Northwest Territories illicit drug trade and toxic drug crisis response.

Setting: The Northwest Territories (NWT) is a sparsely populated, predominantly Indigenous, northern jurisdiction with 33 communities scattered over 1.2 million square kilometres. Though the NWT has seen a delay in the effects of the larger opioid-related epidemic that Canada has been experiencing for years, organized criminals are now seeing NWT as an untapped market to exploit for higher profits. This article highlights our northern context and innovative response to the toxic drug crisis through describing harm reduction interventions such as community-informed education, coordinated early warning efforts, and community collaboration.

Interventions: Interventions prompted by the 2022 cluster of deaths: • The NWT Chief Public Health Officer set up an early warning system among first responders, while working together with intergovernmental partners. The warnings received from first responders resulted in 13 out of 15 of the NWT substance-related public health advisories since 2020 (GNWT, 2024b). • Initial responses to overdose clusters and community conversations have informed numerous community/regional presentations to residents, non-government agencies, and government stakeholders. • Additional harm reduction supplies were distributed, including 2000 naloxone kits (outside of what pharmacies/health authorities already provide) and 1590 fentanyl testing strips. • Community learning has led to the development of educational materials such as "Drugs in the NWT" (GNWT, 2025  https://www.hss.gov.nt.ca/en/services/drugs-nwt ) that can further be used by community to inform discussions from within. • In October 2024, the addition of the Randox MultiSTAT Analyzer ( https://www.randoxtoxicology.com/post-mortem-toxicology/ ) allowed for rapid toxicology screening in the morgue by the Office of the Chief Coroner (GNWT, 2024a). • Testing for illegal drugs in the wastewater surveillance program is now captured on the Canadian Drug and Substance Watch (CDSW) ( https://health-infobase.canada.ca/canadian-drug-and-substance-watch/ ) website.

Outcomes/implications: Innovative interventions paired with community calls to action are allowing the NWT to tackle the toxic drug crisis from multiple angles in the hopes of saving lives.