Toronto Public Health (TPH) is alerting the public after paramedics recently responded to six suspected opioid overdose-related deaths.
The health unit said the number of people who died from drug overdoses between March 14 and 17 is triple the current average seen over a four-day period over the past 12 weeks. The deaths occurred throughout the city, public health said.
1/4: #DrugAlertTO: There has been an increase in suspected opioid overdose deaths attended by @torontomedics, incl. 6 suspected opioid overdose-related deaths between March 14 and March 17: https://t.co/v55NOtwjpq
— Toronto Public Health (@TOPublicHealth) March 18, 2024
And although it is not known at this time exactly what substances those who died consumed, the TPH bulletin made mention of the recent identification of two high-potency synthetic painkillers in the city’s unregulated drug supply.
The “new” drugs found are nitazene opioids and were detected in drug samples collected by the Toronto Drug Enforcement Service, a free and anonymous public health service offered at five harm reduction agencies in the center of the city. city.
The first substance, N-desethylethonitazene, is considered up to 10 times more potent than fentanyl.
It was first identified on February 23 at the Parkdale Queen West Community Health Center (PQWCHC) Queen West site. The sample tested, expected to be fentanyl, was a yellow/beige powder. Instead, it contained a combination of N-desethylethonitazene and caffeine, the service said in a March 18 bulletin.
The second drug is called protonitazepine and is believed to be more than 20 times more potent than fentanyl.
This substance, which is also known as N-pyrrolidino protonitazene or “pyro,” was first found on March 6 and then again on March 7, also in Toronto’s west end, but at the PQWCHC’s Parkdale site. The samples contained a blue powder that was expected to be oxycodone (OxyContin), but actually contained protonitazepine and etonitazepine, another type of synthetic opioid.
Toronto’s Check Checking Service testing site member at the Center for Addiction and Mental Health (Clinical Laboratory and Diagnostic Services) identified these two new medications using a technique known as high-resolution liquid chromatography-mass spectrometry Orbitrap. Another member of the testing site at St. Michael’s Hospital (Department of Laboratory Medicine) also identified them using gas chromatography-mass spectrometry. Both processes essentially separate and identify compounds found in a substance.
It is not known how much of these drugs were found in each sample, as TDCS does not currently quantify N-desethylletonitazene or protonitazepine.
The city’s drug control service noted that none of these samples “were reported to be associated with an overdose or other unpleasant or abnormal effects.”
However, due to the potency of these medications, a larger amount of naloxone may be required to awaken people who are experiencing an overdose, especially when the substance is taken with other central nervous system or respiratory depressants such as related medications. with benzodiazepines or veterinary tranquilizers.
Additionally, the risk of overdose from a nitazene opioid may also be higher for people accustomed to using less potent types of opioids such as oxycodone, Percocet, hydromorphone (Dilaudid), or hydrocodone compared to those who are accustomed to using fentanyl as a measure of tolerance. to opioids. may be lower, TDCS said.
Nitacene opioids were initially synthesized in the 1950s, but were never clinically approved for marketing. Most are stronger than fentanyl and are classified as “high-potency 2 opioids” by the Toronto Drug Enforcement Administration.
According to the service, they began appearing in the unregulated drug supply in Europe, the United States and then Canada (mainly in Ontario and Quebec) in 2019. In Toronto, the opioids nitazene were first identified in unregulated fentanyl. supply in February 2021.
In late 2023, the TDSC identified another highly potent drug that was first found in unregulated supply. Medetomidine/dexmedetomidine is a tranquilizer that can put users into a deep state of unconsciousness, especially when taken in combination with high-potency opioids, benzodiazepine-related drugs, and another animal tranquilizer called xylazine. The effects of medetomidine/dexmedetomidine use cannot be reversed with naloxone as these medications are not opioids.
TIPS FOR THOSE WHO CONSUME UNREGULATED DRUGS
As always, people who use drugs are encouraged to carry naloxone and be trained in its use, monitor their drugs (ideally before use), and use them at a supervised consumption site or overdose prevention site or with another person and take turns detecting each other.
Those who must use it alone are urged to tell someone before consuming it and to take a small test dose first.
People who use drugs are also encouraged to talk to the person from whom they obtained them if the sample did not contain what was expected, or to obtain the drugs from another source.
A naloxone overdose kit is held in downtown Vancouver, Friday, Feb. 10, 2017. (THE CANADIAN PRESS/Jonathan Hayward)