ER Nightmare: Toxic Drug Supply Fuels Violence in Emergency Rooms
An increasingly toxic drug supply is creating a dangerous ripple effect in Canada's already overwhelmed emergency rooms. Doctors are forced to balance reversing overdoses while preventing patients from entering severe withdrawal that can turn violent, endangering both medical staff and other patients.
Illicit street drugs have become contaminated with chemicals such as animal tranquilizers, requiring up to ten times the usual dose of naloxone to restore breathing and prevent death. However, high doses of naloxone given to regular opioid users significantly increase the risk of precipitating acute agitated withdrawal, according to a report published online by the Canadian Journal of Emergency Medicine.
Patients wake up screaming, thrashing, confused, and trying to strike staff. The report emphasizes that severe naloxone-induced opioid withdrawal with agitation should be managed as high-risk agitated delirium, prioritizing safety through standardized protocols including verbal de-escalation, security involvement, and judicious use of physical and chemical restraints.
Calgary emergency physician Dr. Eddy Lang explained that the increased toxicity of street drugs is evident. When naloxone is used to reverse overdoses, patients can become very agitated and violent. They are generally incoherent and in the withdrawal state, they thrash, throw punches, and yell, creating a scary and disruptive environment for the team and other patients.
Lang noted that these incidents can occur just meters away from vulnerable patients, such as a 95-year-old with a broken hip, which is detrimental to everyone's recovery. While opioid-related deaths have trended downward since the COVID-19 pandemic, toxic drug alerts have been issued in recent months across cities from Fredericton to Victoria. Toronto Paramedic Services reported 411 non-fatal suspected opioid overdose calls in February, compared to 171 in February 2025, and 387 calls in March exceeded the monthly average for 2025. An increasingly toxic and unpredictable drug supply prompted alerts in Windsor-Essex and an urgent meeting of community partners. Saskatchewan's health ministry issued an alert for Regina after 140 overdose-related calls in the first three weeks of April, many involving cardiac arrest. In January, the BC Centre for Disease Control issued a province-wide drug alert over an increase in non-fatal poisonings.
