{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T07:34:00Z","timestamp":1771918440512,"version":"3.50.1"},"reference-count":26,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2022,1,11]],"date-time":"2022-01-11T00:00:00Z","timestamp":1641859200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,1,11]],"date-time":"2022-01-11T00:00:00Z","timestamp":1641859200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100000008","name":"Health Canada","doi-asserted-by":"crossref","award":["1718-HQ-000027"],"award-info":[{"award-number":["1718-HQ-000027"]}],"id":[{"id":"10.13039\/501100000008","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Harm Reduct J"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>The  overdose crisis has generated innovative harm reduction and drug market monitoring strategies. In Toronto, Ontario, Canada, a multi-site drug checking service (DCS) pilot project was launched in October 2019. The project provides people who use drugs with information on the chemical composition of their substances, thereby increasing their capacity to make more informed decisions about their drug use and avoid overdose. DCS also provides real-time market monitoring to identify trends in the unregulated drug supply.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Sample data were obtained through analyses of drug and used drug administration equipment samples submitted anonymously and free of charge to DCS in downtown Toronto from October 10, 2019, to April 9, 2020, representing the first six months of DCS implementation. Analyses were conducted in clinical laboratories using liquid chromatography- and\/or gas chromatography-mass spectrometry (LC\u2013MS, GC\u2013MS) techniques.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Overall, 555 samples were submitted, with 49% (271) of samples that were found to contain high-potency opioids, of which 87% (235) also contained stimulants. Benzodiazepine-type drugs were found in 21% (116) of all samples, and synthetic cannabinoids in 1% (7) of all samples. Negative effects (including overdose, adverse health events, and extreme sedation) were reported for 11% (59) of samples submitted for analysis.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Toronto\u2019s DCS identified a range of high-potency opioids with stimulants, benzodiazepine-type drugs, and a synthetic cannabinoid, AMB-FUBINACA. This information can inform a range of evidence-informed overdose prevention efforts.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12954-021-00585-2","type":"journal-article","created":{"date-parts":[[2022,1,11]],"date-time":"2022-01-11T04:45:28Z","timestamp":1641876328000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["Diverse psychotropic substances detected in drug and drug administration equipment samples submitted to drug checking services in Toronto, Ontario, Canada, October 2019\u2013April 2020"],"prefix":"10.1186","volume":"19","author":[{"given":"Kristy M.","family":"Scarfone","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nazlee","family":"Maghsoudi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karen","family":"McDonald","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristiana","family":"Stefan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel R.","family":"Beriault","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ernest","family":"Wong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Evert","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shaun","family":"Hopkins","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Leslie","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tara Marie","family":"Watson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0614-9386","authenticated-orcid":false,"given":"Dan","family":"Werb","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"Toronto\u2019s Drug Checking Service Working Group","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2022,1,11]]},"reference":[{"key":"585_CR1","unstructured":"U. S. Drug Enforcement Administration, Diversion Control Division. National Forensic Laboratory Information System: NFLIS-Drug 2019 Midyear Report. Springfield, VA; 2020. https:\/\/www.nflis.deadiversion.usdoj.gov:8443\/nflisdata\/docs\/NFLIS-DRUG_2019_Annual_Report.pdf#search=2019%20Midyear"},{"key":"585_CR2","unstructured":"Payer DE, Young MM, Maloney-Hall B, Mill C, Leclerc P, Buxton J, the Canadian Community Epidemiology Network on Drug Use, the National Drug Checking Working Group. Adulterants, contaminants and co-occurring substances in drugs on the illegal market in Canada: an analysis of data from drug seizures, drug checking and urine toxicology. Ottawa: Canadian Centre on Substance Use and Addiction; 2020. https:\/\/www.ccsa.ca\/sites\/default\/files\/2020-04\/CCSA-CCENDU-Adulterants-Contaminants-Co-occurring-Substances-in-Drugs-Canada-Report-2020-en.pdf."},{"key":"585_CR3","unstructured":"Public Health Agency of Canada; Special Advisory Committee on the Epidemic of Opioid Overdoses. Opioids and stimulant-related Harms in Canada. Ottawa: Government of Canada Health Infobase; 2020. https:\/\/health-infobase.canada.ca\/substance-related-harms\/opioids-stimulants."},{"issue":"5","key":"585_CR4","doi-asserted-by":"publisher","first-page":"418","DOI":"10.1097\/ADM.0000000000000412","volume":"12","author":"T Gomes","year":"2018","unstructured":"Gomes T, Greaves S, Tadrous M, Mamdani MM, Paterson JM, Juurlink DN. Measuring the burden of opioid-related mortality in Ontario, Canada. J Addict Med. 2018;12(5):418.","journal-title":"J Addict Med"},{"issue":"5","key":"585_CR5","doi-asserted-by":"publisher","first-page":"e2112865","DOI":"10.1001\/jamanetworkopen.2021.12865","volume":"4","author":"T Gomes","year":"2021","unstructured":"Gomes T, Kitchen SA, Murray R. Measuring the burden of opioid-related mortality in Ontario, Canada, during the COVID-19 pandemic. JAMA Netw Open. 2021;4(5):e2112865.","journal-title":"JAMA Netw Open"},{"key":"585_CR6","unstructured":"Overdose in Toronto: Trends, prevention and response. City of Toronto. Toronto Public Health; 2021. https:\/\/www.toronto.ca\/legdocs\/mmis\/2015\/hl\/bgrd\/backgroundfile-83429.pdf."},{"key":"585_CR7","doi-asserted-by":"publisher","first-page":"108830","DOI":"10.1016\/j.drugalcdep.2021.108830","volume":"225","author":"SA Kitchen","year":"2021","unstructured":"Kitchen SA, McCormack D, Werb D, Caudarella A, Martins D, Matheson FI, Gomes T. Trends and outcomes of serious complications associated with non-fatal opioid overdoses in Ontario, Canada. Drug Alcohol Dependence. 2021;225:108830.","journal-title":"Drug Alcohol Dependence."},{"key":"585_CR8","unstructured":"Opioid mortality surveillance report\u2014Public Health Ontario. 2019. https:\/\/www.publichealthontario.ca\/-\/media\/documents\/O\/2019\/opioid-mortality-surveillance-report.pdf."},{"key":"585_CR9","unstructured":"McDonald K, Maghsoudi N, Thompson H, Werb D. What\u2019s in Toronto\u2019s drug supply? Toronto: Centre on Drug Policy Evaluation; 2020. https:\/\/drugchecking.cdpe.org\/."},{"key":"585_CR10","unstructured":"House of Commons of Canada, Standing Committee on Health. Report and recommendations on the opioid crisis in Canada. Ottawa: Government of Canada Publications; 2016. https:\/\/publications.gc.ca\/collections\/collection_2016\/parl\/xc62-1\/XC62-1-1-421-6-eng.pdf."},{"issue":"4","key":"585_CR11","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1080\/02791072.1986.10472371","volume":"18","author":"CL Renfroe","year":"1986","unstructured":"Renfroe CL. MDMA on the street: analysis Anonymous\u00ae. J Psychoact Drugs. 1986;18(4):363\u20139.","journal-title":"J Psychoact Drugs"},{"key":"585_CR12","volume-title":"The Drugs Information and Monitoring System (DIMS). Factsheet on drug checking in the Netherlands","author":"L Smit-Rigter","year":"2019","unstructured":"Smit-Rigter L, Van der Gouwe D. The Drugs Information and Monitoring System (DIMS). Factsheet on drug checking in the Netherlands. Utrecht: Trimbos Institute; 2019."},{"key":"585_CR13","unstructured":"Ontario Agency for Health Protection and Promotion (Public Health Ontario), Leece P. Evidence brief: evidence on drug checking services as a harm reduction intervention. Toronto: Queen\u2019s Printer for Ontario; 2017. https:\/\/www.publichealthontario.ca\/-\/media\/documents\/E\/2017\/eb-drug-checking.pdf."},{"issue":"1","key":"585_CR14","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12954-019-0336-0","volume":"17","author":"N Maghsoudi","year":"2020","unstructured":"Maghsoudi N, McDonald K, Stefan C, Beriault DR, Mason K, Barnaby L, Altenberg J, MacDonald RD, Caldwell J, Nisenbaum R, Leece P. Evaluating networked drug checking services in Toronto, Ontario: study protocol and rationale. Harm Reduct J. 2020;17(1):1.","journal-title":"Harm Reduct J"},{"issue":"1","key":"585_CR15","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12954-017-0179-5","volume":"14","author":"L Harper","year":"2017","unstructured":"Harper L, Powell J, Pijl EM. An overview of forensic drug testing methods and their suitability for harm reduction point-of-care services. Harm Reduct J. 2017;14(1):1\u20133.","journal-title":"Harm Reduct J"},{"issue":"4","key":"585_CR16","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1097\/YCO.0000000000000717","volume":"34","author":"D Ciccarone","year":"2021","unstructured":"Ciccarone D. The rise of illicit fentanyls, stimulants and the fourth wave of the opioid overdose crisis. Curr Opin Psychiatry. 2021;34(4):344\u201350.","journal-title":"Curr Opin Psychiatry"},{"key":"585_CR17","doi-asserted-by":"publisher","first-page":"242","DOI":"10.1016\/j.drugalcdep.2018.06.020","volume":"190","author":"KW Tupper","year":"2018","unstructured":"Tupper KW, McCrae K, Garber I, Lysyshyn M, Wood E. Initial results of a drug checking pilot program to detect fentanyl adulteration in a Canadian setting. Drug Alcohol Depend. 2018;190:242\u20135.","journal-title":"Drug Alcohol Depend"},{"issue":"2","key":"585_CR18","doi-asserted-by":"publisher","first-page":"17","DOI":"10.3390\/jcm7020017","volume":"7","author":"J Guina","year":"2018","unstructured":"Guina J, Merrill B. Benzodiazepines I: upping the care on downers: the evidence of risks, benefits and alternatives. J Clin Med. 2018;7(2):17.","journal-title":"J Clin Med"},{"key":"585_CR19","unstructured":"Kang M, Galuska MA, Ghassemzadeh S. Benzodiazepine toxicity. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2019. https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK482238\/."},{"key":"585_CR20","doi-asserted-by":"publisher","DOI":"10.1093\/jat\/bkaa146","author":"J Gevorkyan","year":"2021","unstructured":"Gevorkyan J, Kinyua J, Pearring S, Rodda LN. A case series of Etizolam in opioid-related deaths. J Anal Toxicol. 2021. https:\/\/doi.org\/10.1093\/jat\/bkaa146.","journal-title":"J Anal Toxicol"},{"key":"585_CR21","unstructured":"Toronto Public Health. Increase in overdoses observed at The Works on February 26, 2020. Toronto: Toronto Public Health; 2020. https:\/\/www.toronto.ca\/wp-content\/uploads\/2020\/02\/9477-Alert_Increase-in-overdoses-on-February-26_2020.pdf."},{"issue":"27","key":"585_CR22","doi-asserted-by":"publisher","first-page":"692","DOI":"10.15585\/mmwr.mm6527a2","volume":"65","author":"AM Riederer","year":"2016","unstructured":"Riederer AM, Campleman SL, Carlson RG, Boyer EW, Manini AF, Wax PM, Brent JA. Acute poisonings from synthetic cannabinoids\u201450 US Toxicology Investigators Consortium registry sites, 2010\u20132015. MMWR Morb Mortal Wkly Rep. 2016;65(27):692.","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"2","key":"585_CR23","doi-asserted-by":"publisher","first-page":"182","DOI":"10.2105\/AJPH.2017.304187","volume":"108","author":"N Dasgupta","year":"2018","unstructured":"Dasgupta N, Beletsky L, Ciccarone D. Opioid crisis: no easy fix to its social and economic determinants. Am J Public Health. 2018;108(2):182\u20136.","journal-title":"Am J Public Health"},{"issue":"2","key":"585_CR24","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1097\/01.pra.0000413274.09305.9c","volume":"18","author":"D Castellanos","year":"2012","unstructured":"Castellanos D, Thornton G. Synthetic cannabinoid use: recognition and management. J Psychiatr Pract\u00ae. 2012;18(2):86\u201393.","journal-title":"J Psychiatr Pract\u00ae"},{"issue":"2","key":"585_CR25","doi-asserted-by":"publisher","first-page":"E35","DOI":"10.1503\/cmaj.171060","volume":"190","author":"M Tyndall","year":"2018","unstructured":"Tyndall M. An emergency response to the opioid overdose crisis in Canada: a regulated opioid distribution program. CMAJ. 2018;190(2):E35\u20136.","journal-title":"CMAJ"},{"key":"585_CR26","unstructured":"Gomis B. How the illicit drug trade is adapting to coronavirus pandemic. World Politics Review; 2020. https:\/\/www.worldpoliticsreview.com\/articles\/28696\/how-the-illicit-drug-trade-is-adapting-to-the-coronavirus-pandemic."}],"container-title":["Harm Reduction Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12954-021-00585-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12954-021-00585-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12954-021-00585-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,1,11]],"date-time":"2022-01-11T04:49:41Z","timestamp":1641876581000},"score":1,"resource":{"primary":{"URL":"https:\/\/harmreductionjournal.biomedcentral.com\/articles\/10.1186\/s12954-021-00585-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,11]]},"references-count":26,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2022,12]]}},"alternative-id":["585"],"URL":"https:\/\/doi.org\/10.1186\/s12954-021-00585-2","relation":{},"ISSN":["1477-7517"],"issn-type":[{"value":"1477-7517","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,11]]},"assertion":[{"value":"6 July 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 December 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 January 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Research Ethics Board approval has been obtained for this research study from Unity Health Toronto, Toronto Public Health, Centre for Addiction and Mental Health, and University of Toronto.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"While informed consent is obtained from participants for this study, the present manuscript does not publish any identifiable personal data or images.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"3"}}