Results from 92 samples checked: October 9 – 22, 2021

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Key findings

  • ­92 samples were checked: 74% were substances1 and 26% were used paraphernalia2
  • 75% of the samples checked were expected3 to be fentanyl, cocaine, or methamphetamine
  • In an average5 fentanyl substance:
    • Fentanyl accounted for 3% of the sample (n=27)
    • Etizolam accounted for 2% of the sample (n=5)
    • Caffeine accounted for 19% of the sample (n=27)
  • 14% of the expected3 fentanyl samples checked were known to be associated with an overdose: almost all contained fentanyl, caffeine, and one or more benzodiazepine-related drug
  • 59% of the expected3 fentanyl samples checked contained at least one benzodiazepine-related drug
  • 12% of the expected3 fentanyl samples checked contained at least one nitazene opioid

Expected fentanyl substances

  • 85% (28) of expected3 fentanyl substances checked4 contained fentanyl and other drugs, including:
    • 89% (25) contained caffeine
    • 61% (17) contained a benzodiazepine-related drug (!):
      • 39% (11) contained etizolam (!)
      • 36% (10) contained flualprazolam (!)
      • 4% (1) contained flubromazolam (!)
    • 21% (6) contained despropionyl fentanyl (4-ANPP) (!)
    • 18% (5) contained a nitazene opioid (!):
      • 11% (3) contained metonitazene (!)
      • 4% (1) contained etonitazepyne (!)
      • 4% (1) contained isotonitazene/protonitazene6 (!)
    • 14% (4) contained phenacetin (!)
    • 7% (2) contained valeryl fentanyl (!)
    • 4% (1) contained xylazine (!)

Unexpected noteworthy drugs found in other expected substances

  • 14% (5) of the remaining substances checked,4 meaning substances that weren’t expected3 to be fentanyl, contained an unexpected noteworthy drug, including:
    • 25% (2) of expected cocaine substances contained levamisole (!)
    • 25% (2) of expected cocaine substances contained phenacetin (!)
    • 13% (1) of expected cocaine substances contained etonitazepyne (!) – note that no cocaine was found in this substance

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.

5 | Average amount of drugs found: Toronto’s drug checking service can now 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 will publicly report the average (median) amount of fentanyl, cocaine, carfentanil, etizolam, and caffeine found in expected fentanyl substances. 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 clients. Noteworthy drugs are flagged when they are unexpectedly found in checked samples.