Diverse psychotropic substances detected in drug and drug administration equipment samples submitted to drug checking services in Toronto, Ontario, Canada, October 2019\u2013April 2020

Kristy M Scarfone,Ernest Wong,Peter Leslie,Nazlee Maghsoudi,Daniel R Beriault,Karen Mcdonald,Cristiana Stefan,Toronto’s Drug Checking Service Working Group ,Mark Evert,Dan Werb,Tara Marie Watson,Shaun Hopkins

doi:10.1186/s12954-021-00585-2

Abstract

BackgroundThe overdose crisis has generated innovative harm reduction and drug market monitoring strategies. In Toronto, Ontario, Canada, a multi-site drug checking service (DCS) pilot project was launched in October 2019. The project provides people who use drugs with information on the chemical composition of their substances, thereby increasing their capacity to make more informed decisions about their drug use and avoid overdose. DCS also provides real-time market monitoring to identify trends in the unregulated drug supply.MethodsSample data were obtained through analyses of drug and used drug administration equipment samples submitted anonymously and free of charge to DCS in downtown Toronto from October 10, 2019, to April 9, 2020, representing the first six months of DCS implementation. Analyses were conducted in clinical laboratories using liquid chromatography- and/or gas chromatography-mass spectrometry (LC–MS, GC–MS) techniques.ResultsOverall, 555 samples were submitted, with 49% (271) of samples that were found to contain high-potency opioids, of which 87% (235) also contained stimulants. Benzodiazepine-type drugs were found in 21% (116) of all samples, and synthetic cannabinoids in 1% (7) of all samples. Negative effects (including overdose, adverse health events, and extreme sedation) were reported for 11% (59) of samples submitted for analysis.ConclusionsToronto’s DCS identified a range of high-potency opioids with stimulants, benzodiazepine-type drugs, and a synthetic cannabinoid, AMB-FUBINACA. This information can inform a range of evidence-informed overdose prevention efforts.

Highlights

The opioid overdose crisis is worsening throughout much of North America, in Canada and the United States [1, 2]
Since 2016, the number of lives lost to fatal overdoses, and/or serious complications related to non-fatal overdoses, has only risen
Incidence of serious complications associated with opioid overdose has increased by 67% from 2010 to 2019, 10% of whom died in the year following discharge [7]

Summary

Introduction

The opioid overdose crisis is worsening throughout much of North America, in Canada and the United States [1, 2]. Between 2004 and 2013, Toronto Public Health reported a 41% increase in the reported number of fatal overdoses in Toronto, increasing from 146 to 206 [6] From this time and until 2016, the unregulated drug supply was generally known to contain heroin by majority, and fentanyl as an emerging adulterant. Incidence of serious complications associated with opioid overdose has increased by 67% from 2010 to 2019, 10% of whom died in the year following discharge [7] It is understood by service users and front-line support services that fentanyl and related high potency opioids are no longer a mere minor adulterant in the unregulated street supply of opioids but have replaced what was largely a heroin market in 2016 as the current opioid majority and leads as the most commonly present opioid in accidental overdose deaths in Ontario [8, 9]. DCS provides real-time market monitoring to identify trends in the unregulated drug supply

Methods

Results

Discussion

Conclusion