Canada’s opioid death toll has escalated to unprecedented levels during the COVID-19 pandemic, and those most critically affected seem to be defying conventional beliefs about addiction.

VANCOUVER, British Columbia – As the strains of Leonard Cohen's "Hallelujah" filled the sanctuary of Christ Church Anglican Cathedral in Vancouver, one by one the people in the pews rose silently. Muffled sobbing could be heard from the back corner of the church as a prayer vigil for those affected by the city's opioid crisis ended.

In the United States, nearly four million people use heroin — a five-fold increase from a decade ago, according to new research from the Columbia University Mailman School of Public Health.