Key findings
- In 25 expected1 fentanyl substances2:
- 2% was the average3 amount of fentanyl found
- 1 – 3% was the range4 of fentanyl found in half of the substances2
- 13% of the expected1 fentanyl samples5 were known to be associated with an overdose: all of these samples contained fentanyl and most contained bromazolam (benzodiazepine-related)
- 50% of the expected1 fentanyl samples5 contained a benzodiazepine-related drug – 17% of these samples contained multiple benzodiazepine-related drugs
- 31% of the expected1 fentanyl samples5 contained fluorofentanyl (up to 2 times stronger than fentanyl)
- No expected1 fentanyl samples5 contained xylazine (veterinary tranquilizer) – we have found xylazine in at least one expected1 fentanyl sample5 every reporting period since July 2022
- No expected1 fentanyl samples5 contained a nitazene opioid (up to 10 times stronger than fentanyl) – we have found nitazene opioids in at least one expected1 fentanyl sample5 every reporting period since May 2022
- No expected1 fentanyl samples5 contained carfentanil (up to 100 times stronger than fentanyl) –we have found carfentanil in one expected1 fentanyl sample5 since April 20, 2023, but were finding it consistently before then
- 25% of the expected1 fentanyl samples5 contained multiple high-potency opioids, including fentanyl and/or fluorofentanyl. Using high-potency opioids in combination may result in extreme sedation and dangerous suppression of the respiratory system. Since these drugs are so strong, the risk of overdose is increased, and greater than normal doses of naloxone may be required to rouse individuals experiencing an overdose.
- Toronto Public Health reported a higher than usual number of suspected opioid overdose-related deaths (11) attended by Toronto Paramedics Services between August 31 – September 6, 2023. Our service continues to confirm that the unregulated opioid supply is toxic, contaminated, and unpredictable.
Expected fentanyl substances
- 89% (31) of the expected1 fentanyl substances6 contained fentanyl and other drugs, including:
- 90% (28) contained caffeine
- 45% (14) contained bromazolam (benzodiazepine-related drug) (!)
- 29% (9) contained fluorofentanyl (!)
- 3% (1) contained phenacetin (!)
Unexpected noteworthy drugs found in other expected substances
- 3% (2) of the remaining substances,6 meaning substances2 that weren’t expected1 to be fentanyl, contained an unexpected noteworthy drug, including:
- 8% (1) of expected1 cocaine substances2 contained levamisole (!)
- 8% (1) of expected1 cocaine substances2 contained phenacetin (!)
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 cocaine sample rather than fentanyl and cocaine 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 amount of fentanyl found in expected fentanyl substances in ascending or descending order, determine the median (i.e., the middle number), and use that number as the “average”. More information about the amounts 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 can be found on our website.
4 | Range: Represents the amount of fentanyl found in 50% of the expected fentanyl substances checked. More information about the amounts 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 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 | 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.
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.