Several forms of extremely potent synthetic opioids are being found in random samples of Toronto’s street drug supply, which experts say is indicative of increased risk for people in a city grappling with an overdose crisis.
“What’s very dangerous for people who use drugs is just that the supply is getting stronger, and it’s also just completely unpredictable — and what people are buying isn’t necessarily what they’re getting,” said Karen McDonald, the lead for Toronto’s drug checking service, which operates out of St. Michael’s hospital.
“It’s definitely alarming to us.”
The emergence of opioids like etonitazepyne, metonitazene and isotonitazene — a phenomenon previously reported on by the Radio-Canada and the Toronto Star — shows that the city’s drug supply is getting stronger and less predictable, McDonald told CBC News.
“It’s just a terrible situation that people are being placed in,” she said.
The opioids are painkillers that were synthesized in the 1950s, but were never clinically approved for market use. The city’s drug checking service, which has been running since the fall of 2019, first started seeing them show up in samples back in May.
The drugs have been filtering in as the city grapples with an increase in deaths linked to opioids.
According to a public health report from last month, Toronto saw 521 confirmed opioid overdose deaths in 2020, which was 78 per cent higher than in 2019 and 280 per cent higher than in 2015.
The number of fatal suspected opioid overdoses attended by paramedics also increased since the COVID-19 pandemic began in March of 2020. Before the pandemic, paramedics attended an average of 13 calls a month, but that number doubled to 26 fatal calls per month in 2020.
According to city statistics, paramedics were called to 448 non-fatal suspected overdose calls last month, which was well above the 202 calls seen in June of last year.
How many overdoses the extra-potent synthetic opioids were responsible for is not clear.
Pandemic created barriers to services
Nick Boyce, director of the Ontario Harm Reduction Network, told CBC News these numbers don’t come as a surprise, as he believes federal laws that prohibit drugs are creating a black market that is volatile.
“There’s always been an element of risk when you’re using unregulated drugs … if we just regulated these drugs and people had drugs of known quality and consistency, we wouldn’t be seeing these overdoses,” he said.
Similarly, the public health report from last month called on federal Minister of Health Patty Hajdu to use her authority to decriminalize the personal use of all drugs, declare a national public health emergency and develop a Canada-wide plan to curb overdoses.
Though COVID-19 has undoubtedly factored into the city’s overdose numbers in some respects, McDonald said she doesn’t think the emergence of these drugs is directly related to the pandemic.
“The unregulated drug supply has been getting worse and worse and worse over the last number of years, and we see this directly because of the rise in overdoses,” she said.
“A lot of people working in my space would say the supply was heading this way, and this would have happened regardless.”
The main thing COVID-19 has done, she said, is thrown up barriers to services.
“So the one main piece of harm reduction advice for people is don’t use alone, but then COVID is telling you stay at your house. So that’s kind of directly conflicting,” she said.