OTTAWA — In the small town of Arnprior, nestled into the Ottawa Valley, at least five suspected opioid overdoses in the span of week prompted police to issue a public warning.
Access to extremely dangerous opioids is not limited to larger cities, said the Renfrew detachment of the Ontario Provincial Police, and the drugs have "infiltrated every corner of our province in some form or another."
"When you are purchasing drugs illegally, you actually don't know exactly what is in those drugs," said OPP Const. Tina Hunt, a community safety officer with the detachment. "Even though you think you're buying one drug, it could be laced with another type of drug."
The problem plaguing Arnprior — a town of 9,000 — is shared by small communities across Canada, according to 2017 data presented late last year by the Canadian Institute for Health Information (CIHI), indicating they in fact have hospitalization rates for opioid poisonings more than double those in Canada's largest cities.
In its public release, Renfrew OPP also warned of something known as "purp" or purple heroin, typically a combination of heroin and its more-potent cousins fentanyl or carfentanil.
Fentanyl is 40 times more powerful than heroin and carfentanil (which was developed as a veterinary painkiller for very large animals) is 100 times stronger than fentanyl, figures that illuminate the challenges of tackling what experts say is increasingly a toxic drug supply.
The synthetic opioids are comparatively easy to manufacture and transport. They can be cut with fillers and sold as heroin or pressed into pills that can be indistinguishable from pharmaceuticals that come from legitimate manufacturers. But a tiny excess in the dose can be deadly.
The data from CIHI indicated that although hospitalization rates for overdoses varied across the provinces and territories, communities of 50,000 to 100,000 people saw some of the highest rates of opioid poisonings.
Brantford, Ont., had an opioid-poisoning hospitalization rate more than 3.5 times the Ontario average. Kelowna, B.C. had one of the highest rates of opioid-poisoning hospitalizations in Canada in 2017. Each has about 100,000 people.
Helen Jennens, who lives in Kelowna and lost both her sons, Rian and Tyler, to opioids, said Monday that resources in her community have been improving but said appropriate supports were not in place in her family's darkest hours.
Larger communities offer more places for people to go to find help, she said. "There's more outreach centres; the access to help is just better."
Both Rian and Tyler had become addicted to opioids after being prescribed painkillers for injuries.
Donald MacPherson, the director of the Canadian Drug Policy Coalition, said Monday that smaller communities are "incredibly underserved" by some basic types of programs such as harm-reduction services, adding that reduced capacity, funding issues and higher costs create challenges outside urban centres. The group promotes more liberal drug policies, arguing that the war on drugs does more harm than good.
There has been an effort in British Columbia to create community action teams to try to address the need for more on-the-ground services, MacPherson said, noting an enormous problem remains "because the drug market doesn't discriminate."
"It exists everywhere, from the smallest places to the largest places," he said. "I think in many places they are left behind ... The rural-urban divide when it comes to the basics of life-saving services is immense."
Canada's Rural Economic Development Minister Bernadette Jordan has witnessed some of the impacts in her own community.
Jordan, who represents the Nova Scotia riding of South Shore-St. Margaret's, said anyone who think the opioid crisis is an urban issue is wrong.
"We are seeing it right across the country, in small communities, in rural communities," she said in a recent roundtable interview with The Canadian Press. "It is a huge, huge challenge; there is no question."
She said she has discussed the issue with the health minister.
"This isn't just happening in Vancouver, in Toronto, in Montreal," she said. This is happening right across the country."
In a statement, a spokesperson for Health Minister Ginette Petitpas Taylor pointed to commitments the Liberals made in their most recent budget.
It proposed additional funding of $30.5 million over 5 years, beginning in 2019-20, with $1 million a year committed after that, for targeted measures to address persistent gaps in harm reduction and treatment.
"We will continue to do all we can to save lives, because this crisis continues to be one of the most serious public-health issues in Canada's recent history," said Petitpas Taylor's press secretary Thierry Belair.
MacPerson said the federal government could accelerate rural innovation in overdose prevention and harm-reduction.
"I think there should be a rural strategy developed that the federal government could fund and co-fund maybe with the provinces," he said.
"This epidemic is presenting a huge challenge and if one good thing comes out of this disaster, is that we begin to do things differently. So the opportunity is to seize that moment and really be serious about changing the way we operate."