The opioid epidemic has worsened all across North America in recent years, mostly due to fentanyl-related deaths. Both medically prescribed and illegal opioids have propelled the crisis. The Public Health Agency of Canada states, “Since the early 1980s, the volume of opioids sold to hospitals and pharmacies for prescriptions in Canada has increased by more than 3000 percent.”
Fentanyl was first reported in British Columbia’s street drugs in 2011. By 2016, the Government of British Columbia had declared a public health emergency due to major increases in drug-related overdoses and deaths. This crisis has no specific boundaries, as it affects people of all ages and socioeconomic backgrounds across the continent.
The Government of Canada released key statistics from 2016–2020:
- Between January 2016 and June 2020, there were 17,602 opioid toxicity deaths in Canada
- Western Canada has been most impacted over these years, but there have been steady increases in overdoses across the rest of the country as well
- 86 percent of all opioid-related deaths in 2020 were in BC, Alberta, and Ontario
- Deaths are most common in males ages 20–49
- In 2020, 75 percent of accidental opioid deaths involved fentanyl
It’s a grim situation, but a drug-checking project at VIU offers some hope. Dr. Chris Gill, Scott Borden, Armin Saatchi, and their team of researchers at Applied Environmental Research Laboratories (AERL) have developed a new drug testing method that has the potential to save lives.
For the past three years, AERL has been working on a new method of drug testing by using paper spray mass spectrometry (PS-MS)—an analytical technique that can measure drug samples quickly and accurately. As previously reported in The Nav, AERL’s pilot project took place in August of 2019 in Vancouver’s Downtown Eastside.
The team worked alongside the Powell Street Getaway Harm Reduction Site, where they successfully utilized the ground-breaking drug detection technique. One strength of the PS-MS is that it requires one milligram of drug sample and takes only a few minutes to see accurate results. The researchers tested over 140 substances in two days.
“One of the strengths of our technique is we can potentially identify things that we don’t expect to be there, like new drugs coming in,” Borden said.
Borden, a Ph.D. candidate at the University of Victoria, is part of the research team that works out of Nanaimo’s VIU campus under Dr. Gill.
“In my hometown of Kamloops, I saw a number of overdoses within my community, and even people I went to high school with,” he said. “There were many of these fatal overdoses. People are losing children, siblings, friends, so you do see it affect people in such a real way.”
There are a number of techniques currently used to test for opioids in street drugs, Borden said, but each has limitations. The Fourier-Transform Infrared Spectroscopy (FTIS) technique and Immunoassay Urinalysis Drug Test Strips are some current qualitative methods—meaning they produce less accurate test results.
“These methods are good at doing certain things, but they do have severe limitations,” Borden said.
For one, their detection limit is high—to get accurate results and prevent deadly overdoses, the lower the detection rate the better. Borden explained that as increasingly potent synthetic opioids like fentanyl and carfentanil are finding their way into street drugs, it’s crucial to have more accurate detection.
The new PS-MS method is quantitative and can detect even trace amounts of lethal opioids in samples. This is what can save lives. “Carfentanil is so potent; one crystal is enough to cause an overdose,” Dr. Gill told the Times Colonist.
Below is a visual representation of the rapid on-site drug testing method that AERL Researchers used in East Vancouver in 2019. Image via Dr. Chris Gill.
The research team uses a spectrometer, which is a scientific instrument to view and analyze substances. In using this instrument, the three building blocks of PS-MS are the “ion source,” where ions are created, the “mass analyzer,” where ions are sorted, and the “detector,” which creates a signal that’s translated into a number showing the percentage of any drug in the sample.
To ionize the neutral drug sample, the molecules must lose an electron and become positively charged. In order to exclusively attract the desired positive charge, the detector is set to a negative charge to act as a magnet. This in turn detects the drug compounds and gives an accurate reading of what is in the given drug sample.
Borden and the researchers on his team begin with a small, inexpensive piece of filter paper cut into a triangle. They put the drug sample on the paper and apply some solvent, like alcohol. As the solvent travels to the tip of the paper, it carries out the drug sample and the molecules they are looking to analyze. Then, they apply a high voltage charge to it and create ions that can then be sent to a detector. This is how they quantify their results and are able to produce extremely accurate findings for any drug sample—not only fentanyl and its derivatives.
Image via Dr. Chris Gill
Since September 2020, the AERL team has been working alongside Lantern Services Drug Checking in Victoria. Borden relayed some shocking information regarding their more recent findings.
“We’re working with an existing drug-checking project and using our technology to put a number on the amount of fentanyl in a submitted opioid sample. Or you know, we might see fentanyl in cocaine. We are able to put a number on it, which oftentimes isn’t possible with current methods.”
“Additionally,” he said, “there have been cases where we have looked at samples and been able to detect carfentanil at less than one percent, which can still be incredibly dangerous and can cause an overdose.”
Borden said the most surprising thing right now with their data is the degree to which samples containing fentanyl are being laced with another drug called etizolam. Etizolam is an analog—a chemical compound that is structurally similar to another but differs slightly in composition—of benzodiazepine medication, similar to Xanax, Ativan, or other anti-anxiety medications.
“The danger here is that if someone has an opioid overdose and their sample contains both fentanyl and etizolam, now the naloxone won’t be able to reverse that overdose, as it does not work [on etizolam],” Borden said.
Naloxone is a medication used to reverse an opioid overdose and is incredibly successful at doing so. If a user has overdosed due to opioids, they have also likely stopped breathing. Naloxone attaches to opioid receptors and is successful in blocking and reversing the effects, returning the users’ breathing to normal.
One of the strengths of the PS-MS technique is it can identify things that are unexpected, like new and dangerous drugs on the scene. “Another drug we have seen more recently is a benzodiazepine that’s even stronger than etizolam, called flualprazolam,” he said.
“I don’t think people are aware of the etizolam issue happening right now. There’s fentanyl overdoses, and to a large degree naloxone distribution has helped with those overdoses. But there is another form of dangerous drugs—benzodiazepines—entering the mainstream street drug scene that prevents naloxone from working.”
The Vancouver Island Drug Checking Project’s blog offers monthly reports on their findings from drug sample research. A blog post from December 2020 includes AERL’s findings. The post reads, “Carfentanil is a highly potent active [drug] present at low concentrations that our instruments struggle to detect. From our collaboration with Vancouver Island University and their paper spray mass spectrometry technology, we are now able to accurately detect carfentanil.”
The website also states, “Benzodiazepines and the structurally-related etizolam continue to be found in the opioid supply. The additive effects of these sedatives [paired with opioids] leads to a higher risk of overdose.” In December 2020, etizolam was found in 41 percent of 50 out of 58 of the drug checking project’s opioid samples, and benzodiazepines in 14 percent.
AERL’s method is able to directly impact drug users’ lives. The method only requires a very small sample of the drug to be able to tell the user exactly what they will be consuming and hopefully prevent a deadly overdose.
“Oftentimes in science, you don’t get the opportunity to do things that have an observable real-world effect,” Borden said. “But working on something where you can immediately see the human impact is pretty special.”
“We have an opioid crisis in this country, especially within British Columbia, and it seems to be only getting worse,” he added. “The solutions that we currently have are working for some things, but there are limitations. We believe that by incorporating the PS-MS technique, we can fix some of those limitations, such as being able to detect and put a number on carfentanil, or telling a user, ‘Your drug has etizolam in it and Narcan [naloxone] will not be able to help you.’”
Borden is encouraged by the results so far.
“We are trying to address these gaps within the current testing methods, and we believe that we have done it. We want to get the word out that this technique can be used as an effective drug-checking tool for harm reduction and can save lives by preventing deadly overdoses.”