New non-opioid drug found in Toronto’s unregulated supply: checking service

An undated photo of an individual cooking drugs for intravenous use. (File image/CTV News)

Toronto’s Drug Checking Service is advising of a new drug that has recently been detected in the city’s unregulated fentanyl supply.

Called nefopam, the service says this substance has also been circulating in Peterborough and Kingston.

It was first found in fentanyl samples collected in Toronto and Peterborough that were checked on March 12.

Between March 12 and 25, nefopam was found to be present in 12 of 102 fentanyl samples checked by Ontario’s Drug Checking Community, which the service’s provincial public health and safety program.

Nefopam is a pain reliever

Sold under the brand name Acupan, Nefopam is described as a “non-opioid pain-relieving drug that is used to help treat moderate to severe pain, particularly after surgery.”

What’s concerning about this substance is how it relieves pain is not well understood, the service said in a memo on Thursday.

Toronto’s Drug Checking Service added that nefopam “appears to block pain messages from being sent to the brain or stop the brain from noticing pain messages.”

Drug not approved for use in Canada, U.S.

Although it is currently not approved for use in Canada or the United States, nefopam is approved and used in the United Kingdom, and in parts of Europe, Asia, and the Middle East, the service said.

“The presence of nefopam is not believed to be as noteworthy as some of the other contaminants we regularly find in the fentanyl supply – like veterinary tranquilizers, benzodiazepine-related drugs, or nitazene opioids – but we felt it was a valuable update to share with our community,” Toronto’s Drug Checking Service said in its note posted online.

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Some of the symptoms of nefopam exposure include nausea and vomiting, drowsiness and dizziness, excessive sweating, agitation, fast heart rate, and stimulant-like effects.

When consumed in high doses it can cause difficulty peeing (urinary retention), hallucinations, confusion, and seizures.

Nefopam is not known to cause respiratory or central nervous system depression but could be associated with minimal sedation, said the service.

Unpredictable, contaminated supply

The adverse effects that come with consuming nefopam occur most often when it is used unknowingly and when the quantity of it is unknown.

This substance can also be problematic when it is taken in combination with high-potency opioids, central nervous and/or respiratory system depressants. This is almost always the case, as the unregulated drug supply s highly unpredictable and extremely contaminated, Toronto’s Drug Checking Service said.

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“We are continuing to monitor this trend and will keep the community informed as we learn more,” it said.