Not just a bad batch: a stable supply is a safer supply

We continue to grieve alongside all those who have been impacted by the ongoing emergency that is the overdose crisis. The tremendous loss that continues to impact our communities is carried with us as we draw attention to the conclusions laid out in this post. The BC Coroners report on the illicit drug toxicity deaths in 2020 has included additional post-mortem toxicology results that further describe the drugs detected in these deaths. Here we present some key findings from this illicit drug toxicity data in comparison to recent data from our drug checking project in Victoria, BC. Overall, we see many similarities and it seems that trends in the current drug supply reflect the post-mortem findings. These similarities indicate an urgent need to address the instability in the drug supply through the expansion of safer supply initiatives and regulatory changes that facilitate the expansion of drug checking and other quality control measures.

Our recent service data shows the volatility and uncertainty in the illicit opioid drug supply in Victoria, BC. It would appear that overdose deaths are less attributable to a ‘bad batch’, but rather the unpredictability of the unregulated market. For example, our data shows that nearly 50% of opioid-down samples in December 2020 were found to have fentanyl concentrations above 10%, which is the average potency we have seen in the supply. This suggests that the illicit supply itself, rather than individual actions and behaviors, is impacting the rate of fatal overdoses.

Not only is the overall trend of increased fentanyl concentrations concerning, there is additional uncertainty with fentanyl concentrations at any given time. Figure 1 shows the variance of fentanyl concentrations we checked within each week of December, with an overall median concentration of 9%. To provide an example illuminating this volatility: in the third week of December, we checked opioid-down samples (n=20) ranging from 1% - 25% fentanyl concentrations. This significant variance within the drug supply reflects its instability and continues to inform calls for a stable and consistent source of opioid-down.

To compound this, the amount of benzodiazepine adulteration continues to increase in opioid-down, significantly impacting overdose response and increasing the risk of multiple harms, including death. While we only began screening for benzodiazepines in the spring of 2020, we are witnessing an increased percentage of samples containing benzodiazepines and/or related compounds. This adulteration, while expected in the context of prohibition, reflects the increased risks people who use drugs face in the ongoing contexts of criminalization and stigma. As this report showcases, benzodiazepines are now a common addition to the supply, ensuring even greater volatility and overdose risk.

It’s been almost six years since the declaration of the overdose crisis and we are continuing to experience the worst of it. While drugs like fentanyl are positioned as the source of this harm, it is rather the inconsistent supply resulting from failed drug policy that continues to kill thousands of people in the province of BC and across Canada. These drugs deemed toxic in the illicit supply are the same drugs deemed safe in medical contexts when the dose is known. Supply and policy-based responses to this crisis are long overdue. While we are encouraged with recent Federal investment in safer supply initiatives, we know that it isn’t enough to substantially change the conditions under which people are dying at such alarming rates. As Federal investments in safer supply are increasing, we need to continue focusing on reducing barriers to accessing quality control measures such as drug checking. After all, a stable supply is a safer supply.

Amidst this unregulated supply, our project continues to offer drug checking services in Victoria, BC. Through the use of various technologies, we can analyze your substances and offer you more information about what it contains. To learn more, please visit our website: substance.uvic.ca or come by our service at the following locations:

Points Travelodge
123 Gorge Road East
Phone: (250) 415-7637
Monday - Friday
1-5pm (last sample collected at 4:30)

Lantern Services
820 Cormorant Street (through the parking lot)
Tuesdays
11-5pm

SOLID
1056 North Park
Currently available for Drop-off / Pick-up only,
In-Person drug checking coming soon!

General inquiries:
Substance UVIC: substance@uvic.ca