As the COVID-19 pandemic took hold of the city in the spring of 2020, fears were growing about a lethal new drug mixture on Peterborough’s streets. In April 2020, PARN – Your Community AIDS Resource Network put out a warning to users of its harm reduction services: There were reports that benzodiazepines, a class of sedative drugs commonly prescribed to treat things like insomnia and anxiety, were being mixed into fentanyl.
“Your drugs could have benzos in them without you knowing it!” the warning read. Suddenly it seemed the deadly opioid fentanyl was becoming even more dangerous. Most alarming was the fact that overdose-reversing naloxone doesn’t stop the effects of benzodiazepines.
Naloxone can still restore someone’s breathing in an overdose from a mixture of opioids and benzodiazepines, said Jocelyn Qualtrough, a health promoter with Peterborough Public Health. However, they may not wake up right away because of the sedative effects of the benzodiazepines, she said. “When things are mixed together and cut together, it just makes it so much more dangerous,” Qualtrough said.
As the pandemic dragged on, PARN spokesperson Dylan DeMarsh heard reports that people were taking longer to respond to naloxone after drug poisonings. In one case, it took four doses before there was a response from someone who was suspected of taking opioids laced with benzodiazepines, he said.
PARN’s warning that spring proved ominous. By the end of 2020, the region covered by Peterborough Public Health had the second-highest rate of benzodiazepine-related deaths in the province, according to data from the Office of the Chief Coroner for Ontario and the Ontario Forensic Pathology Service. Six people died from benzodiazepines that year, double the number in 2019. In five of those deaths, opioids such as fentanyl were also involved.
“We weren't really seeing cocktails of benzos and opioids until the last year and a half,” DeMarsh said. “It may have been happening here but it wasn't on our radar until last year.”
The mixture has added to a “climate of fear” among people who use drugs, because it’s difficult to know in advance if the opioids they buy are contaminated with benzodiazepines, he said. “When we're talking about toxicity in the drug supply, we're talking about people buying something and getting something different than they thought they paid for – something poisoned,” he said.
In Toronto, benzodiazepines were detected in more than half of all fentanyl samples tested by the Toronto Drug Checking Service between March 14, 2020 and January 1, 2021.
For the first time this past summer, Peterborough Public Health put out an advisory to local service providers about street drugs being tainted with benzodiazepines. “We know that the drug supply is just becoming increasingly toxic,” Qualtrough said. “It's just so important that people call 911 [in the event of an overdose] ... people may need more than one naloxone kit for them to regain consciousness, and regain proper breathing.”
“People are trying themselves to counter the impacts of this highly volatile drug supply”
Drug poisoning deaths continued to climb as the months passed, but benzodiazepine contamination alone didn’t explain the whole story. There was a different trend that was also accelerating the drug poisoning crisis.
Toxicology reports conducted on people who had died early in the pandemic showed that many had lethal amounts of both opioids and stimulant drugs, such as cocaine and methamphetamine, in their systems.
This combination had taken lives in Peterborough before – a total of 12 in 2019. But soon that number would more than double.
In total, 25 people in the Peterborough region died from the combined force of stimulants and opioids in 2020, according to coroner data. For the first time, the majority of opioid deaths in the region also involved stimulants.
The problem wasn’t isolated to Peterborough. 1389 people across Ontario died from a combination of stimulants and opioids in 2020. It was an 86 percent increase from 2019.
So what was causing more people to die this way?
Peterborough Currents spoke with Gillian Kolla, a researcher with the Canadian Institute for Substance Use Research. She has worked closely with drug users for years. So she knew that some opioid users tend to also use stimulants. But, in 2020, something appeared to be driving more people to take both drugs.
This is where the two different trends driving the increase in drug poisoning deaths overlap. On the one hand, some people were dying as a direct result of opioids contaminated with benzodiazepines. But in other cases, that contamination had a different – and equally deadly – knock-on effect.
People were beginning to become heavily sedated for hours at a time as a result of taking opioids laced with benzodiazepines, Kolla said. To try to counter this sedation, some people began to also take other lethal drugs – stimulants, she said.
“For people who are experiencing homelessness, [prolonged sedation] can be really quite dangerous,” she said. Heavy sedation can leave people living on the street extra vulnerable to theft and sexual assault, as well as frostbite, and even death, on freezing cold nights, she said.
As a result, more people seemed to be taking stimulants prior to using opioids to stay alert and awake, Kolla said. “People are trying themselves to counter the impacts of this highly volatile drug supply that we have,” she said.
A report co-authored by the Office of the Chief Coroner for Ontario this year, which Kolla contributed to, also noted that benzodiazepine contamination appeared to be driving higher stimulant use. The report also points to a “drastic” reduction in services for people experiencing homelessness during the pandemic, especially at night, to explain the increase. “Service providers have reported that people experiencing homelessness may be increasingly using stimulants to stay awake outside… to maintain both personal safety and to protect belongings,” the authors wrote.
“I’m absolutely gutted to see this,” Kolla tweeted in December 2020, as the death toll from opioids and stimulants climbed. “We all knew that the numbers of overdoses have been bad. But the scale of devastation that communities have faced, all of these much-loved people gone too soon, is horrifying.”
Lack of testing means no one really knows what’s in Peterborough’s drugs
The increase in deaths involving stimulants initially led to some concerns that cocaine and methamphetamine could be laced with fentanyl. Lack of data on what’s in Peterborough’s drugs makes that difficult to verify. Unlike some cities, such as Toronto and Ottawa, Peterborough does not have a free drug checking service where people can go to see what’s in their substances.
Kolla said stimulants are “occasionally” contaminated with fentanyl, but she hasn’t seen evidence that it’s been happening more often.
Qualtrough, from Peterborough Public Health, said having a drug testing service in Peterborough would allow public health officials to warn people about dangerous new substances in the drug supply before they lead to potentially deadly overdoses. “We'd be able to look at the data and tell people with our early warning system what's happening in the community,” she said.
That may become a reality if the drug treatment and consumption site proposed for downtown Peterborough gets the provincial funding it requires to open. The organizations behind the site say it will offer a drug checking service.
“When there's an issue around poisoning, you remove the poison”
Drug users may not know the exact contents of what they’re taking, but they know the drug supply is becoming more toxic and volatile. “We see experienced drug users going down right now, people who really know what they're doing,” DeMarsh said. “People are losing their friends, people are losing their family members.”
The statistics are harrowing. Drug poisonings were already taking dozens of lives a year in Peterborough, when the pandemic hit and the death toll jumped 48 percent (from 29 deaths in 2019 to 43 in 2020). This year is expected to break another record. Between January and September, there were already 35 suspected opioid poisoning deaths in Peterborough city and county, according to Peterborough Public Health.
DeMarsh calls the situation a “catastrophe.” “People are being put at risk because of the toxicity of the drug supply,” he said. “When we know the nature of addiction, I think it becomes just imperative to make sure that drug supply is not poisoned.”
“Everything we know about addiction tells us that people aren't going to just stop at the snap of a finger,” he said. “People need to be ready to make that change in their life… and we need to keep people alive until they're ready.”
A regulated supply of currently illicit drugs would give people certainty about what substances they’re consuming and at what level of potency, Kolla said. “We keep on seeing these new chemicals, these new formulations of different opioids and different benzos getting added into the unregulated opioid supply,” she said. “This really, really speaks to the dangers of an unregulated supply.”
“Anytime that we're dealing with an unregulated supply, we lack the policy levers in order to do something about it,” she said. “And we have a lot more policy levers available when we regulate a supply of a substance, like we do, for example, for alcohol.”
In the meantime, harm reduction workers continue to urge people not to use drugs alone, a life-saving message that’s been complicated by the pandemic. “We've always always asked people to not use alone...you can't use a naloxone kit on yourself,” DeMarsh said. “COVID has changed that… people were encouraged to essentially be alone.”
In response, a national overdose-support hotline was started last year that people can call if they are using drugs alone. “They will stay on the phone with you while you are using,” DeMarsh said. “If it goes silent on the other end of the phone, they're making a call to emergency services for you.”
The number for the National Overdose Response Service is 888-688-6677.
Explore the data
Peterborough Currents analyzed publicly available data with input from experts in the field to create the analysis that informed this story, and to create interactive data visualizations.
How read these charts: The bar labeled as each year represents the total number of opioid-related deaths, the orange bars represent the number of deaths where benzodiazepines were also detected by forensic pathology tests, the red bar represents the number of deaths where stimulants like cocaine and methamphetines were detected, and the grey bar represents all other opioid-related deaths.
Explore the data visualization below by using your mouse to hover over elements.