Monthly Reports Featured

November 2023 Monthly Report

In November we checked 829 samples. Benzos or benzo-related drugs were found in 53% of opioid down samples.

Derek Robinson

• 12 min read
Our new winter mural painted by our talented team member Mo!
Our new winter mural painted by our talented team member Mo!

In this blog post, we discuss our November 2023 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 12.6%
  • The median fluorofentanyl concentration found across all drug categories was 7.0%
  • Carfentanil was found in 5 expected opioid - down samples with a median concentration of 0.5% and maximum concentration of 0.7%
  • Benzodiazepines were found in 53% (207/391) of expected opioid-down samples
  • Bromazolam, the most common benzo found within opioid-down, was found in 163 opioid-down samples with a median concentration of 5.9% and maximum concentration of greater than 25.0%
  • Xylazine was found in 17 expected Opioid - down samples with a median concentration of 0.3% and a maximum concentration of 29.0%

Insight for the November 2023 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 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, and supervised consumption locations. These samples are labelled as “Outreach” samples in the figures/tables herein

Drug Types

Fig. 1 shows the prevalence of each expected drug category checked, split by sample collection location/method. Table. 1 shows the number of samples per drug category split by sample collection location/method.

Figure 1. Prevalence of drug classes checked during November 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 November 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 samples subjected to the spectrometers of Substance:

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.

Ketamine

95% (35/37) of expected ketamine samples checked in November were confirmed to be ketamine with no other active compounds detected. The remaining two expected ketamine samples (both from Victoria) were found to contain the following unexpected active components:

  • Cocaine HCl
  • Fluorexetamine

Cocaine HCl and Cocaine Base

84% (105/125) of expected cocaine samples (79 cocaine HCl/soft, 26 cocaine base/hard/crack) were confirmed to be cocaine with no additional active compounds detected.

16 samples contained an active component in addition to cocaine (Victoria (8), Campbell River (4), Comox Valley (2), Outreach (2)):

  • 4 samples contained cocaine HCl and levamisole
  • 2 samples contained cocaine HCl and phenacetin
    • One of these samples additionally contained fentanyl, this was expected by the service user due to cross contamination prior to checking their drugs
  • 1 sample contained cocaine HCl and ketamine
  • 4 samples contained cocaine base and phenacetin
  • 2 samples contained cocaine base and levamisole
  • 1 sample contained cocaine base and fentanyl or a fentanyl analogue, this was likely due to cross-contamination as the sample contained bright pink specks in addition to large white chunks
  • 1 sample contained cocaine base and an undifferentiated benzodiazepine
  • 1 sample contained cocaine base and fentanyl, this was expected by the service user due to cross contamination from their other samples

3 samples contained solely unexpected active components (not cocaine HCl or cocaine base)

  • 1 expected "synthetic cocaine" sample contained an undifferentiated cathinone, suspected to be 3,4-Methylenedioxypyrovalerone (otherwise known as MDPV)
  • 1 expected cocaine HCl sample contained ketamine instead
  • 1 expected cocaine HCl sample contained benzocaine instead

Methamphetamine

83% (33/40) of expected methamphetamine samples checked were found to be meth with no other active compounds detected.

5 samples contained an active component in addition to methamphetamine (Victoria (4), Campbell River (1)):

  • 1 sample contained methamphetamine and lidocaine
  • 1 sample contained methamphetamine and an undifferentiated benzodiazepine
  • 1 sample contained methamphetamine and amphetamine
  • 1 sample contained methamphetamine and fentanyl or a fentanyl analogue
  • 1 sample contained methamphetamine, bromazolam, and fluorofentanyl

2 samples contained solely unexpected active components (not methamphetamine):

  • 1 sample was found to contain bromazolam, fentanyl, and fluorofentanyl instead of the expected methamphetamine
  • 1 sample was found to contain MDMA instead of the expected methamphetamine

MDMA

86% (48/56) of expected MDA/MDMA samples checked were confirmed to be MDA (1 sample) or MDMA (47 samples) as expected.

2 samples from Victoria contained MDA in addition to MDMA

6 samples contained solely unexpected active components (not MDA or MDMA)

  • 1 expected MDA sample contained MDMA instead
  • 1 expected MDA sample contained MDMA, methamphetamine, and fentanyl or a fentanyl analogue. This was very likely caused by cross contamination as this sample was taken from a container with several other samples in it.
  • 1 expected MDMA sample contained MDA and MMDPPA instead. MMDPPA is an ingredient used to make MDA and is likely leftover from the manufacturing process.
  • 2 expected MDMA samples contained MDA instead
  • 1 expected MDMA sample was methamphetamine instead

Benzodiazepines (n=12)

58% (7/12) of the expected benzodiazepine samples checked in November came to our service sites in the form of pressed pills with the following expected and detected compositions, shown in Table. 2.

Table 2. The composition of benzodiazepine pressed pills checked in November. “Expected Composition” describes the benzo expected/reported by the service user, while “Detected Composition” describes the contents we found through the drug check.
Table 2. The composition of benzodiazepine pressed pills checked in November. “Expected Composition” describes the benzo expected/reported by the service user, while “Detected Composition” describes the contents we found through the drug check.

The remaining five samples had the following expected and detected compositions:

  • 2 samples expected to be alprazolam contained bromazolam instead
  • 1 sample expected to be diazepam (also known as Valium) was confirmed to be diazepam
  • 1 expected unknown sample was found to contain bromazolam cut with caffeine
  • 1 expected unknown sample was found to contain bromazolam and fentanyl or a fentanyl analogue

Opioid-positivity in non-opioid-down samples

In November, we checked 367 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 November.
Table 3. Overview of unexpected opioid detections in non-opioid-down samples in November.

Examining Table 3, we find that 14 samples tested positive for unexpected opioids in November, representing 3.8% of all non-opioid-down samples checked. These samples were as follows:

  • 1 expected unknown benzodiazepine contained bromazolam and fentanyl or an analogue
  • 1 expected cocaine base sample contained cocaine base and fentanyl[1]
  • 1 expected cocaine base sample contained cocaine base and fentanyl or an analogue[1:1]
  • 1 expected cocaine HCl sample contained cocaine HCl , fentanyl, and phenacetin[1:2]
  • 1 expected MDA sample contained MDMA, methamphetamine, and fentanyl or an analogue[1:3]
  • 1 expected methamphetamine sample contained methamphetamine, bromazolam, and fluorofentanyl[1:4]
  • 1 expected methamphetamine sample contained methamphetamine and fentanyl or an analogue[1:5]
  • 1 expected methamphetamine sample contained bromazolam, fentanyl, and fluorofentanyl, making it consistent with an opioid - down sample.
  • 1 * expected* hydromorphone sample contained fluorofentanyl instead
  • 1 expected isotonitazene sample contained both isotonitazene and metonitazene
  • 1 expected oxycodone sample contained fentanyl instead
  • 1 expected oxycodone sample contained metonitazene instead
  • 1 expected Percocet sample contained isotonitazene instead
  • 1 expected N-desethyl isotonitazene sample additionally contained fentanyl

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

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

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.

Opioid-Down (n=391)

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.

  • 83% of expected opioid-down samples contained fentanyl (325/391)

  • 70% of expected opioid-down sample contained fluorofentanyl or fluorofentanyl base (273/391)

  • 4 samples contained heroin and related alkaloids to heroin such as acetylmorphine (MAM) or acetylcodeine, representing 1% of expected opioid-down samples

    • 1 contained morphine
    • 2 samples included the following additional actives: fentanyl, etizolam, and lidocaine

  • 5 samples contained carfentanil

  • 53% (207/391) of expected opioid-down samples contained a benzodiazepine

  • The most common benzodiazepine in opioid-down samples was bromazolam (177), followed by undifferentiated benzos (28), and flubromazepam (11)

  • Xylazine was detected in 4.6% (18/391) of opioid-down samples, most commonly being found in samples from Victoria

In November, 72% (281/391) 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 November 2022 and November 2023 that only contained fentanyl/heroin actives (solid dark blue), opioid-down samples with an additional active detected (dot-dashed 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 November 2022 and November 2023 that only contained fentanyl/heroin actives (solid dark blue), opioid-down samples with an additional active detected (dot-dashed 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 70% (273/391) of opioid-down samples containing fluorofentanyl in addition to fentanyl. Additionally, fluorofentanyl was the only opioid detected in 14% (56/391) 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 53% (207/391) 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 45% (177/258) 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 November, we quantified fentanyl for 304 of the expected opioid-down samples containing fentanyl and found the median concentration to be 13.0%[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 6.7% and 22.6% fentanyl, and any one sample might be the lowest strength (<0.1%) or the strongest (>80%[3]). Fluorofentanyl was seen at concentrations ranging from 0.2% to greater than 40%[3:1] as well, with a median concentration of 7.2%. 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 5.9%. 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 (12.6%) 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 November 2023.
Table 4. Quantification of low-concentration active components in expected opioid-down samples in November 2023.

The fentanyl, and bromazolam concentrations that we quantified in November, 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), fluorofentanyl, (middle panel), and bromazolam (bottom) positive samples quantified during November across all collection locations/methods.
Figure 4. Violin plots of fentanyl (top panel) and bromazolam (bottom) positive samples quantified during November across all collection locations/methods.

We can also examine the regional variability in the unregulated market. Table. 5 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 November 2023. 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 November 2023. 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 Nov 2023 Monthly Report
Substance Drug Checking Nov 2023 Monthly Report.pdf
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Check back next month for the December 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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