Naloxone-resistant street drug linked to 9 deaths in Eastern Canada seized in Alberta

A street drug linked to nine deaths in Eastern Canada is showing up in Alberta, prompting RCMP to issue a warning about its potentially lethal consequences.

Grande Prairie RCMP received a report this week from Health Canada regarding a drug that had been seized on Feb. 28. Police said a large quantity was seized following a suspected fatal overdose.

The drug contained fluorofentanyl mixed with bromazolam, which is a benzodiazepine. It is not approved for medical use in any country.

The analyzed drug was oval in size, stamped with “20” and “SS,” though it can come in other forms.

Benzodiazepines are depressants that slow the nervous system and are commonly prescribed for sedation to treat insomnia or to reduce anxiety, under names such as Valium, Xanax and Ativan.

Health Canada says mixing benzodiazepines (benzos) with other depressants such as alcohol or opioids — also known as benzo-dope — increases the risk of overdose.

Fentanyl is a strong opioid that can result in an overdose causing breathing to slow or stop, unconsciousness and even death. Benzos also cause respiratory depression, sedation and can make a person lose consciousness. It is not an opioid, which means naloxone or Narcan, the medications that reverse some overdoses, cannot be used.

Health officials say the combination of these drugs is extremely dangerous, as fentanyl laced with bromazolam reduces the effectiveness of naloxone or Narcan, requiring the use of additional doses, and may still result in death.

“We’re hearing stories that (first responders) need to use more and more Narcan for patients who are using these more highly potent forms of opioids mixed in with these compounds, such as benzodiazepines,” said Dr. Monty Ghosh, an internist, addictions specialist and assistant professor at the University of Calgary and University of Alberta.

So what is it about this drug that is appealing to addicts?

Ghosh said benzos being mixed with opioids has been happening for few years, and this new combination with bromazolam is new.

“It sort of entered the market around 2016 and it’s getting more and more prevalent  throughout Canada, most on the eastern side of the country,” Ghosh said.

He said xylazine, known on the streets as “tranq” or “tranq dope,” moved from east to west across Canada and that appears to be the trend for drugs laced with bromazolam as well.

“We’re seeing a new shift in the drug supply and I think we’re going to continue to see these types of shifts going forward,” he said, adding the compounds being mixed will likely continue to change.

Ghosh said the half life of bromazolam is eight to 12 hours and his patients have reported the high from the combination of the two drugs is akin to that of heroin.

“Back in the heroin days — when heroin actually existed in our markets — the sort of lasting effects of heroin would last anywhere from four to six hours in their system. That’s long since been gone. And so benzos provides that sort of sustainable high they may not be experiencing otherwise.”

That long half-life means some people who use several times a day end up with a large buildup of benzos in their system.

There are other side effects of the using benzo-dope,  Ghosh said, such as seizures.

“The benzos can cause withdrawal seizures and we’re seeing a lot of that at this moment. We’re seeing a lot of people who are withdrawing from opiates having these seizure-type events, which is not normal.

“Normally when people are coming off of their opiates, they should not be having a seizure-type event.”

This isn’t the first time bromazolam has been found in Alberta.

In May of 2023, RCMP in Strathmore also came across drugs laced with bromazolam. Police said about half a kilogram of laced fentanyl that had a street value of about $109,600 was seized during a traffic stop in the southern Alberta community.

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Alberta RCMP warn of fatal risks of cutting fentanyl

Alberta-based voluntary collective Each+Every is a national coalition of businesses supporting harm reduction and regulation of the drug supply.

It noted that benzodiazepine-related opioid overdoses can keep people unconscious after the naloxone has done its work in restoring respiration.

“Death from benzodiazepine overdose alone is extremely rare,” said Each+Every co-founder Euan Thomson, a Calgary-based business owner and scientist. Last year, he launched Drug Data Decoded — a site dedicated to examining drug policy.

“Naloxone and rescue breathing are still the front-line responses to any suspected overdose where the breath is slow, short or absent, or if a patient is unconscious, as it is almost certainly owing to an opioid.”

Municipalities across Canada have issued warnings about benzo-dope in recent years.

Bromazolam was linked to nine fatal overdoses in New Brunswick between July and November of 2022. The government of New Brunswick issued a warning about it in December of that year, saying fentanyl was also detected in some of these cases.

“The emergence of bromazolam in the street drug supply in New Brunswick is a major concern,” said Dr. Yves Léger, that province’s deputy chief medical officer of health.

“What is especially concerning is that people do not know it is contained in their street drugs.

“There are no warning signs of bromazolam’s presence, as it cannot be detected by sight, smell or taste. There are no telltale signs.”

Last month in Ontario, a drug alert was issued by the Waterloo Region Integrated Drug Strategy after three people died from suspected drug poisonings or overdoses.

The agency said new fentanyl analogues, bromazolam, xylazine, and medetomidine/dexmedetomidine were discovered while running detections on fentanyl samples at a supervised consumption site.

Peterborough Public Health also issued a warning last year about the deadly drug, saying green, round pills being sold as Xanax contained bromazolam and were circulating in the region.

A warning was also issued in central B.C. a year ago, saying drugs sold as down, dope and fentanyl carrying a high concentration of bromazolam and fentanyl were showing up on the streets in Penticton.

Toronto Public Health said in 2020 that benzodiazepines (and benzo-related drugs like flualprazolam and etizolam) had begun showing up in that city’s opioid supply. The warning noted benzo toxicity on top of an opioid overdose might make a person unconscious for a long time.

The city recommended still administering naloxone to help reverse the opioid overdose and improve breathing, but said the person may not regain consciousness due to the sedation from benzos.

Public health officials urge people to never use drugs alone and use testers to check a drug’s strength.

In Alberta, RCMP said opioid-related deaths increased by 24 per cent and benzodiazepine-related deaths have gone up by 32.5 per cent between 2022 and 2023.

RCMP said from January to November 2023, the Alberta Substance Use Surveillance System report shows 1,706 opioid-related deaths and 57 benzodiazepine-related deaths while, in 2022, for the same time period, these numbers were 1,375 and 43, respectively.

For all of 2023, Alberta RCMP said Mounties responded to approximately 1,100 opioid-related calls for service with 368 (33.4 per cent) being fatal.

There were 67 naloxone deployments by Alberta RCMP, increasing by 31.3 per cent since 2022.

Under Canada’s Good Samaritan Drug Overdose Act, anyone who seeks medical help for themselves or for someone else who has overdosed can be protected from being charged for possessing or using drugs for personal use.