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Abstract
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This cohort study uses data from the Drug Analysis Service of Health Canada to describe changes in the presence of benzodiazepines mixed with fentanyl in drug seizures in Canada from 2018 to 2021.
In 2020, there were approximately 60 000 overdose deaths involving synthetic opioids in the US.1 Illegally produced fentanyl entered the heroin supply, but there are increasing reports of mixtures containing stimulants or nonopioids.2 Coingestion of opioids, especially highly potent fentanyls, with benzodiazepines increases risk of death.3
Data lags, limited coordination across US agencies, and the elimination or reduction of the Arrestee Drug Abuse Monitoring program and the Drug Abuse Warning Network impede an understanding of transitioning illicit drug markets. More fundamentally, there are no publicly available incident-level drug seizure data to offer such insights. Comparable US drug seizure data from the National Forensic Laboratory Information System report annual counts from the previous year without describing polydrug mixtures. Better and more current data from Canada can offer some understanding, given its similar experience with illegally manufactured synthetic opioids...
There is a recent and alarming trend toward more harmful supply of drugs sold in illegal markets in Canada. Consumers in Ontario, Alberta, and British Columbia buying powder may be at greater risk for exposure to fentanyl mixed with novel benzodiazepines. In the case of novel benzodiazepines, dealers handling powders may be inclined to mix fentanyl with novel benzodiazepines that are marketed online. Designer benzodiazepines in tablets were likely to be illegally manufactured.
Co-consumption of both drugs poses intense challenges to overdose management and elevates the risk of death. Coroner data from British Columbia exemplify this trend; overdose deaths containing benzodiazepines and fentanyl jumped from 15% in mid-2020 to 60% by mid-2021.6 Shares of seizures in the province containing both drugs rose by a similar factor of 4, from 5.5% in April 2020 to 23.2% in March 2021.
The main limitation of this analysis is whether or not findings from Canada reflect the true nature of drug market evolutions in the US. Nevertheless, the continued lags in overdose and drug seizure data in the US have serious consequences for public health and safety. Informal early-warning networks mention a similar increase in fentanyl-benzodiazepine overdoses, but without near real-time incident-level drug seizure data, it is impossible to know. There is a need to improve monitoring and surveillance of drug consumption in the US as markets continue to trend toward more harmful drug mixtures.
Language: en |