A huge spike in overdose calls that had B.C. paramedics scrambling to treat 130 patients in a single day was caused by a combination of a poisoned drug supply and an injection of cash on the street, observers say.

The record high – matched only by one other day in April 2017 – is a grim reminder that after two years of declaring a public health emergency, the province remains in the grips of an overdose crisis.

“We think what was behind it was a particularly toxic type of fentanyl,” said Linda Lupini, the executive vice-president of BC Emergency Health Services.

“We were hearing about a week prior that there were multiple overdoses and we suspected there was something more toxic than usual in the drug supply. That combined with the income assistance cheques that went out on Wednesday, that would explain the situation we were facing."

Usually paramedics face about 60 such calls each day, Lupini said. But on Wednesday, the number jumped to 107, and stayed high on Thursday at 101. On Friday, it hit 130.

Much of that was driven by Vancouver, which saw 45 of those calls on the Friday. Paramedics responded to 20 calls in Surrey, 29 in the remainder of the Lower Mainland, 17 on Vancouver Island, 16 in B.C.’s Interior and 3 in province's north.

“I’m grateful we didn’t have any fatalities,” said Premier John Horgan at a press availability in Victoria. “That speaks to the professionalism of our first responders… to think that happened 130 times, that’s staggering. It speaks to the amount we have to do to get the scourge out of our province.”

At B.C.’s Overdose Prevention Society, which operates a 12-booth supervised injection site on Hastings Street, manager Dave Hann said he treated two people using Naloxone, the opioid antidote.

“It was pretty crazy. Following welfare day it’s usually kind of crazy. They’re crashing and running out of money, so it gets kind of lively,” he said.

“I’m pretty used to it. At this point I just stay calm and do what I’m trained to do,” he said.

The spikes reminded OPS founder Sarah Blyth about the situation on the street during the peak of the deaths around a year ago.

“In a way we’re better at responding than we ever have been, but we’re still in a full-on crisis,” Blyth said.

Being prepared for these spikes is crucial because these sites save lives, said Jordan Westfall of the Canadian Association of People Who Use Drugs.

Some 620 people died between January and May of this year of opioid overdoses, according to the BC Coroners Service. That’s slightly behind the death toll of 2017, when 1,449 people died.

But despite provincial investment, it’s a sign that the core cause of the enormous number of deaths hasn't been properly targeted, he said.

“The well is poisoned,” he said. “The drug supply is completely poisoned and we need to offer a safer alternative otherwise we will see years of 1,000-plus people dying in the province.”

He said the federal government needs to use a regulation that allows people to access drugs in exceptional circumstances, and the B.C. government needs to radically expand services that allow access to safe opioids such as the Crosstown Clinic, which provides prescription heroin to about 130 people.

Legalization of street drugs would also make clean sources legal and help users avoid contamination by fentanyl and its other analogues, he said.

“If there were safe, accessible non-judgmental situations where people could get access that would make a tremendous difference,’ he said.

Prime Minister Justin Trudeau, whose federal government controls which drugs are criminalized, has said that while marijuana will be legalized on October 17, his government is not considering legalizing heroin.

Marshall Smith, the co-author of a report on drug recovery, said the province’s other major shortcoming is that it doesn’t fund a full continuum of care for addiction, from treatment to recovery.

“We’ve been doing the same thing again and again and expecting different results. As a result, we’re not going anywhere,” Smith said.

“This is an addiction crisis for sure. But it’s also a crisis of community and connection. We have to do a better job preventing this up front.”

Smith called for the creation of recovery care in high schools and universities to detect and respond to addiction early.

“If we had a system of cancer care that you could only qualify at stage four, that wouldn’t make a lot of sense. You want to detect early and treat early. We don’t seem to be taking the same pathways that we do with this disease as other diseases.”