Results from 167 samples checked: November 5 – 18, 2022

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Key findings

  • In 23 expected1 fentanyl substances2:
    • 9.0% was the average3 amount of fentanyl found
    • 3.0 – 13.0% was the range4 of fentanyl found in half of the substances2

Note that this is more than double the average3 amount of fentanyl we typically find in expected1 fentanyl substances.2 This unpredictability coincides with increased contamination of Toronto’s unregulated fentanyl supply and an increase in the City’s number of fatal suspected opioid overdoses.

  • 5% of the expected1 fentanyl samples5 were known to be associated with an overdose: all contained fentanyl, most contained carfentanil (up to 100 times stronger than fentanyl)
  • 49% of the expected1 fentanyl samples5 contained benzodiazepine-related drug(s) and/or xylazine. Of those:
    • 94% contained benzodiazepine-related drug(s) (but no xylazine) – 40% of these samples contained multiple benzodiazepine-related drugs
    • 6% contained xylazine (but no benzodiazepine-related drug(s))
  • 5% of the expected1 fentanyl samples5 contained at least one nitazene opioid (up to 20 times stronger than fentanyl)
  • 14% of the expected1 fentanyl samples5 contained carfentanil
  • 12% of expected1 fentanyl samples5 did not contain fentanyl but contained another high-potency opioid, such as fluorofentanyl (suggested to be the same potency as fentanyl), carfentanil, or etonitazepyne (nitazene opioid up to 10 times stronger than fentanyl)
  • We continued to find desalkylgidazepam (a “new” benzodiazepine-related drug) in expected1 fentanyl samples5 – unfortunately, we know little about its potency or the duration of its effects at this time

Expected fentanyl substances

  • 74% (25) of expected1 fentanyl substances6 contained fentanyl and other drugs, including:
    • 84% (21) contained caffeine
    • 64% (16) contained at least one benzodiazepine-related drug (!):
      • 40% (10) contained bromazolam (!)
      • 20% (5) contained deschloroetizolam (!)
      • 12% (3) contained etizolam (!)
      • 8% (2) contained flubromazepam (!)
      • 4% (1) contained flualprazolam (!)
    • 20% (5) contained despropionyl fentanyl (4-ANPP) (!)
    • 12% (3) contained phenacetin (!)
    • 8% (2) contained fluorofentanyl (!)
    • 8% (2) contained isotonitazene/protonitazene7 (!)
    • 8% (2) contained xylazine (!)
    • 4% (1) contained acetyl fentanyl (!)
    • 4% (1) contained carfentanil (!)

Unexpected noteworthy drugs found in other expected substances

  • 9% (8) of the remaining substances,6 meaning substances2 that weren’t expected1 to be fentanyl, contained an unexpected noteworthy drug, including:
    • 17% (4) of expected1 cocaine substances2 contained phenacetin (!)
    • 4% (1) of expected1 cocaine substances2 contained levamisole (!)
    • 17% (1) expected1 crack cocaine substances2 contained phenacetin (!)
    • 100% (1) of expected1 carfentanil substances2 contained fentanyl (!)
    • 100% (1) of expected1 carfentanil substances2 contained fluorofentanyl (!)
    • 100% (1) of expected1 carfentanil substances2 contained phenacetin (!)
    • 100% (1) of expected1 heroin substances2 contained fentanyl (!)

Notes

1 | 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).

2 | Substances: Could be a small amount of powder, crystals, rocks, blotter, or liquid, or a crushed bit of a pill.

3 | Average amount: We arrange the amount of fentanyl found in expected fentanyl substances in ascending or descending order, determine the median (i.e., the middle number), and use that number as the “average”. More information about the amounts 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 can be found on our website.

4 | Range: Represents the amount of fentanyl found in 50% of the expected fentanyl substances checked. More information about the amounts 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 can be found on our website.

5 | Samples: Includes both substances and used drug equipment. Substances could be a small amount of powder, crystals, rocks, blotter, or liquid, or a crushed bit of a pill. Used equipment could be a used cooker or filter, or leftover liquid from a syringe.

6 | 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.

7 | 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.

8 | Substances that unexpectedly contain high-potency opioids or benzodiazepine-related drugs and not the expected drug: Our reports highlight unexpected noteworthy drugs found in all checked substances. When high-potency opioids or benzodiazepine-related drugs are found unexpectedly in a substance sample and the expected drug is not present, we flag it but are hesitant to consider it contamination of the expected drug. Instead, we assume there is an issue with the expected drug: the person who sold or provided the drugs accidentally mixed up their drugs, the service user accidentally mixed up their drugs, or the expected drug was recorded incorrectly during sample collection. These samples require special consideration.

(!) | 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.