CND Thematic Discussions on Strengthening Public Health Responses to Drug Use
Session 4: Adverse Health Consequences of and Risks Associated with New Psychoactive Substances
Intro & Expert moderator: Mr. Jared Brown, Laboratory and Scientific Services Section, UNODC – seeing an increasing number of NPS in vape liquids, providing particular risks to young people. We heard about nitazenes – synthethic opioids have a wide range of potency. Semi-synthethic kratom related opioids in oceania and Europe. Other sedatives in use expanded beyond benzos, we see … particularly in Asia. NPS are often involved in clusters of overdoses, hence early warning is needed to prevent a crisis developing. UNODC EWS provides support on scheduling decisions, 320 forensic and toxicology labs. Learning from each other what works and what doesn’t work is crucial. Important to use EWS to .. demand, supply and harm reduction responses. We see more interest in drug analysis beyond the usual data for seizures, including data that would be useful in the community.
Moderator: Let’s move to the first question – what challenges are countries facing and how are they supporting effective responses?
Mr. Younes Zebbiche, Professor of Toxicology, Head of the Central Laboratory Service at Ali Ait Idid Hospital Algiers, Algeria: Access to good laboratories is not equal everywhere. Modern technology, spectrometry not available in many countries. Certified reference standards are missing – expensive and hard to get, or not available at all. Toxicological profile of these NPS are still unknown – some look less dangerous, some more harmful. We have to know the profile of the 120 new substances each year. … link directly to the cause of death. A national response is being built step by step. Our meeting today is a strong sign of our common commitment. Hospital toxicology reports and post mortem analysis. Analysis of materials help map how NPS are used in real life. For example, if a drug is smoked or taken orally. Surveys – they’re done with a specific population. Wastewater analysis – it is a very new innovative tool. We can estimate the level of consumption and have the map in real time. Because of these challenges, multinational cooperation is more important than ever. We must integrate this into education – pharmacy, medicine students must be trained in identifying. We need to react faster and save lives.
Moderator: How can advancement in data and toxicology scanning be used more effectively?
Prof. Lee Cheng, Clinical Director, Office of Population Health at Institute of Mental Health, Singapore: comprehensive toxicology screening applied to the acute toxicity, have substantially improved … high resolution spectrometry. Second, accurate mapping for exposure to clinical … when results are combined, … this include disordered behavior, respiratory pressure, cardiac arrest. Samples can be analysed from libraries to identify previously unnoticed exposure. Lastly, with LLM and AI, we can …
Moderator: What data is most helpful for policymakers to understand risks associated with NPS?
Dr. Annette Hinze, German Federal Ministry of Health, Division 122 – Narcotics Law, Trade in Narcotic Drugs, International Narcotic Drug Affairs: We need scientific data. First, we need general informational about substances. Then how many people use them. Which groups they are found in – teenagers, young adults, adults, or male, female or other. Could be differences between students and people in party scenes. Regularly, mixed use amplifies the NPS effects. It is also important to know where they are used – regions, big cities or rural areas, if it is a wealthy area. This helps target intervention to the right people in the right places. Medical data includes hospital, ER, poison control centres. For some NPS, up to .. tests are needed, hence labs need equipment and highly qualified staff. We need international collaboration. Drugmakers don’t care about borders. Identify trends quickly and get info out to partners worldwide. Prevent harm and save lives.
Moderator: Lab data alone is kind of meaningless without understanding motivations of use, and that data might not be in regular data sets. Needs adequate resourcing and international data sharing, which should be built into national plans so it is not an afterthought.
Moderator:
Prof. Zukiswa Zingela, Vice-President, INCB (online): When targeting interventions, it is important to look at medical training, curricula, to make sure it includes these precursors and new substances. Professionals must be able to recognize presentations in children and adolescents and manage toxicity and withdrawal symptoms and underlying mental conditions. By October 2024, we know there were more than 100k trafficking incidents involving NPS. Sensitive care pathways are critical, as children and youth are more exposed. Family-centered approaches that respect the rights of those who use drugs and their dignity. Intelligence tools and coordinated youth responsive systems.
Moderator: it is important we cover a broad range of health professionals who might deal with these substances.
Moderator: How can civil society organisations provide data on harms from NPS to support early warning systems?
Dr. Penny Hill, Harm Reduction Australia (in person): I would like to begin my response with a clear call to action: for Member States to systematically work with and invest in people who use drugs and civil society organisations as partners in generating, sharing, and interpreting drug-related data on new psychoactive substances. Governments alone cannot capture the full picture of emerging drug trends. Harm reduction organisations and people who use drugs are often the first to understand new patterns of NPS use, discover new substances, and understand the emerging risks associated with them. By contributing unique, on-the-ground-level data, civil society can strengthen government-led early warning systems by sharing information on NPS before significant harm is experienced, and can bridge gaps in coverage from other data sources. An Australian example shows how this works in practice: the peer-led, government-supported drug checking service CanTEST in Canberra has detected multiple novel potent nitazene opioids and benzodiazepines since opening a few years ago. Unlike clinical or toxicological sources, these detections were pre-consumption detections, and alongside providing potentially life-saving information to the service users who provided these samples, the service was able to feed this data, through the form of drug alerts, directly into the health-focused national early warning system, the Prompt Response Network. This illustrates how civil society can generate critical, timely information and share it in ways that strengthen national systems while building trust with communities. For another example of civil society led initiatives today, I’d like to draw your attention to another intervention on drug checking that will be provided later in this session from civil society colleagues from Colombia. The barriers to effective data sharing on NPS are often not technical – they are about trust. To overcome them, governments need to create enabling environments where people who use drugs and civil society organisations are recognised as equal partners, resourced appropriately, and are protected from legal risks when sharing data. Therefore, my recommendations are that Member States: 1. Co-design early warning systems with people who use drugs and civil society organisations at the local, national and international levels, with clear roles in data collection and dissemination, whilst recognising community data governance and sovereignty principles. 2. Provide sustainable funding for civil society-led harm reduction initiatives for NPS, including drug checking and community alert systems. 3. Establish trust-building mechanisms – such as formal agreements and co-designed protocols – that ensure data can be shared without compromising the safety of people who use drugs or the organisations that serve them. By investing in partnerships with civil society and people who use drugs, Member States will not only strengthen their own early warning systems, but also improve their capacity to respond rapidly, inclusively, and effectively to the evolving dynamics of the drug situation.
Moderator: Pause here for questions.
CND Chair: Open floor.
Oman: We have different departments – drug control, toxicology, rehab centers. How to integrate them? Are there clear pathways for clear data sharing?
Prof Zebbiche: 2 level collaboration – international and intranational. National drug agency is collecting all the national data, then moving to second level of international collaboration.
Oman: not only data but also interventions, if other departments are not aware of it?
Prof Zebbiche: each country has their own classification. We need to collect data and work together.
Prof. Lee: Singapore is a small country so it is more united and cohesive. Covid showed when there is a crisis, most departments will work together. I’m not encouraging a crisis to happen, but… There is a stigma against people with mental health conditions, people who use drugs. Even psychiatrist might not understand mental health issues. Complex cases where multiple drugs are abused at the same time. Interpretation of results should also be simplified – even doctors are sometimes not able to decipher the significance of some data. Youth, female, pregnant women who are taking drugs, and those with co-morbid mental health conditions. Countries themselves need to pay attention so the policy benefits the patient and entire country.
Moderator:
Dr Penny Hill: Australian Permanent response network. Bring together health departments, police, people who use drugs – anyone you can think of with interest in NPS are involved in this program. The more work you can do to bring together stakeholders, you have more opportunity for data sharing.
Moderator: Best practice in EWS is having a centralized coordinating agency to ensure the relevant stakeholders have access to information at the right time.
Moderator: Hopefully that has given some food for thought, but happy to continue. Back to chair.
Chair:
Mexico: 1 – action 14 of plan of action 2019 speak of vulnerable groups and gender considerations. Challenge 29 of 2014 speaks of training of health professionals and taking measures against overprescription.
Prof. Zukiswa Zingela, Vice-President, INCB: …
CND Chair: Any other delegations wishing to ask questions? See none. Back to Mr Brown.
Moderator: Got a few more questions as plenty to discuss.
Prof. Zebbiche: Adverse health consequences are well documented worldwide. When we analyse NPS …. Spread of these opioids considered an epidemic in some regions, overwhelming emergency response. Novel benzodiazepines .. One of the greatest challenges, when we have multi-drug use. .. sometimes, very little concentration can cause
Moderator: How can we best understand NPS and establish toxicity or dependence?
Prof Lee: there is so much information in the background. On the backend, in hospitals, they are probably more equipped with the knowledge, but they must help the frontline workers. They are the ones who do rehabilitation in the community and if they are not aware, they cannot share. .. we always refer to the reference range. Real time information is important, because when a new substance is coming .. In Singapore we have vapes, vapes containing atomate ((??)) . we need specialized lab capacity, we need to train workers.
Moderator: How to support evidence-based policies?
Hinze: Collaboration and speed are important to us. All data need to follow clear standards. All laboratories should use the same or comparative reports. We already have good models, e.g. European pharmaceutical code. European early warning system bring together EUDA, Europol, EC, natonal early warning systems of 30 countries. The key factor is speed. Information should be available fast, not years later so we can respond and prevent harm. By sharing data rapidly, we can detect NPS early and take action immediately. International data helps us understand how NPS moves across borders. Countries can block and reduce the speed of trade. Standardized, high quality and fast data helps us shape policy.
Moderator: Annual reporting is not the way given the rapid change.
Moderator: What can we do about falsified medicines containing NPS?
Prof. Zukiswa Zingela, Vice-President, INCB: (…)pose acute and chronic risk – unpredictability, potency, adulterants often added. Can lead to failed treatment because of not knowing what the person has taken. Detection and disruption. INCB operations and partnerships under GRIDs has actively supported identifying and chasing the supply chains and intervene quickly. Technology and information sharing – pre-flight incident checks, .. – allow countries to accelerate. Capacity building is important. Build cross-border collaboration. Public-private partnerships are very important. Online platforms must be protected from exploitation.
Moderator: How can civil society organisations collaborate with early warning systems to support NPS risk communication?
Dr Penny Hill: I would like to again begin my response with a call to action: for risk communication on new psychoactive substances to succeed, Member States must invest in working with people who use drugs, and in civil society partnerships where trust already exists to communicate risks on drugs. NPS risk communication only works if people who use drugs trust the messenger. Trust cannot be built from government platforms alone in communicating drug-related risks; it is built through collaboration with people who use drugs, communities, and civil society organisations who already have established relationships with people most affected. Civil society organisations, including peer-led groups, bring not only trust but also the right language, cultural knowledge, and access to key spaces, including festivals, nightlife settings, online platforms, and community networks. When drug alerts are co-designed with people who use drugs, they are more likely to be accessible and free from stigmatising language, and encourage people who use drugs to act on them. In contrast, if risk communication on NPS comes from governments alone, they will likely come from the same systems that simultaneously criminalise the very people they are trying to reach, and in turn fail to reach the communities they are written for, and fail to build trust with communities. Partnerships with civil society in this space must therefore mean more than one-off consultations. It must mean power-sharing: co-developing the messages, deciding the delivery methods, and listening to community feedback. This is not just a question of effectiveness, but of rights. People who use drugs have the right to health, and that includes the right to timely, stigma-free, and reliable information. At the same time, we must recognise the limits of risk communication alone. Without broader reforms – such as decriminalisation, legalisation and regulation, and community-led safe supply initiatives – early warning systems will always be reactive, caught in an endless cycle of issuing alerts after harm has already occurred. But there is a clear opportunity here. By partnering with civil society and people who use drugs, Member States can transform information-sharing on NPS into something more than just early warning initiatives: systems can become a tool of trust, dignity, and health promotion. Collaborating on early warning systems provides an opportunity for Member States to work with civil society, not against us – and in doing so, ensuring that early warning systems truly inform and empower the communities they are designed to serve.
Moderator: Back to Chair.
CND Chair: open the floor. Don’t see any questions. Then thank you Mr Brown and the panellists. Now we begin the interactive discussions so I open the floor to those wjo would like to share.
Thailand: (…)
United States: Overdose rates in the US are starting do decline. However NPS are increasingly found, including xylazine. These substances impact international security as they travel through international trade routes. The US supports initiatives to upgrade … training, technical assistance and tools to improve . to combat drug threats, sharing data and forensic patterns will enhance global preparedness.
Canada: deeply concerned with the illegal toxic drug supply. Fentanyl analogues and .. have brought unique challenges to address the overdose crisis. .. Canada continues to strengthen efforts to monitor and provide information to partners. Strictly controls precursors and analogues. Inr ecent years, takena proactive approach to scheduling by scheduling clusters of chemically related substances. Drug analysis service plays key role. Recently established drug analysis centre that will provide analysis on seized substances in production of methamphetamine to support law enforcement. To reduce adverse health consequences, timely information sharing and collaboration is essential. Will continue to work closely with partners to take action and save lives.
South Africa: registers its concerns about the continuous emergence of NPS and the serious risks it poses across the globe. SA adopted a multifaceted approach, combining public health, international cooperation, early … However, for an NPS to be identified, there needs to be reference samples. We continuously work on obtaining new samples to profile drugs and new compounds. Enhanced surveillance and information sharing is essential. An expert working group is being established to develop national plans. Given the impact of NPS on vulnerable groups, especially youth, South Africa continues to strengthen prevention, like screening brief intervention and referral through schools and our apps, like B-Wise. International cooperation is vital.
Australia: NPS are highly potent, not well understood. Frequently found mixed with commonly used drugs, increasing the risk of unintended harm. The emerging drugs network of Australia reported … across 14 sites. National early warning system issued 20 drug alerts, mostly related to.. Multiple data sources inform, including drug checking, toxicology, anecdotal evidence from peer networks. Pre-consumption data allows for more info without an overdose or another adverse effect taking place. Prompt response network – in addition to early warning, has take home naloxone program to anyone who might experience or witness an overdose or adverse reaction. Peer-led education programs that reduce stigma and improve drug literacy among people who use drug is complementary. We welcome the collaboration resulting from synthetic drugs strategy, particularly ongoing coordination. We encourage multifaceted responses incorporating peer-led and public health responses.
Peru: The dynamic nature of this phenomenon, speed of criminal organizations. Criminal groups take advantage of regulatory gaps. Peru not historically affected, but authorities have been reporting some synthetic drugs like fentanyl. No country is safe. Devida signed with the EUDA a working agreement to promote exchange of methodologies, expertise and data and establishment of early warning system on drugs.
UK: synthetic opioids claimed the lives of over 450 people in last two years. Proactive approach to emerging nitazines will .. we have expanded access to naloxone through recent legislative change, take-home supplies more available. We are not complacent. We have enhanced monitoring. Several new data streams, including post-mortem, ambulance naloxone use, … structured process for assessing the threat. … Stigma amplifies the health risk. … “Talk to Frank” – patterns of use and harm for young people and educators.
China: One of the countries with the largest number of NPS under control and tightest control measures. National lab system enhancing monitoring of NPS abuse. .. special campaigns are focused on key regions and substances to curb their spread. Organized public awareness campaigns targeting youth to increase resilience against NPS.
Colombia: Not exempted from dynamic. There has been increase in supply in demand. Monitoring virtual forums, reports from NGOs and testimonies from people who use drugs proves it. Potency and effects represent a challenge to health service which don’t always have necessary knowledge. Response should not be limited to repression, but include effective harm reduction and accessible information to the public. Criminalization alone does not help, instead it obscures about the composition of substances. International network of substance analysis drug checking services generating evidence … with participation of people who use drugs and intersectionality. Essential to address this global phenomenon with regulatory alternatives. Requires placing public health and human rights at the heart of response. Replace punishment with evidence.
Romania: Aligned with EU statement which should be coming up soon. Our response is anchored in public health. It includes strengthening forensic, in line with EU. Rapid emergence outpaces traditional approaches.
European Union: All member states and following countries aligned: Albania, Bosnia and Herzegovina, Georgia, Iceland, Montenegro, Moldova, Norway, Turkey, Ukraine. For the 2nd year in a row, EU countries reported… the international community has reacted to schedule those substances that were not. EWS are critical to respond to health and social trends. … it is our common responsibility to address while paying attention to vulnerable groups, youth, ppl experiencing homelessness,, people in prisons. Risk and harm reduction models while allowing recovery in an environment free of discrimination. EUDA replaced EMCDDA with stronger mandate to respond proactively by undertaking threat assessments and provide evidence-based responses. With the updated Eu Health and Security framework, the EU is more equipped. … the Commission can declare a public health emergency and mobilize resources if the situation so requires. …
Brazil: … enhance international early warning data sharing, accelerate scheduling decisions on the recommendations of WHO.
France: special attention to synthetic cannabinoids. Consumption amongst the youngest is emerging. Especially when the drug is in liquid form and consumer doesn’t have control over its dosage. Psychostimulants, particularly cocaine. … we promote strengthening knowledge and its dissemination.
IFRC: rapid spread represents a pressing public health challenge. The result is social harm and overdoses overwhelming communities and health systems. We need a coordinated health-centered approach. History has demonstrated that punitive responses are not effective. They push people into marginalization and away from care they need. For a humanitarian response – saving lives through harm reduction and overdose intervention. Preparing health system to respond to fentanyl related emergencies. 2, easy access to treatment without stigma free from punitive restrictions. Without these, people in need are left without options. 3. …. Prisons are pathologic and pathogenic. Prisons create pathology. MS should consider pre-arrest diversion as evidence-based response to redirect people to health services. Already working on what we call humanitarian drug policy. We warmly invite MS to join these efforts and bring support so together we can strengthen collective response.
Jordan Anti-Drug Society: In Jordan and across the Middle East, NPS pose a serious threat. They are cheap, widely available, and often disguised as harmless. Captagon, synthetic cannabinoids, and methamphetamine-based stimulants are increasingly linked to both public health harms and social instability. One of the most alarming aspects is the misinformation surrounding these substances. Young people are told they improve performance or reduce stress, when in reality they can cause psychosis, organ damage, addiction, and even death. At TJADS, prevention is our first line of defense. We focus on four key areas: First, correcting misinformation. We run science-based campaigns in Arabic that debunk myths about Captagon and other synthetics. By changing the narrative, we reduce curiosity and prevent experimentation. Second, youth engagement. We empower young people as peer educators and digital leaders. Since NPS are often promoted online, our youth volunteers create awareness content and lead discussions that resonate with their peers. Third, community partnerships. TJADS collaborates with professional associations, schools, and workplaces to integrate NPS awareness into daily life. When prevention is visible everywhere, it becomes part of the culture, not just a campaign. Fourth, cultural adaptation. Our messages are linked to family protection, social responsibility, and national values, ensuring credibility and trust in communities that may distrust external messages. Despite these efforts, challenges remain. Treatment options for NPS-related disorders are limited, reliable data is scarce, and stigma prevents families from seeking help. This makes prevention not only the first line of defense—it is often the only one available. Therefore, I call on the international community to: 1. Invest in evidence-based prevention tailored to NPS. 2. Support civil society organizations in resource-limited settings. 3. Strengthen regional cooperation and data-sharing to respond effectively. Excellencies, colleagues, NPS are a fast-moving threat, but prevention gives us the chance to move faster. By equipping youth with facts, engaging communities, and supporting civil society, we can protect health, resilience, and the future of our young generations.
Corporación ATS Acción Técnica Social: Drug checking services worldwide have reported on the composition of a mixture marketed as a pink powder commonly referred to as “tusi.” While ketamine and MDMA are the most frequently identified components, a wide range of novel psychoactive substances may also be present. This variability not only introduces potential avenues for experimentation among users but also entails significant and uncertain health risks due to the unpredictable composition of tusi. In contrast to many traditional drugs in the market, tusi can be manufactured without the requirement of large-scale synthesis laboratories or extensive plant-based cultivation. Its composition is highly variable, shaped both by the availability of substances in local markets and by the preferences of specific drug user communities. Reports from Colombia, across the Americas, and in Europe have documented the presence of dissociatives, depressants, stimulants, psychedelics, and even opioids. Since 2013, Échele Cabeza—the drug checking service of Corporación ATS—has implemented colorimetric test reagents to identify a limited range of substances in tusi samples. In 2023, the service expanded its methodology by incorporating additional analytical techniques, such as chromatography, which enabled the detection of compounds not identifiable through colorimetric reactions, including benzodiazepines and certain opioids. That same year, fentanyl test strips were also introduced into the analysis of tusi. A key finding from this approach is that fentanyl has not been detected in any of the more than 500 samples analyzed between 2023 and 2025. This result is consistent with drug market monitoring conducted by the Colombian Drug Observatory, published in November 2024, which likewise reported no evidence of fentanyl. The MDMA market in Colombia has recently undergone significant shifts. During 2025, over 70% of ecstasy pills samples analyzed have been found to contain MDA, while more than 64% of crystalline MDMA have likewise corresponded to MDA. This trend is particularly relevant, as the supply of amphetamine-type stimulants used in the production of tusi is increasingly influenced by a substance that produces more intense psychoactive effects than MDMA. Overall, the health risks associated with tusi remain uncertain. Although the adverse effects of prolonged, frequent, and heavy ketamine use on the urinary tract are well established, there is still a lack of robust evidence on the health implications of combining ketamine with stimulants and other substances that tusi may contain. At Échele Cabeza, we wish to express our concern about the growing trend among young people in Colombia toward polydrug use involving tusi in party settings, as well as its increasingly frequent use, as evidenced by surveys conducted by our organization among people who use drugs. We call upon harm reduction services to strengthen peer-based strategies that facilitate direct dialogue with people who use drugs, in order to better understand their practices and contexts and thereby deepen knowledge of this phenomenon. We also urge health systems to implement care protocols free from stigma, enabling the documentation of complications that may arise in patients reporting the use of this cocktail of substances. Finally, we call on government institutions to explicitly include tusi in public policies and drug consumption studies, recognizing it as a cocktail of substances—rather than categorizing it solely as a psychedelic, stimulant, or dissociative—since the available evidence clearly demonstrates that it is a combination of these.
CND Chair: We have one more video intervention that was supposed to be in the morning but couldn’t play because of technical issues.
Ares do Pinhal: (…)
CND Chair: Any questions? Then my intention is to hand to the expert to summarize.
Moderator, UNODC: Thank you Chair, panellists, and interventions. I’ll pose it in the way of questions to think about. How can we bring interventions to life? Lets think about how we can ensure that shared common ground. Are we prioritizing resources towards this common goal? Are we using all available data to guide response? What we heard today is no single data source will give you all the answers. We need to use comprehensive data systems. Is there access to NPS for scientific research and analysis? …. I’ll leave you with the provocative question – have you shared data in the last month?