Key findings
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- 6% of the expected1 fentanyl samples5 were known to be associated with an overdose: all of these samples contained at least one high-potency opioid (an opioid that is as strong or stronger than fentanyl) and most contained a benzodiazepine-related drug
- 65% of the expected1 fentanyl samples5 contained a benzodiazepine-related drug – 13% of these samples contained multiple benzodiazepine-related drugs
- 38% of the expected1 fentanyl samples5 contained fluorofentanyl (up to 2 times stronger than fentanyl)
- 7% of the expected1 fentanyl samples5 contained xylazine (veterinary tranquilizer)
- 4% of the expected1 fentanyl samples5 contained a nitazene opioid (up to 10 times stronger than fentanyl)
- 39% of the expected1 fentanyl samples5 contained multiple high-potency opioids, including fentanyl, fluorofentanyl, and/or a nitazene opioid
- Amount of drugs found in expected1 fentanyl substances2:
- In 41 expected1 fentanyl substances2:
- 1.8% was the average3 amount of fentanyl found
- 0.9 – 3.7% was the range4 of fentanyl found in half of the substances2
- In 29 expected1 fentanyl substances2:
- 1.1% was the average3 amount of bromazolam found
- 0.6 – 2.6% was the range4 of bromazolam found in half of the substances2
- In 18 expected1 fentanyl substances2:
- 2.3% was the average3 amount of fluorofentanyl found
- 0.6 – 6.1% was the range4 of fluorofentanyl found in half of the substances2
- In 3 expected1 fentanyl substances2:
- 0.4% was the average3 amount of xylazine found
- 0.4 – 0.9% was the range4 of xylazine found in half of the substances2
- In 41 expected1 fentanyl substances2:
Expected fentanyl substances
- 94% (49) of the expected1 fentanyl substances6 contained fentanyl and other drugs, including:
- 94% (46) contained caffeine
- 67% (33) contained at least one benzodiazepine-related drug (!):
- 61% (30) contained bromazolam (!)
- 8% (4) contained desalkylgidazepam (!)
- 2% (1) contained clonazolam (!)
- 2% (1) contained etizolam (!)
- 45% (22) contained at least one additional high-potency opioid (!):
- 43% (21) contained fluorofentanyl (!)
- 4% (2) contained metonitazene (!)
- 2% (1) contained N-desethyl isotonitazene (!)
- 8% (4) contained xylazine (!)
- 4% (2) contained butyryl fentanyl/isobutyryl fentanyl (!)
- 4% (2) contained phenacetin (!)
- 2% (1) contained acetyl fentanyl (!)
Unexpected noteworthy drugs found in other expected substances
- 2% (1) of the remaining substances,6 meaning substances2 that weren’t expected1 to be fentanyl, contained an unexpected noteworthy drug, including:
- One expected1 heroin substance2 that did not contain heroin contained fentanyl (!), fluorofentanyl (!), bromazolam (benzodiazepine-related) (!), and xylazine (!)
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 | 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.