Sedatives added to P.E.I. street drugs have made opioids more risky, says PEERS Alliance

Street opioids have become even more dangerous on Prince Edward Island as suppliers cut drugs like fentanyl with sedatives such as benzodiazepines and Xylazine, says PEERS Alliance. 

The harm reduction and support group, whose name stands for "Prevent, Educate, Empower, Respect, Support," is urging people who use street drugs to test their supply before taking their first dose. 

New numbers from the province's Chief Public Health Office, released Wednesday morning, show a slight year-over-year increase in the number of opioid-related overdoses between January and March. 

There were seven accidental overdoses in those three months of 2023. In 2022, there were five in the same period. 

The sedatives are a relatively new addition to the island's street drug supply, says Angele DesRoches, the program director at PEERS Alliance. 

Benzodiazepines, a class of drugs that includes prescription drugs like Xanax and Ativan, are now being mixed into street fentanyl. So is Xylazine, a veterinary medicine used to sedate horses and cattle. 

Fentanyl has become the new heroin in Canada, said DesRoches, but it doesn't last as long as its predecessor. 

"So what has happened is producers are putting in products like benzodiazepines, like Xylazine, to really extend the life of the substance," she said. 

"It makes what people are taking more toxic ... It's not necessarily the strength of a substance, which folks are often looking for the strongest product on the market, particularly folks who are chemically or physically dependent on a drug. What we see is the combination of synthetic substances that result in a toxic product."

Sedatives complicate overdose reversal

Now when people overdose, those overdoses are more complicated and people aren't rebounding in the same way, she said. 

"Because of the other substances present in that dose, the naloxone isn't as effective at bringing them to," said DesRoches. "So you may see something like somebody overdosing, administering the naloxone, having that person's breath return, but the person is still not conscious and they may not be conscious for several hours."

All officers with the P.E.I. RCMP carry the nasal form of naloxone. It's an easy way to reverse an overdose for people who have no medical training. 

Const. Will Fiset is a trained paramedic and worked as a medic in the Armed Forces. He is part of the RCMP's emergency medical response team and is one of two Island RCMP officers who can give intravenous and injectable naloxone.

He said he's administered naloxone about six times over the last two years, with half of those coming since January of this year.

He's noticed a change too.

"Sometimes it can be difficult to recognize which type of overdose it is," he said, given that a person could simply be deeply intoxicated by alcohol.

"Naloxone won't be harmful if you give it on a benzo overdose. So in case that you're not sure what you're addressing, it's best to give the naloxone just in case." 

New Xylazine test strips

Naloxone works only on opioids like fentanyl, heroin, morphine or codeine, and won't cause harm to someone without those substances in their system, according to the Ontario-based Centre for Addiction and Mental Health.

But since it won't act against sedatives, PEERS Alliance has started carrying test strips so that people can test their drugs before using them. 

DesRoches says her group received test strips for Xylazine just in the past month, adding to their benzodiazepine test strips that have been in use since late 2022. PEERS also carries fentanyl test strips for people who use stimulants. 

"I think there's a [misperception] that folks who are active in substance use are not interested in their health or promoting their health. That is just not the case," said DesRoches. "Folks are hungry for education. They're very interested in what they can do to keep them and their friends and their family safe."

She said about 50 Xylazine test strips have gone out since they arrived, and about 250 benzodiazepine test strips have been picked up. 

Still, DesRoches said, PEERS would like to see more go out the door, especially as these new substances become more common. 

"The casual consumer, the student who's experimenting — those folks are people that we don't see as often. But those are folks who should know that if they're concerned about their substances, if they're interested in drug checking, please come down."