The morning light filters through the windows of Montreal’s harm reduction center as Sarah, a frontline worker, carefully arranges testing strips on a small table. “We’re seeing it almost daily now,” she tells me, her voice steady but concerned. “People bring in what they think is one substance, and it contains something completely different.”
What Sarah and her colleagues are finding has triggered alarm bells across Montreal’s public health system. A dangerous animal tranquilizer called xylazine has been increasingly detected in the city’s drug supply, alongside other potent sedatives typically reserved for veterinary use.
I visited three community health centers across Montreal last week, where workers described a troubling shift in what’s being found in substances circulating on the streets. This isn’t just about one contaminated batch – it’s becoming a persistent pattern that’s changing how frontline workers approach overdose prevention.
“The regular naloxone protocols don’t fully work when xylazine is involved,” explains Dr. Carole Morissette, Montreal’s medical officer of health. “Xylazine isn’t an opioid, so the standard overdose reversal medication can’t address all the symptoms.”
The public health department’s warning comes after their surveillance system detected these veterinary sedatives in multiple drug samples. Their testing revealed that many people unknowingly consumed these powerful animal tranquilizers when they thought they were taking other substances entirely.
What makes this particularly concerning is that xylazine causes profound sedation and respiratory depression but doesn’t respond to naloxone, the life-saving medication that reverses opioid overdoses. When combined with fentanyl or other opioids – as it frequently is – it creates a dangerous cocktail that complicates emergency response.
The health department has documented several cases where individuals experienced unusually prolonged sedation and developed distinctive skin wounds that resist healing – a telltale sign of xylazine exposure that healthcare providers are now being trained to recognize.
“We’re adapting our approaches in real-time,” says Jean-François Mary, executive director of CACTUS Montreal, a community harm reduction organization. “But the unpredictability of the drug supply means we’re constantly playing catch-up.”
The impact extends beyond those who use drugs regularly. Public health officials worry about occasional users who have no tolerance and no expectation that what they’re consuming might contain powerful veterinary sedatives.
When I speak with people accessing harm reduction services, many express frustration about the increasingly unpredictable nature of substances available. “It’s not like years ago when you generally knew what you were getting,” one man in his 40s tells me, requesting anonymity. “Now it feels like Russian roulette every time.”
Montreal isn’t alone in facing this challenge. Health Canada data shows xylazine contamination has been detected in drug supplies across multiple provinces, though the concentration appears particularly high in Quebec. The U.S. has declared xylazine an “emerging threat” after it was found in approximately 23% of fentanyl powder samples across the country in 2022.
Dr. Morissette emphasizes that Montreal public health is taking a multi-pronged approach to address the crisis. They’ve expanded drug checking services, where people can anonymously have substances tested for dangerous additives before consumption. They’re also distributing test strips that can detect the presence of xylazine and other contaminants.
Perhaps most critically, they’re training healthcare providers and community workers to recognize the unique symptoms of xylazine exposure, which can mimic opioid overdose but requires additional medical interventions.
“The presence of these veterinary drugs changes our entire clinical approach,” explains an emergency physician at a downtown Montreal hospital, who’s treated several patients with suspected xylazine exposure. “We’re seeing people who remain unconscious even after receiving multiple doses of naloxone.”
As Montreal grapples with this evolving threat, community organizations continue pushing for broader policy solutions. Many advocates point to the need for a safer, regulated supply as the only definitive way to prevent contamination with unexpected substances.
“Testing and warnings help, but they’re band-aids on a much deeper wound,” says Mary from CACTUS. “As long as the drug supply remains unregulated, new contaminants will continue to emerge.”
Back at the harm reduction center, Sarah carefully explains the risks to a young woman who’s come to have a substance checked. The woman nods, her expression a mix of gratitude and resignation. This is the reality in Montreal today – where knowing exactly what’s in the drugs circulating through the city has become a matter of life and death.
For those seeking information or support, Montreal Public Health has established a dedicated information line and expanded hours at testing sites across the city. Meanwhile, frontline workers like Sarah continue their daily work, hoping the next person who walks through their door decides to test before using – a small decision that, increasingly, could save their life.
