Monthly Reports

March 2024 Monthly Report

Derek Robinson

• 12 min read
March 2024 Monthly Report

In this blog post, we discuss our March 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 23%
  • The median fluorofentanyl concentration found across all drug categories was 5%
  • Carfentanil was found in 4 expected Opioid - Down samples with a median concentration of 0.8%
  • Benzodiazepines were found in 49.9% (185/371) of expected Opioid - Down samples
  • Bromazolam, the most common benzo found within Opioid - Down samples, was found in 150 opioid-down samples with a median concentration of 8% and maximum concentration of greater than 25.0%
  • Xylazine was found in 18 expected Opioid - Down samples with a median concentration of 1% and a maximum concentration of 26%

Insight for the March 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.

Drug Types

On any given day at Substance we see a multitude of drugs. 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 March 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 March 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 (Figure 2) 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.

Dissciatives

92.6% (48/52) of expected dissociative samples (46 ketamine samples, 1 deschloroketamine sample, 1 3-fluoro-PCP sample) checked in March were confirmed to be the expected dissociative with no other active compounds detected.

The remaining 4 samples had the following composision:

  • 2 expected ketamine samples (all from Victoria) contained ketamine cut with benzocaine
  • 1 expected ketamine sample contained ketamine in addition to cocaine and phenacetin. The mixture of ketamine and cocaine is sometimes referred to as "Calvin Klein" due to the brands logo being a "C" and a "K".
  • 1 expected ketamine sample contained 2-fluoro-2-oxo-PCE otherwise known as 2F-NENDCK. This is a novel ketamine analogue discovered in Australia during 2022.

Cocaine

80.3% (110/137) of expected cocaine samples (76 cocaine samples and 34 crack samples) were confirmed to be cocaine with no additional active compounds detected.

23 samples contained an active component in addition to cocaine (Victoria (17), Campbell River (3), Comox Valley (3)):

  • 6 sample contained cocaine in addition to levamisole
  • 5 samples contained crack in addition to levamisole
  • 5 samples contained crack in addition to fentanyl or a fentanyl analogue, likely due to cross contamination with a down sample
  • 4 samples contained crack in addition to phenacetin
  • 1 sample contained cocaine in addition to an unknown benzodiazepine, detected by strip test only
  • 1 sample contained cocaine in addition to benzocaine
  • 1 sample contained cocaine in addition to phenacetin

2 samples did no contain cocaine or crack and instead contained an unexpected active:

  • 1 sample contained only phenacetin
  • 1 sample contained bromazolam and fentanyl, cut with caffeine. This sample was consistent with a down sample in physical description.

2 samples did not contain any active components:

  • 1 expected crack sample sample contained baking soda
  • 1 expected crack sample could not have any actives detected

Methamphetamine

80% (24/30) of expected methamphetamine samples checked were found to be meth with no other active compounds detected.

4 samples contained an active component in addition to methamphetamine (all from Victoria):

  • 3 samples contained methamphetamine in addition to fentanyl or a fentanyl analogue, likely due to cross contamination with a down sample
  • 1 sample contained methamphetamine in addition to fentanyl, fluorofentanyl, an unknown benzodiazepine. However, this sample came from a burnt pipe and therefore is likely residue from smoking down and meth through the same pipe.

1 sample contained an unknown benzodiazepine cut with erythritol instead of the expected methamphetamine

1 sample could not have any actives detected

MDMA/MDA

91.2% (62/68) of expected MDA/MDMA samples checked were confirmed to be MDMA (54 samples), MDMA and MDA (5 samples), or MDA (3 samples) as expected.

The remaining 8 samples had the following composition:

  • 2 expected MDMA samples contained MDMA in addition to MDA
  • 2 expected MDA samples contained MDMA instead
  • 1 expected MDMA sample contained Fluorofentanyl and MD-MAPA (an MDMA precursor). This is a highly unusual sample and represents why getting you drugs checked is imprtant.
  • 1 expected MDMA sample contained caffeine and inositol and no active components

Benzodiazepines (n=29)

48.3% (14/29) of the expected benzodiazepine samples checked in March 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 March. “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 March. “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 (Victoria (6), Comox Valley (1)):

  • 1 sample contained flualprazolam instead of the expected alprazolam
  • 1 sample contained bromazolam instead of the expected alprazolam
  • 1 sample contained alprazolam in addition to bromazolam
  • 1 sample contained bromazolam, as expected
  • 1 sample contained fentanyl, fluorofentanyl, bromazolam, flualprazolam,and xylazine instead of just bromazolam
  • 1 sample contained flualprazolam, as expected

Opioid-positivity in non-opioid-down samples

In March, we checked 411 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 March.
Table 3. Overview of unexpected opioid detections in non-opioid-down samples in March.

Examining Table 3, we find that 26 samples tested positive for unexpected opioids in March, representing 6.3% of all non-opioid-down samples checked. These samples were as follows:

Expected crack samples:

  • 5 samples contained crack in addition to fentanyl or a fentanyl analogue[1]
  • 1 sample contained bromazolam and fentanyl, cut with caffeine

Expected MDMA samples:

  • 1 expected MDMA sample contained Fluorofentanyl and MD-MAPA (an MDMA precursor)

Expected methamphetamine samples:

  • 3 samples contained methamphetamine in addition to fentanyl or a fentanyl analogue[1:1]
  • 1 sample sample contained methamphetamine in addition to fentanyl, fluorofentanyl, an unknown benzodiazepine[2]

Expected bromazolam samples:

  • 1 sample contained fentanyl, fluorofentanyl, bromazolam, flualprazolam,and xylazine

Expected oxycodone samples:

  • 3 samples contained metonitazene
  • 3 samples contained metonitazene and N-desethyl isotonitazene
  • 1 contained isotonitzene
  • 1 contained fentanyl

Expected percocet samples:

  • 2 samples contained fentanyl or an analogue
  • 2 samples contained isotonitzene

Expected hydromorphone samples:

  • 1 sample contained fentanyl or an analogue
  • 1 sample contained metonitazene

In March, 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. ↩︎ ↩︎

  2. This sample was burnt residue from a pipe and therefore is likely due to smoking down and meth through the same pipe. ↩︎

Opioid-Down (n=371)

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.

  • 84.8% of expected opioid-down samples contained fentanyl or fentanyl base (295/348)
  • 50.6% of expected opioid-down sample contained fluorofentanyl or fluorofentanyl base (176/348)
  • 12 samples contained heroin, of these samples, 4 contained the related alkaloid acetylcodeine and 2 contained acetylmorphine (MAM). In total, this represents 3.5% of all opioid - down samples.
    • 10 samples included the one or more of the following additional actives: fentanyl, fluorofentanyl, bromazolam, benzodiazepine (unknown type), and fentanyl analogue (unknown type)
  • 2 samples contained carfentanil
  • 3 samples contained ortho-methyl fentanyl
  • 44.0% (153/348) of expected opioid-down samples contained a benzodiazepine
    • The most common benzodiazepine in opioid-down samples was bromazolam (117), followed by benzodiazepine (unknown type) (36), and flubromazepam (3).
  • Xylazine was detected in 5.2% (18/348) of opioid-down samples, most commonly being found in samples from Substance (10).

In March, 59.1% (219/371) 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, and xylazine in the down supply.

Figure 3. The percentage of expected opioid-down samples checked between March 2023 and March 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), and opioid-down samples that contained xylazine (dashed yellow).
Figure 3. The percentage of expected opioid-down samples checked between March 2023 and March 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), and opioid-down samples that contained xylazine (dashed yellow).

Fluorofentanyl was the most common additional active found within the opioid-down supply, with 31.9% (118/371) of opioid-down samples containing fluorofentanyl in addition to fentanyl. Additionally, fluorofentanyl was the only opioid detected in 1.3% (5/371) 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 50.5% (187/371) 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 74.3% (139/187) of the benzo-positive opioid-down samples. 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 March, we quantified fentanyl for 293 of the expected opioid-down samples containing fentanyl and found the median concentration to be 23%[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 11.3% and 24.3% fentanyl, and any one sample might be the lowest strength (less than 0.1%) or the strongest (greater than 80%[3]). Fluorofentanyl was seen at concentrations ranging from 0.4% to greater than 40%[3:1] as well, with a median concentration of 5%. Similarly, the concentration of bromazolam was across the board in expected opioid down samples, with samples ranging from less than 0.1% to greater than 25.0%[3:2] bromazolam, with a median of 8%. For context, a sample containing 4% bromazolam would be roughly equivalent to two full 2mg Xanax bars worth of benzo per point (100mg).

A selection of low-concentration active components in expected opioid-down samples for March 2024 can be found in Table 4.

  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 (23%) is inclusive of all samples checked, across all drug classes and unknown samples, that contained fentanyl. ↩︎

  3. For samples that contain greater than 80% fentanyl or heroin, greater than 40% fluorofentanyl, or greater than 25% 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 March 2024.
Table 4. Quantification of selected low-concentration active components in expected opioid-down samples in March 2024.

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

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