How to survive the opioid crisis

Important advice for casual party-drug users taking illegal substances bought on the black market

Should you be worried about fentanyl in your MDMA?

As summer festival season approaches and Canada’s fentanyl-fuelled overdose crisis morphs into a full-blown epidemic, there’s worry in harm reduction circles that cross-contamination and even direct adulteration of party drugs are happening more often.

Experts have two important pieces of advice for casual party drug users taking any sort of illegal substance bought on the black market.

“Always, always, always test your substances, and keep a naloxone kit around and know how to use it,” says Thomas Cobb, director of the Toronto chapter of Canadian Students for Sensible Drug Policy.

Cobb’s group recently held its first drug testing seminar at the University of Toronto, organized in reaction to the dramatic rise in fentanyl-related deaths and recent media reports that drugs available on the street, including cocaine, were contaminated with opioids.

The crowd of mostly students and harm reduction workers got a crash course in how to take samples of a given substance and test for its contents, as well as how to recognize the signs of different types of overdoses. 

Such kits are useful, but few can detect fentanyl, and no over-the-counter consumer-level kits can currently test for fentanyl’s stronger cousin carfentanil. 

Participants also learned about a new technique developed at Vancouver’s Insite safe injection site that uses urine strips to detect the presence of opioids in drugs.

But since as little as a grain of sand’s worth of fentanyl can kill you, Cobb says naloxone is the only way to counteract a fentanyl overdose. You can get free injectable naloxone at hundreds of pharmacies across Ontario, and participating pharmacies offer training on how to use the kits. The medication also comes as a nasal spray, but it’s not available for free.

Harm reduction experts don’t all agree on the need for a personal naloxone supply, however.

Nick Boyce, director of the Ontario HIV and Substance Use Training Program, thinks media may be exaggerating the extent of fentanyl contamination in party drugs.

“Pharmacologically, it doesn’t make a whole lot of sense,” he says, for dealers to cut a stimulant like cocaine, for example, with a downer like fentanyl. He does acknowledge, though, that accidental contamination is possible if dealers reuse baggies.

Ontario has no reliable data about whether recent overdoses associated with cocaine or MDMA were caused by fentanyl.

Boyce suggests that “there’s a lot of sensationalism to keep people scared, and unfortunately that has a lot of unintended consequences,” getting in the way of people learning the facts about what different drugs do and what to do if you get into trouble. 

He’s only heard of one lab-confirmed case of an overdose in which opioids showed up in MDMA, and just one anecdotal case in which someone was revived by naloxone after thinking he took MDMA – out of “thousands” who use party drugs in Toronto every weekend.

Despite his doubts, however, Boyce says promoters and club owners could do better by having someone on site who is trained to administer naloxone.

“Maybe they should have a kit on standby in the same way we have defibrillators around the city,” he says.

If you or one of your friends is experiencing an overdose, Boyce says to call 911. 

“Too often,” he says, “people let friends sit in the corner of the club or sleep it off in the bedroom when they actually need medical assistance.”

NOW reached out to Toronto Public Health about whether people using party drugs should carry naloxone kits. In an email response, spokesperson Brian Kellow cites recent reports of contamination and says, “As the recreational drug market is not tested or regulated, non-opioid drugs could be contaminated, so consideration should be given to naloxone kits and training.”

The province is looking at ways to distribute naloxone kits more widely. Kits are now only supposed to be available for those currently on opioids, past users at risk of relapsing and family and friends of those at risk of opioid overdoses.

Deciding to make naloxone more available would be easier if we had better data on opioid use, and the province is exploring ways to gather more through provincial emergency departments. 

But Ministry of Health and Long-Term Care spokesperson David Jensen notes, “This information would be reliant on patients’ self-reporting,” and right now that’s not happening in a comprehensive way.

If you or a friend experience an overdose, Boyce says, don’t be afraid to call 911 – getting medical attention can save a life. | @nowtoronto

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