Carfentanil circulating in Toronto’s unregulated drug supply

What is the purpose of this alert?

Between September 9 and 17, 2020, carfentanil was found in 11% of the expected fentanyl samples checked by Toronto’s drug checking service (4 of 36 samples). The presence of carfentanil was not expected by those who submitted these samples to be checked.

Carfentanil was found in trace amounts, alongside fentanyl, caffeine, etizolam (benzodiazepine-related), and trace amounts of other fentanyl-related drugs. 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 east end, west end, and downtown core. 50% of these samples were reported as being the colour purple (2 of 4 samples).

The presence of carfentanil in Toronto’s unregulated drug supply aligns with an increase in overdoses, as reported by Toronto’s harm reduction community.

Prior to September 9, 2020, Toronto’s drug checking service had detected carfentanil in 1% of the expected opioid samples checked (6 of 574 samples). The last time carfentanil was found by Toronto’s drug checking service was in April 2020.

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.

The Chief Coroner of Ontario reported carfentanil as the opioid that contributed to death in 21% of accidental opioid-related deaths in Toronto and Ontario between April 1, 2019, and April 30, 2020.

Advice to reduce potential harms:

  1. 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’ve used them by submitting paraphernalia, like a cooker or a filter.
  2. Use at a supervised consumption site or overdose prevention site. Here is a list of sites that offer supervised consumption in Toronto.
  3. Use with someone else and take turns spotting for each other. Stay 6 feet from your buddy if you are not from the same household to avoid passing COVID-19. A buddy system is safer than using alone. If you must use alone, 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. Alternatively, you could call the Overdose Prevention Line at 1-888-853-8542 if you are about to use drugs and are located in Ontario.
  4. Do a small test dose first.
  5. Carry and be trained to use naloxone, which can be picked up for free from your local harm reduction agency or pharmacy.
  6. 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.
  7. 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.