Diverse psychotropic substances detected in drug and drug administration equipment samples submitted to drug checking services in Toronto, Ontario, Canada, October 2019-April 2020 - PubMed (original) (raw)

Diverse psychotropic substances detected in drug and drug administration equipment samples submitted to drug checking services in Toronto, Ontario, Canada, October 2019-April 2020

Kristy M Scarfone et al. Harm Reduct J. 2022.

Abstract

Background: The overdose crisis has generated innovative harm reduction and drug market monitoring strategies. In Toronto, Ontario, Canada, a multi-site drug checking service (DCS) pilot project was launched in October 2019. The project provides people who use drugs with information on the chemical composition of their substances, thereby increasing their capacity to make more informed decisions about their drug use and avoid overdose. DCS also provides real-time market monitoring to identify trends in the unregulated drug supply.

Methods: Sample data were obtained through analyses of drug and used drug administration equipment samples submitted anonymously and free of charge to DCS in downtown Toronto from October 10, 2019, to April 9, 2020, representing the first six months of DCS implementation. Analyses were conducted in clinical laboratories using liquid chromatography- and/or gas chromatography-mass spectrometry (LC-MS, GC-MS) techniques.

Results: Overall, 555 samples were submitted, with 49% (271) of samples that were found to contain high-potency opioids, of which 87% (235) also contained stimulants. Benzodiazepine-type drugs were found in 21% (116) of all samples, and synthetic cannabinoids in 1% (7) of all samples. Negative effects (including overdose, adverse health events, and extreme sedation) were reported for 11% (59) of samples submitted for analysis.

Conclusions: Toronto's DCS identified a range of high-potency opioids with stimulants, benzodiazepine-type drugs, and a synthetic cannabinoid, AMB-FUBINACA. This information can inform a range of evidence-informed overdose prevention efforts.

Keywords: Drug overdose; Etizolam; Fentanyl; Flualprazolam; Synthetic cannabinoid.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1

Graphical depiction of sample types stratified by category of drug detected (i.e., benzodiazepine, synthetic cannabinoid, or high-potency opioid) compared to total number of samples in that category (N = 555)

Fig. 2

A breakdown of high-potency opioids, benzodiazepine-type drugs, and synthetic cannabinoids found in samples expected to be heroin, fentanyl, and carfentanil (n = 268)

Fig. 3

A breakdown of unexpected fentanyl and related opioid drugs detected among the associated expected stimulant samples submitted to DCS (n = 110). *MDA: 3,4-Methylenedioxyamphetamine. **MDMA: 3,4-Methylenedioxymethamphetamine

Cited by

A rapid review of current engagement strategies with people who use drugs in monitoring and reporting on substance use-related harms.
Perri M, Khorasheh T, Poon DE, Kaminski N, LeBlanc S, Mizon L, Smoke A, Strike C, Leece P. Perri M, et al. Harm Reduct J. 2023 Nov 14;20(1):169. doi: 10.1186/s12954-023-00902-x. Harm Reduct J. 2023. PMID: 37964286 Free PMC article. Review.
Point-of-care community drug checking technologies: an insider look at the scientific principles and practical considerations.
Gozdzialski L, Wallace B, Hore D. Gozdzialski L, et al. Harm Reduct J. 2023 Mar 25;20(1):39. doi: 10.1186/s12954-023-00764-3. Harm Reduct J. 2023. PMID: 36966319 Free PMC article. Review.
Prevalence of fentanyl in methamphetamine and cocaine samples collected by community-based drug checking services.
Wagner KD, Fiuty P, Page K, Tracy EC, Nocera M, Miller CW, Tarhuni LJ, Dasgupta N. Wagner KD, et al. Drug Alcohol Depend. 2023 Nov 1;252:110985. doi: 10.1016/j.drugalcdep.2023.110985. Epub 2023 Oct 5. Drug Alcohol Depend. 2023. PMID: 37826988 Free PMC article.
Current attitudes toward drug checking services and a comparison of expected with actual drugs present in street drug samples collected from opioid users.
Swartz JA, Lieberman M, Jimenez AD, Mackesy-Amiti ME, Whitehead HD, Hayes KL, Taylor L, Prete E. Swartz JA, et al. Harm Reduct J. 2023 Jul 7;20(1):87. doi: 10.1186/s12954-023-00821-x. Harm Reduct J. 2023. PMID: 37420196 Free PMC article.
Community overdose surveillance: Fentanyl involvement in overdose deaths in rural Michigan.
Victor G, Hedden-Clayton BJ, Lister J, Lee G, Huynh P, Ray B. Victor G, et al. Drug Alcohol Depend Rep. 2023 Mar 29;7:100150. doi: 10.1016/j.dadr.2023.100150. eCollection 2023 Jun. Drug Alcohol Depend Rep. 2023. PMID: 37069960 Free PMC article.

References

1. U. S. Drug Enforcement Administration, Diversion Control Division. National Forensic Laboratory Information System: NFLIS-Drug 2019 Midyear Report. Springfield, VA; 2020. https://www.nflis.deadiversion.usdoj.gov:8443/nflisdata/docs/NFLIS-DRUG_...
1. Payer DE, Young MM, Maloney-Hall B, Mill C, Leclerc P, Buxton J, the Canadian Community Epidemiology Network on Drug Use, the National Drug Checking Working Group. Adulterants, contaminants and co-occurring substances in drugs on the illegal market in Canada: an analysis of data from drug seizures, drug checking and urine toxicology. Ottawa: Canadian Centre on Substance Use and Addiction; 2020. https://www.ccsa.ca/sites/default/files/2020-04/CCSA-CCENDU-Adulterants-....
1. Public Health Agency of Canada; Special Advisory Committee on the Epidemic of Opioid Overdoses. Opioids and stimulant-related Harms in Canada. Ottawa: Government of Canada Health Infobase; 2020. https://health-infobase.canada.ca/substance-related-harms/opioids-stimul....
1. Gomes T, Greaves S, Tadrous M, Mamdani MM, Paterson JM, Juurlink DN. Measuring the burden of opioid-related mortality in Ontario, Canada. J Addict Med. 2018;12(5):418. doi: 10.1097/ADM.0000000000000412. - DOI - PMC - PubMed
1. Gomes T, Kitchen SA, Murray R. Measuring the burden of opioid-related mortality in Ontario, Canada, during the COVID-19 pandemic. JAMA Netw Open. 2021;4(5):e2112865. doi: 10.1001/jamanetworkopen.2021.12865. - DOI - PMC - PubMed

Diverse psychotropic substances detected in drug and drug administration equipment samples submitted to drug checking services in Toronto, Ontario, Canada, October 2019-April 2020 - PubMed (original) (raw)