Advocates concerned by recent tainted drug warnings in Nova Scotia

Advocates are raising concerns about three recent warnings related to illicit street drugs made to look like prescription medications in Nova Scotia.

On Friday, Nova Scotia Health warned that a white substance labelled as Xanax from Windsor had tested positive for flualprazolam, a benzodiazepine similar to Xanax, but much stronger.

"The substance tested was a white, triangular tablet with three lines on each side. It had the logo 'XANAX' on one side and '2' on the other," the health authority said in a tweet.

Kimm Kent, the founder of the Peer Outreach Support Services and Education Project, or POSSE, said flualprazolam is more dangerous than Xanax.

"It's way more potent and hits way faster, and causes memory lapse quicker and can be really fatal when mixed with other substances," said Kent.

"So I'm very concerned because it's also really cheap and marketed largely towards youth."

POSSE is a program working out of Windsor, Sipekne'katik and Sackville that trains people between the ages of 15 and 30 to be peer support outreach workers. They then work with members of their communities to teach harm-reduction strategies for safe drug use.

Friday's warning was the third of its kind in just over a week. Two days before, Nova Scotia Health warned of pills in Cape Breton — which were also marked as Xanax — that contained etizolam, a benzodiazepine-like substance similar to Valium, but is 10 times more toxic.

In the case of flualprazolam and etizolam, naloxone can't be used to reverse an overdose, according to Nova Scotia Health.

And on Dec. 31, Nova Scotia Health warned that some drugs illicitly sold in Cape Breton as methadone pills may be contaminated with fentanyl, a powerful synthetic opioid.

New drug alert program

These warnings were issued under the province's new Drug Harms Alert program, which the health authority said in an email was "designed to establish a flexible, low-barrier, community-driven process for communicating unexpected drug use-related harms observed in the community."

Through the program, Nova Scotia Health receives reports of tainted drugs from law enforcement or community organizations. They can then send out email alerts to harm-reduction groups in the province, such as POSSE, who can then disseminate that information to their communities through outreach and social media.

Kent described the program as a "brilliant idea."

"It's another tool of a harm-reduction strategy to inform people of tainted substances and allow people then to proceed with caution then if they decide to use substances that they know are moving through their community," she said.

It's not only people living with addiction who are in danger of an overdose, said Kent. Experimental users, who are often curious young people, are also at risk.

Kent stressed that all kinds of people use drugs — from people in big cities to small towns, from older folks to youth. She said she has seen teenagers as young as 13 who have used Xanax.

"So there could be youth even younger than that, which is frightening," she said. "I feel like we need to have these alerts and the education because it could be anybody's child."

'It's worrisome'

Matthew Bonn, a program co-ordinator with the Canadian Association of People Who Use Drugs, said he wasn't surprised by the recent alerts about contaminated drugs.

"It's worrisome, [but] it's not surprising. Drugs are here, fentanyl is here," he said.

Although the new Drug Harms Alert program works with organizations to inform communities of contaminated substances, Bonn would like to see a more direct way for people who use drugs to be alerted about a tainted supply. 

B.C., for example, has a program where people can anonymously report tips about bad batches and sign up to have text warnings sent directly to their phone.

"It's not like you have to go looking through your social media, you just put your number in," said Bonn.

But more action needs to be taken to reduce harm and overdoses, said Bonn, such as funding overdose prevention sites — which the province has refused to do — developing safe supply programs, making it easier for people to have their drugs tested, and decriminalizing drug use.

The stigmatization of people who use drugs can prevent them from seeking help or medical attention when they need it. Bonn said it's important to reduce that stigma as much as possible.

"We want to destigmatize drug use as much as possible, but honestly, until we decriminalize drug use, that will never happen," he said.

Almost every other day in Nova Scotia, paramedics and medical first responders in the province use naloxone to reverse an opioid overdose.

A complex problem

Kent agreed that decriminalizing and destigmatizing drug use is the way to go. She said judging or looking down on people who use drugs can do more harm than good.

Instead, it's better to make it as safe as possible for people who do use drugs, she said.

"In a perfect world, people wouldn't be using drugs, but last time I checked, the world isn't perfect," said Kent.

"People use drugs because they're trying to have an experience. Whether we agree with that or not, it doesn't change the fact that that's what they're doing. So to say, 'Well, they just shouldn't do it,' it's oversimplifying. We live in a complex world and humans are complex as well."

Some of those harm-reduction methods include carrying naloxone, testing substances when possible, avoiding mixing substances and avoiding using alone. If someone does use alone — a big possibility during a pandemic — Kent suggested they contact someone to check in on them and have a plan in place if they don't respond.

By creating a safe space at POSSE, Kent said she has known young people who have stopped using recreational drugs after having honest conversations about the potential dangers.

"The more youth go and learn, the better prepared they are to make those decisions," she said.

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