Monthly Reports

June 2024 Monthly Report

Derek Robinson

• 14 min read
June 2024 Monthly Report

In this blog post, we discuss our June 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 8.9%
  • The median fluorofentanyl concentration found across all drug categories was 5.5%. Fluorofentanyl adulteration in opioid - down samples remained at roughly the same level as last month
  • Carfentanil was found in 1 expected Opioid - Down sample
  • Benzodiazepines were found in 43.1% (149/346) of expected Opioid - Down samples
  • Bromazolam, the most common benzo found within Opioid - Down samples, was found in 136 opioid-down samples with a median concentration of 5.8% and maximum concentration of greater than 50.0%
  • Xylazine was found in 13 expected Opioid - Down samples with a median concentration of 0.5% and a maximum concentration of greater than 50.0%
  • Nitazenes were found in 4 expected Opioid - Down samples

Insight for the June 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. Junes Outreach data includes samples collected at Otherworld, A Vancouver Island Regional Arts Event.

Drug types

At Substance, on any given day, we receive and check a wide variety of different samples. 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 June 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 June 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

92.9% (78/84) of expected Dissociatives samples (80 Ketamine samples, 3 O-PCE [Deschloro-N-ethyl-ketamine] samples, 1 2-fluoro-2-oxo-PCE [2F-NENDCK, 2-FXE] sample) were as expected

1 expected ketamine sample (from the Comox Valley) contained MDMA instead of ketamine

1 expected ketamine sample contained ketamine in addition to MDMA
1 expected ketamine sample contained ketamine in addition to cocaine

2 expected ketamine samples contained sucrose (a sugar) and no active ingredients

1 expected 2-fluoro-2-oxo-PCE sample did not match any of our library entries, although it did resemble other ketamine analogues library entries

Cocaine

83.7% (123/147) of expected Cocaine samples (120 Cocaine HCl (powder) samples, 27 Cocaine Base (crack) samples) were as expected

1 expected cocaine sample (from Port Alberni) turned out to instead be a down sample, containing fentanyl cut with mannitol instead of cocaine.

21 samples contained an active component in addition to cocaine or crack (1 from Port Hardy, 1 from the Comox Valley, 1 from Duncan, 4 from Campbell River, and 13 from Victoria, 1 from Outreach):

  • 9 expected cocaine samples contained cocaine in addition to levamisole. Levamisole is used by vets to treat parasitic worm infections in animals
  • 2 expected crack samples contained crack in addition to phenacetin. Phenacetin is a tylenol-like drug that we sometimes find cut into samples, usually cocaine
  • 1 expected crack sample contained crack in addition to levamisole
  • 1 expected crack sample contained crack in addition to MDMA
  • 1 expected crack sample contained crack in addition to fentanyl. This sample contained high enough amounts of fentanyl that it likely was not due to cross-contamination
  • 1 expected crack sample contained crack in addition to fentanyl or a fentanyl analogue. This is likely due to cross contamination with a down sample prior to drug checking
  • 1 expected crack sample contained crack in addition to an unknown benzodiazepine
  • 1 expected crack sample contained crack in addition to an unknown
  • 1 expected cocaine sample contained cocaine in addition to fentanyl or a fentanyl analogue. This is likely due to cross contamination with a down sample prior to drug checking
  • 1 expected cocaine sample contained cocaine in addition to benzocaine, cut with mannitol
  • 1 expected cocaine sample contained cocaine in addition to methamphetamine
  • 1 expected cocaine sample contained cocaine in addition to an unknown

2 samples did not contain the expected cocaine and instead contained only caffeine. It’s probably safe to say that this wasn’t the wake up these service users were looking for.

Methamphetamine

73.9% (17/23) of expected Methamphetamine samples (23 Methamphetamine samples) were as expected

3 samples contained an unexpected active component instead of methamphetamine (all from Victoria):

  • 2 samples contained crack instead of meth
  • 1 sample contained fentanyl instead of meth

3 samples contained an active component in addition to methamphetamine (2 from Victoria, 1 from Duncan):

  • 1 sample contained fluorofentanyl base in addition to meth, cut with caffeine and erythritol. Based on the cuts and buffs, this sample seems more like a down sample that contained meth, rather than the other way around
  • 1 sample contained fentanyl or a fentanyl analogue in addition to meth, this is likely due to cross-contamination prior to drug checking
  • 1 sample contained fentanyl in addition to meth, this is likely due to cross-contamination prior to drug checking

MDMA/MDA

87.9% (124/141) of expected MDMA samples (133 MDMA samples, 7 MDA samples) were as expected

5 samples contained an unexpected active component instead of MDMA or MDA (3 from Outreach, 1 from Victoria, 1 from the Comox Valley):

  • 2 expected MDA samples contained MDMA instead
  • 1 expected MDMA sample contained ketamine instead
  • 1 expected MDMA sample contained meth instead
  • 1 expected MDMA or MDA sample contained MDMA

10 samples contained an active component in addition to MDMA or MDA (7 from Victoria, 2 from Outreach, 1 from Duncan):

  • 5 expected MDMA samples contained MDA in addition to MDMA
  • 1 expected MDMA sample contained meth in addition to MDMA
  • 1 expected MDMA sample contained ketamine in addition to MDMA
  • 1 expected MDMA sample contained MDEA in addition to MDMA
  • 1 expected MDMA sample contained an unknown in addition to MDMA
  • 1 expected MDMA sample contained fentanyl or analogue in addition to MDMA. However, this is likely a false positive as fentanyl test strips are known to cause false positive with MDMA when improperly used

2 samples did not contain the expected MDMA, 1 contained an unknown carbohydrate and the other contained starch

Benzodiazepines (n=47)

68.1% (32/47) of the expected benzodiazepine samples checked in June 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 June. “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 June. “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 15 samples (14 from Victoria, 1 from Outreach):

  • 1 expected alprazolam (Xanax) sample contained an unknown benzodiazepine instead
  • 1 expected alprazolam (Xanax) sample contained etizolam instead
  • 1 expected alprazolam (Xanax) sample contained bromazolam instead
  • 1 expected alprazolam (Xanax) sample contained flualprazolam instead
  • 1 sample was rilmazafone, as expected
  • 1 sample was pyrazolam, as expected
  • 1 sample was etizolam, as expected
  • 1 sample was bretazenil, as expected
  • 1 sample was avizafone, as expected
  • 2 samples were bromazolam, as expected
  • 4 expected unknown benzodiazepines were bromazolam

Opioid-positivity in non-opioid-down samples

In June, 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 June.
Table 3. Overview of unexpected opioid detections in non-opioid-down samples in June.

Examining Table 3, we find that 15 samples tested positive for unexpected opioids in June, representing 2.7% of all non-opioid-down samples checked. These samples were as follows:

Expected Cocaine samples:

  • 1 cocaine sample turned out to instead be a down sample, containing fentanyl cut with mannitol instead of cocaine
  • 1 *crack sample contained crack in addition to fentanyl[1]
  • 1 crack sample contained crack in addition to fentanyl or a fentanyl analogue[1:1]
  • 1 cocaine sample contained cocaine in addition to fentanyl or a fentanyl analogue[1:2]

Expected Benzodiazepine samples:

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

Expected MDMA samples:

  • 1 expected MDMA sample contained fentanyl or analogue in addition to MDMA. However, this is likely a false positive as fentanyl test strips are known to cause false positive with MDMA when improperly used

Expected Methamphetamine samples:

  • 1 sample contained fentanyl instead of meth
  • 1 sample contained fluorofentanyl base in addition to meth, cut with caffeine and erythritol
  • 1 sample contained fentanyl or a fentanyl analogue in addition to meth[1:3]
  • 1 sample contained fentanyl in addition to meth[1:4]

Expected Opioid - Other samples:

  • 2 expected Percocet samples contained fentanyl or a fentanyl analogue, detected by strip test only

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

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=346)

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.

  • 59.5% (206/346) of expected opioid-down samples contained fentanyl as the only active opioid
  • 4.6% (16/346) of expected opioid-down sample contained fluorofentanyl as the only active opioid
  • 8 samples contained heroin, of these samples, 5 contained the related alkaloid acetylcodeine and/or acetylmorphine (MAM). In total, this represents less than 1% of all opioid - down samples.
    • 5/8 samples which contained heroin also contained fentanyl or a fentanyl analogue
  • 1 sample contained carfentanil
  • 17.1% (59/346) of expected opioid - down samples contained ortho-methyl fentanyl
  • 43.1% (149/346) of expected opioid-down samples contained a benzodiazepine
    • The most common benzodiazepine in opioid-down samples was bromazolam (136), followed by benzodiazepine (unknown type) (16), flubromazepam (2), and desalkylgidazepam (2).
  • Xylazine was detected in 3.8% (13/346) of opioid-down samples, most commonly being found in samples from Substance (13).

In June, 45.4% (157/346) 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 June 2023 and June 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 June 2023 and June 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 17.1% (59/346) 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 15% (52/346) of opioid-down samples containing fluorofentanyl in addition to other opioids such as fentanyl. Additionally, fluorofentanyl was the only opioid detected in 4.6% (16/346) 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 43.1% (149/246) 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 39.3% (136/346) of the benzo-positive opioid-down samples. This makes it more common than fluorofentanyl and therefore the most common additional active found 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 June, we quantified fentanyl for 251 of the expected opioid-down samples containing fentanyl and found the median concentration to be 9%[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 5% and 15% 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 6%. In recent months, we have added ortho-Methyl fentanyl to our PS-MS target list, which has enabled us to quantify it. In June, we quantified ortho-Methyl fentanyl in 53 opioid - down samples at a median concentration of 6%, with half of ortho- Methyl fentanyl positive down samples containing between 3% and 10% ortho-Methyl fentanyl. Bromazolam, the most common benzodiazepine adulterant in down samples (and as of lately, the most common adulterant in opioid-down samples), had concentrations ranging from less than 0.1% to greater than 50%[3:2] bromazolam, with a median of 6%. 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 (20%) 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 June 2024.
Table 4. Quantification of low-concentration active components in expected opioid-down samples in June 2024.

The fentanyl and bromazolam concentrations that we quantified in June, 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 June across all collection locations/methods.
Figure 4. Violin plots of fentanyl (top panel) and bromazolam (bottom) positive samples quantified during June 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 June 2024. See Table 3 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 June 2024. See Table 3 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 June 2024 Monthly Report
Substance Drug Checking June 2024 Monthly Report.pdf
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Check back next month for the July report!

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