A Review on Victoria's Drug Supply
Our project members, Jarred Aasen and Ash Larnder, presented on our findings from Nov. 2020 - May 2021 to share recent drug data and trends we are seeing in the Victoria drug supply.
"We often receive a lot of questions about how the illicit supply relates to client use from the local health care community. We aim to present data with this frame of reference to answer these questions. This presentation is focused on the healthcare community here in Victoria that is providing care in the area of substance use."
Here we recap the presentation and include some dialogue from the Q&A that followed.
Q&A Recap from the Presentation
(1) Is there any relationship between the fentanyl % found in down samples and the % of etizolam?
Through preliminary analysis we haven't identified any distinct trends. Both drugs are found to have a high level of variability across samples. A high concentration sample of fentanyl is just as likely to contain either a high or low quantitiy of etizolam.
(2) Do you collect any demographics on people accessing drug checking services?
At the sample intake we collect non-identifiable information including how many times a service user has accessed drug checking before, what the sample is supposed to be, if the sample has been tried before, why the substance is being checked and for who it is being checked for. We have an additional survey option that targets demographic-specific information, but the pandemic has interfered with our ability to collect this data.
(3) The proportion of benzos in the down supply has decreased in the latest report. Do you suspect this is a one-off, or that the opioid supply will continue to trend towards less benzos?
It's hard to comment on future trends, but we will be focused on this topic in the following months. Whether benzos continue to trend downwards depends how responsive the market is, considering a fair amount of people who use down do not want benzos to be present and that benzos are contributing to higher rates of both atypical and fatal overdoses. If down suppliers listen to their market, benzos should hopefully trend downwards.
(4) Do you think you capture a higher prevalence of benzos in Victoria compared to Vancouver due to availability of PS-MS or do you think there is a significant difference in the drug supply?
We currently use benzo test strips, FTIR, Raman and PS-MS to help detect and identify benzos, with PS-MS giving the most sensitive and consistent results when dealing with trace quantities. We have found the benzo strips fail to reliably detect etizolam and that the FTIR struggles to detect most benzos due to their low concentrations. We presume the rate of benzos in the down supply are likely very similar, but that our PS-MS has allowed our project to better see them at this time.
(5) Do you see carfentanil being the new standard and replacing fentanyl in the next few years?
This is a very interesting question, but is very difficult to predict and we can only speculate. DAS labs data has shown carfentanil to oscilate a bit over time in the supply (see here). A good drug checking project will be ready to follow new trends as they begin. As it stands the PS-MS is a good instrument to monitor the frequency of carfentanil in the down supply.
(6) Regarding etizolam detection, is it the structure itself or the concentration? Couldn't you just increase the mg per mL?
It appears that solubility and structure are bigger factors than concentration at this time. Etizolam isn't very soluble in water and therefore it isn't mixing into solution to be adsorbed up the test strip. In addition, etizolam is a thienodiazepine, which has a slightly different structure than other benzodiazepines. This may also contribute to the lack of sensitivity on the benzo strip tests.
(7) Are you tracking the 'expectations' of substances brought in terms of whether the person had already used some of it versus having not yet used?
If so, is there a correlation? Are people able to accurately detect other substances than what they’re expecting?
We do collect subjective reporting of unexpected effects when a substance has already been used; however we haven't done an in-depth analysis as to whether this links with the interpreted sample composition. Anecdotally, we have seen this at times during service, as when a down sample was found to be stronger than normal and it ends up containing a benzodiazepine or carfentanil. Though many times when a service user reports an adverse effect with the psychoactive substance it has more to do with the dose (i.e. took too much), the set (i.e. what was their mindset going into the experience) and setting (i.e. were they in a safe environment surrounded by people they trusted).
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