139 samples checked: November 18 – December 1, 2023

Key findings

  • 7% of the expected1 fentanyl samples5 were known to be associated with an overdose: almost all of these samples contained at least one high-potency opioid (an opioid that is as strong as or stronger than fentanyl) and almost half contained at least one benzodiazepine-related drug
  • 51% of the expected1 fentanyl samples5 contained fluorofentanyl (up to 2 times stronger than fentanyl)
  • 46% of the expected1 fentanyl samples5 contained a benzodiazepine-related drug – 19% of these samples contained multiple benzodiazepine-related drugs
  • 12% of the expected1 fentanyl samples5 contained a methylfentanyl-related drug – we are in the process of determining which methylfentanyl-related drug(s) in collaboration with our analysis site members at Michael’s Hospital (department of laboratory medicine) and the Centre for Addiction and Mental Health (clinical laboratory and diagnostic services), as well as Health Canada’s Drug Analysis Service, the Centre for Forensic Science Research & Education, and the BCCSU Drug Checking Project
  • 7% of the expected1 fentanyl samples5 contained a nitazene opioid (up to 10 times stronger than fentanyl)
  • 1% of the expected1 fentanyl samples5 contained xylazine (veterinary tranquilizer)
  • 48% of the expected1 fentanyl samples5 contained multiple high-potency opioids, including fentanyl, fluorofentanyl, a methylfentanyl-related drug, and nitazene opioids
  • Amount of drugs found in expected1 fentanyl substances2:
    • In 37 expected1 fentanyl substances2:
      • 1.9% was the average3 amount of fentanyl found
      • 1.3 – 6.5% was the range4 of fentanyl found in half of the substances2
    • In 16 expected1 fentanyl substances2:
      • 1.3% was the average3 amount of bromazolam found
      • 0.9 – 3.9% was the range4 of bromazolam found in half of the substances2
    • In 21 expected1 fentanyl substances2:
      • 4.0% was the average3 amount of fluorofentanyl found
      • 2.6 – 5.3% was the range4 of fluorofentanyl found in half of the substances2

Expected fentanyl substances

  • 78% (40) of the expected1 fentanyl substances6 contained fentanyl and other drugs, including:
    • 95% (38) contained caffeine
    • 63% (25) contained at least one additional high-potency opioid (!):
      • 38% (15) contained fluorofentanyl (!)
      • 15% (6) contained a methylfentanyl-related drug (!)
      • 10% (4) contained metonitazene (!)
    • 40% (16) contained at least one benzodiazepine-related drug (!):
      • 30% (12) contained bromazolam (!)
      • 10% (4) contained etizolam (!)
      • 3% (1) contained desalkylgidazepam (!)
    • 20% (8) contained methamphetamine
    • 8% (3) contained furanyl UF-17 (opioid-related) (!)
    • 3% (1) contained acetyl fentanyl (!)
    • 3% (1) contained phenacetin (!)
    • 3% (1) contained xylazine (!)

Unexpected noteworthy drugs found in other expected substances

  • 6% (4) of the remaining substances,6 meaning substances2 that weren’t expected1 to be fentanyl, contained an unexpected noteworthy drug, including:
    • One expected1 benzodiazepine substance2 that did not contain a benzodiazepine-related drug contained xylazine (!)
    • One expected1 hydrocodone substance2 that did not contain hydrocodone contained metonitazene (nitazene opioid considered to be roughly as strong as fentanyl) (!)
    • Two expected1 carfentanil substances2 that did not contain carfentanil contained fentanyl (!) and fluorofentanyl (!) at 69% and 63% of the samples checked, respectively – the average amount of fentanyl and fluorofentanyl we are currently finding in expected fentanyl substances are 2% and 3%, respectively

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 heroin sample rather than fentanyl and heroin 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 amounts of a drug found as a proportion of the total fentanyl substance from smallest to largest, determine the median (i.e., the middle number), and use that number as the “average”. More information about the amounts of drugs found as a proportion of the total sample submitted can be found on our website.

4 | Range: Known as the interquartile range, represents the middle 50% of the amounts of a drug found as a proportion of the total fentanyl substance. More information about the amounts of drugs found as a proportion of the total sample submitted 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 | Reporting similar drugs together: These drugs have a very similar chemical structure, and it is not currently possible for Toronto’s Drug Checking Service to differentiate between them. For this reason, we report these drugs together. For more information on these drugs, view our drug dictionary.

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.