Xylazine detected in unregulated opioids and drug administration equipment in Toronto, Canada: clinical and social implications
Abstract
Background: The North American opioid overdose crisis is driven in large part by the presence of unknown psychoactive adulterants in the dynamic, unregulated drug supply. We herein report the first detection of the psychoactive veterinary compound xylazine in Toronto, the largest urban center in Canada, by the city’s drug checking service.
Methods: Toronto’s Drug Checking Service launched in October 2019. Between then and February 2021, 2263 samples were submitted for analysis. The service is offered voluntarily at harm reduction agencies that include supervised consumption services. Samples were analyzed using gas chromatography–mass spectrometry or liquid chromatography-high resolution mass spectrometry. Targeted and/or untargeted screens for psychoactive substances were undertaken.
Results: In September 2020, xylazine was first detected by Toronto’s Drug Checking Service. Among samples analyzed from September 2020 to February 2021 expected to contain fentanyl in isolation (610) or in combination with methamphetamine (16), xylazine was detected in 46 samples (7.2% and 12.5% of samples, respectively). Samples were predominantly drawn from used drug equipment. Three of the samples containing xylazine (6.5%) were associated with an overdose.
Conclusion: We present the first detection of xylazine in Toronto, North America’s fourth-largest metropolitan area. The increased risk of overdose associated with use of xylazine and its detection within our setting highlights the importance of drug checking services in supporting rapid responses to the emergence of potentially harmful adulterants. These data also highlight the clinical challenges presented by the dynamic nature of unregulated drug markets and the concomitant need to establish regulatory structures to reduce their contribution to overdose morbidity and mortality.
View full article here.
Related Content
Piloting and evaluating drug checking services in Toronto, Ontario
The pilot for Toronto’s Drug Checking Service, which checked and publicly reported on more than 10,000 samples between October 10, 2019, and June 30, 2023, was coordinated by the CDPE. While Toronto’s Drug Checking Service now operates from its own unit within MAP Centre for Urban Health Solutions at St. Michael’s Hospital, a site of Unity Health Toronto, the CDPE continues to work collaboratively with and conduct scientific research on the program.
View
Toronto's Drug Checking Service Website
Toronto's drug checking service has launched an interactive website! We will now publicly share regular information on Toronto’s unregulated drug supply, supporting more evidence-based harm reduction practices, policy, research, and care for people who use drugs.
View
Drug checking use and interest among people who inject drugs in Toronto, Canada
Drug checking services (DCS) provide information on drug composition to inform consumption practices and monitor unregulated drug markets. We sought to identify correlates of recent informal DCS use (e.g., fentanyl test strips) and willingness to use a formal DCS (co-located within a supervised consumption site and employing laboratory-based analyses) in Toronto, Canada prior to its implementation.
View
Emerging synthetic cannabinoids detected by a drug checking service in Toronto, Canada
This article reports on new synthetic cannabinoids (SCs) detected in drug samples submitted to Toronto’s Drug Checking Service (DCS) in Toronto, Canada, in the period following restrictions related to the COVID-19 pandemic in Ontario, during which global drug trafficking patterns are believed to have been affected.
View
Diverse psychotropic substances detected in drug and drug administration equipment samples submitted to drug checking services in Toronto, Ontario, Canada, October 2019–April 2020
This report presents early trends of samples analyzed within the first six months of drug checking service implementation in Toronto, Ontario. We sought to identify the prevalence of high-potency opioids in the unregulated drug supply and to identify noteworthy combinations thereof with stimulants, benzodiazepine-type drugs, and synthetic cannabinoids. We also present data on reported negative effects of samples (e.g., overdose).
View
What’s in Toronto’s drug supply? Results from samples checked by Toronto’s drug checking service: January 1 – December 31, 2020
Between January 1 and December 31, 2020, 1657 samples were checked using mass spectrometry technologies (gas- and liquid-chromatography). This report details the results from the analysis of those samples.
View
Detection of Synthetic Cannabinoid Adulteration in the Unregulated Drug Supply in three Canadian Settings
The objective of this study was to characterise the presence of synthetic cannabinoids in the unregulated drug supply in three Canadian settings.
View
Evaluating Networked Drug Checking Services in Toronto, Ontario: Study Protocol and Rationale
As a harm reduction intervention available in Europe since the 1990s, DCS provide information on the composition of drugs to their clients in order to facilitate more informed drug-related decision-making and to increase the capacity of individuals to avoid ingesting unanticipated toxic substances, which can lead to overdose and death.
View
What’s in Toronto’s Drug Supply?
Results from samples checked by Toronto's drug checking service between October 10, 2019 - March 31, 2020.
View
Drug Checking Services for People Who Use Drugs: A Systematic Review
Given the growing availability of drug checking services and interest in their impacts, we conducted a systematic review to investigate the (a) influence of drug checking services on behaviour of people who use drugs, (b) monitoring of drug markets by drug checking services, and (c) outcomes related to models of drug checking services.
View