Montreal public health officials are warning residents about a dangerous, illicitly manufactured cough syrup circulating in the city. The syrup, marketed as containing promethazine and codeine, is actually laced with a highly toxic opioid, protonitazene, and a benzodiazepine, posing a significant risk of overdose and death.
The product is packaged to resemble legitimate pharmacy-sold cough syrup, labeled as “Promethazine with Codeine Oral Solution.” This deceptive packaging makes it particularly dangerous, as individuals may unknowingly consume a potentially lethal substance believing it to be a standard medication.
“Over time, different mixtures have been identified in containers that appear identical,” according to a statement released by Montreal’s public health department. Previously, the syrup contained a mixture known as “lean,” a combination of soda and codeine syrup. Recent analysis, however, has revealed the presence of protonitazene, a potent opioid, and bromazolam, a benzodiazepine not approved for medical use in Canada. The exact composition of the syrup is “completely unpredictable,” says Geneviève Paradis, a spokesperson for the DRSP.
The danger lies in the combined toxicity of the two substances. Protonitazene is a powerful opioid, and benzodiazepines are central nervous system depressants. When taken together, their effects are amplified, substantially increasing the risk of respiratory depression and arrest. This combination is particularly concerning because it can overwhelm the body’s ability to maintain vital functions.
This warning follows a tragic incident in Laval, Quebec, in , where an individual died after consuming a similar counterfeit syrup. The analysis of that case revealed a mixture of a synthetic opioid, a benzodiazepine, and an antihistamine.
Understanding the Risks: Opioids and Benzodiazepines
Opioids, like protonitazene, work by binding to receptors in the brain and body, reducing the perception of pain. However, they also slow breathing and heart rate, and can lead to sedation and unconsciousness. Protonitazene is particularly dangerous because This proves estimated to be several times more toxic than fentanyl, a potent opioid already responsible for a significant number of overdose deaths. Importantly, nitazenes, including protonitazene, are not detected by standard fentanyl test strips, making it difficult to identify their presence.
Benzodiazepines, such as bromazolam, are depressants that slow brain activity, producing a calming effect. They are often prescribed for anxiety, insomnia, and seizures. However, they can also cause drowsiness, impaired coordination, and slowed breathing. Combining benzodiazepines with opioids significantly increases the risk of overdose, as both substances depress the central nervous system.
The Canadian Centre for Substance Use and Addiction (CCSA) highlights that the combination of non-medical benzodiazepines (NMBs) and opioids dramatically increases the risk of drug poisoning. Benzodiazepine withdrawal can also be dangerous, particularly when occurring alongside opioid withdrawal or stimulant toxicity.
What to Do If You Suspect an Overdose
As of now, Montreal public health officials have not reported any confirmed overdoses or deaths directly linked to this specific counterfeit syrup within the city. However, they are urging caution and vigilance. The quantities of the syrup currently in circulation are unknown, making it difficult to assess the full extent of the risk.
Public health officials strongly advise against consuming drugs alone. If someone chooses to use, they should do so with a trusted friend who can provide assistance in case of an emergency. Accessing drug checking services, when available, can also help identify potentially dangerous substances.
Crucially, Montreal Public Health emphasizes the importance of having naloxone readily available. Naloxone is a life-saving medication that can temporarily reverse the effects of an opioid overdose, restoring breathing. It is available without a prescription at many pharmacies and community organizations. Knowing how to administer naloxone can be the difference between life and death.
Symptoms of an opioid overdose include difficulty breathing, slowed or stopped breathing, pinpoint pupils, unresponsiveness, and bluish lips or fingertips. If you suspect someone is experiencing an overdose, call 911
immediately. Administer naloxone if it is available and you are trained to do so. Stay with the person until emergency medical services arrive.
This situation underscores the dangers of obtaining medications from unregulated sources. Counterfeit drugs often contain unexpected and potentially lethal ingredients, posing a serious threat to public health. Individuals seeking medication should always obtain it from a licensed pharmacy and follow the instructions provided by their healthcare provider.
