Opioids are substances that produce analgesic effects and can be natural or synthetic.
Synthetic opioids in particular are infamous due to their potency. Since opioids can also be produced or obtained illegally, there has been a rising trend of substance abuse and overdose from opioids.
Fentanyl is common synthetic opioid that has been approved for medical use, however it has grown increasingly common throughout the years due to its potential to be trafficked and abused as a street drug.
Fentanyl is currently considered a high-potency opioid, but authorities are now seizing substances much stronger than fentanyl.
In recent years, with the ongoing opioid epidemic, the street supply of opioids in Canada has been increasing steadily; however, it is believed that due to the border closures during the COVID-19 pandemic, the supply chain was disrupted. This played a role in the creation of new and more lethal synthetic opioid cocktails, and the increased use of “Ultra-potent opioids”.
Ultra-potent opioids such as carfentanil, etonitazene, and isotonitazene have been found circulating in unregulated drug supplies in Toronto, as well as other major cities in Canada.
Carfentanil
An analogue of the synthetic opioid fentanyl, typically used by veterinarians on very large animals. Carfentanil was first synthesized in 1974 by a team of chemists at Janssen Pharmaceutica which included Paul Janssen.
It is approximately 100 times stronger than fentanyl, 4,000 times stronger than heroin, and 10,000 times stronger than morphine
It has no distinguishable odor and comes in many forms, including powder, tablets, patches, blotted paper,
liquid, and sprays. It can be administered orally, nasally, or intravenously. Although known to
resemble powdered cocaine or heroin, this drug has also been seized as a pale yellow, pink, or brown powder.
Common street names of carfentanil include “drop dead”, “C.50”, “serial killer”, and when mixed in
combination with other opioid/opioid-like drugs, “grey death”.
Between March 1 and May 17, 2021, carfentanil was found in 4% of the expected fentanyl samples checked by Toronto’s drug checking service (11 of 274 samples).
“This is the most carfentanil we’ve identified in a period of less than three months since launching our service in October 2019”
Toronto’s Drug Checking Service
“Preliminary data from LifeLabs also shows a significant increase in carfentanil found in urine samples from across the province of Ontario. In both March and April 2021, LifeLabs detected carfentanil in approximately 1.5% of all urine broad spectrum drug screens, compared to 0.1% of all urine drug screens completed in August 2020”
Carfentanil was usually found alongside fentanyl and caffeine – and a benzodiazepine-related drug was found in over half of these samples. Three of these samples were purple in colour and one sample was known to be associated with an overdose.
Etonitazene
An opioid synthesized in the 1950s for pain relief that was never clinically approved for market.
It is approximately 10 to 20 times stronger than fentanyl
It can be seen in the form of an orange powder or grainy substance.
Etonitazene was first detected in Saskatoon by a Health Canada lab on Nov. 2, 2021. It is the first time the drug has been spotted in the province, however it was also found in Toronto in May.
“Between March 31 and May 17, 2021, isotonitazene and/or etonitazene were found in 4% of the expected fentanyl or down samples checked by Toronto’s drug checking service, in 6 of 171 samples”
Toronto’s Drug Checking Service
Isotonitazene
It is a synthetic version of etonitazene. An opioid synthesized in the 1950s for pain relief that was never clinically approved for market. Isotonitazene itself is relatively new, it has not been explicitly illegal and therefore can be found sold online in the dark web.
It is approximately 5 times stronger than fentanyl
A Halifax Regional Police street crime unit came across a new street drug in the city during an investigation and seized 1900 pills, Health Canada later confirmed that the pills were isotonitazene.
The pills are white in colour and shaped like a triangle with rounded corners, with an M initial on one side and number 8 on the other. Police warned that it can be dangerous to even handle the substances without precautions.
“Like other designer or novel psychoactive substances, isotonitazene is not detected in a standard opiate drug test; special drug screens are currently being developed in order to detect the substance on a routine (drug screen)”
https://www.healthline.com/health-news/iso-the-new-synthetic-opioid-that-is-causing-overdose-deaths
Benzodiazepine-related substances were also found in those samples and fentanyl was typically present, three samples were also known to be associated with an overdose.