What is the purpose of this alert?
Between March 3 and April 1, 2021, carfentanil was found in 3% of the expected fentanyl samples checked by Toronto’s drug checking service (3 of 104 samples). The presence of carfentanil was not expected by those who submitted these samples to be checked.
Carfentanil was found alongside caffeine, fentanyl, and etizolam (benzodiazepine-related). It is noteworthy that even trace amounts of carfentanil have the potential to increase the risk of overdose.
These samples were collected in Toronto’s west end and downtown core. 67% of these samples were reported as being the colour purple (2 of 3 samples). None of these samples were known to be associated with an overdose or adverse effect.
The presence of carfentanil in Toronto’s unregulated drug supply aligns with a record number of overdoses, as reported by Toronto’s harm reduction community, Toronto Public Health, and the Office of the Chief Coroner for Ontario. Preliminarily information shared by the Office of the Chief Coroner for Ontario on April 6, 2021, states that carfentanil was detected in 16 suspected drug-related deaths since the start of 2021.
Toronto’s drug checking service has detected carfentanil in 1% of the expected fentanyl samples checked since October 2019. An alert was released by Toronto’s drug checking service in September 2020 when there was a resurgence of carfentanil in Toronto’s unregulated drug supply. To date, 5 fentanyl samples in 2021 have contained carfentanil.
What is carfentanil?
Carfentanil is a synthetic opioid that is related to fentanyl. However, carfentanil is approximately 100 times stronger than fentanyl, 4,000 times stronger than heroin, and 10,000 times stronger than morphine. It is typically used by veterinarians on very large animals, like elephants and moose.
What are the potential effects of using carfentanil?
The use of carfentanil may result in extreme sedation and dangerous suppression of the respiratory system. Since carfentanil is so strong, the chance of overdose is increased. It is more difficult for naloxone to reverse overdoses caused by such a strong opioid and greater than normal doses of naloxone are required. Carfentanil contributes to death: the drug presented in over 33% of the opioid-related deaths in Toronto in 2019.
Advice to reduce potential harms:
- Carry and be trained to use naloxone. Naloxone, also known by the brand name Narcan, is a drug that can temporarily reverse an opioid overdose. Naloxone can be picked up for free from your local harm reduction agency or pharmacy and free training is available online. Consider carrying multiple doses of naloxone.
- Get your drugs checked before using. In Toronto, drug checking services are offered at Moss Park Consumption and Treatment Service, Parkdale Queen West Community Health Centre (Queen West and Parkdale sites), South Riverdale Community Health Centre, and The Works at Toronto Public Health. You can also check your drugs after you have used them by submitting paraphernalia, like a cooker or a filter.
- Use at a supervised consumption site. Here is a list of sites that offer supervised consumption in Toronto and an interactive map of sites that offer supervised consumption across Canada.
- Use with someone else and take turns spotting for each other. A buddy system is safer than using alone. Stay 6 feet from your buddy if you are not from the same household to avoid passing COVID-19.
- If you must use alone, let someone know before you use. Call someone you know and have them stay on the phone with you while you use. Tell them your address and keep your door unlocked. If you are in Ontario, you could call the Overdose Prevention Line at 1-888-853-8542. The National Overdose Response Service is available to anyone in Canada and can be reached at 1-888-688-NORS (6677). BeSafe is an app that can be downloaded on your phone and provides another way to let someone know before you use.
- Do a small test dose first.
- Call 911 in an overdose situation. The Good Samaritan Drug Overdose Act provides legal protection from drug-related charges for carrying drugs for personal use and other simple possession offences.
- If your drugs did not contain what you were expecting, consider talking to the person you got your drugs from, or get your drugs from another source if possible.