Key findings
- 19% of the expected1 fentanyl samples5 were known to be associated with an overdose: almost all of these samples contained a high-potency opioid (an opioid as strong as or stronger than fentanyl) – many contained multiple high-potency opioids, as well as benzodiazepine-related drugs and veterinary tranquilizers
- 69% of the expected1 fentanyl samples5 contained multiple high-potency opioids, including fentanyl, fluorofentanyl, a methylfentanyl-related drug, nitazene opioids, and/or carfentanil
- 61% of the expected1 fentanyl samples5 contained fluorofentanyl (up to 2 times stronger than fentanyl)
- 61% of the expected1 fentanyl samples5 contained a methylfentanyl-related drug (roughly as strong as fentanyl)
- 59% of the expected1 fentanyl samples5 contained a benzodiazepine-related drug – 17% of these samples contained multiple benzodiazepine-related drugs
- 25% of the expected1 fentanyl samples5 contained a veterinary tranquilizer – 17% contained xylazine and 8% contained medetomidine
- 3% of the expected1 fentanyl samples5 contained a nitazene opioid (up to 25 times stronger than fentanyl)
- 2% of the expected1 fentanyl samples5 contained carfentanil (up to 100 times stronger than fentanyl) – the last time we identified carfentanil in Toronto’s unregulated drug supply was January 12, 2024, and we have only identified it 5 times since April 1, 2023
- 31% of the expected1 fentanyl samples5 did not contain fentanyl – most of these samples instead contained fluorofentanyl, a methylfentanyl-related drug, and/or nitazene opioids
- We released two communications on emerging trends in Toronto’s unregulated opioid supply: N-desethyl etonitazene and protonitazepyne: “New” nitazene opioids circulating in Toronto’s unregulated opioid supply and Nitazene opioids in Toronto opioid samples that are not expected to contain high-potency opioids
- Amount of drugs found in expected1 fentanyl drug samples2:
- In 12 expected1 fentanyl drug samples2:
- 3.3% was the average3 amount of fentanyl found
- 1.5 – 7.8% was the range4 of fentanyl found in half of the drug samples2
- In 12 expected1 fentanyl drug samples2:
- 1.8% was the average3 amount of fluorofentanyl found
- 0.7 – 6.6% was the range4 of fluorofentanyl found in half of the drug samples2
- In 14 expected1 fentanyl drug samples2:
- 2.2% was the average3 amount of bromazolam found
- 0.6 – 3.2% was the range4 of bromazolam found in half of the drug samples2
- In 5 expected1 fentanyl drug samples2:
- 3.7% was the average3 amount of xylazine found
- 2.9 – 7.3% was the range4 of xylazine found in half of the drug samples2
- In 12 expected1 fentanyl drug samples2:
Expected fentanyl drugs samples
- 66% (29) of the expected1 fentanyl drug samples6 contained fentanyl and other drugs, including:
- 100% (29) contained caffeine
- 83% (24) contained at least one additional high-potency opioid (!):
- 62% (18) contained fluorofentanyl (!)
- 62% (18) contained a methylfentanyl-related drug (!)
- 3% (1) contained metonitazene (!)
- 3% (1) contained carfentanil (!)
- 72% (21) contained at least one benzodiazepine-related drug (!):
- 69% (20) contained bromazolam (!)
- 7% (2) contained flualprazolam (!)
- 3% (1) contained flubromazepam (!)
- 24% (7) contained at least one veterinary tranquilizer (!):
- 14% (4) contained medetomidine (!)
- 10% (3) contained xylazine (!)
- 3% (1) contained acetyl fentanyl (!)
- 3% (1) contained phenacetin (!)
Unexpected noteworthy drugs found in other expected drug samples
- 8% (7) of the remaining drug samples,6 meaning drug samples2 that weren’t expected1 to be fentanyl, contained an unexpected noteworthy drug, including:
- 13% (1) of expected1 methamphetamine drug samples2 contained phenacetin (!)
- 50% (1) of expected1 crack cocaine drug samples2 contained phenacetin (!)
- One expected1 carfentanil drug sample2 contained fentanyl (!), a methylfentanyl-related drug (!), benzodiazepine-related drug bromazolam (!), and veterinary tranquilizers medetomidine (!) and xylazine (!)
- We are observing an increase in the presence of high-potency opioids in samples expected to be oxycodone (OxyContin), Percocet, hydromorphone (Dilaudid), hydrocodone, and oxymorphone – the risk of overdose may be further increased for people who use these drugs, as compared to people who use fentanyl, because their opioid tolerance may be lower:
- One expected1 Percocet drug sample2 that did not contain8 oxycodone or acetaminophen contained fentanyl (!)
- One expected1 Percocet drug sample2 that did not contain8 oxycodone or acetaminophen contained isotonitazene/protonitazene7 (!)
- One expected1 oxycodone (OxyContin) drug sample2 that did not contain8 oxycodone contained N-desethyl etonitazene (!)
- One expected1 oxymorphone drug sample2 that did not contain8 oxymorphone contained N-desethyl etonitazene (!)
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 | Drug samples: 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 substance found as a proportion of the total fentanyl drug sample 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 substances 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 substance found as a proportion of the total fentanyl drug sample. More information about the amounts of substances found as a proportion of the total sample submitted can be found on our website.
5 | Samples: Includes both drugs and used drug equipment. Drugs 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 drug samples: While Toronto’s Drug Checking Service checks both drugs 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 substances may be found. This means that when equipment is re-used, substances from past use may present in the results for the sample that is being checked. This can interfere with up-to-date drug market monitoring, so we’ve noted when we exclude used equipment from this report.
7 | Reporting similar substances together: These substances 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 substances together. For more information on these substances, view our drug dictionary.
8 | Drug samples 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 drug samples. When high-potency opioids or benzodiazepine-related drugs are found unexpectedly in a drug 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.