2023-09-09 22:51:37
According to the DEA, 200 people die every day in the United States from fentanyl use.
Foto: Getty Images/Science Photo… – WLADIMIR BULGAR/SCIENCE PHOTO LIBRARY
At the invitation of President Gustavo Petro, the Latin American and Caribbean Conference on Drugs was held this week in Cali. The summit, at a high political level, could not avoid an issue that has raised alarm bells in the United States and Canada: the public health crisis due to the problematic use of synthetic drugs, especially opioids derived from fentanyl, which left North America more of 100,000 deaths in 2021.
Although the consumption of these substances is very low in Latin America, it cannot be ignored that the global drug agenda increasingly revolves around this issue. A phenomenon that 52 human rights organizations in Latin America described as a “foreign war,” which seeks to perpetuate the “warlike and punitive approach” against drugs that the United States has led.
But what challenges does the war against fentanyl have on the continent and what can Colombia learn? In an interview with El Espectador, Canadian Candice Welsh, regional director of the United Nations Office on Drugs and Crime for the Andean Region and the Southern Cone (Unodc), gives very good points about this conversation that we must begin to assume. rigorously in the country.
Candice Welsch, Director of UNODC for the Andean Region.
Photo: El Espectador – Jose Vargas Esguerra
In the UNODC global drug report in 2022, it was stated that in the United States and Canada the epidemic due to the consumption of opiates, for non-therapeutic purposes, unleashed a crisis that has resulted in even the consumption of heroin being almost replaced. completely due to the consumption of fentanyl, what is the outlook this year?
The data from the world report continue to refer especially to the situation in the United States and Canada where, in addition, heroin is being mixed with fentanyl or sometimes they only consume fentanyl. But the consumption situation in the rest of the world is not the same and especially here in South America it cannot be said that fentanyl is replacing heroin. The available data show very low consumption in the region.
In Colombia, clandestine fentanyl laboratories have not yet been identified; what has been seized is the product of diversions from the legal pharmaceutical market. What have you been able to find in this fentanyl diversion chain in the region?
What we have found in Colombia and other countries in the region is that this diversion is occurring mainly due to theft from pharmacies, clinics and hospitals. That is why it is important to strengthen and support medical authorities to be able to identify where the greatest risks of opioid diversion are.
You talked about the United States and Canada, specifically, was the opioid crisis in these two countries accentuated in 2022 compared to the previous year?
Crisis is a good word, because it is something very serious. There are no confirmed figures yet for 2022, but if we look at the figures for 2021, the issue is chilling. There were more than 100,000 overdose deaths, 66% of these (more than 70,000) were associated with synthetic opioids. It is estimated that today there are more than 150 deaths every day in the United States due to the use of these synthetic drugs. In Canada the issue is also very serious. In 2022 there were more than 7,000 deaths. That is the reason why today we have put a lot of attention and efforts into preventing more cases and fighting this phenomenon, but the truth is, I believe that the crisis is continuing.
What do you think are the learnings and experiences that should be taken into account?
We are lucky that we are not in the same situation here. That gives us an opportunity to prevent a crisis of these dimensions. It is important to talk about the prevention of consumption, to have greater knowledge of the good and not so good practices that have been implemented. The capacities of the health system and also the work of the Police must be strengthened, because it is very difficult to detect it, since these are very small quantities and we must think of other ways to investigate these cases.
Explain that challenge a little better…
To give you an idea, in Colombia, when we talk especially about cocaine, we tend to talk about seizures in kilograms or tons; with fentanyl and other synthetic derivatives, we are talking about milligrams, such as carfentanil, which is 10,000 times stronger than morphine. Substances that are easily moved by certified mail because they are very small quantities.
What other challenge do you see?
A challenge that exists in Colombia is that exemptions on substances depend a lot on the quantity, and that has to change because, as I said, the quantities are going to be very different. Fentanyl is a drug that is too powerful in terms of quantity compared to its effect. While a normal dose of cocaine can be 200 milligrams, a dose of non-therapeutic fentanyl can be two milligrams, depending on its type, because that is another issue, we talk about fentanyl as if it were just one and at this moment there are more than 70 different molecules related to fentanyl, each with a different potency. Typically, a fentanyl can be 50 times more potent than morphine, but a carfentanil is 10,000 times more potent than morphine.
Is that one of the reasons why it generates so many fatal overdoses?
Of course, because dosing that so that the user does not overdose is extremely difficult. The drug trafficker does it by hand, by eye, and many times he does not know if he has fentanyl or carfentanil in his hands and that difference is life or death, because the possibility of generating lethal doses is very high.
Another notable challenge facing synthetic drugs is that it is not so easy to monitor or estimate their size, because any kitchen in an ordinary house can be a potential laboratory for synthetic drugs. How to guide public policies for the prevention and control of such a phenomenon?
The response needs to face these circumstances, understand what is happening and have other strategies, because there are many synthetic substances today, more than 1,200, and many of them are necessary and used medically and legally for the treatment of different diseases. Thinking about public policies must also involve strengthening medical treatments against addiction to these substances, because many countries do not know how to treat these cases. In Colombia, for example, there has always been a lot of attention on exports of illicit drugs, such as cocaine, but today more attention must be paid to the drugs and substances that are entering.
Regarding the drug summit in Cali, several civil society organizations in Colombia and Mexico published a public statement warning about the warlike or punitive approach that the United States and Mexico are implementing in relation to fentanyl. What do you think about the topic?
At the United Nations we believe that it is very important to have a comprehensive and balanced approach. International conventions are the framework for this and their focus is precisely on the protection of public health. Although each country has a different situation, we think that knowledge should be shared between nations and prevention should be addressed with strong public campaigns.
Because?
Because medical treatments are the only possible solution with this type of drugs due to their high addictive power. It is very difficult for a person alone to face such a strong addiction. So it is essential to have effective treatment services. The WHO has given international standards on this that must be taken into account. Because, if it is about facing a drug as addictive as fentanyl, it does not help that the treatment is only authorized six months later.
This year, El Espectador published an audiovisual investigation about the fashionable drug in the country known as tusi, a colored powder that is inhaled and that comes from the artisanal mixture of synthetic drugs, to which in some cases they are adding pharmaceutical fentanyl. Have they found that same finding in their internal reports?
We have records that since 2021 there have been seizures of tusi with fentanyl. At that time, it was the first time that this mixture was detected in the region. But it is key to continue conducting consumer surveys because it is important to detect these changes and trends early.
In the United States and Canada, the figures on the impact began to become apparent when the health system began to warn of the enormous number of deaths from overdoses of fentanyl and other opioids. In Colombia, have they been able to establish this relationship with the health system so that cases of poisoning by these substances for non-therapeutic uses are actively reported?
That is a challenge not only for Colombia, it is also regional. Its detection is not done routinely by forensic services. The forensic service’s protocol identifies routine alcohol, cocaine and cannabis, but does not look for fentanyl, unless requested by the toxicologist or the Prosecutor’s Office. Additionally, the doses are so small that they are not easy to detect. Look at the case of Buenos Aires: just a week later the authorities were able to identify that the cocaine that caused 24 deaths and more than 80 poisonings in the northwest of the capital, in February 2022, contained carfentanil and that is why they had died. Mixing cocaine with fentanyl is also leaving many dead in the United States and sometimes users have no idea.
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In that sense, what risks do you see in tusi, so fashionable in Medellín and Bogotá?
The combination of synthetic drugs, such as tusi, is the most dangerous thing there can be. Because the consumer does not have accurate information about what they are consuming: they may have ecstasy, ketamine, methamphetamines and now sometimes even pharmaceutical fentanyl.
In Mexico, clandestine fentanyl laboratories have been detected. Are there alerts in this regard in the region?
Yes, we have received alerts in this regard in Chile, Peru, Paraguay and Argentina. In the Southern Cone there is a market for synthetic drugs, so the risk cannot be ignored. Colombia must take this phenomenon as an early warning to prevent an opioid crisis. And it is not just fentanyl, in Africa, for example, the crisis is due to tramadol. There are very sad stories of the lives that are lost because of this. For example, I recently learned of the case of a 16-year-old girl in the United States who was given a pill to control anxiety by a supposed friend. She arrived at her house, took it at night, and woke up dead. The capsule was 100 percent fentanyl. I have a 16-year-old daughter and this story touched me greatly.
How do you see the use of the drug naloxone that can reverse an opioid overdose with non-therapeutic uses?
It is a very effective medication to prevent these deaths that is being widely used in the United States and, as such, may be part of the solution, but not the only answer that is needed. The prevention approaches for these consumption must be very strong as well. Not only should it be said in general terms: drugs are dangerous, education must also be given about specific risks depending on the drug.
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