Image courtesy of Dopamine Montréal.

A pride flag flaps defiantly in the wind above a welcoming front porch. A basket of free naloxone kits hangs on the front door. On the wall upstairs, a poster reads “Activities to avoid dying sad/to make you happy” and lists acupuncture, bowling, and picnics.

This is the home of Dopamine Montréal. Just like its namesake, Dopamine uptakes and releases a rush of essential resources to those who use illicit drugs. But the organization operates under the spectre of the law: Clients, many of whom are low-income or houseless, struggle to access employment, housing, and security as long as drug use is criminalized.

Montreal is considered a progressive urban centre, located in a province with relatively strong social services like universal daycare and subsidized college programs. When it comes to tackling the overdose crisis, though, the city is in traction. According to the Public Health Agency of Canada, 541 people died from an opioid-related drug overdose in Quebec in 2022, an increase of nearly 20 percent from the year before. Emergency interventions in the city of Montreal were reportedly four times as frequent in 2022 as they were before the pandemic. These numbers paint an incomplete picture, however. CACTUS Montréal, another harm reduction organization that serves the Gay Village, recorded a 350 percent increase in overdose deaths in the city from 2019 to 2022—about one per day. According to their numbers, as of this January, the rate has jumped to two per day.

Harm reduction groups such as Dopamine and CACTUS are filling the gaps in community care. Established in 1994 amid the HIV/AIDS crisis, Dopamine serves the Hochelaga- Maisonneuve neighbourhood through a day centre located in a converted home and a supervised injection site (SIS) a few streets over that operates from 8 p.m. to 1 a.m. After what CACTUS says was a decade-long bureaucratic process involving loads of paperwork and city approval, the SIS opened in 2017 alongside CACTUS Montréal’s.

Dopamine was founded on three core values: humanism, accessibility, and solidarity. The words reinforce that Dopamine is part of a political struggle against the conditions that create poverty and lead to people being incarcerated for drug-related crimes.

Executive director Martin Pagé knows how the cycle works; he’s seen it firsthand through his personal experience and through Dopamine’s staff, several of whom used or continue to use their services. “We are par et pour,” he says, both by and for the community. Criminalizing drugs pushes the market underground, where products are cut with riskier substances, such as often-deadly fentanyl or carfentanil, at variable concentrations. Once someone’s drug use is made legible through a criminal record, barriers to housing and employment get even taller. “It’s the exact opposite of what they should be doing,” Pagé says. Without safe, controlled injection sites that provide sterile tools, the risk of contracting HIV or Hepatitis C grows significantly.

At Dopamine, academic experience and lived experience are both valued and essential to fostering trust with clients. Intervention coordinator Yanick Paradis has worked at Dopamine for 18 years, with 12 years of street work experience. Many staff and casual employees are users themselves, Paradis explains. “We involve the people who visit the organization at different levels,” he says. “We will compensate people for their work, no matter what kind, whether it’s lawn mowing or a service offer…Ideally, our group is led by the community.”

As the organization has a history rooted in the AIDS epidemic, an integral part of their community mandate is to make health services accessible. Dopamine runs a drop-in medical clinic every Tuesday for their regular clients. Though it’s not a totally effective alternative to Quebec’s crumbling health-care infrastructure, the clinic focuses on preventive care and follow-ups for those who face barriers to access. “We reflected on how we could bring community health closer, and have health care that gives people positive experiences,” Pagé explains.

Pagé says the pandemic exacerbated every problem the community group sees. Clients are in increasingly precarious housing situations; the social safety net is eroding and organizations like theirs represent the last threads. And sex workers, immigrants, and trans people all find themselves at the intersection of socioeconomic instability and government negligence.

As paramedics administered naloxone a record high of 291 times in the city in 2022, according to Radio-Canada, drug testing has become one of the most crucial services Dopamine and CACTUS have to offer. Data gathered by CACTUS reports that Montreal’s Gay Village is at the epicentre of the overdose crisis in Quebec. But municipal and provincial governments are not treating it that way, though there’s precedent to do better. British Columbia was granted a federal exemption to decriminalize possession of illicit substances weighing less than 2.5 grams in January of this year, while the city of Toronto began the process of applying for the same exemption in 2021. Long-progressive Edmonton, often subject to Alberta’s conservative political lean despite its ability to operate separately, tabled a motion to decriminalize drugs within the city. Over 100 harm reduction groups across the country support the Canadian Drug Policy Coalition’s proposal to make all drugs legal for personal use nationwide— but fierce opposition from some premiers, municipal governments and lobbyist groups makes it unlikely to move forward.

In the summer of 2022, Mayor Valérie Plante told the CBC that she supported the idea of decriminalization in Montreal. Her administration has yet to apply for the same exemption.

The municipal government’s vague response illustrates just how easy it is to shirk responsibility for a manufactured crisis. “We are actually in a worse situation than we were [in] the HIV pandemic,” says Jean-François Mary, CACTUS’s executive director. “Because actually, in those days, there was a real partnership between public health and community organizations.” In the 1990s, a Quebec coalition representing 31 community organizations gave presentations to a federal committee to advocate for increased funding and support. Now, Mary says that public health officials are detached from the reality of intervention on the ground, hindering their approach to resource allocation.

“They talk, we die,” is the slogan CACTUS and Dopamine jointly rallied behind at a protest in early April. They are pushing for decriminalization, increased funding from Quebec’s public health division, and a non-prohibitive approach to the overdose crisis. “And Valérie Plante is talking,” says Mary. “But what are they doing? What have they done?”

CACTUS provided the municipal government with the paperwork to apply for the exemption, according to Mary. In an email to This, the city’s media relations office referred to a non-partisan motion adopted by city councillors in 2021, asserting that they were in favour of decriminalizing simple possession and calling on the city to apply for the exemption. But they did not confirm that an application was in the works. They did say the “[police] will continue to apply the law.”

People working on the ground know that prohibition won’t help those already pushed to the margins. “An important saying in harm reduction is if you can’t help, then at least try to do no harm,” Pagé says. Whether Montreal’s policymakers will heed this duty of care remains to be seen.