Monthly Reports

July 2024 Monthly Report

Derek Robinson

• 13 min read
July 2024 Monthly Report

In this blog post, we discuss our July 2024 report and provide more information on how to interpret the results. The PDF report can be found at the end.

Key findings:

  • The median fentanyl concentration found across all drug categories was 14%
  • The median fluorofentanyl concentration found across all drug categories was 5%. Fluorofentanyl adulteration in opioid - down samples has risen compared to last month.
  • Benzodiazepines were found in 34.2% (119/248) of expected Opioid - Down samples
  • Bromazolam, the most common benzo found within Opioid - Down samples, was found in 92 opioid-down samples with a median concentration of 5% and maximum concentration of 35%
  • Xylazine was found in 6 expected Opioid - Down samples with a median concentration of 1% and a maximum concentration of 9%
  • Medetomidine was found in 5 expected Opioid - Down samples with a median concentration of 1% and a maximum concentration of greater than 50%

Insight for the July 2024 Monthly Report

This blog, and the associated pdf report, breakdown our sample counts into six categories:

  • Samples received through direct service provision in Victoria, where service users are bringing samples into the Substance storefront. These samples are labelled as "Substance" samples in the figures/tables of this blog post
  • Samples received through direct service provision in Campbell River, where service users bring samples either to the Vancouver Island Mental Health Society (VIHMS) or Campbell River AVI Health & Community Services. These samples are labelled as "Campbell River"
  • Samples received through direct service provision in the Comox Valley, where service users are bringing samples to AVI Health & Community Services in Courtenay, BC. These samples are labelled as "Comox Valley"
  • Samples received through direct service provision in the Cowichan Valley, where service users bring samples to the Duncan Lookout Society OPS in Duncan, BC. These samples are labelled as "Duncan"
  • Samples received through direct service provision in Port Alberni, where service users bring samples into Port Alberni Shelter Society’s OPS. These samples are labelled as "Port Alberni"
  • Samples received through direct service provision in Port Hardy, where service users bring samples into Island Health Mental Health and Substance Use. These samples are labelled as "Port Hardy"
  • Samples received through indirect service provision, where samples are collected through no-contact drop-off envelopes, are collected by harm reduction workers and other community members at supported housing sites, overdose prevention sites, supervised consumption locations, and the Hospital sample submission kiosks located in Victoria, Nanaimo, and Campbell River. These samples are labelled as "Outreach" samples in the figures/tables herein. Julys Outreach data also includes samples collected at Phillips Tilt and Pachena Bay Music Festival.

Drug types

At Substance, a wide variety of samples are brought in to be checked, from well known drugs like fentanyl to obscure drugs like 3-HO-PCE. Figure 1 shows the prevalence of each expected drug category checked, split by sample collection location/method. Table 1 shows the number of samples received at each sample collection location per expected drug category.

Figure 1. Prevalence of drug classes checked during July split by sample collection/method. Bars are stacked by the percentage of samples in each drug class, with the individual percentages overlaid. Drug classes which represent less than 1% of a given location’s total do not have their percent overlaid onto the bar.
Figure 1. Prevalence of drug classes checked during July split by sample collection/method. Bars are stacked by the percentage of samples in each drug class, with the individual percentages overlaid. Drug classes which represent less than 1% of a given location’s total do not have their percent overlaid onto the bar.
Table 1: Sample counts per location
Table 1: Sample counts per location

The Sample Breakdown

For the majority of samples checked, we confirm the presence of the expected drug with no additional active compounds detected above the limitations of the drug check. The bar charts below highlight a few classes of drugs, differentiating samples where only the expected active component was detected - from situations when other unexpected active components were detected.

Figure 2. Compositional breakdown by drug class and sample collection location/method. Bars are stacked by the percentage of samples in each category, with the relative proportions overlaid. Proportions less than 1% are not overlaid for clarity. “Dark Blue” groups samples that were *as expected* with no other notable compounds detected, “Purple” groups samples that contained the expected drug and contained other unexpected active(s), “Magenta” groups samples that did not contain the expected active but did contain unexpected active(s), Salmon groups samples where we were unable to determine the composition (e.g. scenarios where we do not have appropriate reference spectra), and Lime displays samples where no active compounds were detected.
Figure 2. Compositional breakdown by drug class and sample collection location/method. Bars are stacked by the percentage of samples in each category, with the relative proportions overlaid. Proportions less than 1% are not overlaid for clarity. “Dark Blue” groups samples that were *as expected* with no other notable compounds detected, “Purple” groups samples that contained the expected drug and contained other unexpected active(s), “Magenta” groups samples that did not contain the expected active but did contain unexpected active(s), Salmon groups samples where we were unable to determine the composition (e.g. scenarios where we do not have appropriate reference spectra), and Lime displays samples where no active compounds were detected.

Dissociatives

95.3% (81/85) of expected Dissociatives samples (82 Ketamine samples, 1 2-fluoro-2-oxo-PCE samples, 1 3-HO-PCE sample, 1 O-PCE sample) were as expected

1 expected ketamine sample (from Victoria) contained MDMA instead of ketamine
1 expected ketamine sample (from Victoria) contained cocaine cut with levamisole instead of ketamine

1 expected ketamine sample contained benzocaine and no active ingredients
1 expected ketamine sample had no active components detected

Cocaine

82.5% (137/166) of expected Cocaine samples (117 Cocaine HCl [powder] samples, 49 Cocaine Base [crack, rock, hard] samples) were as expected

4 expected cocaine sample (from Victoria) turned out to instead be a down samples, containing either fentanyl, fluorofentanyl, or ortho-Methyl fentanyl
1 expected cocaine sample (from Port Hardy) contained methamphetamine instead
1 expected cocaine sample (from Campbell River) contained acetaminophen instead

20 samples contained an active component in addition to cocaine or crack (19 from Victoria, 1 from Campbell River):

  • 4 expected cocaine base samples also contained levamisole
  • 4 expected cocaine samples also contained levamisole
  • 2 expected cocaine sample contained cocaine base in addition to levamisole
  • 2 expected cocaine samples also contained lidocaine
  • 1 * expected* cocaine base sample also contained an unknown
  • 1 expected cocaine base sample also contained fentanyl. This sample was residue from a burnt brillo pad (used as a filter for smoking)
  • 1 expected cocaine base sample also contained phenacetin and trace amounts of fentanyl or an analogue, likely due to cross contamination
  • 1 expected cocaine base sample also contained fentanyl or an analogue, likely due to cross contamination
  • 1 expected cocaine base sample also contained fentanyl and caffeine, likely due to cross contamination
  • 1 expected cocaine base sample also contained lidocaine and procaine
  • 1 expected cocaine sample also contained methamphetamine
  • 1 expected cocaine sample also contained fentanyl or an analogue, likely due to cross contamination

3 expected cocaine base samples had no active components detected, one of which contained lactose (sugar)

Methamphetamine

84.0% (21/25) of expected Methamphetamine samples were as expected

2 samples contained an unexpected active component instead of methamphetamine (1 from Victoria, 1 from Port Hardy):

  • 1 sample contained MDMA instead of meth
  • 1 sample contained cocaine base and phenacetin instead of meth

2 samples contained an active component in addition to methamphetamine (both from Victoria):

  • 1 sample contained fentanyl and fluorofentanyl in addition to meth, cut with caffeine. This sample had visible pieces of purple down in it.
  • 1 sample contained fentanyl or a fentanyl analogue in addition to meth, this is likely due to cross-contamination

MDMA/MDA

87.7% (143/163) of expected MDMA samples (151 MDMA samples, 8 MDMA and MDA samples, 4 MDA samples) were as expected

8 samples contained an unexpected active component instead of MDMA (3 from Outreach, 3 from Victoria, 2 from the Comox Valley):

  • 4 samples contained ketamine instead of MDMA
  • 1 sample contained MDA instead of MDMA
  • 1 sample contained cocaine instead of MDMA
  • 1 sample contained acetaminophen, sildenafil, and tadalafil instead of MDMA
  • 1 sample contained para-Methoxyphenylpiperazine instead of MDMA

8 samples contained an active component in addition to MDMA or MDA (3 from Victoria, 4 from Outreach, 1 from Duncan):

  • 3 expected MDMA samples contained MDA in addition to MDMA
  • 3 expected MDMA samples contained an unknown in addition to MDMA
  • 1 expected MDA sample contained an unknown in addition to MDA
  • 1 expected MDMA sample contained cocaine and ketamine in addition to MDMA

4 samples did not contain the expected MDMA, 1 contained sucrose and the others had no active components detected

Benzodiazepines (n=32)

78% (25/32) of the expected benzodiazepine samples checked in July came to our service sites in the form of pressed pills with the following expected and detected compositions:

Table 2. The composition of benzodiazepine pressed pills checked in July. “Expected Composition” describes the benzo expected/reported by the service user, while “Detected Composition” describes the contents we found through the drug check. “Benzodiazepine (unknown type)” refers to samples where the benzo strip test was positive but no benzos were identified with our other instruments. These unknown benzo samples either contain a benzo at very low concentrations and/or novel benzos that are not in our targeted method for the mass spectrometer.
Table 2. The composition of benzodiazepine pressed pills checked in July. “Expected Composition” describes the benzo expected/reported by the service user, while “Detected Composition” describes the contents we found through the drug check. “Benzodiazepine (unknown type)” refers to samples where the benzo strip test was positive but no benzos were identified with our other instruments. These unknown benzo samples either contain a benzo at very low concentrations and/or novel benzos that are not in our targeted method for the mass spectrometer.

Within the remaining 7 samples (all from Victoria):

  • 2 samples were bromazolam, as expected
  • 1 sample was diazepam, as expected
  • 1 sample was rilmazafone, as expected
  • 1 sample was etizolam, as expected
  • 1 sample was flualprazolam, as expected
  • 1 unspecified benzodiazepines was bromazolam

Opioid-positivity in non-opioid-down samples

In July, we checked 548 samples that were not expected to contain fentanyl or other “unexpected” opioids[1]. Since the opioid-down supply is no longer “just heroin” or “just fentanyl” and is instead a complex, potent, and ever-changing polysubstance market containing other synthetic opioids like fluorofentanyl or nitazenes, here we will examine the prevalence of any unexpected opioid, not just fentanyl, detected in non-opioid-down samples.

  1. Specifically, we are excluding samples that were expected to be “opioid-down” or samples that had an “unknown/missing” expected composition. In the case of “opioid-other” samples, e.g. hydromorphone tablets and oxycodone pills, “unexpected opioids” are defined as any opioid that is not the expected opioid. ↩︎

Table 3. Overview of unexpected opioid detections in non-opioid-down samples in July.
Table 3. Overview of unexpected opioid detections in non-opioid-down samples in July.

Examining Table 3, we find that 15 samples tested positive for unexpected opioids in July, representing 2.6% of all non-opioid-down samples checked. These samples were as follows:

Expected Cocaine samples:

  • 4 expected cocaine sample (from Victoria) turned out to instead be down samples, containing either fentanyl, fluorofentanyl, or ortho-Methyl fentanyl
  • 1 expected cocaine base sample also contained fentanyl. This sample was residue from a burnt brillo pad (used as a filter for smoking)
  • 1 expected cocaine base sample also contained phenacetin and trace amounts of fentanyl[1]
  • 1 expected cocaine base sample also contained fentanyl or an analogue[1:1]
  • 1 expected cocaine base sample also contained fentanyl and caffeine[1:2]
  • 1 expected cocaine sample also contained fentanyl or an analogue[1:3]

Expected Benzodiazepine samples:

  • 1 unspecified benzodiazepine sample contained bromazolam and trace amounts of fentanyl

Expected Methamphetamine samples:

  • 1 sample contained fentanyl and fluorofentanyl in addition to meth, cut with caffeine. This sample had visible pieces of purple down in it.[1:4]
  • 1 sample contained fentanyl or a fentanyl analogue in addition to meth[1:5]

Expected Opioid - Other samples:

  • 1 expected hydromorphone sample contained fentanyl
  • 1 expected hydromorphone sample contained isotonitazene
  • 1 expected methadone sample contained fluorofentanyl base

In July, no unexpected opioids were detected in samples expected to be MDMA, dissociatives, psychedelics, other.

In people’s personal quests for bodily autonomy and informed consumption, there is often evaluation of risk and consequence, but when the consequences can be severe and the risks are unknown or are intentionally exaggerated, these become difficult, if not impossible, conversations to weigh. We believe that drug checking can help provide people with the information needed to evaluate the risks, and provides harm reduction advice to minimize undesired consequences of substance use. These data are not meant to downplay concerns or invalidate past experiences. We recognize the tragic consequences of when fentanyl is found in non-opioid samples and honour the heartbreak that such experiences produce. Instead, we present these data with the intent to combat misinformation and provide an evidence-based context for people to consider when making decisions about substance use. While these numbers reflect what we have seen over the course of the project, these (roughly) 1-in-100 events still occur, so we always encourage folks to get their stuff checked.

  1. The presence of fentanyl in these samples is most likely due to cross-contamination with an opioid - down sample. ↩︎ ↩︎ ↩︎ ↩︎ ↩︎ ↩︎

Opioid-Down (n=348)

In this section we present results specific to the opioid-down supply, therefore they may differ from the highlighted findings above that are inclusive of all expected drug categories.

  • 49.7% (173/348) of expected opioid-down samples contained fentanyl as the only active opioid
  • 6.3% (22/348) of expected opioid-down sample contained fluorofentanyl as the only active opioid
  • 7 samples contained heroin, of these samples, 4 contained the related alkaloid acetylcodeine and/or acetylmorphine (MAM). In total, this represents 2% of all opioid - down samples.
  • 6/7 samples which contained heroin also contained fentanyl or a fentanyl analogue
  • 0 samples contained carfentanil
  • 16.9% (59/348) of expected opioid - down samples contained ortho-methyl fentanyl
  • 34.2% (119/348) of expected opioid-down samples contained a benzodiazepine
  • The most common benzodiazepine in opioid-down samples was bromazolam (92), followed by benzodiazepine (unknown type) (24), flubromazepam (2), and etizolam (2).
  • Xylazine was detected in 1.7% (6/348) of opioid-down samples, most commonly being found in samples from Substance (6).

In July, 52.8% (186/348) of all opioid-down samples checked contained an additional active to the expected fentanyl/heroin. These data are shown in Fig. 3 highlighting the prevalence of benzos, fluorofentanyl, ortho-methyl fentanyl, and xylazine in the down supply.

Figure 3. The percentage of expected opioid-down samples checked between July 2023 and July 2024 that only contained fentanyl/heroin actives (solid dark purple), opioid-down samples with an additional active detected (dot-dashed light purple), opioid-down samples that contained a benzodiazepine-related drug (dotted magenta), opioid-down samples that contained fluorofentanyl (dashed salmon), opioid-down samples that contained ortho-methyl fentanyl (dashed orange), and opioid-down samples that contained xylazine (dashed yellow).
Figure 3. The percentage of expected opioid-down samples checked between July 2023 and July 2024 that only contained fentanyl/heroin actives (solid dark purple), opioid-down samples with an additional active detected (dot-dashed light purple), opioid-down samples that contained a benzodiazepine-related drug (dotted magenta), opioid-down samples that contained fluorofentanyl (dashed salmon), opioid-down samples that contained ortho-methyl fentanyl (dashed orange), and opioid-down samples that contained xylazine (dashed yellow).

Ortho-Methyl fentanyl, a new fentanyl analogue which appeared in the down supply earlier this year, was found in 17.6% (62/348) of opioid-down samples. This makes ortho-Methyl fentanyl the third most common additional active found within the opioid-down supply. Ortho-Methyl fentanyl is a fentanyl analogue that is thought to be similar in potency or slightly weaker than fentanyl, however, there are very few studies on its effect in humans.

Fluorofentanyl was the second most common additional active found within the opioid-down supply, with 20.6% (72/348) of opioid-down samples containing fluorofentanyl in addition to other opioids such as fentanyl. Additionally, fluorofentanyl was the only opioid detected in 6.3% (22/348) of opioid-down samples (i.e. no fentanyl or heroin was detected in these samples).

Benzo-related drugs contribute to a majority of the other additional actives found in expected opioid-down samples, with 34.2% (119/348) of expected opioid-down samples checked containing a benzo-related drug. Bromazolam continues to be the most common benzo seen in the down supply, with bromazolam being detected in 77.3% (92/119) of the benzo-positive opioid-down samples. This makes it just slightly less common than fluorofentanyl within the opioid-down supply. Scattered detections of other drugs are still found and can be reviewed in the pdf report at the end of this blog.

Quantification for Expected Opioid-Down[1]

In July, we quantified fentanyl for 261 of the expected opioid-down samples containing fentanyl and found the median concentration to be 14%[2]. Though the median is a useful indicator, it doesn’t capture the volatility of fentanyl concentrations present in the opioid supply, as half of fentanyl-positive down samples contained between 8% and 25% fentanyl, and any one sample might be the lowest strength (less than 0.1%) or the strongest (greater than 50%[3]). Fluorofentanyl was seen at concentrations ranging from 0.3% to greater than 50%[3:1] as well, with a median concentration of 7%. In recent months, we have added ortho-Methyl fentanyl to our PS-MS target list, which has enabled us to quantify it. In July, we quantified ortho-Methyl fentanyl in 59 opioid - down samples at a median concentration of 4%, with half of ortho- Methyl fentanyl positive down samples containing between 2% and 7% ortho-Methyl fentanyl. Bromazolam, the most common benzodiazepine adulterant in down samples, had concentrations ranging from less than 0.1% to greater than 50%[3:2] bromazolam, with a median of 5%. For context, a sample containing 4% bromazolam would be roughly equivalent to two full 2mg Xanax bars worth of benzo per point (100mg).

  1. Not all opioid down samples brought to our service can be quantified. This is primarily due to too limited sample collected for our instruments to report a reliable mass percentage. Nevertheless, qualitative detection is still possible. ↩︎

  2. This number is specific to fentanyl quantified in opioid-down samples. The median concentration listed in the Key Findings at the beginning of this blog (14%) is inclusive of all samples checked, across all drug classes and unknown samples, that contained fentanyl. ↩︎

  3. For samples that contain greater than 50% fentanyl, heroin, fluorofentanyl, or bromazolam by weight, our mass spectrometer is presently unable to reproducibly assign a concentration due to the upper limits of the calibration methods currently adopted. ↩︎ ↩︎ ↩︎

Table 4. Quantification of low-concentration active components in expected opioid-down samples in July 2024.
Table 4. Quantification of low-concentration active components in expected opioid-down samples in July 2024.

The fentanyl and bromazolam concentrations that we quantified in July, across all expected drug categories and service models, are presented in Fig. 4. Small black dots are individual opioid-down samples, the large white dot shows the median concentration, dashed white lines bound half of the quantified samples, and the width of the shaded regions mirrors the number of samples at a given concentration.

Figure 4. Violin plots of fentanyl (top panel) and bromazolam (bottom) positive samples quantified during July across all collection locations/methods.
Figure 4. Violin plots of fentanyl (top panel) and bromazolam (bottom) positive samples quantified during July across all collection locations/methods.

We can also examine the regional variability in the unregulated market. The table below expands on the quantitative data presented above. It focuses only on fentanyl, fluorofentanyl, carfentanil, bromazolam, and xylazine quantified within expected opioid-down samples, separated by collection location/model. Weight percentage is reported; “IQR” is the interquartile range: the range that contains half of the quantified samples.

Table 5. Quantification of low-concentration active components in expected opioid-down samples, split by service models/location, in July 2024. See Table 4 for the overview from all locations. Weight percentage is reported; “IQR” is the interquartile range: the range that contains half of the quantified samples.
Table 5. Quantification of low-concentration active components in expected opioid-down samples, split by service models/location, in July 2024. See Table 4 for the overview from all locations. Weight percentage is reported; “IQR” is the interquartile range: the range that contains half of the quantified samples.
Substance Drug Checking July 2024 Monthly Report
Substance Drug Checking July 2024 Monthly Report.pdf
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Check back next month for the August report!

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