on Walnut Street in Toronto.
The longtime opioid user had drug paraphernalia on his body and a needle in his ankle, but police initially thought he was sleeping, said Chapman's sister, Leigh Chapman.
It took a week for the family to be notified that her homeless brother was in hospital, she told CBC Toronto.
By then, the father of three was brain dead.
"The hospital said they had suspected it was fentanyl, because he sort of went quickly into respiratory and cardiac arrest," Leigh Chapman said. "We never suspected it was intentional ... so it would have been helpful to know if it was a contaminated supply or whether he took too much."
As the number of fatal fentanyl overdoses climbs across the country, Toronto's civic leaders are trying to develop a strategy to prevent an opioid epidemic.
Preparing in case of a crisis
Toronto Public Health is hosting a meeting today with more than a dozen organizations including police, paramedics, the Centre for Addiction and Mental Health and community service providers to share information and come up with ideas to keep opioid users safe.
"The better information we have about what's in the illicit drug market, the better we are able to develop responses to it," said Susan Shepherd, manager of the Toronto Drug Strategy Secretariat. "That's difficult information to get because it's an unregulated market."
Anecdotally, Toronto Public Health's front-line workers are already seeing more users overdose on opioids.
"With our clients, we're getting self-reports that people use heroin, but they think that it has fentanyl in it," said Shaun Hopkins, manager of The Works, a Toronto harm-reduction program.
Fentanyl is a powerful synthetic opioid commonly prescribed as pain medication, which is now being increasingly found in street drugs across Canada. According to the U.S. National Institute on Drug Abuse, fentanyl is between 50 and 80 times more powerful than morphine.
Illicit drug users can take fentanyl unknowingly when other drugs like cocaine or heroin are laced with it. It has no taste or smell, and police say it can take on the composition of the drug with which it's mixed.
The chief coroner for Ontario reports that fentanyl was involved in 165 deaths in 2015, a slight rise from the previous year, but almost double the 86 deaths documented in 2010.
This province's rate of fatal overdoses, however, pales in comparison to the situation in British Columbia, which reported 755 opioid-related deaths between January and November 2016. That's an increase of 70.4 per cent compared to the same period last year, something B.C.'s chief coroner attributes primarily to the presence of fentanyl.
Toronto police say they're keeping a close eye on the situation here; they respond to all overdose calls.
Acting Insp. Steve Watts said that in 2015, the drug squad primarily confiscated pharmaceutical-grade fentanyl patches that had been taken apart and then smoked or injected.
"What we're seeing more in 2016 is pill and powder form," Watts said. "You will not have the ability to determine how much fentanyl is in that powder. That's the danger from a user perspective, from a public health perspective."
All paramedics in the city now carry naloxone, the antidote used to treat a narcotic overdose. Prior to 2016, only 30 per cent of paramedics had the antidote in their kits.
Hopkins said The Works has also ramped up its distribution of naloxone and they teach the friends and family of users how to administer it.
And more people are asking for the antidote.
"Since 2011, we've given out over 7,000 doses of naloxone to people and we've heard it's been used in 570 overdose situations."
The city is waiting on federal approval for three supervised injection sites. And then once the province provides funding, the clinics could be operating in six months, Hopkins said.
"Supervised injection services will really help in terms of ... helping us to be able to intervene and save someone's life — and reduce the impact of the overdose from a medical point of view, because the intervention is happening fairly quickly."
She hopes today's meeting will provide a forum to share information that can be passed on to drug users so they can better protect themselves.
"The concern is, what drugs are coming?" she said. "Is carfentanil coming? Are we going to see more fentanyl in the drug supply ... in other drugs like cocaine? And how can we ramp up our services to ensure that even people who typically don't use opiates have a naloxone kit just in case?"
Leigh Chapman, however, wants to see all first responders carry naloxone and be trained to recognize the signs of an overdose.
"In Brad's case in particular, the police stood with him for 13 minutes," she said of her brother. "It takes much less time than that for brain death to occur.
"If police had been able to recognize the signs of overdose and been able to act accordingly, in terms of positioning him in a recovery position, I think a lot of lives would be saved."