'They did not lose their right to care': families speak as jury weighs Collins Bay fentanyl deaths

A coroner’s inquest examining the deaths of five men who died of fentanyl toxicity while in federal custody at Collins Bay Institution has been submitted to the jury for deliberation.

The two-week inquest concluded Thursday, Feb. 5, 2026, after examining the deaths of Shane Gammie, Christopher Sipes, Qinlong Xue, Quinn Borde, and Shimon Abrahams, who died between 2018 and 2022 while in the care or supervision of Correctional Services Canada (CSC).

All five men had documented histories of substance use and repeated contact with institutional health or mental health services. Each died in the evening or early morning hours after exposure to fentanyl, either inside Collins Bay Institution (CBI) or after being transferred to hospital.

Testimony highlighted recurring patterns of addiction, chronic illness, mental health challenges and systemic gaps in care, alongside conflicting approaches to harm reduction and drug enforcement inside federal prisons. Jurors heard from institutional representatives, advocacy organizations, and family members of the deceased.

Shane Gammie

Shane Gammie, 35, died in the early hours of November 24, 2018, while serving a sentence of just under six years for drug-related offences. A father of three, Gammie had shown signs of progress at CBI, completing his high school diploma and participating in substance use programming.

Records described Gammie's growing insight into his addiction and his efforts to delay parole in order to complete treatment. However, he struggled to quit smoking, received disciplinary charges for possession of tobacco, and was transferred back to medium security shortly before his death.

Gammie was found unresponsive in his cell during a routine check. Correctional staff administered naloxone and attempted cardio-pulmonary resuscitation (CPR), but he was pronounced dead shortly after paramedics arrived. An autopsy confirmed fentanyl toxicity.

In her closing remarks, Gammie's former partner, Linda Berthelet, described the inquest as “a final piece of closure” for their family and urged jurors to support recommendations aimed at improving care for incarcerated people with substance use disorders.

“I have been able to approach this inquest with the lived experience of loving someone who is both a person with substance use disorder and a person who is incarcerated in the care of Correctional Service Canada,” she said.

“Unlike many of the institutional witnesses, my heart is not bound by any regulation or duty to a government body or employer. Our loved one, Shane, is gone. And of course, we would want to do everything and anything to prevent future pain and suffering for families who rely on CSC for the care of our family members.”

Berthelet told jurors that Gammie had sought medical attention for a long-standing shoulder injury before his death, waiting 11 days to be seen and receiving no pain medication. Citing expert testimony that people often use substances to self-medicate pain, she urged timely access to health care and nicotine replacement programs.

Christopher Sipes

Christopher Sipes, 51, died on November 21, 2019, after nearly two years in federal custody. He entered Joyceville Assessment Unit in February 2018 to serve a five-year sentence for possession of fentanyl for the purpose of trafficking.

Intake assessments identified significant medical and mental-health concerns, including heart disease, chronic obstructive pulmonary disease (COPD), sleep apnea, obesity, depression, anxiety, and a long history of substance use.

During his incarceration, Sipes was repeatedly hospitalized for cardiac and respiratory complications and attended frequent appointments at Kingston General Hospital and the Kingston Heart Clinic.

He was found unresponsive in his cell at CBI medium security. Despite naloxone and CPR, he was pronounced dead later that night. An autopsy found fentanyl and heroin toxicity.

Qinlong Xue

Qinlong Xue, 26, died in November 2020 after less than six months in federal custody. He entered custody in May 2020 after receiving a life sentence for second-degree murder and was transferred to CBI maximum security in July.

Correctional planning documents identified substance use as a high area of need, and Xue reported a long-standing addiction to crystal methamphetamine.

On November 10, 2020, Xue was found unresponsive in his cell following an evening that included interactions with other inmates and an apparent assault. Correctional officers administered naloxone and CPR, restoring Xue's pulse, but medical tests revealed fentanyl in his system and extensive anoxic brain injury (lack of oxygen to the brain).

He was pronounced neurologically deceased two days later. An autopsy confirmed fentanyl toxicity.

Quinn Borde

Quinn Borde, 39, died in April 2022 after nearly 14 years in federal custody. He was serving a 23-year sentence for violent offences.

Court and correctional records presented at the inquest described Borde's ongoing mental health challenges linked to prolonged segregation, alleged assaults by correctional staff, and exposure to deaths in custody. He participated intermittently in mental health programming, and staff expressed concerns about substance use.

In October 2021, Borde was found unresponsive in his cell and was revived with naloxone after a suspected overdose. He was later transferred back to medium security.

On March 29, 2022, he was again found unresponsive and died several days later from a catastrophic brain injury. An autopsy confirmed toxic levels of fentanyl and the presence of etizolam.

Addressing the jury, his daughter, Keisha Board, said incarceration did not strip her father of his basic rights.

“When my father entered his incarceration, he lost his freedom,” she said. “He did not lose his right to care, dignity, and protection.”

She criticized failures in suicide-risk assessment and information sharing following his October 2021 overdose.

“Unpredictability in custody is not a minor flaw,” she said. “It can be fatal.”

Shimon Abrahams

Shimon Abrahams, 41, died on June 17, 2022. He had a lengthy history of substance use and multiple overdoses while in federal custody, including hospitalizations in 2020.

Correctional records documented ongoing illicit drug use, transfers between security levels, and placements in the Structured Intervention Unit. After his statutory release was suspended due to escalating substance use, Abrahams was hospitalized for drug-induced psychosis before returning to custody.

He was later found unresponsive in his cell at CBI maximum security. Despite being given multiple doses of naloxone, he suffered severe anoxic brain injury and was pronounced neurologically deceased. An autopsy cited fentanyl toxicity, with a possible airway obstruction as a contributing factor.

Yolanda Abrahams thanked the jury and said the inquest helped her family seek closure, urging jurors to consider how their recommendations could lead to systemic change.

Expert submissions and recommendations

Across all five cases, correctional staff initiated emergency responses, including CPR and naloxone, but were unable to prevent death. The inquest heard that illicit opioids continued to circulate inside federal institutions despite interdiction efforts.

Jerry Wu, counsel for the John Howard Society, urged jurors to recognize that drugs are present in prisons and that punitive approaches alone fail to prevent deaths. He highlighted gaps in overdose prevention services, which often close before high-risk evening hours.

“When substance use is treated as a moral failing rather than a health issue, people hide their issues,” Wu said. “They avoid services that might otherwise save lives. They use alone, and people die.”

Frank Nasca, counsel for the Prison Harm Reduction Coalition, told jurors the deaths were preventable and called for timely medical care, evidence-based addiction treatment, and expanded harm reduction measures.

Representing CSC, counsel Taylor Andreas expressed condolences to the families.

“Each of these men were more than inmates,” Andreas said. “They were friends and family members taken way too soon.”

Andreas cautioned against simple solutions, saying corrections policy is complex and jurisdictional limits restrict what a provincial inquest can compel. He said CSC would review the jury’s recommendations.

In her closing address, inquest counsel Erin Winocur urged jurors to focus on prevention as they deliberate on 17 proposed recommendations addressing health-care capacity, policy clarity, harm reduction, and enforcement.

“These recommendations have been deliberately scoped and focused in the interests of death prevention,” she said.

Winocur thanked the families for their advocacy, telling jurors their role could help prevent future deaths in custody.

The jury began deliberations on Thursday, Feb. 5, 2026, at noon and returned late Friday, Feb. 6, 2026, with their findings. More to come.