Quebec’s opioid crisis is worsening. In 2023, paramedics administered more naloxone to treat acute overdoses than ever before, and death from opioid toxicity is set to reach its highest levels yet, continuing an upward trend since 2019. Novel synthetic opioids, such as isotonitazene, which can be deadly even in minute quantities, continue to exacerbate the crisis in Montreal. Premier François Legault has said very little in response to the province’s opioid crisis, illustrating that it is not a priority for his government. This should come as no surprise. His populism is uniquely unsuited to tackle this crisis as there is no quick and easy political solution that will rally his base and address the issue at its core. Tackling Quebec’s opioid problem will require policy leg-work and a commitment to nuanced conversations that Quebec’s current government is ill-equipped to engage in. 

Since the 1990s, the role of opioids has changed in the medical community. Opioid prescriptions’ limited use for palliating individuals with painful cancers has expanded to the treatment of chronic non-cancer pain. This change in culture is often associated with mis-interpretations of the now infamous Porter-Jick study, which shifted the pain management paradigm toward opioids. Concurrently, the now-defunct Purdue Pharma provided misleading data to sales representatives and the medical community suggesting that Oxycontin, their flag-ship opioid drug, was less addictive and dangerous than their competitors’ products. Today, Canada is among the world’s largest per-capita consumers of opioids. For the past few decades, prescription opioids have been relatively easy to access both by prescription or through family members to whom they have been prescribed. 

In 2001, Portugal became the first country to decriminalize possession of hard drugs for individual use. As a consequence, incarcerations, HIV transmissions, and overdoses decreased in Portugal in the early 2000s. With Portugal’s policies being largely viewed as a success, British Columbia received an exemption from article 56(1) of Canada’s Controlled Drugs and Substances Act. More recently, Toronto requested a federal exemption, and although Montreal’s city council has signalled its support for an exemption they have yet to request one from the Public Health Agency of Canada. 

However, decriminalization is not an unfettered panacea. Portugal has failed to invest in and invigorate existing programs linked with decriminalization; thus, the country’s success at addressing its drug issue is waning, and they are no longer touted as an ideal model for the policy. This failure demonstrates that persistent effort and adopting a dynamic approach to decriminalization are necessary to address the opioid crisis. As seen in Portugal, the decriminalize-and-walk-away model does not work. However, Legault’s reluctance to maintain funding for supervised injection sites in Montreal stifles hopes for any form of sustained effort to address Quebec’s opioid crisis. This demonstrates not only his apathy toward those suffering but an unwillingness to engage with a public health issue whose mortality continues to increase. Legault’s complacency on Quebec’s opioid crisis also perpetuates colonial violence by neglecting an issue that disproportionately affects Indigenous peoples. 

Ultimately, Legault’s populism is antithetical to what the opioid crisis requires. The crisis is most visible in urban areas–– areas whose populations do not make up a consequential percentage of the CAQ’s voter base. It’s an issue that Conservative leader Pierre Polievre has demonstrated can easily become partisan. But hoping Legault will be the saviour and both depoliticize and articulate a nuanced message on a public health failure is delusional. Consider his approach toward addressing the decline of French as first language across the province, for example: The provincial government forfeited nuance in favour of challenging the viability of institutions that form the pillars of Quebec’s tertiary education system. 
Legislators must make decriminalization politically viable to the electorate, but Legault’s government continues to demonstrate an inability to push any debate beyond a simple populist divide. Until Quebec’s politics catches up with the scale of the opioid crisis, local governments and individual advocates must protect the institutions meaningfully addressing the crisis, notably supervised consumption services such as Cactus Montreal, Dopamine, L’Anonyme and Spectre de rue.