Almost 80 per cent of street drugs tested for fentanyl at a Vancouver safe injection site were laced with the potentially deadly opioid, a nine-month pilot study has found.
The study, presented Monday at the 25th Harm Reduction International conference in Montreal, found more than 80 per cent of the heroin and crystal meth and about 40 per cent of the cocaine brought into Insite by clients contained illicit fentanyl.
In all, more than 1,000 drug samples -- the vast majority of them heroin -- were tested between July 2016 and March 2017 at the Downtown Eastside supervised injection centre using specialized strips that detect the presence of fentanyl.
"Clients at Insite were able to use the results from the drug-checking service to reduce their dose and decrease their risk of overdose," said lead researcher Dr. Mark Lysyshyn, medical health officer for Vancouver Coastal Health.
"If drug checking can help clients at a supervised injection site like Insite where nobody has ever died from an overdose, imagine how much it could help people in places without these life-saving programs."
In British Columbia alone, more than 900 people died of apparent illicit drug overdoses in 2016, with about 60 per cent of the deaths linked to illicitly manufactured fentanyl. The synthetic opioid is 100 times more toxic than morphine and a dose the size of a grain or two of sand can result in a fatal overdose.
Over the study period, Insite clients were asked if they wanted their drugs tested for fentanyl, said Lysyshyn, who estimated that about five of the roughly 600 daily visitors accepted the researchers' offer.
Of all the drugs checked, almost 80 per cent were heroin, while crystal meth represented 7.2 per cent of the drugs and cocaine made up 5.3 per cent. About 38 per cent of testing was performed pre-consumption and the remainder post-consumption by analyzing traces of the drugs left in "cookers" used by clients to prepare their injections.
Testing is done with strips designed to detect fentanyl in urine. But the B.C. researchers used the highly sensitive strips to test for the potent opioid by mixing a drug sample with water. If the strip reacts by showing a single pink line, the test is positive; two lines means no fentanyl is present.
"It was the community that asked for this. Drug users said we want to know what's in our drugs, so we offered it to them and they're doing the test and we let them deal with the information," Lysyshyn said.
"People are much more likely to check a drug that they have previously overdosed on, or that they felt weird when they were taking it, or it looks different than their normal drugs."
However, the results of the study need to be interpreted with caution, he added.
"It's not saying 80 per cent of the heroin on the streets of Vancouver is contaminated. It may be, but this could be an overestimation of that based on the fact that people are more likely to check what they think are contaminated drugs."
Rick Lines, executive director of Harm Reduction International, said the study "proves that the alarm bells that have been sounding over this public health emergency are fully warranted."
"Street drugs are costing lives and this research confirms what we've long known -- that supervised injection sites and drug checking can prevent unnecessary deaths."
There are four centres in Vancouver where users can inject their drugs under the watchful eyes of staff, who are trained to give shots of the rescue medication naloxone in the event of an overdose. The centres also provide sterile equipment, information about drugs, basic health care and addiction treatment referrals.
Lysyshyn said the researchers want to find other settings where fentanyl testing could be offered in a bid to reduce fatal overdoses.
On Friday, federal Health Minister Jane Philpott announced that two of three supervised injection sites in Montreal passed inspections and have been authorized to begin operating. A number of other cities, including Ottawa, Toronto and Edmonton, have applied to the federal government for permission to open similar safe drug consumption centres.
Such sites would require an exemption from the Controlled Drug and Substances Act, which prohibits illicit drug-related activities. The government has proposed new legislation, Bill C-37, which if passed by Parliament would streamline the application process for such sites.
Lysyshyn said most drug-checking projects have been done in dance-club settings or at music festivals, "where suburban kids check ecstasy and if it's contaminated they throw it out."
"Here we have people who are dependent on these drugs, they will be in withdrawal if they don't use them, so we didn't really expect people were going to dispose of their drugs very often," he said.
"But we wanted to give them some information about those drugs so that they could do things like reduce their dose, not use alone, use at a supervised injection site, get trained in naloxone -- all the things that we know work. And understanding when their drugs are contaminated can motivate them to do those things."
