Winnipeg Regional Health Authority, Population and Public Health, is alerting service providers of significant shifts in opioid-related drug harms in the Winnipeg Health Region over the first half of 2020. An increase in opioid-related harms may indicate an increase in opioid use in the population, and/or more toxic drug market products circulating.

For details see: https://www.survwpg.ca/DrugHarms/Aug2120alert/August%202020_DRUG%20HARMS%20UPDATE.pdf

If you use drugs:

• Call 911 (or your local emergency response number) if you witness or experience an overdose. The Good Samaritan Overdose Protection Act will protect those involved from drug possession charges or breach of probation/pre-trial release charges
• Get naloxone and overdose training before using – bring a friend
• Be aware that benzodiazepines don’t respond to naloxone
• Do not use drugs alone or behind a locked door. Have a designated responder: Stagger use with friends so someone can respond/call 911 if needed
• Use a less direct route when you take drugs. Injecting a drug is the most direct and dangerous route.
• If you mix drugs, reduce the amount of each drug you take and use opioids before benzos or alcohol. Use the most unpredictable drug first.
• Use one drug at a time, test your drugs every time by doing a smaller than usual test amount first
• Wait before taking another dose – some drugs take longer to take effect
• The amount of naloxone in a take-home kit may not be enough to reverse very powerful overdoses, such as those caused by fentanyl-like drugs.
• If you inject do not share any injection equipment (needles, cookers, filters, rinse). Sterile drug use supplies and take home naloxone kits are available free from many places, See www.streetconnections.ca

Counterfeit (fake) Xanax TS tablets (often called Xani Bars) containing carfentanil, fentanyl, and benzodiazepine called flubromazolam have been found circulating in Winnipeg.

The tablets are white rectangular shaped bars marked with the word “XANAX” and three vertical lines across for breaking the tablet into smaller pieces.

The contaminants in these pills are extremely toxic. Carfentanil and fentanyl are highly toxic opioid drugs, up to 10,000 times stronger than morphine. There is no known way to safely use carfentanil in humans. Opioids and can rapidly stop a person from breathing, leading quickly to death. Flubromazolam is a benzodiazepine drug – which like opioids is a downer or sedative that may cause a person to lose consciousness. Carfentanil and fentanyl overdoses will usually respond to naloxone, but benzodiazepines will not.

If you use drugs:

• Call 911 (or your local emergency response number) if you witness or experience an overdose. The Good Samaritan Overdose Protection Act will protect those involved from drug possession charges or breach of probation/pre-trial release charges
• Get naloxone and overdose training before using – bring a friend
• Be aware that benzodiazepines don’t respond to naloxone
• Do not use drugs alone or behind a locked door. Have a designated responder: Stagger use with friends so someone can respond/call 911 if needed
• Use a less direct route when you take drugs. Injecting a drug is the most direct and dangerous route.
• If you mix drugs, reduce the amount of each drug you take and use opioids before benzos or alcohol. Use the most unpredictable drug first.
• Use one drug at a time, test your drugs every time by doing a smaller than usual test amount first
• Wait before taking another dose – some drugs take longer to take effect
• The amount of naloxone in a take-home kit may not be enough to reverse very powerful overdoses, such as those caused by fentanyl-like drugs.
• If you inject do not share any injection equipment (needles, cookers, filters, rinse). Sterile drug use supplies are available from many places – See www.streetconnections.ca

Street level opioids being cut with benzodiazepines: Overdoses in Vancouver, Toronto, and Calgary not responding to naloxone.

There have been increasing reports of street level opioids being cut with a drug called etizolam. This has been occurring in Vancouver, Toronto, and Calgary, but has not been confirmed in Winnipeg at this time.

Etizolam is not an opioid but it does cause respiratory depression and sedation—it is actually a type of benzodiazepine (drugs typically used for anxiety or sleep). Because it is not an opioid, naloxone does not work on it.

What is happening in these centres is that people who are overdosing will receive naloxone, but still aren’t becoming responsive. It is creating complications for first responders and there have been reports of people being treated for overdose but continuing to be unconscious or unresponsive for a couple hours afterwards.

If you use drugs:

• Call 911 (or your local emergency response number) if you witness or experience an overdose. The Good Samaritan Overdose Protection Act will protect those involved from drug possession charges or breach of probation/pre-trial release charges
• Get naloxone and overdose training before using – bring a friend
• Be aware that benzodiazepines don’t respond to naloxone.
• Do not use drugs alone or behind a locked door. Have a designated responder: Stagger use with friends so someone can respond/call 911 if needed
• Use a less direct route when you take drugs. Injecting a drug is the most direct and dangerous route.
• If you mix drugs, reduce the amount of each drug you take and use opioids before benzos or alcohol. Use the most unpredictable drug first.
• Use one drug at a time, test your drugs every time by doing a smaller than usual test amount first
• Wait before taking another dose – some drugs take longer to take effect
• The amount of naloxone in a take-home kit may not be enough to reverse very powerful overdoses, such as those caused by fentanyl-like drugs.
• If you inject do not share any injection equipment (needles, cookers, filters, rinse). Sterile drug use supplies are available from many places – See www.streetconnections.ca

1. Fentanyl and W18 found in Fake Oxy Pills in Winnipeg

Counterfeit pills (round, green, fake oxys marked with CAN 80) have been circulating in Winnipeg and have been tested and confirmed to contain Fentanyl and W18.

Fentanyl is a very toxic opioid drug that can result in overdose causing respiratory depression, unconsciousness and death.

W18 is a synthetic (laboratory made) chemical that is not well understood. W18 is not an opioid so it does not cause opioid effects (decreased breathing) and does not respond to naloxone. In high doses W18 may interfere with heart rhythms. For scientific information see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5752382/

2. Carfentanil found on board in recent deaths in Manitoba

From mid-2016 through mid-2017 there were a significant number of overdose deaths where carfentanil was found in the victim’s system. Carfentanil seemed to drop off sharply in mid to late 2017, but has re-emerged lately and been associated with overdose deaths since September of 2018.

Carfentanil is a highly toxic opioid drug, about 10,000 times stronger than morphine. It is used by veterinarians to tranquilize large animals. There is no known way to safely use carfentanil in humans. Opioids can be dangerous because an overdose can stop a person from breathing, leading quickly to death.

If you use drugs:

• Get naloxone and overdose training before using – bring a friend
• Do not use drugs alone or behind a locked door. Stagger use with friends so someone can respond/call 911 if needed
• Use a less direct route when you take drugs. Injecting a drug is the most direct and dangerous route. In the case of carfentanil, even swallowing, smoking, and snorting has been fatal.
• If you mix drugs, reduce the amount of each drug you take and use opioids before benzos or alcohol
• Use one drug at a time, test your drugs every time by doing a smaller than usual test amount first
• Wait before taking another dose – some drugs take longer to take effect
• The amount of naloxone in a take-home kit may not be enough to reverse very powerful overdoses, such as those caused by fentanyl-like drugs
• Call 911 (or your local emergency response number) if you witness or experience an overdose. The Good Samaritan Overdose Protection Act will protect those involved from drug possession charges or breach of probation/pre-trial release charges
• If you inject do not share any injection equipment (needles, cookers, filters, rinse). Sterile drug use supplies are available from many places – See www.streetconnections.ca
  

  DRUG AND OVERDOSE ALERTS WINNIPEG: October 16, 2018