Towards cross-Canada monitoring of the unregulated street drug supply

Abstract

Background The well-being of people who use drugs (PWUD) continues to be threatened by substances of unknown type or quantity in the unregulated street drug supply. Current efforts to monitor the drug supply are limited in population reach and comparability. This restricts capacity to identify and develop measures that safeguard the health of PWUD. This study describes the development of a low-barrier system for monitoring the contents of drugs in the unregulated street supply. Early results for pilot sites are presented and compared across regions. Methods The drug content monitoring system integrates a low-barrier survey and broad spectrum urine toxicology screening to compare substances expected to be consumed and those actually in the drug supply. The system prototype was developed by harm reduction pilot projects in British Columbia (BC) and Montreal with participation of PWUD. Data were collected from harm reduction supply distribution site clients in BC, Edmonton and Montreal between May 2018–March 2019. Survey and urine toxicology data were linked via anonymous codes and analyzed descriptively by region for trends in self-reported and detected use. Results The sample consisted of 878 participants from 40 sites across 3 regions. Reported use of substances, their detection, and concordance between the two varied across regions. Methamphetamine use was reported and detected most frequently in BC (reported: 62.8%; detected: 72.2%) and Edmonton (58.3%; 68.8%). In Montreal, high concordance was also observed between reported (74.5%) and detected (86.5%) cocaine/crack use. Among those with fentanyl detected, the percentage of participants who used fentanyl unintentionally ranged from 36.1% in BC, 78.6% in Edmonton and 90.9% in Montreal. Conclusions This study is the first to describe a feasible, scalable monitoring system for the unregulated drug supply that can contrast expected and actual drug use and compare trends across regions. The system used principles of flexibility, capacity-building and community participation in its design. Results are well-suited to meet the needs of PWUD and inform the local harm reduction services they rely on. Further standardization of the survey tool and knowledge mobilization is needed to expand the system to new jurisdictions.

Evaluation of an emergency safe supply drugs and managed alcohol program in COVID-19 isolation hotel shelters for people experiencing homelessness

“…The dosing strategy informed by the BCCSU guidelines were appropriate for most patients in this setting (Halifax, Nova Scotia) where the illicit drug supply is comprised primarily of pharmaceutical hydromorphone and cocaine, with relatively little fentanyl and methamphetamine availability in the community compared to elsewhere in Canada ( Brothers et al, 2021 , Brothers et al, 2022 , Lapointe-Gagner, 2022 , Schleihauf et al, 2018 ). Compared to Nova Scotia, British Columbia has much higher rates of illicitly manufactured fentanyl, fentanyl analogues, novel benzodiazepines, and methamphetamine availability and use ( Biggar et al, 2021 ). People who use drugs in Nova Scotia most often use hydromorphone tablets (immediate release or extended release) and cocaine, though rates of illicitly manufactured fentanyl use are increasing ( Brothers et al, 2022 , Brothers et al, 2021 , Brothers et al, 2022 , 2022 ).…”

Prevalence and blood concentrations of benzodiazepines and opioids in opioid‐positive death investigations in Ontario, Canada, from 2017 to 2021

“…Biggar et al. [7] found that 90.9% of individuals who tested positive for fentanyl in Montreal, Quebec, had not intentionally used the drug. Similarly, Kenney et al.…”

“…The volatility of the drug supply significantly increased at the start of the pandemic as supply routes were affected by border closures leading people to use anything they had available [5]. A toxic, unregulated drug supply can lead to the use of unintended drugs and potentially deadly consequences [6][7][8].…”

Application of dose‐addition analyses to characterize the abuse‐related effects of drug mixtures

“…Stimulants, in particular, are frequently mixed with caffeine, lidocaine, or levamisole (Arango‐Meriño et al, 2021; Brandt et al, 2010; Broséus et al, 2015; Davies et al, 2010; Fiorentin et al, 2019; Goh et al, 2008; Lapachinske et al, 2015; Seely et al, 2013; Spiller et al, 2011; Wolford et al, 2012; Zuba & Byrska, 2013), which serve as bulking agents, effectively reducing the amount of illicit drug per gram, while also contributing a mild stimulant or local anesthetic effect. Recently, it has become increasingly common for the mu‐opioid receptor agonist, fentanyl, to be used (intentionally or unintentionally) in combination with other illicit substances, including heroin, cocaine, and methamphetamine, which has contributed to an increase in overdose deaths (Biggar et al, 2021; Karch et al, 2021; Kariisa et al, 2019; LaRue et al, 2019). Thus, despite clear evidence that most human drug use involves multiple substances, a vast majority of preclinical and human laboratory studies evaluate the abuse‐related effects of pure compounds studied in isolation.…”