The i2i Peer Support Project

09/22/2026

Cychlorphine, explained: 10 things to know about the new synthetic opioid
By: Ella Ruder - (Sept 14, 2026)

A potent new synthetic opioid is spreading through the illicit drug supply, and federal officials are warning it’s harder to detect and harder to reverse than fentanyl alone. Cychlorphine has been linked to dozens of deaths since 2025, and it was named in a May DEA advisory on emerging synthetic drugs increasingly mixed into the nation’s fentanyl supply.

For behavioral health executives, the drug’s rise raises immediate questions about naloxone protocols, toxicology screening, surveillance tools like wastewater testing, and staff preparedness.

Here are 10 things to know.

1. Cychlorphine is an unregulated synthetic opioid not approved for human use. The DEA identified cychlorphine, alongside nitazenes, as one of a group of potent synthetic opioids increasingly turning up mixed into fentanyl and counterfeit pills, the agency said in its May 12 advisory.

2. It traces back to a 1960s Belgian research effort, not a modern illicit lab. Cychlorphine belongs to a class of compounds called orphines that were developed in a Belgian research lab in the 1960s in a search for stronger painkillers for conditions like bone cancer. The drugs were never approved for medical use because they were considered too strong and dangerous, The New York Times reported.

3. The recipe is publicly available, which is part of why it spread. Because the synthesis was published in academic journals decades ago and is now accessible online, people can produce the drug without the infrastructure needed for other illegal drugs, Keith Humphreys, a Stanford psychiatry professor and former senior drug policy adviser in the Obama administration, told the Times.

4. It may be up to 10 times as potent as fentanyl. Experts cited by the Times put cychlorphine’s potency at roughly 10 times that of fentanyl, a figure that aligns with the Office of National Drug Control Policy’s April drug threat notice, as reported by Becker’s.

5. Reversing an overdose may take multiple doses of naloxone — more than most people carry. The Times reported that cychlorphine can require numerous doses of Narcan to reverse, though most people carry only one or two doses at a time, consistent with DEA guidance that cychlorphine “might require several doses of naloxone to be effective.”

6. Standard fentanyl test strips don’t detect it. Test strips that can identify fentanyl are not effective at detecting cychlorphine, the Times reported, leaving both individual users and health systems with a blind spot that fentanyl-era tools weren’t built for.

7. Timing is critical for naloxone to work. Naloxone needs to be administered before brain swelling occurs, Lewis Nelson, MD, a medical toxicologist at Florida Atlantic University’s Charles E. Schmidt College of Medicine, told MedPage Today.

8. The drug has already spread beyond its initial hot spots. Cychlorphine has appeared in Europe and on the East Coast over the past couple of years, the Times reported, in addition to the Ohio, Tennessee and Texas cases Becker’s has covered and the San Francisco death examined by the Times.

9. Wastewater testing is being used — and re-funded — to catch novel drugs earlier. San Francisco had been testing wastewater to detect emerging substances until federal funding lapsed in 2024. It resumed the practice in July, with the city’s health department planning to begin publishing findings on novel drugs this fall, according to the Times.

10. At least 55 deaths nationally have been tied to the drug since 2025, with regional concentration in the South and Midwest. Cychlorphine has been linked to at least 55 deaths nationally from 2025 to 2026, with the highest prevalence in Ohio, Tennessee and Texas, MedPage Today reported Sept. 8. The Knox County (Tenn.) Regional Forensic Center reported 41 overdose deaths tied to the drug between July 2025 and February 2026.

At the Becker's Fall Behavioral Health Summit, taking place November 4–5 in Chicago, behavioral health leaders and executives will explore strategies for expanding access to care, integrating services, addressing workforce challenges and leveraging innovation to improve outcomes across the behavioral health continuum. Apply for complimentary registration now.

https://shrlnk.ca/s/sGuULhhy

09/22/2026

Improvising in an emergency:
Doctors respond to medetomidine withdrawal with no roadmap, by Hannah Harris Green
- (08 Sep 2026)

• pic: "Pittsburgh from Children's Hospital" by Dominic Salvucci is licensed under CC BY-SA 2.0.

In Pennsylvania, a mystery fentanyl adulterant began causing withdrawal related heart attacks in 2024. Doctors have been rushing to catch up.

One reason Brandie wants to quit street fentanyl is she can't take the “brain zaps,” anymore; “It feels like somebody ringing a bell inside your head, and it goes through your whole body.” The zaps have become routine since late 2024, when medetomidine, a powerful tranquilizer, became the newest adulterant to compromise the Pittsburgh street fentanyl supply. The sensation can be so intense it brings Brandie to her knees.

Brain zaps have become an important signal for both clinicians and for people like Brandie. For Brandie, they’re a sign to either re-dose, get to the hospital, or risk stroke or heart attack. For Dr. Divya Venkat, an addiction and primary care physician in Pittsburgh, brain zaps are the fastest way to determine which patients are withdrawing from fentanyl alone, and which might soon be in critical condition. Rapid urine toxicology panels cannot detect medetomidine. Brain zaps are not a symptom of typical opioid withdrawal, but they are near-universal in medetomidine withdrawal, according to Venkat and other clinicians, as well as several first-hand accounts.

“We needed to do som**hing because people were very, very sick.”
—Dr. Michael Lynch, emergency toxicologist, UPMC

Medetomidine withdrawal patients have been filling Pennsylvania ICU wards for over a year, and the problem has yet to slow down. At the end of August, Pittsburgh’s Poison Control Center received 139 reports of medetomidine related emergencies in the space of just 5 days. Doctors are catching up on the fly—there’s no time for proper scientific procedure. Normally, researchers conduct experiments before landing on a preferred treatment, according to Dr. Michael Lynch, professor of toxicology, addiction and emergency medicine at the University of Pittsburgh Medical Center. They compare new interventions to placebo or an existing treatment, and figure out what’s best. But in a crisis like this one, where inaction can lead to seizures, heart attacks, and strokes, science must wait on doctors’ and patients’ experience, not the other way around. Lynch compared the situation to Covid-19. Before there was evidence, “we needed to do som**hing, because people were very, very sick.”

As new, unpredictable adulterants continue to rotate in and out of the street drug supply, strategies focused on opioid overdose prevention are no longer enough.

Rapid-fire protocol development could, by necessity, become the norm. According to Dr. Nabarun Dasgupta, founder of the Street Drug Analysis Lab, US disruptions to cartel leadership mean that drug manufacturing is currently in a “mix-it-up” phase—it’s hard to predict what’s coming up the pipeline next.

The US has had several decades to figure out how to best tackle the problem of street opioids. But tranquilizers like medetomidine and its predecessor, xylazine, have only become common adulterants in recent years. Pennsylvania made intent to sell xylazine a felony in late 2024. Within weeks, medetomidine took its place, according to an analysis by Dasgupta. Dasgupta’s lab also analyzed street drug samples from Prevention Point Pittsburgh, a local harm reduction organization, to confirm medetomidine in the Pittsburgh fentanyl supply.

The opioid strategy turned on its head

For decades, public health authorities have poured resources into preventing opioid overdoses and addiction. Access to naloxone expanded dramatically, and it’s become common for people who use opioids to carry naloxone and to have many experiences using it to save friends’ lives. The FDA has approved new formulations for people who want to quit opioids in recent years, and the DEA has removed some of the red tape around access.

“It’s not the use that’s killing people, it’s the stopping that’s killing people.”
—Alice Bell, director, Prevention Point Pittsburgh

Fentanyl is by far the most dangerous drug ever to dominate the street supply, but its toll has started to ease, thanks to public health measures and international interdiction efforts specifically designed to tackle the potent synthetic opioid. In 2025, US overdose fatalities declined for the third consecutive year, to fewer than 70,000 for the first time since the pandemic, driven largely by a drop in opioid overdoses.

But in Pennsylvania, where medetomidine has become pervasive in the fentanyl supply, the strategies that helped reduce opioid overdoses have suddenly become less useful. Naloxone can't prevent fatalities related to withdrawal. A key overdose prevention strategy is to get people into substance use treatment with as little friction as possible. Now, anyone wanting to quit fentanyl in Pittsburgh or Philadelphia is strongly advised to go to the hospital first, as withdrawal from medetomidine can quickly become a medical emergency.

“It’s not the use that’s killing people, it’s the stopping that’s killing people,” said Alice Bell, director of Prevention Point Pittsburgh. Bell and Venkat have both observed that while withdrawal related fatalities are rising, overdose deaths have declined since medetomidine appeared in the fentanyl supply. “We're seeing a lot fewer overdose deaths, fewer naloxone administrations,” Bell said.

Fentanyl mixed with medetomidine is more likely to cause extreme sedation than a classic opioid overdose, according to Venkat and Bell's observations, though naloxone is still essential if breathing has dramatically slowed or stopped. “People are not jumping up from being revived like they used to,” said Malcolm Visnich, an overdose prevention specialist at Prevention Point. “Now you just don't know what's going on with them [when they’re lying still.] So you have to really pay attention to their breathing.” Rescue breaths can help ensure that unconscious people continue to get the oxygen they need to avoid brain injury.

Catching up to the science

Medetomidine is an alpha-2 agonist, a class of drugs that can help calm the sympathetic nervous system, which regulates blood pressure as well as anxiety. While lighter alpha-2 agonists like clonidine and guanfacine can gently regulate anxiety, impulsivity and blood pressure, medetomidine’s strength means small amounts are incapacitating. When someone stops using it, the sudden activation of the sympathetic nervous system constricts the blood vessels, creating rising pressure in the brain that leads to symptoms like the “brain zaps” mentioned earlier, as well as seizures, heart attacks and stroke. The over-activated sympathetic nervous system also leads to unbearable levels of anxiety, worse than withdrawal from opioids alone, Venkat said. “The anxiety we see with opioid withdrawal is awful. But this feels like they're crawling out of their skin.”

Brandie, who is 40, said she and her partner Chris, 36, had been using opioids for seven years, and medetomidine is the worst adulterant they’ve encountered. The fentanyl high is gone—their drugs simply knock them out. And once they wake up, they have to use again in a couple of hours just to “stay well,” Brandie said. It’s expensive, and exhausting. So when Brandie was fed up and ready to quit, she followed public health recommendations and went to the hospital.

"Like ten people got interested in me really quickly. They were taking my blood pressure, my blood sugar. They put shock pads on me." —Brandie

The treatment Brandie received when she was withdrawing from medetomidine was available thanks to doctors like Lynch, who cobbled together a protocol by scouring through any and all relevant literature, then closely observing patients to see what works. For example, Lynch was able to figure out that medetomidine dependence and withdrawal both develop with unusual rapidity—thanks to research on dexmedetomidine, a human medication that contains one of the two molecules found in the racemic medetomidine compound that’s taken over the Pittsburgh street supply.

When Brandie arrived at the hospital, she had no severe symptoms, so she just had to wait. Her nurse started to clear the room when Brandie’s heart rate spiked. Brandie asked if everything was alright. “There's just gonna be a lot of people in here really fast,” Brandie recalls the nurse saying, “And she wasn't lying, like ten people got interested in me really quickly. They were taking my blood pressure, my blood sugar.” Brandie heard her own room number over the hospital loudspeaker—it was terrifying.

“They put the shock pads on me. They’re not like in the movies, they’re these big stickers. One’s red and one’s blue." Brandie told the nurse “this doesn’t look good.” “It’s just in case,” she said.

Brandie went to the ICU and received intravenous dexmedetomidine. “I was asleep for two days,” she remembered, “When you wake up, you feel pretty okay. For the next week and a half, Brandie received oxycodone and va**um every four to six hours in the hospital. “They would have never given that type of medication for just fentanyl. They basically have to wean you off the street drugs with op**te medications.”

Lynch’s protocol involves dosing patients with other alpha-2 agonists, analogous to how opioid withdrawal is often treated with other, weaker opioids. Clonidine, a blood pressure medication that is also prescribed for anxiety, and guanfacine, a drug that’s used to treat ADHD related impulsivity as well as high blood pressure, are both starter medications for medetomidine withdrawal. More severe cases can require intravenous administration of dexmedetomidine, the human-approved formulation of the medetomidine molecule, also known by the brand-name Precedex. Dexmedetomidine is typically only available in ICU settings because it is so potent. Lynch published this advice in Annals of Emergency Medicine, but cautioned the paper is “not evidence based in the truest sense,”—there was no carefully planned trial with a control group. Since publishing, Lynch has kept tweaking. “Every time we adjust, we get more aggressive, so doses get higher.”

Lynch said that ideally, once someone’s withdrawal symptoms have been stabilized, they will get started on treatment for opioid use disorder. But a significant percentage of patients end up leaving the hospital early, in what’s called “patient-directed discharge” according to Venkat. “They leave the hospital against physician’s orders because they don’t feel good. They’re scared. And I so wish there was more of a safety net to capture those people.” When people leave the hospital and begin using fentanyl adulterated with medetomidine again, it can mean they'll have to take another trip to the ICU. Brandie's partner Chris had two heart attacks related to medetomidine withdrawal—he said he already had heart health issues. Both times he went to the ICU, it was because he'd been arrested and started withdrawing without access to his drugs. The second heart attack was fatal.

Unanswered questions

Doctors like Lynch have made it possible for many patients to get through medetomidine withdrawal alive. But there is no established treatment for prolonged medetomidine withdrawal, and many patients end up back on adulterated fentanyl, and, like Chris, back in the ICU. Venkat says this is partly because treatments for opioid use disorder don’t help with prolonged medetomidine withdrawal symptoms.

There is no diagnostic code for medetomidine withdrawal, and there may be many cases where the physician never realizes that's what's going on.

This cycle is exhausting for patients and expensive for hospitals. One study found that withdrawal related costs went up more than tenfold in ICUs where medetomidine had emerged. “We need a different detox model that is cheaper, and we need to be building this now," Dasgupta said. But funding cycles are slow—Lynch worries the next adulterant will already have taken over by the medetomidine research gets funded.

And so long as medetomidine’s true death toll remains obscure, related research may seem less urgent than it is. “That’s going to be a really tricky thing, how do you quantify it?” Bell said. There is no diagnostic code for medetomidine withdrawal, and there may be many cases where the physician never realizes that's what's going on.

The profound sedating effect of medetomidine might lead to deaths that will never be recorded at all. Calla Kainaroi, executive director of Bridge to the Mountains, a Pittsburgh non-profit that connects unhoused people to services, said there have been reports of people hurt or killed while unconscious. Some are assaulted, some roll down the Pittsburgh hills into traffic.

A man who I’ll call Marcus, who uses fentanyl in Pittsburgh, said a friend of his was hit by a train while unconscious. Marcus himself remembers waking up under a car, completely forgetting how he got there—his drugs, money and coat gone in the winter. His fiancée, who I’ll call Ellie, said he’d have frozen to death if his friends hadn’t found him. While Ellie does not use fentanyl herself, she spends a lot of time with people who do.

Since medetomidine, she says, “nobody feels good, not even for a minute. I watch it from the outside looking in and it’s sad. Nobody is enjoying it. They just do it because they don’t want to die.”

This reporting was supported by a grant from USC's Impact Fund for Health Journalism

Coming soon:
• Why "but the children!" is a hypocritical justification for prohibition
and
• Can people who use drugs organize?

In 2024, a mystery fentanyl adulterant began causing potentially withdrawal symptoms, like stroke and heart attack, in Pennsylvania.

08/18/2026

On Monday August 31, the District of Sechelt Municipal Hall will be illuminated in purple in recognition of International Overdose Awareness Day, a global day of remembrance for those who have died from overdose and toxic drugs. It's also a day to acknowledge the many people whose lives have been touched by the death of a friend, a family member, a colleague, a child, a parent, a community member.

The District of Sechelt has also officially proclaimed August 31 as International Overdose Awareness Day, helping to bring visibility to the ongoing impact of the toxic drug crisis and the importance of remembering those who have died.

If you're passing by the Sechelt Municipal Hall on August 31, consider taking a moment to pause, reflect, and remember the lives behind the statistics.

Because every person matters. Every person deserves to be remembered.

We remember those who have died.
We support those grieving.
We honour the lives behind the statistics.
We raise awareness to reduce stigma and encourage compassion.

💜 We Remember.
On International Overdose Awareness Day, we pause to honour the people whose lives were lost to overdose and toxic drug poisoning.
They were family members, friends, parents, children, coworkers, teammates, neighbours, and community members.
They were loved. They mattered. They are missed.
Today we stand with everyone carrying grief, remembrance, and hope. We acknowledge the lasting impact of these deaths and the strength of those who continue to advocate for compassion, dignity, and change.
As we gather on Monday August 31, may we remember not only how people died, but how they lived.

Always remembered. Never forgotten.

• Join us as we come together in remembrance, reflection, and community.
• Monday, August 31, 2026
1:00 PM - 4:00 PM
• Hackett Park, ch’atlich - Sechelt

Together, we remember. Together, we learn.
Together, we work toward a future where fewer lives are lost



Sunshine Coast Hospice
Sunshine Coast Community Services Society
RainCity Housing
Vancouver Coastal Health
on the Coast
Nation
Sunshine Coast Resource Centre
Arrowhead Clubhouse
The i2i Peer Support Project

04/26/2026

https://www.facebook.com/share/p/1Nq6Vvtmsj/

The weeklong event series is officially wrapped.
So thankful and grateful for the support we received this week and the solidarity from those who came to learn, support and stand with us. 💚❤️ Arrowhead Clubhouse The i2i Peer Support Project Arrowhead Reception Gabe Pausch Pender Harbour Health Centre Sunshine Coast Resource Centre Coast Reporter Community Hope, Healing and Harm Reduction Peer Support Sunshine Coast B.C. Jennie Alexis Greg Heminger Feral Fae BC Centre for Palliative Care District of Sechelt Town of Gibsons

04/19/2026

https://www.facebook.com/share/p/1JBusUPj2J/

Remember all of them. Thank you Gabe Pausch

04/19/2026

Brain injury a shadow crisis amid overdose deaths in British Columbia - (Apr 14, 2026)

People who have experienced a drug poisoning or overdose are 19.5 times more likely to suffer brain damage than those who had not, the B.C. Centre for Disease Control says.

• (pic: Eddy Bergsson suffered a brain injury from an overdose five years ago and has since found a new purpose in life at work at the Second Chance Cafe, a workplace staffed by survivors of brain injury located inside the Cedar Hill Recreation Centre in Saanich, B.C., on Wednesday, March 25, 2026. THE CANADIAN PRESS/Chad Hipolito)

Edwin Bergsson's friend broke down the door of his recording studio in Victoria about five years ago, found him unconscious, and saved his life.

"It's incredible that I'm here today," Bergsson said in an interview.

He had overdosed after taking what he believed was crystal m**h. But while he counts himself lucky to have escaped with his life, Bergsson suffered a brain injury caused by lack of oxygen.

His Lyrics Studio folded after the overdose and he now works in a café operated by fellow brain injury survivors.

Bergsson still struggles with his short-term memory. In fact, he couldn’t remember exactly how long ago he overdosed.

"Maybe almost five years ago now," he said. "I don't have the details, but it's, it was at night."

It has taken rehabilitation and support for him to find his new normal.

Bergsson said he doubts most people in his situation would get the care, direction and community support he received after his extended hospital stay.

"I feel like there's probably a lot of people who don't get any of that and have this big gap of 'how do I get through any of this,'" he said.

While the fatal overdose toll in British Columbia is staggering, experts warn that people like Bergsson are part of a far-reaching shadow crisis of brain injury and concurrent mental illness.

Dr. Daniel Vigo, B.C.’s chief scientific adviser for psychiatry, toxic drugs and concurrent disorders, says those with brain injury and mental illness fell into a blind spot for harm-reduction policies, such as safer supply and drug decriminalization, that instead became a form of "harm enhancement" for people with mental impairment.

He's now trying to steer policy toward better serving thousands of brain-injured victims of the public health emergency that will mark its 10th anniversary next week.

"The problem was not that safe supply was wrong, not that decriminalization was wrong, not that voluntary care shouldn't be the first option always — it is that the way that it was implemented was completely blind to the fact that for people with severe mental illness, harm reduction is not harm reduction, it is harm enhancement," Vigo said.

"That safe supply is actually a disincentive for treatment and that involuntary care, when there's a person with mental impairment, is a question of saving the person's life."

• (pic: Then provincial health officer Perry Kendall and Health Minister Terry Lake declare the toxic drug crisis a public health emergency in B.C. on April 14, 2016. GOVERNMENT OF B.C.)

More than 18,000 people have died from toxic illicit drugs since the public health emergency was declared in the province on April 14, 2016.

But Dr. Michael Krausz, head of the addictions and concurrent disorders group at the Centre for Advancing Health Outcomes, estimates the number of overdose survivors is likely "between five and ten times higher" than the death toll.

"So, that means you have thousands of patients which need to be taken care of, and I don't see any indication that is happening," he said.

The B.C. Centre for Disease Control says people who have experienced a drug poisoning or overdose are 19.5 times more likely to suffer brain damage than those who had not.

"There is a growing population in British Columbia who have survived toxic drug poisoning and have been diagnosed with encephalopathy (brain damage) as the unregulated drug supply becomes more potent," it said in a "knowledge update" last year.

"The rise in unregulated drugs adulterated with benzodiazepines and tranquillizers has amplified the risks of toxic drug poisoning for people who use drugs, making the issue even more complex."

Krausz said any time people are unable to breathe for five minutes or longer "always causes brain damage."

"That is a very basic fact. If you are overdosing and your brain is not supplied by oxygen for a certain amount of time, you have a high likelihood (of having) some brain damage done."

Despite that — and the acknowledgment from the BCCDC — he said "the health-care system is not really prepared to take that seriously enough."

AN 'INVISIBLE' CRISIS

University of Victoria professor of psychology Mauricio Garcia-Barrera said there are between 75 to 100 overdoses in B.C. every day, but it is difficult to estimate the number of people involved over time, since individuals can be involved in multiple incidents.

The brain injuries that result are often "invisible, and that's why I think it's overlooked," he said.

Garcia-Barrera said people with brain injury can suffer cognitive impairments, including problems with attention, memory, motor function, emotional dysregulation and "executive deficits like difficulty making decisions, completing tasks or solving problems."

B.C.'s Ministry of Health said in a statement "acquired brain injuries can be misunderstood and difficult to diagnose, which can make it challenging for survivors to access the care they need."

Garcia-Barrera is part of a group of researchers working "to reach a consensus on the priorities and solutions needed to best serve people experiencing the intersections of brain injury, mental health, and addictions in British Columbia." He emphasized the complexity of the phenomenon that he said touches many social systems.

"There is trauma, there is poverty, there's a health system that is overtaxed, so there are so many layers into this, like an onion," he said.

• (pic: A tent city is seen outside the newly opened Fraser Health supervised consumption site in Surrey, B.C., on Tuesday, June 6, 2017. THE CANADIAN PRESS/Jonathan Hayward)

There is a well-established intersection between homelessness, addiction and brain injury, he said, pointing to a study published in The Lancet Public Health in January 2020 that found 53 per cent of unhoused people had a history of brain injury before they became homeless.

"That has to tell us som**hing," Garcia-Barrera said.

Shirley Wilson said the intersection of brain injuries and drug use is a "chicken or the egg" situation.

Bergsson acquired a brain injury as a result of his overdose. But for Wilson's son Jacob, it played out the opposite way, after being run over by a pickup truck in 2018, when he was 21.

He had substances in his system at the time of the accident, but his mother said how he ended up on the road at 3 a.m. that day remains unclear.

Wilson said her son was resuscitated three times in the immediate aftermath — on the road where he was found, at Abbotsford Regional Hospital and in a helicopter as he was airlifted to Royal Columbian Hospital in New Westminster.

"They weren't sure he was going to make it," Wilson said.

After an extended hospital stay he was discharged and sent to a recovery house, where Wilson said his addiction took off.

"His drug of choice was m**h, although he drank and still used cannabis," Wilson said.

She said Jacob never received the support he needed, and after years of struggling and cycling through treatment options, he died of an overdose in an Abbotsford hotel on Nov. 11, 2021. His body was found on a wellness check, she said.

Wilson began speaking out in the years that followed about the systems she felt failed her son.

"His life is a testament to the failure of health care and social impact," she said. "His life and what he went through has to matter."

She is part of a group of people who encouraged the federal government to establish a national strategy on brain injuries.

The resulting Bill C-206, the National Strategy on Brain Injuries Act — which passed first reading in the House of Commons last June — calls for improved prevention, awareness, diagnosis, treatment and rehabilitation.

It also aims to address intersections of mental health, homelessness and unstable housing, interactions with the legal system and substance use.

As governments grapple with how to best respond to the toxic drug crisis, Kix Citton, executive director of the Nanaimo Brain Injury Society, said community services are seeing the need first-hand.

"Our organization is at capacity and slammed," she said of the society that helps people "navigate life after brain injury."

When people can't get access to primary care, they go to the most accessible space, "which is community organizations," she said.

"That pressure is showing up in our work. While the funding isn't following suit, so we're absorbing a lot of that demand."

• (pic: Psychiatrist Dr. Daniel Vigo, the province’s scientific adviser for psychiatry, toxic drugs and concurrent disorders. DARREN STONE, TIMES COLONIST)

Citton said her organization is "purposefully low barrier" and does not require a diagnosis.

"When someone is managing, or trying to manage, their symptoms of a brain injury, it's very, very difficult to do that without support, and the support's just simply either are not there, especially in our rural communities, or are inadequate," she said.

The need for services in Nanaimo has resulted in a three-week wait list at the society, she said.

Citton said the society that was founded almost 40 years ago began "talking about the intersection of brain injury, mental health and substance use" in 2018. She noted the connections with housing, mental health, income support among other issues.

"Brain injury is on both sides of that equation. It's the cause of these things and it's the consequence of these things, but it's a hidden piece that we haven't quite been able to wrap our heads around how to best offer these supports," she said.

People need help to understand what is happening, how to self-manage and access the necessary supports, she said.

"We're doing our best, but the funding and the resourcing has not kept up with the demand on services."

Garcia-Barrera echoed that, saying the "most impactful" systems of care "tend to be free" but they also "tend to have limited capacity."

He said another issue is that services related to brain injury, substance use and psychiatric mood disorders are often siloed.

"But what we identified in these conversations is a big barrier, is that there are no integrated services," he said.

'THERE WAS A BLIND SPOT'

Vigo said his 2024 appointment to advise the government on the toxic drug crisis was an attempt to "steer the ship in a different direction."

He said the previous focus in B.C. was on harm reduction, including safe consumption sites, safe supply, voluntary treatment and the decriminalization pilot project, that was scrapped earlier this year. But, he said, such approaches do not work for the entire population, especially those with concurrent disorders.

He estimated there are at least 3,000 people in B.C. "who have severe mental illness, severe substance use and severe acquired brain injury."

"So, these patients with concurrent disorders could not access addiction services," he said. "There weren't enough psychiatrists who knew how to treat them, and so there was a blind spot and these patients started developing acquired brain injury."

He has made a series of recommendations that include a directive aiming to help clinicians and others decide when involuntary admission is appropriate.

The vast majority of people with mental disorders, including substance-use disorders, will not meet the "stringent threshold" for involuntary treatment, he said.

"Leaving treatment to the person at the moment that they seek it just doesn't work for this group of patients, for the patients that have severe mental illness, and so there was a blind spot in that policy," he said.

Other suggestions by Vigo the government is working to adopt include clarifying the use of the Mental Health Act for those with substance-use disorders, expansion of treatment and recovery beds, and creating mental health units in correctional facilities.

Krausz, meanwhile, is calling for proper training for emergency room physicians and for every patient to be assessed for cognitive function.

Garcia-Barrera said his hope is that everyone who suffers an overdose is screened for a brain injury, so those with a diagnosis can get the help they need.

• (pic: Edwin Bergsson speaks with members from the Muffin Break stamp club while at work at the Second Chance Cafe, a workplace staffed by survivors of brain injury located inside the Cedar Hill Recreation Centre in Saanich, B.C., on Wednesday, March 25, 2026. THE CANADIAN PRESS/Chad Hipolito)

Bergsson said his situation "stands out" from the norm because supports were provided proactively. After an extended hospital stay, he was connected to the Cridge Centre, a Christian-based organization that has been providing brain injury services since 1991.

He moved into a recovery house before eventually graduating to independent living.

But he's not sure most people with brain injury would be ushered toward getting help, unless they had a story similar to his.

"I wouldn't have taken any of these steps had I not been in the hospital and inched along."

Bergsson now works two days a week at Second Chance Cafe in Saanich, which is run by the centre. He is praised by Cridge Centre staff as a warm and friendly presence, who occasionally breaks out in song.

"It's amazing how much I remember from the songs of my past," he said. "I have a constant Rolodex of mid-'90s music that just the playlist repeats in my head, so those songs just come up sometimes."

Though he no longer works in the music industry, he continues to be a casual fan, spending free time with his eight-year-old daughter or playing video games.

Jacob Wilson's story offers a tragic counterpoint.

"My hope is that we don't have to recognize Jacob as a perfect person. We have to recognize that the people who were supposed to help him didn't," Shirley Wilson said.

"The system isn't broken, it was never built, and people are inadequate with their own resources about how to do this."

- This report by The Canadian Press was first published April 9, 2026.

People who have experienced a drug poisoning or overdose are 19.5 times more likely to suffer brain damage than those who had not, the B.C. Centre for Disease Control says.