Abstract Background: The Canadian opioid crisis is primarily characterized by synthetic opioids such as fentanyl. However, culturally distinct patterns of opioid use, specifically traditional preparations, remain under-recognized in South Asian diaspora populations, Canada’s largest racialized group. Objective: To characterize the use of traditional opioids (afeem, doda, and kamini) and identify the emerging risks involving fentanyl adulteration and heavy metal toxicity. Methods: A narrative synthesis of clinical case observations, public health surveillance data, and ethnographic literature. Results: Traditional opioids are frequently used “functionally” for pain, occupational endurance, and perceived sexual stamina. These substances are often viewed as natural remedies rather than illicit drugs, delaying treatment. Critical emerging risks include lead toxicity from traditional processing and unintentional fentanyl exposure through adulterated informal supply chains. Conclusion: Clinical screening must evolve to include specific inquiries into traditional substances. Culturally responsive care requires addressing the stigma of “addiction” while managing the physiological risks of synthetic adulterants and heavy metals.
Avi Aulakh (Thu,) studied this question.