Incessant reporting on fentanyl and related deaths have created a reality where people using drugs in British Columbia (BC) fear that every bag of white powder could contain a deadly clump of fentanyl. But recent data suggests that, for people who don’t use opioids, the risk of drug contamination with fentanyl is around 2%, or even lower for certain substances.
“This sort of fear that fentanyl is in everything, it’s a very valid fear when we are having unprecedented levels of overdose,” said lead author Bruce Wallace, a professor of social work at the University of Victoria and a scientist with the Canadian Institute for Substance Use Research (CES).
BC has the highest overdose rates in Canada, with 85% percent of overdoses there involving fentanyl. It’s an urgent public health concern that the government and media have labeled a crisis.
The study that Wallace and others produced sought to examine how valid the fear of fentanyl being across all drug supplies actually is. By analysing data sourced from multiple drug testing locations in BC of non-opioid drugs like MDMA, cocaine, psychedelics and amphetamines, the team found that only 2.1% of tested samples were contaminated (found unexpectedly) with fentanyl or similar opioids.
For certain substances, rates of contamination were even lower. For example, only 0.4% of MDMA samples contained opioids; cocaine had less than 2%; while psychedelics and dissociatives came in at around 0.5%.
“I don’t see the benefit in causing this mass panic. We have so many people that are just so scared when they come in here that their MDMA or cocaine is going to have fentanyl in it,” said Michelle Thomas, Site Manager at Get Your Drugs Tested, an independent drug testing service in Vancouver. Thomas agreed that actual rates of unexpected opioids in drugs were lower than public perception, and pointed to public data from the British Columbia Centre on Substance Use, which corroborated much of Wallace’s findings.
While fentanyl isn’t everywhere, some substances carry a greater risk of contamination. Unregulated opioids carried a 15.5% risk of containing unexpected opioids, while benzodiazepines had a 7% risk, and methamphetamines 3.5%. The paper also shows the risk of an opioid being present jumps tenfold when the expected substance isn’t in the sample. For example, someone thinking they had ketamine, but testing showed methamphetamine.
“Somebody made a mistake or misrepresented that drug,” said Wallace. “They’re in a criminalised context, you don’t usually write the drug on the baggies and so drugs are like white powder in baggies. We see hundreds of those. So somebody might have mixed up baggies that were mis-sold or it might have been bought by accident or just somebody mixed up which baggie was which.”
Most unexpected opioids were at ‘trace levels’
Of the 2% of samples showing unexpected opioids, 61% percent contained other opioids at trace levels. Just like mislabeled baggies, these trace amounts are assumed by Wallace and Thomas to be human error.
“My suspicion is a lot of those positive results that we’re seeing, at least in our experience here at our site, most people are also doing fentanyl themselves and they are contaminating their own supply,” said Thomas. “It’s incredibly rare that we test recreational substances for fentanyl, and that person was not doing fentanyl themselves.”
In the US, there’s some evidence that other drug supplies – particularly for cocaine and methamphetamine – also had low levels of contamination. In drug samples tested in drug checking sites in around 25 American states, researchers
Wallace sees value in establishing harm reduction practices further upstream from the end consumer. Illegal distributors can be handling multiple drugs in one location while using the same equipment. Unlike regulated labs, informal markets have no set standards for transport, manufacture, measuring, and cleaning. It’s a reality that doesn’t need to be explained by malicious intent and perhaps could be changed through education.
“I think what we were arguing is basically getting harm reduction compounding pharmacy, there’s proven methods of how you would be doing pill presses,” said Wallace, who has also published research on the perception of ‘clumps’ of fentanyl in BC’s supply.
Fentanyl is a powerful drug, and Wallace’s paper is clear that trace levels of it don’t necessarily equate to ‘safe’. Different tolerances, expected effects, and doses all pose risks for even small amounts of an unexpected synthetic opioid. “There’s a lot of different scenarios and they all have significant impacts if somebody was not expecting fentanyl,” said Wallace.
Navigating BC’s informal drug market
While results of fentanyl contamination are low, this is not to say that it isn’t possible; people should still seek information on their local drug market trends and check their substances for contaminants.
“Of course, we always encourage everybody should still be testing. Definitely, always double-check because you never want to be that one case that has fentanyl-positive MDMA or fentanyl-positive cocaine,” said Thomas.
“There is a value in fentanyl test strips still in the hands of people who know how to use them,” said Wallace. He also emphasizes the importance of educating people on how to use test strips and how to interpret its results.
Other research by Wallace has also confirmed BC’s drug supply shifting away from heroin into fentanyl and other analogues, echoing a trend of decreasing heroin seizures across Canada by the Royal Canadian Mounted Police (RCMP). He said that tracking these changes across multiple, largely separate testing organizations without official standardization or a central database is a challenge.
Harm reduction organisations frequently put out drug alerts about certain batches to inform people of harmful substances. Publicly sharing data and alerts is increasingly popular, yet both Wallace and Thomas were careful to note that communicating risk needs to be balanced with grounded perspectives to avoid stirring up panic.
Thomas adds that narratives can focus too heavily on fentanyl while ignoring the risks of other contaminants. Cocaine, for example, can be cut with phenetidine, a compound similar to paracetamol which can cause liver damage with extended use. Risks shift regionally too, with RCMP on the East Coast issuing warnings about extremely high potency cocaine leading to deaths.
With a shifting drug supply, going beyond fentanyl test strips to test for a wider array of substances is always going to be safer.
“I think that we fall for some of these really scary myths because the crisis is really scary. And I think that fentanyl is in everything all the way up to Halloween candy is a myth,” said Dr. Wallace. “We have a real right to be fearful and a real right to be alarmist, but at the same time we need to be able to try to get as much information in people’s hands and increasing the drug literacy is one form of harm reduction.”
