The Addiction Crisis in Montreal

Montreal is at the epicentre of Quebec's escalating overdose crisis. In April 2026, Montreal public health issued an urgent warning after carfentanil — roughly 100 times more potent than fentanyl — was detected in the city's street drug supply, triggering a sharp rise in non-fatal overdoses. Between April 10–24, 2026, Urgences Santé crews responded to approximately 67 overdose cases in under two weeks. Paramedics were administering naloxone roughly 75 times per month in 2025. The MUHC's Addiction Psychiatry Program closed in 2024, compressing an already strained treatment system. Fourteen supervised consumption sites operate across Quebec, several in Montreal, yet frontline workers report that demand for services consistently outpaces capacity.

Canada recorded approximately 7,150 apparent opioid-related deaths in 2024 (PHAC / APTNNEWS), down 11% from 2023's figure of roughly 7,560. British Columbia, Alberta, and Ontario together account for 78% of national deaths. Quebec is a stark outlier: while most provinces saw declining deaths in 2024, Quebec reached its highest-ever annual total. This means Montreal and Quebec are experiencing a countercyclical crisis — worsening as the national picture marginally improves — and require targeted provincial and local responses rather than reliance on national trend lines.

01. What is happening in Montreal

02. A crisis that did not start this month

Quebec is experiencing a historic and worsening overdose crisis that is moving in the opposite direction from the rest of Canada. In 2024, the province recorded 645 confirmed or suspected drug overdose deaths — the highest annual total ever reported in Quebec, up from 536 in 2023 and more than double the count from 2022. Through the first nine months of 2025, INSPQ reported 453 deaths, putting the province on pace for a second consecutive year above 600. This contrasts sharply with a national trend: Canada as a whole saw an 11% decrease in opioid-related deaths in 2024. Fentanyl or its analogues are now detected in nearly two-thirds of Quebec opioid deaths. The supply has grown more chemically diverse and dangerous — cocaine, methamphetamine, and now carfentanil are increasingly present alongside fentanyl. The opioid death rate in Quebec rose from 5.1 per 100,000 in 2018 to 7.3 per 100,000 in 2024.

03. Why is it getting worse?

Several intersecting factors are driving Montreal and Quebec's worsening crisis. First, the illicit drug supply has shifted dramatically: fentanyl has largely displaced heroin, and carfentanil — detected only occasionally before 2026 — is now appearing regularly in Montreal's street supply, making each exposure far more likely to be fatal. Second, stimulant use (cocaine, methamphetamine) has surged since the COVID-19 pandemic, adding a second drug class driving deaths and hospitalizations. Third, treatment capacity has eroded rather than grown: the closure of the MUHC Addiction Psychiatry Program in 2024 removed a key Montreal resource even as demand expanded. Fourth, Quebec's harm reduction infrastructure, while established, is unevenly distributed and undersized for the current volume — paramedics administered naloxone roughly 75 times per month in Montreal in 2025, reflecting the gap between overdose frequency and community-level reversal capacity. Fifth, Quebec's crisis is diverging from national trends, suggesting province-specific supply chain dynamics and policy gaps rather than purely national drivers.

04. Where hope still lives

Communities across Quebec are responding with naloxone distribution, harm reduction programs, and peer support networks. Every person trained in naloxone use is a potential life saved.

05. In the news

The reporting behind this page:

• Montreal public health warns of rise in overdoses linked to fentanyl mixturesGlobal News · 2026-04-25
• Carfentanil found in Montreal's fentanyl supply as overdoses spikeCTV News Montreal · 2026-04-09
• Quebec on pace to record back-to-back years with 600 drug overdose deathsCBC News · 2025
• Overdose deaths in Quebec are on the rise, and the problem could get worseCBC News · 2025
• How to fight Quebec's toxic drug problem? A former user says change the conversationCBC News · 2025
• Overdose Epidemic in Quebec: Population-Level Approaches and Clinical ImplicationsMDPI Pharmacy (peer-reviewed) · 2025