Open this photo in gallery Thunder Bay paramedic Kristi Campbell speeds to a call. A street drug nicknamed 'purple down' has been keeping first responders busy in a city struggling to prevent opioid-overdose deaths. Photography by David Jackson/The Globe and Mail

On a Saturday afternoon at the Circle K, a shoplifter ignores the convenience store clerk’s pleas to stop stealing. Customers tackle him and call 911.

Soon a police officer is in the parking lot, using gloved hands to frisk the man. But the arrest pauses when the suspect confesses to using drugs. Now he’s a more pressing problem for the paramedics.

“He’s admitted to using opioids – ‘purple down,’ specifically,” Kristi Campbell radios in as she races her ambulance to a hospital while her patient drifts in and out of consciousness. “It’s been killing people,” she says of the street drug to a Globe and Mail reporter who is spending a shift with the paramedics to get a view of a mounting crisis in this Northern Ontario city.

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Open this photo in gallery Paramedic Kristi Campbell arrives at the Circle K to see the shoplifter being detained by police.

Days earlier, Thunder Bay’s emergency and public-health officials got together to announce a year-over-year surge of more than 40 per cent in opioid-overdose deaths and to plead for additional help from the provincial and federal governments. Preliminary data showed that 44 people likely died of opioid overdoses in the city and surrounding area in 2018 – by far the most in 14 years of published data. This in a region that already had the highest per-capita rate of fatal opioid overdoses in the province in 2017.

The opioid crisis is a national public-health emergency. The federal government estimates that, on average, a Canadian fatally overdoses on opioids every two hours.

It’s a problem that is growing, in part, because on the streets oxycodone, heroin and highly lethal fentanyl are selling in ever more potent concoctions, often under vague names that can mask their ability to kill.

Confronted with what is increasingly referred to as a toxic drug supply, all levels of government are now funding interventions that can occur at the site of an overdose.

Thunder Bay got its first permanent supervised drug-use site this winter, and the nurses there keep a watchful eye over about 250 people a month. For years, naloxone kits have been distributed to residents, so friends and family members of drug users are increasingly administering these antidotes.

What is lacking, however, are the supports and solutions that are applied after an overdose. There are several clinics prescribing methadone, a drug that alleviates the wretched symptoms of withdrawal, but there is a shortage of addiction-rehabilitation facilities in the region.

“Medical professionals such as hospitals and EMS are hoping for properly staffed and funded rehab centres,” says Andrew Dillon, a deputy chief with the Superior North Emergency Medical Service.

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Open this photo in gallery Opioid-related deaths are a nationwide problem, but Thunder Bay has been hit harder than most communities. In 2017, it had Ontario's highest per-capita rate of fatal opioid overdoses.

Open this photo in gallery Ms. Campbell and her colleague Brent Hogan help a man up after he was found face-down on a suburban street.

Cynthia Olsen, executive director of the Thunder Bay Drug Strategy, said there is a long line of people trying to access rehabilitation services. “Unfortunately, we have to turn people away at times,” she says, adding she doesn’t know how many additional spaces are needed overall.

She points to a local withdrawal-management facility known as the Balmoral Centre. It’s the only “Level 3” facility in Thunder Bay, where medical staff keep a round-the-clock eye on drug users going through the initial, punishing physical symptoms of quitting.

At the start of this decade, the centre had only seven beds and was turning away a thousand potential patients a year. A funding infusion bumped up its capacity to 22 beds. That managed the overflow for a while, but the centre says it is again turning away as many people as it takes in – about 2,100 a year now.

To help manage today’s growing overflow, health groups in the city recently announced they have secured funding for an additional 30 “transitional housing” beds for homeless people grappling with mental-health and addiction issues.

Starting this fall, the beds will offer an additional layer of support for drug users, who often cycle through the emergency department, withdrawal management, shelters and even jail, the St. Joseph’s Care Group said in a statement last month. Last year, the group received government funding to expand the city’s “rapid access addiction medicine” clinics, which offer short-term treatment and counselling to drug users.

Still, the opioid crisis continues to worsen. Paramedics now respond to about one opioid poisoning a day – on a monthly basis, more than double the number of calls of two years ago. Only one such incident – the convenience-store call – was witnessed by The Globe when it shadowed the two-person paramedic team. That call concluded inside the local hospital’s ambulance bay, where city paramedics jostle for space with crews and patients arriving in air ambulance helicopters.

Open this photo in gallery The man apprehended at the Circle K is brought to the Thunder Bay Regional Health Sciences Centre.

There, the paramedics who responded to the Circle K call learn their patient’s opioid overdose was relatively tame. Another overdose patient is in critical condition.

“She’s fighting for her life right now,” paramedic Peter Heithorn says, relaying how he helped a 50-year-old woman who overdosed on crack cocaine and prescription oxycodone. He says he shocked her nine times with defibrillator paddles and drilled a hole into her leg bone to inject medicines into the marrow because he could not find any workable veins for a needle.

It’s impossible to say what happened to that woman, or the shoplifter, afterward. “Unfortunately, we do not get that information regarding outcomes,” paramedic service Deputy Chief Dillon says.

Open this photo in gallery A readout from an ambulance shows the heartbeat records of a woman who overdosed.

For some families, the opioid scourge has cost them loved ones.

Keith Rojik lost his son, Tyler, in June. Like his father and grandfather, Tyler worked at the Bombardier plant in Thunder Bay. Two years ago, at 25, he had saved enough money for a down payment on a house. At some point, he became addicted to opioids and sought the most potent forms of the drugs he could find, his father says.

On June 10, Tyler was found dead, three days after his 27th birthday. “He had gone through treatment twice,” says Mr. Rojik, who is still searching for answers. He knows that someone who had been with Tyler called 911 but didn’t stick around for the emergency workers. One of his son’s friends has texted to say he heard the fatal overdose was caused by a street drug – something called “purple down.”

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Open this photo in gallery Drug paraphernalia lies on the ground in a back alley behind Simpson Street.

Canada’s opioid crisis: More reading

The calendar of grief: a mother’s record of her son’s opioid addiction

The story of the opioid crisis, told on skin

In Brantford’s opioid nightmare, a community sees more hopeful days ahead

In Newfoundland and Labrador’s opioid crisis, a flying doctor lifts rural residents’ hopes of recovery

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