Monthly Reports

May 2024 Monthly Report

Derek Robinson

• 13 min read
May 2024 Monthly Report

In this blog post, we discuss our May 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 20%
  • The median fluorofentanyl concentration found across all drug categories was 5%. Fluorofentanyl adulteration in Opioid - Down samples remained at roughly the same level as last month.
  • Carfentanil was found in 0 expected Opioid - Down samples
  • Benzodiazepines were found in 40.3% (154/382) of expected Opioid - Down samples
  • Bromazolam, the most common benzo found within Opioid - Down samples, was found in 121 opioid-down samples with a median concentration of 5% and maximum concentration of greater than 25.0%
  • Xylazine was found in 16 expected Opioid - Down samples with a median concentration of 2% and a maximum concentration of 15%

Insight for the May 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

Day to day at Substance, 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 May 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 May 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

92.7% (51/55) of expected dissociative samples (53 Ketamine samples, 1 3-MeO-PCP sample) checked in May were confirmed to be ketamine or 3-Meo-PCP with no additional actives detected.

  • 1 expected ketamine sample (from Victoria) contained MDA instead of ketamine.

  • 1 expected unspecified dissociative sample contained ketamine

  • 1 expected ketamine sample contained ketamine in addition to an unknown

  • 1 expected ketamine sample was found to contain sucrose (a sugar) and no active ingredients. This one is for the sweet tooths out there!

Cocaine

81.2% (104/128) of expected cocaine/crack samples (99 Cocaine HCl (powder) samples, 29 Cocaine Base (crack) samples) were confirmed to be cocaine or crack with no additional active compounds detected.

4 samples contained an unexpected active component instead of cocaine:

  • 1 sample from Victoria contained Metformin instead of cocaine. Metformin is a medication used to treat diabetes.
  • 1 sample from Duncan contained phenacetin instead of crack. Phenacetin (a.k.a. ‘superbuff’) is a tylenol-like drug that we sometimes find cut into samples, usually cocaine.
  • 1 sample from Victoria contained methamphetamine instead of crack.
  • 1 sample from Campbell River contained procaine and ortho-Methyl fentanyl instead of cocaine.

20 samples contained an active component in addition to cocaine (1 from the Comox Valley, 2 from Campbell River, and 17 from Victoria):

  • 6 expected cocaine samples contained cocaine in addition to levamisole. Levamisole is used by vets to treat parasitic worm infections in animals.
  • 4 expected crack samples 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.
  • 3 expected crack samples contained crack in addition to phenacetin, 1 sample additionally contained Ecgonine, an alkaloid found in the coca plant and likely left over from the extraction of cocaine.
  • 2 expected cocaine samples 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 Zolpidem. Zolpidem, otherwise known as Ambien, is often used to treat sleep problems and is rarely seen in illicit drugs, especially cocaine.
  • 1 expected crack sample contained crack in addition to methamphetamine.
  • 1 expected crack sample contained cocaine and benzocaine instead.
  • 1 expected crack sample contained crack in addition to an unknown benzodiazepine confirmed via strip test only.
  • 1 expected cocaine sample contained cocaine in addition to an unknown benzodiazepine.

Methamphetamine

78.1% (25/32) of expected Methamphetamine samples were found to be meth with no other active compounds detected.

4 samples contained an unexpected active component instead of methamphetamine (2 from Victoria, 1 from Port Alberni, 1 from Campbell River):

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

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

  • 2 samples contained amphetamine in addition to methamphetamine,1 of these samples additionally contained an unknown benzodiazepine
  • 1 sample contained fentanyl in addition to methamphetamine. This was likely caused by cross contamination with a down sample in the same envelope.

MDMA/MDA

86.7% (72/83) of expected MDMA samples (75 MDMA samples, 6 MDA samples, 1 MDMA and MDA and Meth sample, 1 MDMA and MDA sample) were found to be their expected active(s) with no other active compounds detected.

  • 1 expected MDMA sample contained ketamine instead

10 samples contained an active component in addition to MDMA (all from Victoria):

  • 8 samples from the same service user contained MDMA in addition to methamphetamine
  • 2 samples contained MDMA in addition to MDA

Benzodiazepines (n=37)

62.1% (23/37) of the expected benzodiazepine samples checked in May 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 May. “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 May. “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 14 samples (13 from Victoria, 1 from the Comox Valley):

  • 5 samples were bromazolam, as expected
  • 2 samples were Avizafone, as expected
  • 2 expected bromazolam samples contained an unknown benzodiazepine
  • 1 sample was Bretazenil, as expected
  • 1 sample was diazepam, as expected
  • 1 sample was etizolam, as expected
  • 1 expected unknown benzodiazepine was fentanyl
  • 1 expected unknown benzodiazepine was bromazolam

Opioid-positivity in non-opioid-down samples

In May, we checked 433 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 May.
Table 3. Overview of unexpected opioid detections in non-opioid-down samples in May.

Examining Table 3, we find that 15 samples tested positive for unexpected opioids in May, representing 3.5% of all non-opioid-down samples checked. These samples were as follows:

Expected Cocaine samples:

  • 4 expected crack samples contained crack in addition to fentanyl or a fentanyl analogue[1]
  • 2 expected cocaine samples contained cocaine in addition to fentanyl or a fentanyl analogue[1:1]
  • 1 sample contained procaine and ortho-Methyl fentanyl instead of cocaine

Expected Benzodiazepine samples:

  • 1 expected unspecified benzodiazepine sample contained bromazolam and fentanyl cut with caffeine
  • 1 expected unspecified benzodiazepine sample contained bromazolam and fentanyl cut with erythritol (a sugar) and caffeine.
  • 1 expected bromazolam sample contained bromazolam and metonitazene

Expected Methamphetamine samples:

  • 1 sample contained fentanyl instead of meth
  • 1 sample contained fentanyl in addition to methamphetamine[1:2]

Expected Opioid - Other samples:

  • 1 expected Hydromorphone sample contained isotonitazene instead
  • 1 expected Oxycodone sample contained fentanyl and fluorofentanyl instead
  • 1 expected Oxycodone sample contained N-desethyl Isotonitazene instead

In May, no unexpected opioids were detected in samples expected to be MDMA, 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=382)

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.

  • 62.0% (237/382) of expected opioid-down samples contained fentanyl as the only active opioid
  • 7.6% (29/382) of expected opioid-down sample contained fluorofentanyl as the only active opioid
  • 3 samples contained heroin, of these samples, all 3 contained the related alkaloid acetylcodeine and acetylmorphine (MAM). In total, this represents less than 1% of all opioid - down samples.
    • 2 of these samples also included fentanyl or a fentanyl analouge
  • 0 samples contained carfentanil
  • 14.7% (56/382) of expected opioid - down samples contained ortho-methyl fentanyl
  • 40.3% (154/381) of expected opioid-down samples contained a benzodiazepine
    • The most common benzodiazepine in opioid-down samples was bromazolam (121), followed by benzodiazepine (unknown type) (35), flubromazepam (3), and flualprazolam (1).
  • Xylazine was detected in 4.2% (16/382) of opioid-down samples, most commonly being found in samples from Substance (12).

In May, 45.1% (172/382) 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 May 2023 and May 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 May 2023 and May 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 14.7% (56/382) 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 13.1% (50/382) of opioid-down samples containing fluorofentanyl in addition to other opioids such as fentanyl. Additionally, fluorofentanyl was the only opioid detected in 7.6% (29/382) 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 40.3% (154/382) 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 31.7% (121/382) 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 May, we quantified fentanyl for 243 of the expected opioid-down samples containing fentanyl and found the median concentration to be 16%[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 7% and 27% 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 0.2% to greater than 40%[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 May, we quantified ortho-Methyl fentanyl in 48 opioid - down samples at a median concentration of 7%, with half of ortho- Methyl fentanyl positive down samples containing between 3% and 15% 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 25.0%[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 (20%) 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 May 2024.

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

As always, send us feedback at substance@uvic.ca on how we can continue to offer our drug checking results in a useful way.

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