'We're losing control': Ultra-potent, unpredictable street opioids are claiming more lives in Canada

Canada's street supply of opioids is becoming increasingly toxic, unpredictable and contaminated thanks to ultra-potent and deadly mixtures of fentanyl, prompting renewed calls for safe supply programs that could help regain control of the drug supply and save lives.

It's believed pandemic border closures have played a role in disrupting the supply chain, prompting the creation of new, more lethal cocktails.

“We’re absolutely losing control of the drug supply, and it’s causing people to die,” Karen McDonald, lead of the Toronto drug-checking service operated by St. Michael's Hospital, told CTV National News.

“Fentanyl can be used safely … but it can’t be used safely when you have no idea how much fentanyl is in it.”

Launched in 2019 in response to the growing opioid epidemic, Toronto’s anonymous drug-checking service offers drug users detailed information on the contents of their drugs in a bid to reduce overdoses.

McDonald says the lab has been detecting an increasing number of ultra-potent opioids – drug mixtures that are considered to be five to 20 times stronger than fentanyl alone – in recent months, as well as a spike in suspected overdose deaths.

Many of these drugs are mixed with opioids that are that were synthesized in the 1950s to relieve pain but never actually made it to market.

“Fentanyl is already considered a high-potency opioid – it’s 80-100 times more potent than morphine. And now what we’re seeing is drugs that are even stronger than fentanyl presenting in fentanyl,” she said.

“It’s unexpected by the people that are going to be using them.”

The use of fentanyl, cannabis and methamphetamines spiked across cities in Canada during the early pandemic, according to Statistics Canada’s Canadian Wastewater Survey, which analyzed wastewater in major cities. Researchers say this may be a strong contributing factor to the spike in overdose-related deaths last year.

According to the study, the amount of fentanyl detected in Toronto’s wastewater supply tripled early in the COVID-19 pandemic. Per-capita loads of fentanyl in Vancouver were more than four times higher than in any other city, with detectable loads jumping 66 per cent between March and July 2020 compared to last year.

But the pandemic is not entirely to blame. Alberta reported an increase in ultra-potent opioids as early as 2019, putting programs like McDonald’s on high alert and prompting calls for regulated, government-supported safe drug programs.

“The supply is the issue,” McDonald said, noting that this is the nature of an unregulated drug supply; there are no recipes, no dosage recommendations for those addicted to opioids.

“There are some safer opioid programs that are starting to be introduced. This is like a form of regulation. A person with an opioid dependency would be transitioned off of the street [supply] and onto a pharmaceutical supply.”

Those living the realities of opioid dependency are also calling for increased education and overdose training within shelters and other areas users frequent.

Angie Austin watched her partner of 16 years, Oliver Smith, die of a suspected overdose in Toronto at a city-run shelter.

“I couldn't feel no air coming out of his mouth, so i started to shake him and telling him to wake up,” Austin told CTV National News. “It took 26 minutes for the ambulance to arrive – I timed it.”

Austin says there was no oxygen available on-site – a factor some say could prevent deaths.

“If people just had some basic overdose response training and you were allowed to use oxygen, we would see far fewer fatalities,” Sarah Grieg, Moss Park consumption and treatment service program manager in Toronto, told CTV National News.

“We also need access to safer supply. Injectable heroin, fentanyl, pharmaceutical-grade recommended doses [of each] so that there’s not the adulterants that are polluting people and poisoning people.”

Toronto city shelters are not required to have oxygen on-site but are required to have Naloxone, a medication used to counteract the effects of opioids. Staff are trained in how to administer Naloxone; however, the City of Toronto would not say whether Naloxone was used in Smith’s case.