Paramedics in our Ontario city were burning out. Then the opioid crisis came to town.

In Belleville, where I’m the chief paramedic, people were dropping like flies. Soon, the city declared a state of emergency.
Carl Bowker
A picture of a needle and some pills on the ground

Up until the 1990s, paramedics had a limited role: we were basically drivers who brought patients to the hospital as quickly as possible. But then colleges began training paramedics in advanced life support, and soon we were practising a form of medicine in the backs of our trucks, administering IV medications and intubating patients. I studied paramedicine at Algonquin College, where I did ride-alongs with the Ottawa-Carleton Regional Ambulance Service, or OCRAS, as it was known back then. That’s how I fell in love with the job. I dealt with folks from all walks of society, and the work made me a better person. I started as a paramedic in 1998 with SkyMed and later joined OCRAS.

In 2007, I moved to the city of Quinte West, Ontario. Working as an advanced-care paramedic there was an adjustment. The city only had 50,000 residents compared to Ottawa’s nearly one million, so I went from eating lunch en route to an emergency to having time to take a nap here and there. The Hastings-Quinte Paramedic Services serves Prince Edward County, Hastings County and the two cities of Quinte West and Belleville—an area of almost 200 kilometres north to south, which is equivalent to serving all of Prince Edward Island. I moved up the ladder and am now the Hastings-Quinte Paramedic Services chief.

Get our top stories sent directly to your inbox twice a week

Last fall, a new problem needed our attention: the opioid crisis. The nationwide housing crunch has exploded into smaller cities such as ours—and in 2023, the homeless population in Belleville reached at least 200 people, which is a bit higher than the per-capita rate of homelessness in Toronto. Precarious housing amplifies the risks of opioid-related harms, and we’re seeing the effects of that on our streets. We usually get six or seven calls for suspected overdoses each week, but in the first week of November in 2023, we responded to 90 calls. There was a tainted drug supply in town—opioids mixed with medetomidine, an animal tranquilizer. Naloxone, a medication we normally use to reverse opioid overdoses and restore breathing, doesn’t work on tranquilizers. 

One of our supervisors was working on November 1, a day when we received more than 20 calls related to overdoses. He drove to my house after his shift and said, “I don’t know what to do, Carl. I’ve never seen anything like this in my life.” He said it was like armageddon: they’d be treating one person, and someone else would yell out and collapse on the street. Then 100 metres down the road, another person would collapse. People were dropping like flies. 

Coming out of the pandemic, there’s been a shortage of paramedics across Canada. The overdoses have strained our overburdened system even further. I can’t give my staff time off, and we’re still short on ambulances most days. At peak capacity, we station six of our 14 ambulances in Belleville. Sometimes, we have to station even more to respond to overdoses, leaving the 150-kilometre area from Belleville to Bancroft with no service. We pray that we don’t get a call.

At the end of January, we heard rumblings from paramedics, hospital staff, police and firefighters that a tainted drug was circulating again. Then, within two and a half hours in early February, we responded to 13 calls and transported nine people to hospitals, all in downtown Belleville. Whenever a person collapsed on the sidewalk—unconscious, seizing or going into respiratory arrest—their friends from the homeless community gathered around them. The police blocked access to the downtown core so that paramedics could work unimpeded. We called in two advanced-care community paramedics who were doing home visits in the area, even though they don’t normally respond to emergencies, and coordinated with homeless shelters to monitor for more overdoses. Sometimes our firefighters responded to suspected overdoses. Even they were overwhelmed. It was all hands on deck.

Between February 6 and 8, we had 23 overdoses and one death from a suspected overdose, which prompted Belleville mayor Neil Ellis to declare an addiction, mental health and homelessness emergency. Ellis asked the provincial government for $2 million to help fund a detox centre and a community hub in the city. The Ontario government gave us $216,000.

READ: Vincent Lam has worked on the frontlines of Canada’s opioid crisis. What he’s seen haunts him.

With the overwhelming workload and pressure combined with the opioid crisis, paramedics are burning out. Some are leaving the profession altogether. Last year, more paramedics left our service than we were able to hire. Many became police officers or nurses, and a few retired. Meanwhile, current staff often skip lunch, respond to calls at the end of their shift and get denied vacation time. We have a number of staff off on medical leave. The community needs us. I feel the pressure every day. There’s no winner here.

New graduates are coming into the field, but dealing with the opioid crisis is contributing to higher incidences of PTSD among their ranks. When paramedics administer antidotes, patients can sometimes get angry: they may have gone to great lengths to get the drug and numb their pain, and our antidote takes their high away. Sometimes, a patient can even get violent because opioids have temporarily altered their brain state. Our paramedics may also pick up the same couple of patients shift after shift, which makes them frustrated and lose compassion for these folks. 

Often, our patients are back on the streets after hospitals discharge them. There’s nowhere else for them to go. We don’t have a treatment centre, detox centre or safe consumption site here, nor basic mental health and addiction services. We only have Grace Inn Shelter, a 21-bed emergency shelter for adults experiencing homelessness in downtown Belleville, as well as Bridge Street United Church, which has a drop-in centre that offers homelessness services and part-time nurses. Obviously, these are not enough. 

The storm has passed for now, but no one can predict when the next bad batch will come to town. I want to be able to tell our staff that help is coming, because we’re on the front lines of this crisis. We’re fighting an uphill battle and we need help. Solving the homelessness and addiction emergency here will be challenging, but we have a collaborative health-care community here and lots of good people who desperately want solutions. But until additional services and supports are in place, we’re going to continue to respond. Over and over again. 

—As told to Emily Latimer