Opioids less prevalent in Quebec than elsewhere in Canada

While the opioid crisis is hitting the western part of the country particularly hard, Quebec —which is by no means spared— stands out for the popularity of stimulants, which are much more prevalent within its borders.

The landscape of street drugs is shifting, according to the latest data from Health Canada’s Drug Analysis Service, which analyzes suspected illicit drug samples submitted by law enforcement agencies and public health partners across the country. They analyze approximately 100,000 samples per year.

“Stimulants rank first across the country, but if you look at Quebec, the trend is particularly striking,” notes Dr. Alexandre Larocque, an emergency medicine specialist, toxicologist at the Quebec Poison Control Center, and consulting physician in toxicology at the Montreal Regional Public Health Directorate.

He made this comment on Tuesday during a webinar on trends in street drugs, organized by the National HIV and Hepatitis Mentoring Program.

In Quebec, the most commonly identified substance is cocaine. It is also the most commonly identified substance across Canada as a whole.

For several years, up until 2024, methamphetamine surpassed cocaine in Quebec, but last year and so far in 2026, it has ranked second. Overall, in recent years, the province has consistently had the same three most commonly identified drugs: cocaine, methamphetamine, and MDMA.

Fluorofentanyl, a fentanyl analogue, ranks third nationwide. “It ranks second behind cocaine in British Columbia and slightly lower in Ontario. In Quebec, however, it makes the top 10 but is near the bottom of the list. We’re still seeing a fairly marked regional difference when it comes to the situation in Quebec,” says Dr. Larocque.

“With opioids, we see that there are provinces where the problem is particularly severe—including British Columbia, Alberta, and Ontario—while Quebec is well below the Canadian average. […] This will shape the picture of overdoses in Quebec,” he adds.

“Another factor that sets Quebec apart is that the opioid most commonly found on the illicit market is hydromorphone, a pharmaceutical-grade opioid that is present across Canada. We see that it doesn’t make the top 10 in British Columbia; it’s present in Ontario, but behind fentanyl and other analogs,” notes Dr. Larocque.

In Ontario, medetomidine is the second most commonly identified drug by the SAD. It is a veterinary sedative and analgesic that is mixed with fentanyl. “So, the statistics for medetomidine generally closely follow those for fentanyl or its analogs,” explains Dr. Larocque. This drug ranks fourth nationally and is among the top 10 in Quebec.

“Why is there so little difference? Again, fentanyl—which is talked about a lot—isn’t disappearing, but it is becoming much rarer because its analogs have taken its place,” explains Dr. Larocque during the webinar.

In Ontario, Alberta, and even British Columbia, medetomidine accounts for a significant portion of seizures. “Whereas in Quebec, it remains relatively minor compared to the overwhelming amount of stimulants present,” the expert points out.

New trends are emerging in street drug use. Given the current socioeconomic context, some opioid users find themselves on the streets. They can’t find a place to stay at night—it’s dangerous—and since their reflexes are impaired by opioids, they use a stimulant to stay awake and reduce their hunger.

“There are quite a few people who are starting to use stimulants in combination with other substances, even though historically they were exclusively opioid users. This is from a very practical perspective. Unfortunately, for some, this contributes to overdose situations,” says Dr. Larocque.

“This phenomenon definitely seems to be taking hold,” he says. “We’re seeing more and more concurrent use in the population.”

Quebec is below the Canadian average in terms of overdose deaths. According to Health Canada data, from January to March 2026, the rate of deaths apparently related to opioid intoxication was 1,354 per 100,000 residents in Canada, compared to 158 in Quebec (which also includes other drugs for Quebec).

In Montreal, data from the Coroner’s Office indicate that the majority of overdose deaths occur at home. “We often have this image in our minds—sometimes a bit caricatured or biased—of a highly vulnerable person dying in an alleyway with a syringe in their arm,” explains Dr. Larocque. Although this reality does exist, the majority of overdoses involve people who use drugs alone at home.

–This report by La Presse Canadienne was translated by CityNews