Organised by the Government of the United States. Conference Room M6; 1.10-2.00pm

“Synthetic drugs are one of the most significant drug problems worldwide. The Panel will present geographically diverse outlooks on synthetic drugs; including efforts taken to prevent and control their spread, challenges, and to share best practices and lessons learned. The US State Department’s Assistant Secretary for International Narcotics and Law Enforcement, William R. Brownfield, will make opening remarks, followed by representatives from the United States, Canada, China and Estonia.”

William R. Brownfield (US State Department’s Assistant Secretary for International Narcotics and Law Enforcement)

Good afternoon and welcome. With me today are representatives of the United States, Canada, China and Estonia. Our experiences of the threats posed by New Psychoactive Substances (NPS). More than 800 substances have appeared in the last five years. Synthetics opioids such as Fentanyl have resulted in many deaths in the last few years. 75% of overdose deaths involved Fentanyl. We must identify ways to schedule more synthetic substances. We are currently scheduling 10 substances a year. It will take us 70 years to schedule currently identified substances. We must prioritise early warning systems to warn of new substances. Prevention and education are key.

United States – Antonio Guzman (Associate Section Chief of the Synthetic Drugs & Chemicals Section, US Drug Enforcement Administration (DEA))

“NPS, Opioid/Fentanyl Threat in the United States”

I’d like to start by explaining what’s occurring in the United States – DEA/NFLIS data identifies the drugs most used on the streets in the US – the top 4 are cannabis, methamphetamine, cocaine and heroin. Fentanyl is number 7. Cannabinoids have been of our most concern, but are diminishing. Cathinones have also been high, but are diminishing. Everything in the NPS world is about accessibility and availability. US has always had a traditional heroin market, and the heroin threat is increasing – heroin and opiates are the number one cause of death from overdose. There has been exponential growth in the use of fentanyl, and it is continuing at an alarming rate. 91 Americans die everyday from opioid overdoses. Heroin seizures are down, predominantly because of high rates of fentanyl seizures. Fentanyl reports are most prevalent in OH, MA, NY – in the New England and Mid West states.

Traffickers realise the real money is in counterfeit pills. It is also sold as black tar.

It’s my units job to identify where the illicit substances are coming from.

DEA’s 360 strategy – a response to heroin and opioid pill crisis. We have a three pronged approach: coordinated LE Actions against drug trafficking; Diversion Control enforcement actions (with industry, practitioners and pharmacies); and community outreach.

NPS/Fentanyl Outlook – challenging and evolving – fentanyl laced heroin continues to be the popular method of distribution in the US. Almost 90% of the fentanyl samples had minimal manufacturing skills.

If we work together, we can impact the NPS/Opioid/Fentanyl crisis. I invite you to move from a community of interest to a community of action.

Canada – Luc Chicoine (National Drug Program Coordinator, Royal Canadian Mounted Police)

Good afternoon and thank you for letting us explain the problems that are occurring in Canada. The focus of Law Enforcement focuses on opioids. Fentanyl is causing most of the deaths from overdose, but only making up 4% of seizures.

We have an opioid crisis, mostly focused in British Columbia (BC), Alberta and Ontario. The number of deaths are still growing.

Current situation – BC – 2 deaths per day.

80% cut with caffeine, 30% mixed with heroin, 40% mimicking physical property of oxycodone tablets. Also seen mixed with cocaine and methamphetamine. In 2011, opioids seized started overcoming other substances.

In recent months, Canada launched a new action plan on Opioid Misuse – focused on awareness -“we can not arrest our way out of the drug problem”, better informing Canadians about the risks of opioids, supporting better prescribing practices, reducing easy access to unnecessary opioids, reducing the availability of opioids on the streets.

The Government is also proposing new actions to reduce the supply of illicit opioids through Bill C-37 – controlling pill presses, addressing issues surrounding mail shipments, emergency temporary scheduling. 6 precursor chemicals used in fentanyl synthesis have been controlled.

Law Enforcement Initiatives: Officer (First Responder) Awareness program- including bulletins (printed and online), Naloxone, training, policy, safety equipment. We have provided an excess of 17,000 Naloxone kits – 104 uses in BC, 8 unsuccessful. Also pushing for public awareness. We have identified that the main source of fentanyl and precursors in Canada has come from China. MOU’s signed with China in 2010 and 2016, having joint operations between the two countries.

China – Wei Xiaojun (Deputy Secretary General of National Narcotics Control Commission (NNCC), Deputy Director General of Narcotics Control Bureau)

Thank you. It is an honour to be here on behalf of the Chinese Government. We a proactively taking measures to identify problems with NPS in China. In regards to precursors in China, preventing precursor diversion is our goal. We are stepping up to severely punish precursor crime. NPP will be controlled very soon. We regard to NPS control in China – NPS control has become more controlled in recent years. With legislation, certain substances have been added to the list of scheduled substances since 2010. 116 NPS were scheduled. Of this month,  new NPS related to fentanyl have been identified. 133 NPS under control in China currently. Most are manufactured without any abuse in China, while causing abuse in other countries. NPS manufacture in China comes predominantly through people with a pharmaceutical or chemical background, and are mailed out of China. 8 NPS laboratories have been dismantled, with tonnes of unscheduled NPS seized. With regard to major challenges – lacking of legal business while NPS have increased dramatically. It is difficult to identify NPS and precursors through internet providers. Taking matters to control demand side and internet needs to occur in Western countries. Sharing information and intelligence between different countries is needed. Tracking numbers, addresses and other information should be recorded, for backtracking. Enhancing international and domestic collaboration is needed. A crackdown on illicit activities is needed. Global efforts are needed – this problem cannot be solved by one country alone, to reduce drug demand and supply.

Estonia – Anna-Liisa Paasukene (Advisor, Public Health Department, Estonia’s Ministry of Social Affairs)

Thank you and good afternoon. A brief overview of the fentanyl problem in Estonia – it first occurred in 2001-2002 with the heroin problem in the Middle East. Initially we thought that fentanyl would fade away and heroin would come back, but this was not the case. Fentanyl is the main drug causing harm to people who inject drugs. It is easier to smuggle as less is needed. Fentanyl used in Estonia is manufactured illegally and mainly manufactured in other countries. In the beginning of the 2000s we had to re-evaluate interventions previously used for heroin users. Fentanyl is injected more frequently than heroin (4-5 times a day) and the rate of overdose is higher than heroin. 170 deaths in 2011 – we only have 2 million people in Estonia. This number has gone down in 2015, and has had a slight rise in 2016 with stronger fentanyl derivatives. In 2015, we lost more people to overdose deaths than road accidents. We have the highest rates of death from overdose in Europe. Naloxone program launched in 2013, started training fentanyl users and their families, and people released from prison are provided with Naloxone kits. We are planning to provide naloxone training to police officers.

Antonio Guzman – This is a problem that requires leadership – it is a persistent problem.

Question Time –

To the US delegation – Randy Thomson, Help Not Handcuffs – are harm reduction programs being considered as a response to the US Fentanyl crisis?

Guzman – we are reviewing all possible solutions.

To Estonia – are methadone programs being considered for Fentanyl users?

Paasukene – Methadone will not get users the high they are looking for from fentanyl, so is not appropriate

To US – regarding shift from using prescription medication to heroin.

Guzman –  consequences have occurred from prescription diversion programs. There is no quality control when it comes to fentanyl.