Double trouble: New drug on B.C. streets brings hallucinations, vomiting, ICU after overdose

The toxic drug supply is constantly mutating, and the latest change is an ugly one.

For months, British Columbia’s health officials have been issuing warnings about a new street drug that’s sent overdose calls soaring, but the risk of withdrawal hasn’t been well understood.

The animal tranquilizer, medetomidine, has been found mixed with the opioid fentanyl in up to half of the drugs tested by the B.C. Centre for Substance Use. It’s that combination, increasingly found across Canada, that makes the situation so challenging and increasingly life-threatening.

“Naloxone is still effective and it will reverse the fentanyl component of the overdose, (and) the added complication with medetomidine is that we also are having very complicated withdrawal syndromes,” said Dr. Nadia Fairbairn, a St. Paul’s Hospital physician and addiction specialist who’s treated those patients.

She explained that some people don’t realize they’ve been consuming the tranquilizer until they start experiencing debilitating symptoms within six to 12 hours of their last use: high heart rate, extremely high blood pressure, agitation or delirium, shaking, nausea and vomiting.

“Patients are really uncomfortable and in distress when they’re in this withdrawal syndrome and that is difficult for us as care providers and it’s also difficult for families,” said Fairbairn.

It’s those extreme symptoms after they’ve recovered from the initial overdose that can send patients to the intensive care unit for life-saving medical intervention.

Spreading the word

Public health officials aren’t just trying to notify drug users and the general public of the new twist in the toxic drug crisis, they’re also warning frontline medical providers of the prolonged sedation that can come before the hallucinations and spike in blood pressure.

Related: Drug poisoning on the rise in B.C., health officials warn

“It’s really been driving overdoses across our region and many of the other regions in B.C.,” said Dr. Mark Lysyshyn, deputy chief medical health officer for Vancouver Coastal Health.

Drug bulletins from different agencies carry different descriptions of what to watch out for, from crumbly material to blue powders, though it’s all derived from a white chemical powder.

“I think it just highlights the unpredictability of the unregulated drug supply and speaks to why we need to do surveillance for overdoses at emergency rooms, at our supervised consumption sites and overdose prevention sites,” he added.

The limits of testing

The B.C. Centre for Substance Use regularly takes street drug samples for detailed analysis with a spectrometer that identifies the random chemicals and ingredients – ranging from pure drugs to drywall compound – to try and track the changes in the illicit supply to provide warnings and allow officials to determine appropriate responses.

Related: Toxic drug deaths appear to be falling in B.C.—and no one is sure why

While those samples are tested in Vancouver, Victoria, and other labs in Canada, blood and urine taken from patients who are suspected to be suffering from medetomidine effects are sent to labs in the United States for analysis.

Lysyshyn pointed out that even domestic testing can take a week or longer, so treatment for a patient isn’t predicated on those results.

“Our role (as addiction medicine specialists) is to look at different syndromes and try to figure out what we think is most likely at play, so it has become more complex for us to be able to do that,” pointed out Fairbairn. “We’re usually able to manage quite well with our medical care, but we just need that increased observation and sometimes other medications that we haven’t traditionally needed to use.”