FROM SYNTHETIC DRUG THREATS TO SYNTHETIC DRUG REALITIES: EXAMINING THE ROLE OF GLOBAL DRUG POLICIES AND CHARTING A WAY FORWARD Organized by the Washington Office on Latin America with the support of the Canadian Association of People who Use Drugs, the Canadian Drug Policy Coalition, the Centre on Drug Policy Evaluation, the Drug Policy Alliance, the International Drug Policy Consortium, Mexico Unido Contra la Delincuencia and the Transform Drug Policy Foundation

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Theshia Maidoo, Drug Policy Alliance (DPA): (…) opioid overdose crisis in the US, NPS infiltrating the market (…) By 2014, an adulterated opioid response was implemented, focusing on the fentanyl penalty. As a result, we observed an increase in fentanyl analogs, substances on the Poli. Temporary classification and scheduling of fentanyl analogs occurred, yet we continue to see more substances flooding the market, including new bans. Some of these drugs are surpassing us, and we must respond to the opioid overdose reversal. Overdose rates are increasing, and heroin continues to pose a threat. Over 100,000 lessons have been learned, but efforts have not saved lives and may have exacerbated drug use. It’s imperative to recognize that focusing solely on enforcement and the supply side will not suffice. Solutions to the overdose crisis must be evidence-based. A public health response is necessary, including public education campaigns targeting individuals, community-based organizations, and public health workers. It involves expanding access to addiction services, evidence-based treatments, and medications like methadone and buprenorphine. Access to life-saving services such as Naloxone, drug testing, and overdose prevention centers is crucial. While the US-led global coalition offers promising new approaches, it also poses risks of repeating ineffective public health responses. The draft US legal recognition, with a score of 67 out of five, is a positive step toward focusing on evidence. As more states grapple with the opioid crisis, prioritizing concrete actions that prioritize health over lip service to public health is essential.

Andrej Celinski, Canadian Drug Policy Coalition: Canada is seen as a leader in many of these programs but on the other hand, these are pilot projects that are rolled out in an incremental matter. For example, safe supply would be a key issue – with the increased prevalence of fentanyl analogues and synthetic. But this is not able to address many key effects. Major cities across Canda are at a danger of losing funding and there is also a public backlash that we are grappling with. Lot of programmes, especially in rural areas, have closed down or are under risk of being closed, struggling with retaining staff. Education has to be centered around keeping people safe. Harm reduction practices in other areas such as seat belts are a part of the status quo , but when it comes to drugs, we have to fight to the nail to get individuals under protection.  There is not a one size fits all approach int his program which makes it more complicated. We need to scale up our efforts, monitor supply, alert people, communicate, etc. Scheduling substance after substance is just fueling the cycle of new substances entering the market. The supply has gotten more dangerous as the years have passed. So I want to emphasize the need to safeguard the supply. Society benefits as a whole by reduced crome rates, reduced toll on healthcare. I think we should think about medicalized models but also look at the drug user liberation front, there are many models already out there that are effectively keep people safe.

Moderator: Thank you. I would like to emphasize that we have to understand the role of prohibition itself in contributing to the dangers people who use drugs face.

Julian Quintero: According to UN scientific evidence, the amount of NPS on the global market is constantly increasing. A year ago, UNODC reported to have found new ketamine-based cocktails. In Colombia, the drug checking services have analyzed the currently circulating substances and about half of them has surprise component. Pink tusi, for example, has become a very popular drug and sadly, 100 of 203 samples contain some adulterant. … When it comes to reducing harms and following real life patterns, people who use drugs are at the center of the solution. Peers! So, beyond legal barriers, funding and public perception, peer exchanges and peer-led interventions are championing the wellbeing of all peoples and are successfully save lives.

Moderator: This was a beautiful example of how civil society is leading the way, supplementing services where policy has failed.

Maria Goretti, IDPC (video message):  In Africa, the challenge of accessing crucial pain medication remains a pressing concern, exacerbated by the intricate and often prohibitive process of obtaining approval from the International Narcotics Control Board (INCB). This regulatory hurdle not only impedes timely access to essential medications but also perpetuates a cycle of suffering, particularly among vulnerable populations who lack the resources to navigate the bureaucratic maze effectively. Furthermore, the current approach to drug regulation tends to criminalize poverty. Street drugs, often of dubious quality and lacking in medical grade standards, become the only recourse for individuals unable to obtain prescribed medications through legitimate channels. This not only compromises the health and safety of those in need but also fuels an underground market rife with exploitation and danger. Moreover, the international scheduling of certain substances, while well-intentioned, can inadvertently catalyze the proliferation of illicit drug trade. As enforcement efforts tighten around one substance, such as tramadol, individuals seeking relief from pain and suffering may turn to alternative options with similar effects, perpetuating a vicious cycle of substance misuse and criminal activity. The de facto criminalization of tramadol, driven by stringent regulatory measures, comes at a steep cost, particularly for healthcare professionals. The burden of navigating complex regulatory frameworks falls heavily on these frontline workers, diverting valuable time and resources away from patient care and exacerbating existing healthcare disparities. To address these multifaceted challenges, a nuanced and evidence-based approach to drug policy is imperative. Policy frameworks must prioritize public health outcomes while ensuring equitable access to essential medications for all individuals, regardless of socioeconomic status. Furthermore, repressive policies that criminalize drug use must be reevaluated in light of their disproportionate impact on marginalized communities, particularly in regions with young and burgeoning populations. In essence, the complexities of drug regulation in Africa demand a holistic and compassionate approach that recognizes the interconnectedness of public health, social justice, and human rights. By prioritizing harm reduction strategies, promoting access to evidence-based treatment and support services, and fostering community engagement, policymakers can work towards a more equitable and effective response to the challenges posed by drug misuse and addiction.

Steve Rolles, Transform: I’m going to speak briefly about this in the UK and European experience and try to position that in some of the debates that have been happening this week and last week at the lineup segment. Where obviously SiteScope was quite a high-profile issue. The situation you’re in is pretty quite different to North America with regards to investigating opioids. Most of the heroin in North America came from Mexico, whereas in Europe, most of it came from Afghanistan. As I’m sure many of you know, the Taliban opposed the ban on poppy cultivation, which essentially stopped heroin production in Afghanistan. Stockpiles and previous harvests filled the gap in opium production supplying Europe. The constriction on heroin supply to Europe is real and it may be to some extent permanent or long enough to get beyond the stockpile bridge to the point where heroin supply to Europe contracts significantly. The obvious risk there is that demand for the effects of opioids doesn’t disappear; it will just be met by other sources, including significant synthetic opioids but also probably synthetic benzodiazepines and possibly other drugs as well. Another difference in the dynamic between North America and Europe is that fentanyl hasn’t really been anything like a significant part of the illicit opioid market in Europe. There have been fentanyl-related deaths, but it seems like, for reasons I don’t really understand, fentanyl hasn’t dominated the market in Europe as it has in North America. Fentanyl and its analogs are between 50 and 1000 times stronger than morphine. So we’re dealing with a similar phenomenon, but fentanyl hasn’t been the major player in Europe. We are very much at the beginning of this journey within Europe. In the UK at the moment, there are about two deaths a week related to this issue. In reality, that number may actually be higher due to underreporting because forensics and disease aren’t everywhere. But those numbers are rising. A hundred thousand pills were seized, signaling potential industrialization of this process, and there was a real fear, although I’m very opposed to scaremongering within drug policies. It’s a rather unfortunate element of several narratives. Now, we could be about to come headlong into this catastrophic overdose crisis. Right now, in America over the last five years, our view transforms your organization. Our view is that we need an emergency public health response across Europe. You’ll forgive me for not talking about other regions; I have expertise and I think this could easily be a major issue in Africa as well, for example, but certainly in Europe, we need an emergency response drawing on lessons from North America. We know what works in terms of agency harm reduction responses. I’m talking about things like drug checking services, those are acts of service, in supervised injection facilities that we’ve seen across countries across the world. There’s more than 200 of these now, they’re very well evidence interventions and safe injecting practices, sometimes referred to as XY. In Canada, they’re making things available like prescription morphine pills and also safe injecting facilities, as well. But just to underpin all of that, it isn’t about law enforcement; it’s about ending the criminalization of people in disguise to reduce the amount and increase in people, the implementation of those services. I think what was striking to me about this phase I’ve witnessed over the last week or so last week with the director of see, was there was a lot of attention around public health and sanctions and harm reduction.

Moderator: I would like to open the floor now for questions.

Audience: There is already evidence that adulterants have played a role in the current situation. (…) drug laboratories?

Andrej: Yeah the measures in place in Canada seem to be very effective, that is what I can say – we have evaluations on a monthly basis. It’s crucial to emphasize the role of analogs. I think all the speakers in the last week have been very clear on this: safeguarding people and their dignity and well-being should inform public health responses rather than serve as justification. It’s important to recognize that there’s an opportunity for people to use drugs, much like going to a grocery store and knowing where your food comes from.

Audience: We are in an election year in Mexico. So my question is what would your recommendation for new Congress or improve their response? Of the problem in the rest of us?

DPA: I mean, I would recommend you learn from the lessons of last five decades that punitive impacts and positivity I think the US kind of mentioned this, we have a lot of lessons learned about how to implement effective public health approaches. So how can we share lessons with our Mexican public health departments? I know that you’re looking at data that is brought in supplies of synthetic fuel usage in Mexico. So how can we share lessons about Naloxone, early warning systems and supplies and services so I would say let’s be a good neighbor, to our partners in Mexico and to what we know from a public health perspective. The rhetoric that’s ongoing and militarizing the border is going to do that in the United States, and certainly it’s not going to be.

Julian: There should be conditions to generate all the trust possible so that people are actually going to the services. New drugs might appear because PWUD provide the samples to the testing services. So, accessibility and reliability should be prioritized.

Moderator: Thank you everyone. We have run out of time.