Extreme opioids hit Toronto streets causing overdose deaths

Aug 18, 2021

In recent months, powerful synthetic opioids have been discovered in Toronto’s street drug supply, resulting in a spike in overdose deaths.

According to the results of the investigation carried out by the Toronto Star and Investigative Journalism Bureau (IJB), the presence of the new synthetic opioids, some of which are far more powerful than fentanyl, has quadrupled in tests of street drugs in the city to 4% from less than 1% before the COVID-19 pandemic.

“[This increase] is hugely meaningful,” said Dr. Daniel Beriault, who tests the contents of Toronto street drugs at St. Michael’s Hospital and heads the biochemistry division at Unity Health Toronto. “It’s life and death.”

The new synthetic opioids appearing in Toronto include etonitazepyne and etonitazene (which are considered 10 to 20 times stronger than fentanyl), as well as etodesnitazene and metonitazene (both of which are considered to have similar potency to fentanyl). Furthermore, four months earlier, a similar synthetic opioid called isotonitazene (which is five times more potent than fentanyl) appeared for the first time in Toronto’s illicit drug supply.

In addition, carfentanil, a highly potent opioid which is approximately100 times stronger than fentanyl, is also re-emerging in Toronto’s drug supply

The new opioids were identified by the Centre on Drug Policy Evaluation (CDPE), a Toronto-based research agency that conducts testing on samples of street drugs. Specifically, the “ultra-potent” synthetic opioids were detected in samples that were sold as pure fentanyl.

The emerging opioids were originally created as prospective pain relievers in the 1950s but did not gain approval for medical use. These powerful opioids have not been extensively studied and researchers are still not sure why they are appearing now.

“The actual toxicological effects of many of these novel psychoactive substances is not known,” said Dr. Cristiana Stefan, a clinical biochemist and toxicologist and laboratory director at the Centre for Addiction and Mental Health (CAMH).

Currently, so little is known about the newly emerging potent opioids that the World Health Organization’s expert committee on drug dependence referenced a Reddit post in an official report earlier in 2020 to describe the addictive potential of isotonitazene.

The results of new studies show that the ongoing opioid crisis has resulted in an unprecedented number of overdose deaths during the COVID-19 pandemic with Toronto seeing an 81% increase in opioid-related deaths between 2019 and late 2020.

In addition, research has demonstrated that border closures and drug supply chain disruptions have resulted in emerging new drugs and compounds.

“Any time you disrupt drug trafficking routes, unexpected things will happen,” said Dr. Daniel Werb, the executive director of the CDPE and a research scientist at St. Michael’s Hospital, in his interview with the Toronto Star. “That’s why you see increasingly potent opioids on the market because the higher the potency, the more efficient the package is, the easier it is to traffic.”