Results from samples checked by Toronto’s drug checking service: May 8 – 21, 2021

Key findings

  • 122 samples were checked: 66% were substances1 and 34% were used paraphernalia2
  • 68% of the samples checked were expected3 to be fentanyl or cocaine
  • 15% of the expected3 fentanyl samples checked were known to be associated with an overdose: most of these samples contained fentanyl, caffeine, and a benzodiazepine-related drug
  • 72% of the expected3 fentanyl samples checked contained at least one benzodiazepine-related drug
  • Flubromazepam (benzodiazepine-related drug) presented for the first time in an expected3 fentanyl sample
  • We published an alert about “ultra potent” opioids continuing to circulate in Toronto’s unregulated drug supply and continued to see carfentanil, isotonitazene, and etonitazene in samples expected to be opioids
  • AMB-FUBINACA (a synthetic cannabinoid-related drug) resurged in expected3 fentanyl samples

Expected fentanyl substances

  • 80% (24) of expected3 fentanyl substances checked4 contained fentanyl and other drugs, including:
  • 92% (22) contained caffeine
  • 80% (19) contained a benzodiazepine-related drug (!):
    • 58% (14) contained etizolam (!)
    • 54% (13) contained deschloroetizolam (!)
    • 21% (5) contained flualprazolam (!)
    • 13% (3) contained bromazolam (!)
    • 4% (1) contained flubromazolam (!)
  • 54% (13) contained despropionyl fentanyl (4-ANPP) (!)
  • 33% (8) contained cocaine
  • 8% (2) contained phenacetin (!)
  • 4% (1) contained benzyl fentanyl (!)
  • 4% (1) contained furanyl UF-17 (opioid-related) (!)
  • 4% (1) contained xylazine (!)

Unexpected noteworthy drugs found in other expected substances

  • 28% (14) of the remaining substances checked,4 meaning substances that weren’t expected3 to be fentanyl, contained an unexpected noteworthy drug, including:

Expected cocaine substances (18)

  • 33% (6) contained levamisole (!)
  • 11% (2) contained phenacetin (!)
  • 6% (1) contained a benzodiazepine-related drug (!)

Expected methamphetamine substances (4)

  • 25% (1) contained a benzodiazepine-related drug (!)

Expected crack cocaine substances (2)

  • 100% (2) contained phenacetin (!)
  • 50% (1) contained levamisole (!)

Expected heroin substances (2)

  • 50% (1) contained a benzodiazepine-related drug (!)
  • 50% (1) contained despropionyl fentanyl (4-ANPP) (!)
  • 50% (1) contained fentanyl (!)

Expected down substances (1)

  • 100% (1) contained a benzodiazepine-related drug (!)
  • 100% (1) contained isotonitazene (!)

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.