How Cocaine Became the Leading Overdose Killer in Newfoundland

Jeff Bourne knows from experience the devastation cocaine can cause. Now two decades sober, he grappled with drug and alcohol use before turning to recovery and dedicating his life to supporting others. In 2011, he and his wife Tammy started the U-Turn Drop-in Centre in Carbonear, a town of about 5,000 on Newfoundland’s Avalon Peninsula, as a service for people struggling with addiction. The centre has since grown to a staff of five, all with lived experiences of addiction. Over the years, they’ve supported thousands from the area and as far as St. John’s, an hour’s drive away. And although Bourne is used to being around cocaine, what he’s seeing now alarms him.

• Cocaine is the world’s fastest-growing illicit drug market
• While stimulant-related deaths are surging across the country, Atlantic Canadians are hit especially hard
• Considering social determinants of health is an important approach for harm reduction

There are, he says, “a lot more issues with mental health. People aren’t used to the potency of the drug. A lot of them come to us with psychosis.”

Fuelled by a changing market in high-potency cocaine and uncertainty around the make-up of illicit drugs, cocaine-related deaths in the region have spiked in the past few years. While Canada has been caught in the grips of a well-documented and much-publicized opioid toxicity crisis for some time, the harms caused by cocaine and other stimulants have increased mostly under the radar. Recent data suggests that Atlantic Canadians—especially in Newfoundland and Labrador—are being hit hard.

It’s perhaps no coincidence that the four Atlantic Canadian provinces also have among the highest rates of poverty in the country. Financial precarity is being compounded by a housing shortage that has pushed record numbers into living on the streets or in tent encampments springing up in communities across the region. That’s why, for Bourne and others on the front lines, the worrying rise in harms caused by cocaine is intricately connected to intersecting issues of housing access, food security, poverty, and mental health.

The global cocaine trade is booming. According to a 2023 report from the United Nations Office on Drugs and Crime, cocaine is the world’s fastest-growing illicit drug market, driven by a rise in global production and cheaper prices, mainly due to an increase in coca bush cultivation in Colombia. Much of the drug is bound for eager markets in Europe and North America, with Canada near the front of the pack. Wastewater monitoring analysis from Statistics Canada and the European Union between 2022 and 2023 placed Halifax third among a number of Canadian and European cities for cocaine use. (Montreal, Edmonton, Vancouver, and Toronto also made the top ten.) The 2019 Global Drug Study surveyed more than 130,000 people across thirty-six countries and showed Canada trailing only Scotland in per capita cocaine consumption.

Across Canada, drug-related crime rose in 2024 for the first time in over a decade, with cocaine responsible for the largest proportion of drug offences. Newfoundland and Labrador saw the highest increase of drug-related crime among all provinces (not including the territories) between 2019 and 2024. Province-wide, cocaine has eclipsed opioids as the leading overdose killer, fuelled by a surge in the availability of the drug. The explosive growth in street-level cocaine has come with an increase in violent and organized crime, both in St. John’s and in more remote parts of the province.

At the same time, stimulant-related deaths are surging across the country. Nationwide, the rate of apparent stimulant toxicity deaths (ASTDs) more than doubled between 2018 and 2024. Cocaine overdose deaths are highest in men aged thirty to fifty-nine. In Newfoundland and Labrador, the number of deaths related to stimulant use rose from eighteen to forty-four between 2022 and 2024, according to the provincial health services authority. In 2024, cocaine was the leading contributing substance in overdose deaths and acute substance use–related hospitalizations.

“We are seeing an increased demand for cocaine across the province,” says Wayne Bishop, program manager for the Newfoundland and Labrador Centre on Substance Use. “But we’re also seeing a cocaine and illicit stimulant supply that’s stronger than we’ve seen it before.”

Cocaine belongs to a class of drugs that speed up the central nervous system. While prescribed stimulants like Ritalin are used to treat conditions such as ADHD, illicit stimulants like cocaine are often used for the intense euphoria they ignite as pleasure-inducing dopamine and serotonin flood the brain.

In the past, illicit cocaine might have been cut at 15 or 20 percent levels of purity. But informal drug checking and analysis of cocaine seized by the Royal Canadian Mounted Police show recent purity levels have spiked to 90 percent and higher in Newfoundland and Labrador, driven by a flooded global market which allows traffickers to sell concentrated product more cheaply. Users unaccustomed to such potency may be susceptible to heart attacks or other cardiac damage. And unlike an overdose with an opioid like fentanyl, which can lead to respiratory failure, there’s no quick remedy like a naloxone spray that might reverse the harm.

Toxic drug mixing is also a problem. In 2024, more than 75 percent of toxicity deaths in Canada involved more than one substance. Polysubstance use—where users knowingly or unknowingly consume two or more substances together within a short period—can increase the risk for an apparent stimulant toxicity death. In 2022, over three-quarters (78 percent) of ASTDs also involved an opioid. Because opioids and stimulants impact the body differently—opioids depress the nervous system and slow breathing, while stimulants increase heart rate and blood pressure—this particular combination can sometimes be lethal.

Gillian Kolla, an assistant professor and public health researcher at Memorial University, says that cocaine and stimulant use have been under-researched. “Much of our prevention programs within harm reduction and within public health actually came out of the HIV crisis, and they were very focused on injection and blood-borne disease transmission. And so, we’ve been less focused on the drugs that people tend to smoke or inhale, like crack, cocaine, and crystal meth.”

Despite the recent increase in stimulant toxicity deaths, Kolla says it’s unclear whether cocaine use itself is actually increasing overall, even as harms associated with cocaine use have grown. Only 2.7 percent of Canadians say they use the drug, though due to stigma, stimulant use tends to be underreported. Those who use cocaine may not always be aware of what else is in their drug. Some stimulant users accidentally get a dose of an opioid, like fentanyl, when they think they’re taking cocaine, an inherent risk when supply is unregulated and safe drugs are hard to come by.

Kolla says that, across Canada, cocaine overdoses have been prevalent among men working in the trades sector. Stimulant use is also increasing among the most vulnerable—the unhoused, former inmates, those engaged in survival sex work, and people who have experienced significant trauma.

Sara Davidson, a physician who works with marginalized populations in Fredericton, has seen how cocaine and stimulant use can be a way to cope with the harsh realities of living outside or to keep trauma at bay. Since 2021, the number of people living unhoused has more than tripled in New Brunswick’s three largest cities. Davidson says roughly a third of unhoused individuals grew up in the foster care or group home system.

Over the years, Fredericton police have conducted sweeps to dismantle illegal tent encampments, pushing many of Davidson’s most vulnerable patients ever farther afield. For those forced into living on the city’s fringes during frigid winter weather, Davidson says stimulants can help keep bodies warm or suppress the effects of hunger.

She cautions that any drug policy needs to be realistic. The root causes driving addiction will always need to be addressed: “I wouldn’t want to just try to medicate this away if you have a whole bunch of people still living outside in a tent.”

The visible increase in drug crime and violence may explain recent calls to expand involuntary treatment programs for drug users and to dismantle tent encampments. Yet experts note these tactics do little to help users. Kolla calls forced treatment one of the zombies of drug policy, an approach that keeps popping back up in the public discourse despite years of research contradicting its effectiveness.

• Inside the North’s Only Line of Defence Against the Opioid Crisis
• The Opioid Crisis Is Surging. We’re Still Ignoring Experts
• When Therapy Didn’t Work, I Turned to an Illegal Drug

As well as leading the harm-reduction-focused Riverstone Recovery Centre in Fredericton, Davidson pioneered an experimental replacement therapy for stimulant users. She prescribed safe, long-acting, legally available stimulants that replicate the feeling of an illicit stimulant in the user’s nervous system. Daily drop-in clinics allowed users to gather together, asking for medical advice in a stigma-free area where they could also access snacks and peer supports. Over time, Davidson hired patients for small jobs at the clinic, so they could gain skills and build confidence as they sought to transition to more stable employment. (The centre, which was launched as a five-year project, is now closed.) It’s the kind of compassionate approach that Bourne has spent years nurturing at U-Turn.

In St. John’s, Bishop underscores this critical link between reducing harm and addressing the effects of lived trauma among users while factoring in other social determinants of health. “Housing and employment and poverty and food security, they’re all connected here,” he says. “So, this is not just a drug toxicity crisis or a stimulant use crisis. It’s all connected to a larger issue.”

For Kolla, the small-town nature of Atlantic Canada inspires hope that policy change and community supports can be implemented more quickly than in larger urban centres. It’s part of the reason she was drawn to Newfoundland and Labrador, after years spent working in Toronto. “One of the things that I find most interesting here is that there still seems to be this impetus to care for folks who are going through really hard times. I feel like in some of the bigger parts of Canada right now, we’ve lost all empathy.”

Join us on Tuesday, March 24 for The Walrus Talks Opioids. Seven expert speakers will explore how policy, care, and community can transform lives amidst a drug toxicity crisis. Attend in person in Toronto, or sign up for the online livestream. Register here.