Winnipeg Regional Health Authority, Population and Public Health, is alerting service providers of ongoing opioid-related harms in the Winnipeg Health Region. In 2021, there has been an increase in opioid-related harms. An increase in opioid-related harms may indicate an increase in opioid use in the population, and/or more toxic drug market products circulating.

Winnipeg Fire and Paramedic Services (WFPS) Data

Calls for service where the WFPS administered naloxone to a person suspected opioid overdose almost doubled from 1403 calls in 2019 to 2684 calls in 2020, with cases peaking in July 2020 (390 calls).  In 2021, 2544 calls were reported (as of Nov. 17), with cases peaking again in July  (321 calls).  In 2020/2021 combined:

• 66% of cases were among those aged 20 to 39 years of age, with almost two thirds of these male.
• 63% of calls for service occurred in the downtown wards of Mynarski, Daniel McIntyre and Point Douglas combined.

In October 2021, the City of Winnipeg started to publish timely data on cases where WFPS administered naloxone/Narcan and when responding to substance use-related medical emergency. These data can be found at:

City of Winnipeg Open Data Catalogue

The Manitoba Collaborative Data Portal provides alternative and user-friendly representations of the data appearing in the City of Winnipeg Open Data Catalogue. This information can be found at:  

Overdose and Drug Related Harms - Manitoba Collaborative Data Portal (mbcdp.ca)

Chief of Medical Examiner Office Data 

According to preliminary data provided by the Office of the Chief Medical Examiner (OCME), substance-related deaths in Manitoba have reached an unprecedented number in 2020.

• 369 substance-related deaths were identified in 2020, representing a 94% increase compared to the 2017-2019 average (190 deaths per year).
• 236 substance overdose deaths were reported by the OCME, from January to July 2021. The number of drug-related deaths in 2021 is anticipated to exceed 2020’s total. 

Community Reported Overdose Events

Healthy Sexuality and Harm Reduction (HSHR), Population and Public Health, WRHA Naloxone Distribution Program Data: From January 1 to October 31, HSHR distributed an average of over 260 take home naloxone kits a month. Over 30% of these kits were replacement of kits that had been used in overdose/poisoning events.

For the same period, the HSHR team in Winnipeg received reports from community members on 53 apparent opioid overdose events where take-home naloxone kits were used.

• In 53% of the events the person who apparently overdosed was male
• 65% of events occurred in private residences. An additional 10% of the events occurred outdoors (i.e., street, alley or park).
• Over 75% of apparent opioid overdose events were reportedly attributed to non-pharmaceutical opioids (fentanyl, heroin, ‘down’), descriptions included: blue, purple, pink.
• 911 was not called in 41.5% of the events

If you use drugs:

• Call 911 (or your local emergency response number) if you witness or experience an overdose. The Good Samaritan Overdose Protection Act will protect those involved from drug possession charges or breach of probation/pre-trial release charges
• Get naloxone and overdose training before using – bring a friend
• Be aware that benzodiazepines don’t respond to naloxone
• Do not use drugs alone or behind a locked door. Have a designated responder: Stagger use with friends so someone can respond/call 911 if needed
• Use a less direct route when you take drugs. Injecting a drug is the most direct and dangerous route.
• If you mix drugs, reduce the amount of each drug you take and use opioids before benzos or alcohol. Use the most unpredictable drug first.
• Use one drug at a time, test your drugs every time by doing a smaller than usual test amount first
• Wait before taking another dose – some drugs take longer to take effect
• The amount of naloxone in a take-home kit may not be enough to reverse very powerful overdoses, such as those caused by fentanyl-like drugs.
• If you inject do not share any injection equipment (needles, cookers, filters, rinse). Sterile drug use supplies and take home naloxone kits are available free from many places, See www.streetconnections.ca

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A sample of substances sold as "pink down" or "fentanyl pink" in Winnipeg was tested by Get Your Drugs Tested services. This sample, tested by FTIR technology, was found to have a combination of Erythritol 55-60% (a sugar-based filler), Caffeine 15-20%, Fentanyl 10-15%, Uncertain Match 5-10%. This sample also tested positive for Benzodiazepines by test strip (<5%),

Fentanyl is a very toxic opioid drug that can result in overdose causing respiratory depression, unconsciousness and death.

Benzodiazepine (benzos) causes respiratory depression and sedation and may cause a person to lose consciousness. Because it is not an opioid, naloxone does not work on it.

The combination of these two substances can compound harms.

If you use drugs:

• Call 911 (or your local emergency response number) if you witness or experience an overdose. The Good Samaritan Overdose Protection Act will protect those involved from drug possession charges or breach of probation/pre-trial release charges.
• Get naloxone and overdose training before using - bring a friend 
• Be aware that benzodiazepines don't respond to naloxone.
• Do not use drugs alone or behind a locked door. Have a designated responder: stagger use with friends so someone can respond/call 911 if needed.
• If you are using alone consider calling the National Overdose Prevention Hotline at 1-888-688-6677, where you will be connected to a safe consumption volunteer who stays on the line for 15-10 minutes while you use the substance.
• Use a less direct route when you take drugs. Injecting a drug is the most direct and dangerous route.
• If you mix drugs, reduce the amount of each drug you take and use opioids before benzos or alcohol. Use the most unpredictable drug first. 
• Use one drug at a time, test your drugs every time by doing a smaller than usual test amount first.
• Wait before taking another dose - some drugs take longer to take effect.
• The amount of naloxone in a take-home kit may not be enough to reverse powerful overdoses, such as those caused by fentanyl-like drugs.
• If you inject do not share any injection equipment (needles, cookers, filters, rinse). Sterile use supplies are available from many places - see www.streetconnections.ca

Winnipeg Regional Health Authority, Population and Public Health, is alerting service providers of significant shifts in opioid-related drug harms in the Winnipeg Health Region over the first half of 2020. An increase in opioid-related harms may indicate an increase in opioid use in the population, and/or more toxic drug market products circulating.

For details see: https://www.survwpg.ca/DrugHarms/Aug2120alert/August%202020_DRUG%20HARMS%20UPDATE.pdf

If you use drugs:

• Call 911 (or your local emergency response number) if you witness or experience an overdose. The Good Samaritan Overdose Protection Act will protect those involved from drug possession charges or breach of probation/pre-trial release charges
• Get naloxone and overdose training before using – bring a friend
• Be aware that benzodiazepines don’t respond to naloxone
• Do not use drugs alone or behind a locked door. Have a designated responder: Stagger use with friends so someone can respond/call 911 if needed
• Use a less direct route when you take drugs. Injecting a drug is the most direct and dangerous route.
• If you mix drugs, reduce the amount of each drug you take and use opioids before benzos or alcohol. Use the most unpredictable drug first.
• Use one drug at a time, test your drugs every time by doing a smaller than usual test amount first
• Wait before taking another dose – some drugs take longer to take effect
• The amount of naloxone in a take-home kit may not be enough to reverse very powerful overdoses, such as those caused by fentanyl-like drugs.
• If you inject do not share any injection equipment (needles, cookers, filters, rinse). Sterile drug use supplies and take home naloxone kits are available free from many places, See www.streetconnections.ca