Open this photo in gallery The area around the Grand River that runs through downtown Brantford, Ont. An increasingly deadly overdose problem galvanized city leaders to act, and for now it looks as if overdose figures fell sharply last year compared with their peak in 2017. Photography by Fred Lum/The Globe and Mail

Canada’s opioids epidemic rolled over this historic Southwestern Ontario city like the wave from a burst dam.

The first ripples were felt a couple years ago. On a summer weekend in 2016, Brantford recorded four drug overdoses, one of them fatal. That fall, two women collapsed from overdose while pushing a stroller down the street. Kids who attend a local youth centre began seeing their mothers, fathers or other adults overdose right in front of them at home. More discarded hypodermic needles started showing up on city streets and in public parks. Child-protection officials even found a needle in a toy box.

Twenty-five people died of overdoses in Brantford and surrounding Brant County in 2017, more than triple the number (eight) for 2016. Brantford had the highest rate of emergency department visits for overdose – 144 for every 100,000 people – of any city in Ontario. It had the second highest rate of hospital admissions for overdose of any city in Canada. Only Kelowna, B.C., exceeded it. The hometown of hockey legend Wayne Gretzky was earning another distinction: as a national leader in OD rates.

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City leaders knew they had to act. Police Chief Geoff Nelson led the response. A respected, 30-year veteran of the force, he huddled with other local officials and put together a plan. Start treating users as sick people rather than criminals; make it easier for them to get addiction treatment; spread the word about the dangers of fentanyl, the drug that kills most overdose victims; hand out lots of free naloxone, the drug that reverses overdoses. To make sure it all happens, involve every city agency in the fight, from the hospital to the police force to charitable groups.

Brantford released the Community Drugs Strategy 15 months ago. Early results are promising. Although officials are quick to say the crisis is far from over, overdose figures were down sharply last year from their peak in 2017. Emergency services responded to 35 per cent fewer overdose incidents in 2018. The hospital emergency department got 44 per cent fewer overdose visits. The number of deaths is still shocking – 13 in the first nine months of 2018 – but at least the line on the chart turned down instead of up; Brant County had 20 deaths in the first nine months of 2017.

Brantford’s campaign may hold lessons for other communities beset by the opioids crisis, which is killing 11 people a day across the country. The overdose surge that first washed over big urban centres such as Vancouver has now spread to smaller cities and towns. Like many of them, Brantford was caught off guard. Some locals thought: “That is something that happens in larger cities. That doesn’t happen here,” says Christina Rajsic of the Brant County Health Unit. "Until we realized, wow, it’s everywhere.”

Brantford lies on the banks of Grand River about 100 kilometres down the road from Toronto. The Great One learned to love hockey here, on the backyard rink his father, Walter, made with a lawn sprinkler.

Named for Joseph Brant, the Mohawk warrior chief, the city became first a farming then a manufacturing hub, a smaller partner to the nearby steel town of Hamilton. Its yellow-brick churches and Victorian mansions are proof of its past glory.

Trouble came in the 1980s when the giant farm-equipment maker Massey-Ferguson closed its local plant. As with many smaller Ontario cities hit by the decline of manufacturing in Canada’s economic heartland, the community of 100,000 has struggled with social problems ever since.

Poverty, homelessness and drug and alcohol addiction have been visible in the growing municipality for years, especially downtown. But the opioid crisis is on a whole new scale.

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Open this photo in gallery Yellow boxes to dispose of used needles are now a fixture in Brantford. At left, a dropbox outside the Elements Casino Brantford; at right, a sharps collector hangs from the wall of a washroom at a downtown Tim Horton's.

Open this photo in gallery Downtown Brantford, as seen from the Brantford Public Library. The city of 100,000, once a hub of manufacturing, fell on hard times in the 1980s when the local Massey-Ferguson farm-equipment plant closed.

Open this photo in gallery A shopping cart, filled with personal belongings and items picked up around downtown, lies unattended in Brantford. Signs of the city's poverty and homelessness are especially pronounced downtown.

City leaders realized they needed to attack the problem from many angles. At least 2,500 nasal-spray kits of life-saving naloxone were distributed last year, free of charge, by pharmacies, social agencies and others. Police, firefighters, paramedics and child-protection workers started to carry it. Police even used the drug to revive a man who collapsed of an overdose in court while sitting in the prisoner’s dock.

The city set up needle-drop boxes at several spots around town to allow for the safe disposal of used needles. They look like bright-yellow mailboxes.

Police officers went into the schools to warn about the dangers of fentanyl, a synthetic opioid many times more powerful than heroin. Officials brought in a marketing company to produce a public-service campaign with an eye-catching logo: FCK, for Fentanyl Can Kill. The fire department wrapped its engines with the message.

The city held a series of forums to tell residents about the impact of the crisis. At one, a mother told a hushed audience how her 16-year-old son had overdosed after smoking a joint laced with fentanyl.

To help end the dangerous isolation of drug users, a group of volunteers did a Jane’s Walk around Brantford last spring, part of the annual series of city walks named after the urban thinker Jane Jacobs. Walkers visited local hangouts, greeted users they met and picked up discarded needles.

To get faster help to vulnerable users, the community opened a new clinic last fall. The rapid access addiction medicine, or RAAM, clinic is one of 60 that have sprouted around Ontario to combat the crisis. Its purpose is to get around the paperwork and waiting lists that often keep drug users from treatment. The clinic gets drug users on safe replacement medicine and sets them up with other services in the bargain: addiction counselling, housing support, mental health help. A special counsellor is available for Indigenous patients, some of them from nearby Six Nations.

Open this photo in gallery Stephanie Rochon is clinical co-ordinator for the Brantford RAAM, or rapid access addiction medicine, clinic.

A shift in policing methods is a key to Brantford’s campaign. As with many police commanders, Chief Nelson found he could not arrest his way out of the drug problem. Simply rounding people up or moving them along failed to address the underlying causes of the vagrancy, public intoxication, panhandling and discarded needles that plague parts of the city. “The criminal justice system does not solve addiction,” he says.

Brantford, he argues, has to get help for users and police have to steer them toward that help, not just chuck them in jail. He is pushing to get outreach teams on city streets to help users who might not walk through the door of a clinic.

Chief Nelson, like just about everyone else involved in the effort to quell the overdose epidemic, cautions that the fight has only begun. This year’s improved numbers could be a blip. Or the bad numbers from 2017 might have been the anomaly. “This is not just a one-time put up a website and pat ourselves on the back,” he says.

Open this photo in gallery Brantford police Chief Geoff Nelson.

Evidence of the drug crisis is still all around, despite the city’s efforts. The amount of fentanyl seized by police went up dramatically last year. When the Ontario Provincial Police found 17 grams of the potent drug in a traffic stop just after Christmas, a bulletin warned it was “enough to provide a lethal dose to 68,000 people.” This month, police have been finding discarded equipment from a suspected drug lab dumped at various places around the city.

Some residents are not convinced things are improving at all. Tracey Bucci, the manager of a city law office, leads the Brantford Guardian Angels, a small group that tours city streets handing out food, clothes and kind words. She says the drug and homelessness problems are getting “worse, and worse and worse.”

Randy Roberts, 54, a lifelong drug user who gives talks about his “lived experience” of the crisis, says the RAAM clinic is a great start but Brantford need a detox centre and an overdose-prevention site where users can take drugs under supervision in case they OD. His ex-wife overdosed and died on Jan. 24, 2018. His daughter found her sitting bent over in a chair with her lottery-ticket-scratching tools. “She went to sleep and never got up,” Mr. Roberts says. “I’m tired of having friends and family die.”

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But, even if they agree more needs to be done, those involved in Brantford’s campaign think it is making a difference. The RAAM clinic co-ordinator, Stephanie Rochon, says that regular visitors are overdosing less and getting more help coping with their struggles. At a case-management meeting before the RAAM’s 9 a.m. opening one recent Friday, she helped review the needs and progress of clients.

One woman who had four drug overdoses in two weeks had just started on methadone, the replacement opioid often used to treat addiction. She needed counselling and mental-health treatment as soon as possible. Another woman had found a place in a detox centre in nearby Hamilton. A troubled family of four that was evicted from a local apartment had moved into a new place, but there was no furniture so they were sleeping on the floor. The clinic was trying to find them some mattresses.

Portrait of a user

Open this photo in gallery Randy Roberts of Brantford, 54, has been an opioid user since he was 12 years old.

Open this photo in gallery Mr. Roberts adds a few drops of water to some crystal meth he will inject into his arm. Drugs have taken a heavy toll in his life and his family's. Last January, Mr. Roberts's daughter found his ex-wife dead of an overdose. 'She went to sleep and never got up,' he says.

Open this photo in gallery He is supportive of Brantford's rapid access addiction medicine clinic, or RAAM, which gets users on safe replacement medicine. But he says a detox centre and overdose prevention site are needed too.

Open this photo in gallery 'I'm tired of having friends and family die,' Mr. Roberts says.

The children left behind

Children are paying a heavy price for the drug-overdose epidemic. Some lose mothers or fathers to an overdose. Some go hungry or neglected because their parents suffer from addiction. Some are born addicted themselves because the mother used drugs while pregnant. Some have to recover from the trauma of having a parent OD and collapse.

At Brant Family and Children’s Services, they have seen it all. Andy Koster, the veteran head of the Brantford-based agency, which steps in when children are at risk at home, says the crisis is the worst he has seen in five decades. A quarter of the agency’s cases are related to opioid use. While other Ontario cities have been seeing declining numbers of children in child protection, Brant’s caseload has grown to around 440. It is running out of foster homes for children.

The stress on child-protection workers is enormous. When they go into houses to investigate, says Mr. Koster, “we often don’t know what we’re going to find.”

To give a sense of what the crisis is doing to children, Mr. Koster assembled seven women who work for his agency around a table at a family centre in a Brantford housing estate. They talked for more than an hour one recent afternoon, piling story on story.

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In one case they handled, a mother and father both overdosed. In another, a six-year-old boy was present when his father ODed. In still another, police arrived to find a father passed out on the floor from an overdose with drug paraphernalia all around and a three-year-old screaming on the floor. The child, who had been visiting his father for the weekend, went into foster care.

The agency often finds used syringes outside its buildings. They found 10 on one recent day alone. Mr. Koster shows a picture of them, collected in a box.

With local rents rising and the wait for subsidized housing long, some families end up in rooming houses or seedy motels where drug dealing and sex work goes on.

Children who live in houses where drugs are being used often can’t cope with school, the women around the table say. Many suffer from attention deficit or other learning problems. Some cycle through four or five schools before Grade 3. They don’t show up for class or come wearing clothes that don’t suit the weather. In the households where they live, the drugs come first.

Some of the saddest cases are the babies, born to addicted mothers, who are suffering from drug withdrawal. Some spend months in hospital. One was so inconsolable that a foster mother had to hold him for 18 hours a day. Addicted mothers will visit their infants who have been taken away, but often they can’t cope. One mother kept nodding off as she held her child. She was on methadone, the substitute drug used in addiction treatment. Protection workers were afraid she would drop the baby.

“We are up against a huge beast of a problem,” said Annali Leeson, one of the agency’s managers. She says the dangerous opioid fentanyl “is everywhere, it’s in everything.”

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Mr. Koster says these caring women are doing their best, but with the volume of cases they are getting, “people are just holding on here,” trying to make a difference.