VANCOUVER — A gradual surge in lethal opioid overdoses shows no sign of slowing, and some experts say the worst is yet to come unless governments do more to counteract the deadly crisis.
The incursion of fentanyl into Canada's supply of street drugs, combined with decades of liberal opioid prescribing practices and entrenched stigmas around addiction, has brought about what some describe as one of the worst drug-safety crises in Canadian history.
Hundreds have died this year, though the true scope of the problem remains unknown because of the absence of a standardized system to track overdoses countrywide.
Dr. Perry Kendall, British Columbia's provincial health officer, said the move in some province's to increase opioid-substitution treatment as well as additional harm-reduction measures are steps in the right direction.
Still, the body count continues to rise.
"I wouldn't say I feel pessimistic, but I would say I'm very concerned," Kendall said.
The death toll appeared to drop during the first three quarters of 2016, but both October and November saw an upsurge in fatal overdoses, he added.
"I'm hoping they're not going to get any worse."
Experts agree about the need to change public views around addiction and the belief that fentanyl only affects the mentally ill and the impoverished living on the streets.
Here are a few stories about the impact opioid overdoses have had on Canadians and their loved ones:
Nathan Huggins-Rosenthal, Calgary
When Rosalind Davis thinks about her partner, she tries to focus on the positive — visits to the dog park with their two small mutts, hot yoga classes, leisurely weekend mornings drinking coffee and reading the newspaper.
"That's how I try to remember him, as that person who actually enjoyed life," Davis said. "You definitely watch the life disappear from someone once they become addicted to opioids."
Nathan Huggins-Rosenthal worked in finance and was renovating an old character house in Calgary that he and Davis had bought several months earlier when he hurt his back helping a contractor carry a washing machine.
A prescription from his doctor for the painkiller Percocet marked the beginning of his spiral into an opioid addiction that would eventually take his life, one month shy of his 35th birthday in early 2016.
"I would describe him as an incredibly intelligent man," Davis said. "He was charming and funny. He came from a loving family. He had a philosophy degree and an MBA and he worked as a successful stock broker at the National Bank."
Huggins-Rosenthal bounced in and out of treatment centres, spending months on waiting lists while his addiction worsened, Davis said.
In mid-February, six weeks after he overdosed at work and was rushed to hospital, Huggins-Rosenthal overdosed again while staying at his mother's home and died.
"When we believe addiction is a choice it really absolves society of any responsibility," Davis said. "And when we shame people who are suffering from addiction we push them further into the shadows."
Joshua Graves: Berwick, N.S.
There was a period after her brother's death when Amy Graves would repeatedly play back a recording he had made using a small toy phone while playing with her one-year-old daughter.
"For the longest time, I kept this phone in a ziplock bag and I would open it and just listen to his voice and listen to him talk to my daughter," she said, her voice breaking. "It killed me to listen to after his death."
While Joshua Graves's death in early 2011 predated the fentanyl crisis, it heralded the early days of the opioid epidemic that would erupt five years later.
Graves said her brother, 21, was at a party in Nova Scotia's Annapolis Valley where he tried a small capsule of hydromorphone that was being passed around. That night he would go to sleep and not wake up.
What most bothers Graves is the stigma.
"I was told (by police): 'Your brother was a big boy. He chose to take those drugs. It's his own fault that that happened to him,' " she said. "And fair enough. I mean, he did make a poor choice. But he was a human."
A formal complaint led to a written apology from the police, who reopened the investigation into Graves's death.
Her brother had spent two years in Alberta and had just secured a promotion and moved back to Nova Scotia to work as an arborist, Graves said. He had a car, an apartment and a girlfriend who worked as an addictions counsellor.
"You think there are going to be warning signs. You think he's going to lose his job and his life is going to fall apart," she said.
"But that's what's so scary about opioids: You don't necessarily have to get to that point," she added. "It can happen to almost anyone."
Ryan Pinneo, Kamloops, B.C.
Sandra Tully walked into her son's room to find him slumped over in his chair, dead, with 3 1/2 pills of pure fentanyl on his desk.
"I knocked ... and I slowly opened his door and I found him," Tully said about that Wednesday in early 2016 in Kamloops. She described the "screaming and tears and hysteria" that followed as the entire family rushed in.
"It will be something that never leaves me. I wish I could take a little toothbrush and just erase that memory from my brain."
Pinneo, 22, approached his parents in 2014 to tell them he was struggling with opioids, but he was reluctant to go to a local detox centre because he knew people there and worried they would recognize and judge him, Tully said.
He eventually went for treatment out of the city and was making progress when he died, his mother said.
"The shame is probably a big part of what kept Ryan from seeking help, the shame and how he would be viewed," she said. "I'd like to see the stigma from people who are suffering from substance abuse removed."
We all need to have a little bit more compassion for each other," she said.
Pinneo was an avid gym user who loved basketball and volleyball, his mother said. At the time of his death he was working to save money to get more schooling.
Tyler Charlie, Vancouver
Janet Charlie gestures to the ground beneath her, pointing out the non-descript section of sidewalk where her son fatally overdosed on fentanyl earlier this year.
"It's his birthday coming up," she said, wiping away tears. "But when I think about it, he's with his brother. He's with his grandparents and his aunts and uncles up there. He's surrounded by love up there, I know that. But it can be hard."
Charlie was volunteering at a market in Vancouver's Downtown Eastside in August when someone raced up to tell her that her son Tyler had collapsed nearby.
"She said, 'Tyler went down. Doesn't look like he's going to make it,' " Charlie recounted.
Charlie said she rushed around the corner to see her son unconscious on the ground, shirt open as paramedics worked to revive him.
He was pronounced brain dead and died about a week later. He was 26 years old.
Charlie compared using opioids with Russian roulette.
"You're playing a game, whether you're going to be here today or tomorrow," she said.
