Results from samples checked by Toronto’s drug checking service: March 26 - April 8, 2022

Key findings

  • 126 samples were checked: 85% were substances1 and 15% were used equipment2
  • 71% of the samples checked were expected3 to be fentanyl, methamphetamine, or cocaine
  • In an average5 fentanyl substance1:
    • Fentanyl accounted for 5% of the sample (n=34)
    • Etizolam accounted for 3% of the sample (n=3)
    • Caffeine accounted for 28% of the sample (n=33)
  • 13% of the expected3 fentanyl samples checked were known to be associated with an overdose: all contained a high-potency opioid (fentanyl and/or a nitazene opioid) – many also contained other central nervous system and respiratory depressants, like benzodiazepine-related drugs or xylazine
  • 38% of the expected3 fentanyl samples checked contained at least one benzodiazepine-related drug
  • 27% of the expected3 fentanyl samples checked contained a nitazene opioid
  • 25% of the expected3 fentanyl samples checked contained xylazine
  • A new data visualization to summarize noteworthy drug(!) trends found in samples checked since our service launched in 2019 has been added to our website

Expected fentanyl substances

  • 84% (32) of expected3 fentanyl substances checked4 contained fentanyl and other drugs, including:
    • 100% (32) contained caffeine
    • 38% (12) contained a benzodiazepine-related drug (!):
      • 16% (5) contained etizolam (!)
      • 16% (5) contained flualprazolam (!)
      • 13% (4) contained bromazolam (!)
    • 31% (10) contained xylazine (!)
    • 28% (9) contained despropionyl fentanyl (4-ANPP) (!)
    • 28% (9) contained a nitazene opioid (!):
      • 19% (6) contained metonitazene (!)
      • 9% (3) contained isotonitazene/protonitazene6 (!)
      • 3% (1) contained etodesnitazene (!)

Unexpected noteworthy drugs found in other expected substances

  • 19% (13) of the remaining substances checked,4 meaning substances that weren’t expected3 to be fentanyl, contained an unexpected noteworthy drug, including:
    • 13% (2) of expected cocaine substances contained levamisole (!)
    • 7% (1) of expected cocaine substances contained phenacetin (!)
    • 6% (1) of expected methamphetamine substances contained flualprazolam (benzodiazepine-related) (!)
    • 50% (1) of expected crack cocaine substances contained phenacetin (!)
    • Six expected methamphetamine substances submitted from London, Ontario contained fentanyl (!) – a public health alert was by disseminated by the Middlesex-London Health Unit
    • One expected MDMA substance that did not contain MDMA contained 5-aminoisotonitazene (!) and isotonitazene/protonitazene6 (!)
    • One expected oxycodone (OxyContin) substance that did not contain oxycodone contained etonitazepyne (!)

Notes

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

2 | Used equipment: Two types of samples are accepted by Toronto’s drug checking service: substances and used drug equipment. Used equipment 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 was bought or got as 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 equipment, drug equipment – 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 equipment 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 noted when we exclude used equipment from this report.

5 | Average amount of drugs found: Toronto’s drug checking service can report the amount of fentanyl, cocaine, carfentanil, etizolam, and caffeine found as a proportion of the total sample submitted for expected opioid, cocaine, crack cocaine, and some other powder substance samples. Every other week, we include the average (median) amount of fentanyl, cocaine, carfentanil, etizolam, and caffeine found in expected fentanyl substances in our report. More information is available on our website.

6 | Isotonitazene/protonitazene: Because isotonitazene and protonitazene have a very similar chemical structure, it is not currently possible for Toronto’s drug checking service to differentiate between the two. For this reason, we report the two drugs together.

(!) | Unexpected noteworthy drug: “Noteworthy drugs” are drugs 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 service users. Noteworthy drugs are flagged when they are unexpectedly found in checked samples.