Spike in B.C. overdoses linked to veterinary additive in street drugs

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They began collapsing late in the afternoon: four, five people at once – an alarming number of suspected drug overdoses at a Vancouver Island shelter where such incidents are infrequent.

As staff scrambled to respond, people rushed in from the street to grab kits of naloxone, the medication used to reverse opioid overdoses. People were going down outside, they said. The nearby overdose-prevention site was also unusually busy.

Over a 36-hour period beginning Nov. 18, more than 80 people suffered illicit drug poisonings on those few blocks in Duncan. The disturbing increase was seen across much of British Columbia that week, breaking several records for drug-related emergency calls nearly a decade into the province’s toxic drug crisis.

Health authorities are linking the spike to medetomidine, a powerful veterinary anesthetic that is among the latest substances being added to the ever-changing street-drug supply. November’s surge does not appear to correspond with a similar increase in deaths.

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“It was like, oh my God, what is happening here? Everybody’s going down,” said Erin Kapela, executive director of the Canadian Mental Health Association’s Cowichan Valley branch, which operates the Duncan shelter.

“It was an extremely toxic supply, it hit really hard and really fast, and it was really scary.”

Paramedics across the province responded to 222 suspected drug-toxicity calls on Nov. 19, surpassing the previous record set on June 21, 2023, by one, according to BC Emergency Health Services data. They attended a total of 1,251 such events that week, surpassing the previous weekly record of 1,181 set in August.

In Vancouver, firefighters responded to 54 drug-related calls on Nov. 21 – a single-day record for the department. By comparison, they averaged 16 such calls a day in the spring.

At the Duncan shelter, people began dropping in clusters of around five at a time, just as the nearby overdose-prevention site and other outreach services were winding up for the day, Ms. Kapela said.

She phoned and text messaged other service providers in the area, assembling a crew that took to the streets with backpacks full of naloxone, reversing 46 drug poisonings and overdoses in the first six hours.

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Less than 24 hours earlier, law-enforcement officers had dismantled an encampment on the street, which Ms. Kapela said made locating and checking on the welfare of its former residents challenging.

“We didn’t have a solid understanding of where everybody was, so there was a lot of concern for the front-line workers, like where are people? Can we keep them safe?” she said.

Island Health, the local health authority, said there was a dramatic increase in toxic drug poisonings in the Cowichan area beginning Nov. 18, during which it provided additional naloxone kits to the shelter and overdose-prevention site. The authority issued a drug poisoning overdose advisory for the area the following day.

Medetomidine was first detected in Canada’s illicit drug supply in Ontario in 2022, and in B.C. the following year.

Jennifer Matthews, drug checking program lead at the BC Centre on Substance Use (BCCSU), said B.C. has seen a “rapid increase in detection of medetomidine in opioids brought in for drug checking starting in June.”

The drug causes deep and prolonged sedation and can decrease breathing, heart rate and blood pressure to dangerous levels, increasing the complexity of response. By some estimates, medetomidine is 200 times stronger than xylazine, another veterinary sedative that has been detected in street opioids.

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Brian Twaites, public information officer with BC Emergency Health Services, said the opioid-medetomidine combination adds to the stress and complexity of calls. Paramedics treat such patients with naloxone to reverse the effects of the opioids, but the deep sedation still puts them at high risk of aspiration.

“There are times where our advanced life support paramedics will even have to physically intubate patients in the field – that’s where we actually place a breathing tube into their lungs – because they just don’t respond,” he said. “It can be a heavy call.”

He stressed the importance of never using illicit substances alone.

Paxton Bach, an addiction medicine specialist and co-medical director at the BCCSU, noted that medetomidine appears to cause more profound withdrawal effects than xylazine. In hospital, this would typically be treated with intravenous medications in intensive care.

While Dr. Bach said it is important to recognize the symptoms of medetomidine toxicity, he cautioned against focusing on any one substance as the driver of the drug crisis.

“They’re all part of the same pattern, and that is of this rapidly evolving, unpredictable drug supply that continues to be contaminated by any number of different synthetic opioids and non-opioid sedatives,” he said.

“It feels like a perverse game of Whac-A-Mole, where as soon as we start to get a handle on a substance, everything changes.”