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

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.

A distributed model to expand the reach of drug checking

“…Fentanyl test strips are often integrated within harm reduction services at supervised consumption sites and overdose prevention services and are used off-label to provide a simple positive/negative result of the presence of fentanyl in a sample (Bergh et al , 2021; Park et al , 2021; Peiper et al , 2019; Weicker et al , 2020; Zibbell et al , 2021). At the same time, more sophisticated methods, typically optical-based technologies such as spectrometers, are being pursued for their potential to detect and report on the full composition of a sample including the active (psychoactive) ingredients and cuts and, whenever possible, to determine and report on the concentration of ingredients (Borden et al , 2021; Green et al , 2020; Maghsoudi et al , 2020; Scarfone et al , 2022). In other words, these technologies seek to provide both a qualitative analysis (all of the ingredients detected in a sample) as well as a quantitative analysis (the concentration of main ingredients, notably the actives).…”

Development of a Graphene-Oxide-Deposited Carbon Electrode for the Rapid and Low-Level Detection of Fentanyl and Derivatives

“…In addition, the recent prevalence of benzodiazepines in the illicit drug supply 29 demonstrates that there is a pressing need to be able to detect and quantify both drugs. The fentanyl signal can be separated out from benzodiazepines, such as lorazepam, as it has an oxidative peak around +1.1 V far from the adsorptive peak of fentanyl at +0.08 V.…”

“…A quantitative measure of fentanyl in the illicit drug supply would be beneficial for harm reduction strategies, preventing overdose and death. 28,29 We show the advantages of our electrochemical approach of quantifying fentanyl in a drug sample, or as the adulterant in heroin and cocaine samples without having to physically separate fentanyl using a liquid chromatography separation column in an additional step, saving time.…”

“It would really support the wider harm reduction agenda across the board”: A qualitative study of the potential impacts of drug checking service delivery in Scotland

“…While DCS have primarily been framed as an intervention providing harm reduction support to "recreational drug users not generally seen at other services" [29 p.2], service delivery models and target demographics are diversifying as DCS proliferate globally [30]. For example, community-based DCS in North America have been established in low-threshold harm reduction settings, such as injecting equipment provision and overdose prevention sites, and aim to engage those at highest risk of experiencing drug harms [31][32][33]. Diversification of service delivery poses questions concerning the impact of DCS and how to best evaluate outcomes.…”