Opioids rank near bottom of Montreal's drug crisis — stimulants dominate the city instead

Montreal's drug crisis looks different from the rest of Canada. Cocaine is the most commonly identified substance in illicit drug samples across Quebec, followed by methamphetamine at second place as of 2026 — a pattern that would alarm most provinces but defines the local reality.

Health Canada's Drug Analysis Service examined approximately 100,000 suspected illicit drug samples submitted by law enforcement and public health partners across Canada. The data reveals sharp regional divides.

Fluorofentanyl ranks third nationally and is the second-most identified drug in British Columbia behind only cocaine. In Ontario, it ranks slightly lower. In Quebec, it makes the top 10 but sits near the bottom of the list. Hydromorphone, a pharmaceutical-grade opioid, is the opioid most commonly found on Montreal's illicit market — a substance that does not make the top 10 in BC and ranks behind fentanyl and other analogs in Ontario.

Dr. Alexandre Larocque, consulting physician in toxicology at the Montreal Regional Public Health Directorate, presented the analysis during a webinar Tuesday organized by the National HIV and Hepatitis Mentoring Program. "Stimulants rank first across the country, but if you look at Quebec, the trend is particularly striking," Larocque said.

Medetomidine — a veterinary sedative and analgesic mixed with fentanyl — ranks second most identified in Ontario and fourth nationally, accounting for a significant portion of seizures across BC, Alberta, and Ontario. In Quebec, it remains among the top 10 but relatively minor compared to stimulants.

Layered together, the data shapes a distinct picture: "With opioids, we see that there are provinces where the problem is particularly severe — including British Columbia, Alberta, and Ontario — while Quebec is well below the Canadian average. This will shape the picture of overdoses in Quebec," Larocque said.