Results from samples checked by Toronto’s drug checking service: April 10 – 23, 2021

Key findings

  • 76 samples were checked: 55% were substances1 and 45% were used paraphernalia2
  • 62% of the samples checked were expected3 to be fentanyl or methamphetamine
  • 8% of the samples checked were known to be associated with an overdose: each sample contained fentanyl and caffeine, all but one sample contained a benzodiazepine-related drug
  • 17% of expected3 fentanyl samples checked contained xylazine
  • 12% of expected3 fentanyl samples checked contained carfentanil
  • We published an alert about the introduction of highly potent opioid isotonitizene in samples checked
  • Benzodiazepine-related drugs bromazolam and flurazepam presented for the first time in expected3 fentanyl samples checked
  • 59% of expected3 fentanyl samples checked contained at least one of the following benzodiazepine-related drugs: alprazolam (Xanax), bromazolam, desalkylflurazepam, deschloroetizolam, diazepam (Valium), etizolam, flualprazolam, flurazepam, or meclonazepam

Expected fentanyl substances

  • 75% (9) of expected3 fentanyl substances checked4 contained fentanyl and other drugs, including:
  • 100% (9) contained caffeine
  • 56% (5) contained a benzodiazepine-related drug (!):
    • 44% (4) contained etizolam (!)
    • 22% (2) contained flualprazolam (!)
  • 22% (2) contained despropionyl fentanyl (4-ANPP) (!)
  • 22% (2) contained methamphetamine
  • 22% (2) contained phenacetin (!)
  • 11% (1) contained acetyl fentanyl (!)
  • 11% (1) contained carfentanil (!)
  • 11% (1) contained xylazine (!)

Unexpected noteworthy drugs found in other expected substances

  • 7% (2) of the remaining substances checked,4 meaning substances that weren’t expected3 to be fentanyl, contained an unexpected noteworthy drug, including:
    • 33% (1) of expected cocaine substances contained levamisole (!)
    • 100% (1) of expected crack cocaine substances contained phenacetin (!)

Notes

1 | Substances: Two types of samples are accepted by Toronto’s drug checking service: substances and used paraphernalia. Substances could be a small amount of powder, a crushed bit of a pill, blotter, or a small amount of liquid.

2 | Used paraphernalia: Two types of samples are accepted by Toronto’s drug checking service: substances and used paraphernalia. Used paraphernalia could be a used cooker or filter, or leftover liquid from a syringe.

3 | Expected (drug): When a sample is submitted to be checked, the drug that sample is expected to contain is recorded. We call it the “expected drug”. Knowing the expected drug helps us tailor our harm reduction advice. It also helps us understand contamination to drugs rather than combinations of drugs (e.g., fentanyl was found in a cocaine sample rather than fentanyl and cocaine were found together).

4 | Reason for reporting only substance samples: While Toronto’s drug checking service checks both substances and used paraphernalia, we’re sharing findings from substances only. Paraphernalia, like cookers, are often re-used. The mass spectrometry technologies used for this drug checking service are so sensitive that very trace amounts of drugs may be found. This means that when paraphernalia is re-used, drugs from past use may present in the results for the sample that is being checked. This can interfere with up-to-date drug supply monitoring, so we’ve excluded used paraphernalia from this report.

(!) | Unexpected noteworthy drug: “Noteworthy drugs” are drugs that that (i) are linked to overdose or other adverse effects, (ii) are highly potent or related to highly potent drugs, or (iii) may not be desired by some clients. Noteworthy drugs are flagged when they are unexpectedly found in checked samples.