ArticleCanadian journal of public health = Revue canadienne de sante publique2025
Novel adulterants in unregulated opioids and their associations with adverse events.
Article in Canadian journal of public health = Revue canadienne de sante publique, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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The trial behind it
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Who cites it
7 citing papers in PubMed.
- Drug sellers' use of a drug checking service amid the overdose crisis in British Columbia, Canada.Addiction (Abingdon, England) · 2026Article
- Neural Network-Based Detection of Adulterants in Opioid Samples Using IR Absorption Spectroscopy.Drug testing and analysis · 2026Article
- Temporal and regional associations between fentanyl concentrations in the unregulated drug supply and drug-related mortality in British Columbia, Canada.The International journal on drug policy · 2026Article
- How population-level drug supply data are integrated into health outcomes research: a scoping review.Epidemiologic reviews · 2026Article
- The Donovan Memorial Lecture: 'Fentanyl-Plus': A New Era of Fentanyl Polydrug Combinations in the North American Overdose Crisis.Journal of medical toxicology : official journal of the American College of Medical Toxicology · 2026Article
- Awareness of drug supply changes and uptake of fentanyl testing services among people who use drugs in Kampala, Uganda.Drug and alcohol dependence · 2025Article
- Responding to the toxic drug crisis: Promising innovations, gaps, and calls to action.Canadian journal of public health = Revue canadienne de sante publique · 2025Article
Corrections and comments
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Authors and funding
5 authors.
Funding
Abstract
objectiveIn recent years, Canada's unregulated drug supply has become permeated by novel adulterants (e.g., fentanyl analogues, benzodiazepines, xylazine). While fentanyl has been shown to be associated with overdose mortality and other non-fatal health outcomes, adverse events (AE) associated with these adulterants remain poorly described. This study seeks to identify whether common adulterants identified through drug checking services are associated with increased prevalence of specific adverse events reportedly experienced by people who use drugs.
methodsDrug checking samples were analyzed using Fourier-transform infrared spectroscopy and immunoassay strips at harm reduction sites in British Columbia. Self-reported AE (e.g., non-fatal overdose, prolonged sedation, seizures) were recorded from individuals who checked opioids post-consumption. Adjusted prevalence ratios (aPR) and 95% confidence intervals (95% CI) of AE among common adulterants were calculated using generalized linear models with a Poisson distribution, controlled for presence of other adulterants, expected drug, geographic location, and month.
resultsBetween February 2022 and May 2024, 80,415 samples were analyzed at community sites. Among eligible samples, 36.1% were expected opioids, 42.2% of which were checked post-consumption. AE were noted among 10.7% of post-consumption opioid drug checks. After adjustment, the presence of benzodiazepines in opioid samples was associated with increased prevalence of any AE (aPR 1.97; 95% CI 1.70-2.27), as was the presence of xylazine (aPR 1.50; 95% CI 1.09-2.07). Considering specific AE, benzodiazepines were associated with increased prevalence of overdose (aPR 2.05; 95% CI 1.68-2.51) and prolonged sedation (aPR 3.35; 95% CI 2.54-4.43).
conclusionNon-fatal AE associated with unregulated opioids have been largely undescribed. Our findings report specific AE associated with different adulterants in the unregulated opioid supply. With this information, tailored public health interventions and services focused on these adulterants can be developed.
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