milton park is a symptom of a broken system: dealers give away fentanyl as rehab waits grow

drug dealers are masquerading as homeless people to get close to them and exploit them. the information comes from intervention workers on the ground in milton park and in other neighbourhoods of montreal. milton park, they say, is the acute symptom of a broken system of care that is leaving society’s most vulnerable members exposed to criminals.“dealers will sometimes act as if they’re also on the street and kind of blend in,” one of the workers said.“they act like they’re unhoused and really they’re just trying to prey on vulnerable people in the community.”the gazette isn’t identifying the workers for their protection.in mid-april, word passed among intervention workers that dealers were giving out free fentanyl to unhoused people in an apparent attempt to turn them into returning clients.all kinds of drugs are being laced with fentanyl, including crack, the workers said. in fact, the montreal public health department recently issued a public warning that an animal tranquillizer, xylazine, which is deadly to humans, is also increasingly turning up in street drugs. it’s being cut with opioids to get users high for longer. the dealers’ victims aren’t all unhoused.the intervention workers said they know of cases of dealers in montreal “commandeering” the apartments of vulnerable people by exploiting their drug addiction, paying them off with “a little piece of drug here and there,” to turn their home into a “trap house” — slang for a residence used for dealing illicit drugs.“imagine how easy it is when a person has cognitive impairments, mental illness, addiction,” a worker said of the manipulation.another worker said predators use “the boyfriend scheme” to target indigenous women on the street so they can be trafficked as “a great source of revenue.”"it can come in the form of ‘oh, you’re so beautiful, i can be your boyfriend,’” the worker said.employees working in quebec’s health and social services network agree with the intervention workers’ assessment that the system is broken. they point to chronic government underfunding for substance abuse and mental health treatment, increased centralization and a lack of prevention in every area, from addiction to youth protection.“the lack of perspective and a symptom-focused, curative approach, rather than a preventative one, are at the very root of the problem,” said simon dubé, a provincial representative of the alliance du personnel professionnel et technique de la santé et des services sociaux. the union represents 65,000 technicians and professionals working in the province’s health and social services network. “these issues are interdependent and should be addressed through a comprehensive, integrated approach. ultimately, political will must translate into concrete investments.”an example of the lack of prevention is shown in what dubé calls the “catastrophic” proportion of young adults who end up on the streets when they come out of quebec’s youth protection system at age 18. the 2022 head count of quebec’s visible homeless population found that one in three unhoused people in the province were previously under the care of the youth protection system, the direction de la protection de la jeunesse. “they’ll tell you they have social reintegration programs, particularly for young people who have been placed in care,” dubé said. “that’s true. but how many of them actually have access to these programs? when we see the proportion of these young people who end up on the street when they reach adulthood, we have the right to question the resources actually available to support them upstream, preventively. clearly, there’s a gap — the statistics speak for themselves.”meanwhile, inadequate access to mental health care fuels the drug crisis, street intervention workers say. “you don’t get into addiction because you’re well,” one of the workers said.“it’s because … of trauma, or undiagnosed mental illness. you can have all these other problems and because no one is treating the source of the issue, which is mental illness and helping somebody work through the traumatic things they went through, it’s really easy for people to fall through the cracks.”addiction and mental health treatment can be critical steps toward regaining or maintaining housing. but it’s at least a six-month wait for a mental health clinician to begin treatment, whether in french or english, all of the sources said. “the goalpost set by the ciusss is to evaluate a person within two weeks of contacting (it) for help,” one source who works in the system said. “but evaluated doesn’t mean you were taken on. there might not be an available clinician to take them on.”

john mahoney / montreal gazette

meanwhile, the current wait time to enter a public inpatient drug treatment program in montreal is a couple of months, the source said — that’s an eternity to someone who is suffering and ready for help right now. the waiting list is shorter if a person’s condition is severe.and for people who need addiction treatment in english, including people from northern quebec and first nations communities, the only public inpatient treatment centre in the montreal area — the foster pavilion — was folded into a francophone inpatient treatment centre, the centre de réadaptation en dépendance de montréal, this spring. the establishment, which is located in milton park, is now called a “bilingual” resource. “efforts are being made to offer access in english, but at this stage, the transition is complex,” dubé said.inpatient rehab at the foster pavilion was 28 days five years ago. it’s currently 21 days in the bilingual centre after having been cut back even further during the past few years, a source said.the foster pavilion was located on the south shore, but responsibility for it was transferred a year ago from the cisss de la montérégie-ouest to the ciusss du centre-sud-de-l’Île-de-montréal, also known as the south-central ciusss. the foster pavilion’s building on the south shore is now a francophone inpatient rehab. agreements with private residential rehab services to house english-speaking clients were allowed to lapse at the time of its transfer to the south-central ciusss, dubé said.the change comes after an addiction psychiatry program at the mcgill university health centre was closed at the end of 2024. complex cases are now referred to the french-language centre hospitalier de l’université de montréal.the loss of dedicated access points for anglophones is “problematic,” dubé said. two bilingual positions have been created at the south-central ciusss’s addiction access point, he said. but there are no bilingualism requirements in french-language institutions, and operations and internal training material are in french, he said. information is given to the public in french, including the website of the south-central ciusss. its only english page is a resource directory.inpatient rehab isn’t the first or the only option to deal with an addiction. the options range from reduction to abstinence, and it depends on the substance and the severity and length of use.an unhoused person with a severe withdrawal risk or other health conditions can detox in a hospital for five to seven days, but then they’re bused back to a shelter because there’s no place to wait for an inpatient rehab centre, the intervention workers said.even after a drug rehab program, vulnerable people return to a shelter or the same neighbourhood where they fell in with drugs and alcohol, and they repeat the cycle of addiction, the workers said. if they want to avail themselves of outpatient support, they have to chase those services with phone calls and appointments — a challenge for a person who is unhoused.a cycle of detox and relapse can be lethal, one source in the health and social services network said. a person with an alcohol addiction who has a severe withdrawal risk can suffer physical complications such as hallucinations, seizures and even death if they detox and relapse, the person said. “the more times you do a detox, the more complicated the detox becomes if there’s a relapse,” the person added. and an opioid addict who gets clean and then relapses also risks an overdose because they’ve lost their tolerance for the drug.