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Killing Season: A Paramedic's Dispatches from the Front Lines of the Opioid Epidemic

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When Peter Canning started work as a paramedic on the streets of Hartford, Connecticut, twenty-five years ago, he believed drug users were victims only of their own character flaws. Canning began asking his patients how they had gotten started on their perilous journeys. And while no two tales were the same, their heartrending similarities changed Canning's view and moved him to educate himself about the science of addiction. Armed with that understanding, he began his fight against the stigmatization of users.

In Killing Season, we ride along with Canning through the streets of Hartford as he tells stories of opioid overdose from a street-level vantage point. A first responder to hundreds of overdoses throughout the rise of America's epidemic, Canning has seen the impact of prescription painkillers, heroin, and the deadly synthetic opioid fentanyl firsthand. Bringing us into the room (or the car, or the portable toilet) with the victims of this epidemic, Canning explains how he came to favor harm reduction, which advocates for needle exchange, community naloxone, and safe-injection sites.

Stripping away the stigma of addiction through stories that are hard-hitting, poignant, sad, confessional, funny, and overall, human, Killing Season aims to change minds about the epidemic, help obliterate stigma, and save lives.

314 pages, Hardcover

First published April 6, 2021

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Peter Canning

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Displaying 1 - 30 of 37 reviews
Profile Image for Petra X.
2,456 reviews35.8k followers
June 10, 2021
Update 7 of us in this comment thread have family or friends affected by heroin. It is a crisis for true.

My boyfriend's son went to Princeton and was on the baseball team - a young man with everything to live for - and was found in his bedroom by his youngest brother dead of a heroin overdose.
Sometimes there is not enough love in the world to beat this. Heroin was simply too strong for my son.
This is a quote from the book. My bf, the parents of almost all the deceased people, victims of an often fatal illness, would say that.

My bf's son's girlfriend said that it was Fentanyl that killed him, and on reading this book I agree that this was the 'weapon' that killed him. But he didn't die of Fentanyl-adulterated heroin, he died of a sickness that bears a stigma. We don't stigmatise people with anorexia, for example, we treat them well in hospital and offer them ancilliary services and everything is done to keep them alive in the hope that they will be able to 'see the light' and work to conquer their illness and be a happy, productive member of society again.

But drug addicts are different, they are treated with disgust, it's their own fault, give them Narcan to reverse the effects, revive them with CPR and send them out again. We wouldn't do this to (smoking-caused) lung cancer or (alcohol-caused) kidney disease. But addicts are different. they are not treated with compassion and helped up every time they fail at rehab, every time they give in to the almost irrestistible lure of heroin.

The author's main point is to treat addiction as disease, and he's right. Some countries, notably Switzerland and Portugal, heroin shots can be got, legally, at hospitals. These countries have decriminalised all drugs, halved the crime rate and offer major treatment programs to addicts.

However, there is the problem of illegal distibution. As long as opioids remain illegal, they are a pathway to economic success for a small investment and low risk - the manufacturers of drugs rarely get caught, just the users and street distributors.
The economics behind it are stunning. You can buy an industrial pill press along with some pill dies on the internet for a couple thousand dollars. A kilogram of pure fentanyl costs four thousand dollars. Add a couple hundred dollars for cutting agents like baby formula, and you are in business. According to the Drug Enforcement Administration, a kilogram of fentanyl broken down into a milligram per pill would yield one million counterfeit pills. At a street cost of twenty dollars per pill, an investment of several thousand dollars can generate up to twenty million dollars in profit.
Fentanyl, an incredibly strong drug with which heroin is often adulterated in varying and possibly fatal amounts, is the cause of many deaths. But false information doesn't help. The 'war against drugs' has descended to the lows of Nancy Reagan and her stupid, 'just say no' campaign. Fentanyl is an extremely effective strong painkiller and is used daily as a prescription patch, pill, nasal spray at home or (in hospitals) injection.
In 2016 the DEA releases a two-minute video, Fentanyl: A Real Threat to Law Enforcement.1 Jack Riley, the deputy administrator, opens the video by stating that “a very small amount [of fentanyl] ingested or absorbed through your skin can kill you.”

He introduces two police detectives who describe their experience with a fentanyl exposure. One detective describes how, in sealing a baggie of the drug, some of it “poofed up” into the air, and the detectives ended up inhaling it. “I felt like my body was shutting down,” the other detective says. “People around me say I looked really white and lost color. And it just really felt like … I thought that was it. I thought I was dying. That’s what my body felt like. If I could imagine or describe a feeling where your body is completely shutting down, and, you know, preparing to stop, stop living, you know, that’s the feeling I felt.”

The first detective adds, “You actually felt like you were dying. You couldn’t breathe, very disoriented. Everything you did was exaggerated in your mind, I guess. It was the most bizarre feeling that I never ever would want to feel again. And it was just a little bit of powder that just puffed up in the air.” Riley concludes, “Fentanyl can kill you.:
The author says, "What they are describing doesn’t sound like an opioid overdose. People who use heroin describe it as the most wonderful feeling they have ever experienced. They feel euphoria." He said it sounded like they were having an anxiety attack! A year later, to add to this fake news, the DEA update the video to say that being in contact with Fentanyl, even a few grains of sand, can kill you. And advises all sorts of PPE and room searches before.... helping a victim who might be lying there needing CPR to hang on to life. Drug use should not be treated as a criminal offence but as a public health issue. As is tobacco and alcohol.

There are many stories in the book. They are very repetitive. All sorts of people of all ages the author, a paramedic, goes to help when they are either dead or dying. Some recover, and their stories are all varieties of a friend introduced them to it, or from trauma they were put on pain medication and when the prescriptions ran out... .heroin is very cheap. A lot of them have been to rehab once, or several times. Sometimes he meets the same people repeatedly and he sees the circumstances they have descended to in order to 'chase the dragon' that they cannot escape.

Nothing is going to change unless people become more compassionate to this illness, there are safe, sanitary places to inject, hospitals can prescribe it where addicts can go to get their shots, heroin is decriminalized so that it won't be economic to produce and sell it, and people realise that junkies aren't the greasy guys and girls with tattoos on street corners, but it could be anyone in your family, your friends' family in every racial, religious, social and economic group. Have compassion.

"Sometimes there is not enough love in the world to beat this. Heroin was simply too strong for my son".
Profile Image for Chantae.
396 reviews
February 17, 2023
This book and The Empire of Pain should be required reading for everyone. Peter Canning seems like a really, really good person. I learned a lot from him.
Profile Image for Diane.
146 reviews1 follower
January 20, 2023
An interesting read from a paramedics point of view of the opioid crisis. I enjoyed it and learned a lot. I can see where it would be very frustrating to have to save the same people over and over, but the author was always so kind because he understands it’s an illness.
A lot of research and references.
1 review
April 19, 2021
The first Peter Canning book I read was ‘Paramedic: On the Front Lines of Medicine’ which provided a broad view into the daily work of paramedics in Hartford, CT. 'Killing Season', although strictly focused on the opioid crisis, provides much more: it contains well researched and referenced facts, stories of day-to-day encounters with users in the Hartford area, a narrative of how the author’s views of the people involved has changed over the years, and solutions how the epidemic can be handled better. I particularly liked how each chapter focuses on a particular aspect of the crisis. For example, in the chapter ‘Age’ the described episodes make it clear that opioid addiction occurs in all age groups, including senior citizens. Canning’s style makes a stunning read, providing in-depth insights into how the opioid crisis came about and why overdosing and death of users is so common. It provides a feeling of why many/most users cannot overcome their addiction and it makes clear that, independent of background and status, no one is safe from opioid addiction coming to one’s family or neighborhood. Finally, backed up by his decades-long experience with opioid users, Canning makes well-founded suggestions how users should be treated to minimize deaths and maximize their chances for rehab. I judge this book as a must read for everyone who wants to understand this ongoing crisis amidst our communities.
Profile Image for Furciferous Quaintrelle.
197 reviews40 followers
August 19, 2021
Probably a bit weird to say that I loved everything about a book detailing the fall-out from the opioid epidemic, but it was just so well-written, engaging and perfectly paced...I pretty much blasted through it. Peter Canning is the perfect tour-guide through this devastated landscape, littered with human detritus. He begins his tale looking upon drug addicts as being nothing more than scumbags, but after time spent talking with them, getting to know their stories and liaising with others working on the front line of this crisis, he gradually changes perspective; now he views all the people he treats as fellow human beings, with empathy, sympathy and no judgement.

Someone in another review said that a lot of the stories are repetitive...but that's the point. Canning is trying to show the reader just how commonplace a call-out to an overdose is on his territory; how similar so many of the causal factors for each individuals downfall are; how relentless the task he and his colleagues perform every day is. He also really brought me around to the aspects of harm-reduction that a lot of people are unwilling to consider, despite it being proven to save more lives and bring more addicts around to a place where they're ready to give rehab a try.

This is a really informative book for anyone who wants to learn more about the dangers of fentanyl and it's subsequent synthetic analogues (like carfentanil) the root causes of the opioid epidemic and the ways in which health professionals are trying to fight back against the tide of overdose. I read 'Dopesick' by Beth Macy and then 'Dreamland' by Sam Quinones, both of which cover this opioid crisis from different angles. I'd recommend both of those titles, but would also recommend this book by Peter Canning too, because it offers an entirely different perspective of this topic. Peter Canning comes across as a genuinely lovely guy and a paramedic with great integrity. I'm really glad he chose to share his perspective in this book.
4,073 reviews84 followers
August 6, 2023
Killing Season: A Paramedic’s Dispatches From the Front Lines of the Opioid Epidemic by Peter Canning (Johns Hopkins University Press 2021) (362.29) (3839).

Author Peter Canning is a paramedic who has witnessed firsthand the rise and fall of opioids in the 2000s and the resulting havoc this has wreaked on American society.

Canning writes principally about the homeless population that he serves in Hartford, Connecticut. The author’s stated purpose in sharing what he has learned is the desire to keep addicts alive until they are finally ready to quit. Canning’s ideas are all aimed at helping addicts survive accidental overdoses at a time when heroin and other injectable drugs are almost inevitable cut with ever more dangerous adulterants (including fentanyl and carfentanil) which can kill an unsuspecting addict graveyard dead - if the dealer’s added adulterants are not perfectly distributed into the powdery mix.

Canning’s suggestions to keep IV drug-using addicts alive include “safe injection sites aka harm reduction centers,” which refers to sites where addicts can come indoors without the fear of arrest and prosecution to find a measure of privacy while they inject themselves with drugs that they purchased off site. “Safe injection sites” have personnel on location to provide clean injecting equipment (including a needle exchange), to be available to monitor the users to deal with overdoses by administering Narcan in the event of an overdose, to provide counseling when a user is receptive to rehab or treatment, and to provide testing (if requested by an addict) of street drugs by gas chromatography to analyze unknown drug samples for against dangerous contaminants, including fentanyl and carfentanil.

Why does Canning endorse “harm reduction centers” for addicts? Canning writes, “If we can stop chasing [users] into the shadows where they use alone and unsafely [to avoid arrest], we can end the deaths.” (The Killing Season, p. 265).

Canning’s approach seems particularly prescient regarding one particular portion of the population: recently-released prisoners. Canning cites a study from the New England Journal of Medicine which reveals that newly-released inmates are 129 times more likely to die of an accidental opioid overdose during the first two weeks of freedom than were members of the general population when matched for age/sex/race. (The Killing Season, p. 190).

Why are released inmates so much more likely to die of an overdose? Canning names an obvious reason for this: Most jails decline to provide maintenance opioids to inmates who are addicted to opioids at the time they are incarcerated, thus dooming the inmates to the misery of a “cold turkey” withdrawal alone, in the jailhouse, and unassisted by medicine. After going through forced withdrawal and then spending a chunk of time in jail as they serve their sentences, the inmates when newly released have lost the physical tolerance to their drugs of choice that they had built up before they went to jail. This means that addicts’ bodies are much more sensitive to these potent drugs upon release than they were the last time the addicts used, and this makes the addicts much more likely to overdose - 129 times more likely to die of an overdose, according to the New England Journal of Medicine. (The Killing Season, p.191).

How awful. Peter Canning is absolutely right in his approach.

My rating: 7.25/10, finished 8/5/23 (3839).

Profile Image for Stefanie Robinson.
2,401 reviews18 followers
February 26, 2024
This is the personal memoir of a paramedic with a special interest in the opioid crisis. Opiates and opiate derivatives are very prevalent on the street. They are in all neighborhoods. Chances are, everyone here reading my silly little book reviews knows, at minimum, one person who is struggling with some variant of addiction. Chances also are that that addiction has something to do with opiates. People are given pain medication, which is a wonderful and useful thing, and become addicted that way. People use opiates recreationally, developing an addiction that way. Some of us turn to them as a means to escape something. Opiate addiction is a difficult addiction to fight, and the effects of it in the aftermath are sometimes things that someone who hasn't struggled with this wouldn't imagine. The dangers of overdose aside, there are so many impurities in drugs on the street. They use all manner of things to cut with, which can kill you before the drugs do. Infections, diseases, homelessness, and other things are often byproducts of addiction. The author of this book relates many experiences he had on shifts, as well as the experiences of people he has treated.

This book is currently available on Audible Plus, which is the copy that I listened to. Listening time for this book was approximately 8 hours. The print copy is approximately 300 pages if you would prefer that version. I appreciated this book for several reasons. Struggling with heroin addiction is a very familiar conflict for me. It can happen to anyone, for a wide variety of reasons. People's journey's into addiction can be wide-ranging, but there are so many similarities in our stories. I appreciated that this author viewed those mentioned in the book as human beings, because, a lot of the time, that is not the case at all. Some of this book was tough to listen to for personal reasons, but this is such an important topic these days. I think this book did a great job about raising awareness for the issue of opioids and how to combat it.
20 reviews
February 28, 2022
This was such an enlightening read that I almost feel activated by it. The concept of "Harm Reduction" as it pertains to opioid addicts will now be prioritized in my approach towards my thinking, my care, and my goals in being a proactive advocate from this moment on. Addiction being a brain disease was at one time a novel concept, but at this point it is considered settled science. What we now need to acknowledge as a disease is Americas hardened attitude towards addiction, and its archaic unwillingness to approach addiction with progressive forms of harm reduction. I'm also incredibly moved by author Peter Canning's love and compassion for the community he serves. This is someone I plan on reaching out to and connecting with.
Profile Image for Tiffany.
555 reviews1 follower
September 26, 2022
The more I read the more I disliked the author’s writing style. Given his occupation, his point of view is understandable and it’s valuable to read differing viewpoints to get a balanced point of view. However as a believer in moral hazard I can’t read paragraphs like “safe injection houses make sense so people can take their time injecting and not be rushed. Rushing can lead to tissue damage when the user pushes a shot in without the needle’s point being in a vein”. Like …what????? What I do agree with is the fact that without strong policy you can’t expect drug addicts to save themselves. Valuable to read a real life account
Profile Image for Eddy Ream.
20 reviews
April 28, 2025
Review from Another Medic

I work full time as a night shift paramedic in one of the major cities in my state. I can empathize with a lot of what Mr. Canning wrote in this book and appreciate his candid insight on how we respond to these incidents and the need for a change in attitude and approach by providers, the system, and people in general. There are a few times that he repeats himself on certain topics, but that’s just being nit-picky. This book was an easy read and an excellent example of how I hope more paramedics treat their patients suffering from opioid addiction.
Profile Image for cypher.
1,629 reviews
August 22, 2025
interesting book, filled with lots of true stories of drug addiction, written from a paramedic's firsthand accounts. tragic and powerful.
the drug addiction problem is a very serious one in modern society, and it does not look like things are getting better, so books like this are important to educate the population on this issue and bring more general awareness.
i'm not sure i personally agree with safe-use houses as a solution for the problem (while they would keep drug addicts safer, they are also partially supporting their habits...although it may very well be that they can save public funds in the overall fight against drug abuse), but, otherwise, the book was very good.
Profile Image for Will.
56 reviews
December 5, 2025
Canning does such an amazing job of using his real world experiences and passion for connection to break the barriers between the reader and the addicts he encountered as an EMS medic. As an educational or informational tool, he went above and beyond in humanizing all involved parties to the reader, as his harm-reductionist views would lead him to; However, he also does an amazing job of showing why this same approach is still so uncommon yet important.

As a lover of (less dangerous) drugs myself, this book is inspiring in its discussion of future opportunities to better care for our fellow man.
Profile Image for Andi.
140 reviews1 follower
June 8, 2022
Having just finished "The Least of Us" prior to reading this one, it all tied together. The Least of Us" talks about the big picture of the influx of opioids and how people end up on the street drugs after being prescribed painkillers, and now this book brings it down to the street level. All throughout the book the author humanizes this epidemic, introducing you to individuals caught up in this ugly business. These are our neighbors, colleagues, friends and family...we cannot turn our backs, and we cannot "punish" our way out of this.
Profile Image for Jess Botha.
73 reviews
February 14, 2024
This is such a powerful book, and I think many, many more people should read it. It's very raw and devastating, while providing insight into the opioid epidemic, especially in the US, from a place of research and first hand experience. It covers a range of related topics, from brain chemistry right up to the war on drugs. It's really opened my eyes and made me consider my views on those that become addicted to heroin, which really could happen to anyone. This book is seriously well worth your time.
Profile Image for Serena Strouse.
343 reviews
August 31, 2024
This book was an eye opener. I am an EMT and 911 dispatcher and reading this book I felt how he felt. The overdose calls one right after another, watching people waste away from this condition and not knowing how to help them. This book really gives incite on HOW to help them the best way we can and this author/paramedic will go on to do great things. I hope he is able to teach others the way he informed me in this book. I really learned a lot from this and I think ALL providers should read this and try to understand the opioid epidemic. 4/5 stars
Profile Image for Matthew Romero.
92 reviews
August 26, 2025
It feels weird tagging something like this as a favorite read given its contents, but this is a pertinent, informative and emotive read on exactly just how bad the extent of the American opioid epidemic is, just in one mid-sized American city.

This is a topic I had always heard and read about in varying amounts of detail, but these dispatches from the front line really drive the key points home. It also lays bare the clear flaws in the American medical system, and makes for a depressing read into the psyche of the human mind both from a dealer and users perspective.

9.25/10
Profile Image for Jonathan Mahoney.
2 reviews4 followers
January 10, 2023
This is a fascinating book full of personal stories about patients the author met as a paramedic. For some reason I thought the book would be more about a big picture with lots of statistics, but it is about real people and real stories. I think this book will really inform my future career as a paramedic. I've already gifted a copy and I think I'll read it again myself at some point. Highly recommended.
Profile Image for Sharon.
725 reviews4 followers
August 17, 2023
Audio. A well written non fiction book about the realities of the opioid epidemic. The fact is, this impacts all of us and we need to find a solution. This book may alter your perspective a bit, as it focuses on harm reduction. If you do not understand harm reduction, this is a good place to start.
Profile Image for Melanie Wintjes.
41 reviews
March 26, 2025
It was a good perspective from a paramedics eyes. Who he sees regularly, what he hopes for. A solution seems far away… people need more support which it doesn’t seem like we have the ability to current give or provide. Sad world to live in. Interesting take on treating someone addicted just like someone who has poor health from drinking or smoking.
Profile Image for Lizzie.
49 reviews
May 29, 2025
An eye-opening argument for harm-reduction. This man has a massive heart for those struggling with addiction. If anyone wants to better understand the opioid crisis or how we can help those affected, this is a must-read. God bless him and the EMTs who practice compassion every day!
Profile Image for Amanda.
447 reviews19 followers
March 4, 2022
The world could use a lot more people with Peter Canning's compassion.
Profile Image for Karin Irene.
155 reviews20 followers
May 4, 2022
I know was too many people suffering (or have suffered) from this epidemic. This book is honest and clarifying to the realities. Great pairing after watching Dopesick on Hulu.
Profile Image for Renee Brodeur.
462 reviews
September 9, 2023
Wow this was tough to read but such an interesting take on drug culture from the point of view of an EMT working on the streets in Hartford everyday…. Saving people with Narcan.
Profile Image for Mishon.
459 reviews2 followers
August 28, 2024
It’s sad to know that so many people are stuck living like this. And frightening to realize 90% of the heroin addicts started with dr prescribed pills… it could happen to any of us
Profile Image for Betty.
419 reviews
March 3, 2025
Very informative and hearbreaking to read about all those death from Opioids.
Displaying 1 - 30 of 37 reviews

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