What is the purpose of this alert?
Between September 18 and October 13, 2020, a synthetic cannabinoid, AMB-FUBINACA, was found in 6% of the expected fentanyl samples checked by Toronto’s drug checking service (7 of 118 samples). AMB-FUBINACA was found in trace amounts (less than 2% of drugs found), alongside fentanyl, caffeine, heroin, and other fentanyl-related drugs.
These samples were collected in Toronto’s east end, west end, and downtown core. The presence of AMB-FUBINACA was not expected by those who submitted these samples to be checked.
AMB-FUBINACA has not been found consistently by Toronto’s drug checking service since November 2019. Other synthetic cannabinoids, like ACHMINACA, have also been found by Toronto’s drug checking service (mostly throughout May and June 2020). Since Toronto’s drug checking service launched in October 2019, synthetic cannabinoids, like AMB-FUBINACA and ACHMINACA, have been found in 4% of the expected fentanyl samples checked (27 of 701 samples).
What is AMB-FUBINACA?
AMB-FUBINACA is a synthetic cannabinoid. Synthetic cannabinoids are manufactured to be like THC, which is the main psychoactive component in cannabis, but can produce significant negative and unexpected effects. AMB-FUBINACA is very strong. In fact, it has been reported to be hundreds of times stronger than THC.
The effects of synthetic cannabinoids may be intense – even by consuming very small amounts. Common side effects include distorted perception of time, having difficultly moving, increased heart rate, hallucinations, paranoia, confusion, fear, agitation, anxiety, nausea, and vomiting. More severe side effects include rapid loss of consciousness, chest pain or stroke, seizures and involuntary movement, high blood pressure, acute kidney injury, psychosis, aggressive and violent behaviour, and even death.
It is unlikely to be able to determine the presence of synthetic cannabinoids by sight or taste.
What are the potential effects of using AMB-FUBINACA in combination with opioids?
Unlike cannabis, synthetic cannabinoids have been known to suppress breathing and other vitals during overdose situations. When synthetic cannabinoids and opioids are used together, the risk of dangerous suppression of vitals is increased. This is also true for synthetic cannabinoids in combination with other central nervous system depressants, like benzodiazepines or benzodiazepine-related drugs, which have presented in over 45% of all fentanyl samples checked by Toronto’s drug checking service. Unfortunately, not much more is known about the effects of using opioids and synthetic cannabinoids together.
Advice to reduce potential harms:
- Get your drugs checked before using. In Toronto, drug checking services are offered at Moss Park Consumption and Treatment Service, Parkdale Queen West Community Health Centre (Queen West and Parkdale sites), South Riverdale Community Health Centre, and The Works at Toronto Public Health. You can also check your drugs after you’ve used them by submitting paraphernalia, like a cooker or a filter.
- Use at a supervised consumption site or overdose prevention site. Here is a list of sites that offer supervised consumption in Toronto.
- Use with someone else and take turns spotting for each other. Stay 6 feet from your buddy if you are not from the same household to avoid passing COVID-19. A buddy system is safer than using alone. If you must use alone, call someone you know and have them stay on the phone with you while you use. Tell them your address and keep your door unlocked. Alternatively, you could call the Overdose Prevention Line at 1-888-853-8542 if you are about to use drugs and are located in Ontario.
- Do a small test dose first.
- Carry and be trained to use naloxone, which can be picked up for free from your local harm reduction agency or pharmacy. Naloxone will not work on synthetic cannabinoids but will work on any opioids.
- Call 911 in an overdose situation. The Good Samaritan Drug Overdose Act provides legal protection from drug-related charges for carrying drugs for personal use and other simple possession offences.
- If your drugs did not contain what you were expecting, consider talking to the person you got your drugs from, or get your drugs from another source if possible.