12/04/19 Gilberto Gerra

Century of Lies
Gilberto Gerra
Drug War Facts

By the end of 2018, the European Center on Drugs and Drug Addiction was monitoring 731 new psychoactive substances. This week on Century, UNODC's Gilberto Gerra, MD, discusses new psychoactive substances, plus we hear from EMCDDA Director Alexis Goosdeel about the release of the new 2019 EU Drug Markets Report.

Audio file



DECEMBER 04, 2019

DEAN BECKER: The failure of the Drug War is glaringly obvious to judges, cops, wardens, prosecutors, and millions more now calling for decriminalization, legalization and the end of prohibition. Let us investigate the Century of Lies.

DOUG MCVAY: Hello and welcome to Century of Lies. I am your host, Doug McVay, Editor of www.drugwarfacts.org.

At the end of November the European Union’s drug monitor agency, The Monitoring Centre for Drugs and Drug Addiction (EMCDDA) released a 2019 EU Drug Markets Report. This report, which was co-produced by the EMCDDA and Europol. According to the news release, “Covers trends along the supply chain from production and trafficking to distribution and sales. It describes how the drug market has wide ranging impacts on both health and security and how a holistic approach is crucial for affective drug control policies”. Later in the show we are going to hear a portion of the news conference on the report’s release.

One of the items in this report that is of great concern is the increasing number of new psychoactive substances (NPS) on the drug market. Yes, it is an EU drug report but the drug market is global. We don’t talk about NPS very much in the United States and that is a problem. Sure people in the U.S. have heard of fentanyl and know that it is a synthetic opioid but there are dozens of synthetic opioids on the market and the number continues to grow. People in the U.S. have heard of “Spice” and “K2”, which are synthetic cannabinoids but there are dozens of these things these days and I am understating things when I say dozens. By the end of 2018, the European Union was monitoring 731 new psychoactive substances. The number of NPS is currently growing at the rate of one a week and that is a big improvement from 2014 when there were 101 new psychoactive substances detected – that is almost two a week. According to the U.N. Office on Drugs and Crime (UNODC), 36% of these new psychoactive substances are synthetic stimulants, 30% are synthetic cannabinoid receptor agonists which are commonly referred to as synthetic cannabinoids, 15% are classic hallucinogens, 7% are synthetic opioids, 3% are sedatives and hypnotics, 3% are disassociates, and the remaining 5% have yet to be assigned a category – who knows what they are.

Before we get to that EU Drug Report, we are going to hear first from the Chief of UNODCs Drug Prevention and Health Branch, Gilberto Gerra, MD. Dr. Gerra gave a presentation to the Commission on Narcotic Drugs on October 16th during its Intersessional Meeting. Here is Dr. Gilberto Gerra.

DR. GERRA: I start with a question to you and that is are you concerned about stimulants in general. I say that we have to be concerned about depressant of the central nervous system by heroin, opioids, and synthetic opioids. We cannot joke or wish away the stimulants and we cannot (UNINTELLIGIBLE) the problem created by stimulants. The number of stimulants in the (UNINTELLIGIBLE) report this year we have presented 68.2 million people using amphetamine, cocaine, and ecstasy and only 53 million people using heroin and prescription opioids which means that most of the people exposed to stimulants is larger than that exposure to depressant of the central nervous system and this is not including the new psychoactive substances because most of the families of the new psychoactive substances is a very (UNINTELLIGIBLE). Synthetic cannabinoids have a stronger (UNINTELLIGIBLE) but the service for people affected by Stimulant Use Disorder and NPS are not available or nonexistent. There is nothing offered that is appealing for the patient and the laboratory is unable to detect the substances. We offering only counseling and some psychosocial intervention if you are very lucky. In spite of this, in Sweden 189 cases of drug intoxication in the emergency room or intensive care unit you find that around 50 substances out of these 189 cases is an enormous amount with the 50 substances belonging to the families of the NPS and related stimulants. These drugs – and particularly the NPS – are utilized as adulterants. You buy MDMA (ecstasy), amphetamine, cocaine, methamphetamine. But in reality they are selling you New Psychoactive Substances (UNINTELLIGIBLE). In this case they evaluated 173 samples at the laboratory and they found that in 20 cases there was an association of the classic drugs with NPS. In 49 cases the classic drugs were not there, only NPS were replacing them. There is also some good news from the world of the New Psychoactive Substances. We have interviewed the people using these drugs and they are saying that they like the old stuff better. They are seeking their own cocaine, heroin, and cannabis (UNINTELLIGIBLE) synthetic drugs should produce more depression and more concentration on difficulties as well as fear and anxiety and problems with the legs.
These drugs are deeply affecting the brain simply because they are mimicking the effect of a stimulant neurotransmitter in the brain that releases dopamine. (UNINTELLIGIBLE) is very similar to the cut coming from the plant (UNINTELLIGIBLE), it is very similar to dopamine. We find the group within the amphetamine family that are mimicking (UNINTELLIGIBLE) and other stimulants of our brain and we found anti-wormer medication that was used before to treat a worm infection in the intestines. This has been used by illicit traffickers to produce medication that acts as a hallucinogen mimicking the serotonin effect in the brain. The line between legal and illegal drugs is subtle as you will see here with the first two in blue. You see clozapine and alazopene of the pyrazines family are not sold in the illegal market. They are sold in the pharmacy as one of the most modern and effective antipsychotic medication. The other drugs are not usable for these medical purposes and they are sold as ecstasy and considered a stimulant and a hallucinogen in the illicit market. In the family of synthetic cannabinoids that are mimicking THC in the marijuana. It is also mimicking the neurotransmitter in the brain that is a natural, neurological cannabinoid (UNINTELLIGIBLE). In this case with the strong (UNINTELLIGIBLE) not only using (UNINTELLIGIBLE) for cardiovascular disorders. When you see this so-called herbal medicine, it is actually not herbal medicine but a way to present the synthetic cannabinoids that could have problems such as mitochondrial infarction, ischemic stroke, acute kidney failure, and (UNINTELLIGIBLE). When you see young people in the emergency room with cardiovascular symptoms you should think immediately about synthetic cannabinoids. When we have more hallucinogenic NPSs (UNINTELLIGIBLE) coming from “magic” mushrooms.

I want to show you some different settings and party reviews. For example, this NPS is utilized at a rave party where they say no drugs, no party. No NPS – no party. Among this population, 75% of the participants were positive on the toxicology analysis but 36% of the 75% were positive for NPS. This was so-called “recreational” use but there is also no recreational use but more of a self-medication of these substances by children, adolescents, or young adults with a higher level of psychological distress. In Japan there was an increase in the numbers of people using the NPS but they are calling this user a dysfunctional user that is not for recreational use. There is a group of people using these drugs to medicate their lack of capacity to establish friendly relationships. For example, they want to have an increased ability to socialize through these substances. There are sensation seekers who want to feel stronger emotions and we can’t forget that 22% of the admissions in the psychiatric hospitals are positive for NPS, stimulants, and methamphetamine. This use of drugs is going to exacerbate to aggravate the already existing (UNINTELLIGIBLE) psychologies. We have a group of people that consider themselves (UNINTELLIGIBLE) they don’t (UNINTELLIGIBLE) they want to navigate the mind and the soul and better understand. You can call them philosophers, alchemists, psychedelic researchers and these are using the most hallucinogenic NPS. It is sort of a new Shamanism when you can mix the effect of rhythmic music together with substances obtained and modify status of conscious and it is also sort of (UNINTELLIGIBLE) status to look to yourself from outside and understanding an advanced self-knowledge. All of these groups are totally different from a cultural point of view and they need a different approach as the outreach that was done before was totally not valued for this kind of new drugs. For example, new psychoactive substances and methamphetamine are accompanying the mystical beliefs of the range of experiences and the perception of being in an oneness with God and the Universe as well as values of spirit quality. Remember the famous movie, “The Matrix”, where you have two tablets and with the use of the tablets you have the capacity to understand the reality as it is in your reality because the reality you see and your opinion of this group is not the true one. You can have a professor at the university in chemistry and physics want to have an effect on students who want to have effect on brain enhancing, increasing the capacity of their brain and cognitive capacity and that they are using these drugs without considering the consequences. About methamphetamine, you don’t need to travel to East Asia to see methamphetamine. This is very impressive (UNINTELLIGIBLE) in my opinion because you have methamphetamine 34%, which is more than one-third among those who are asking for treatment for a period of time in the United States, so the people are going to say they are heroin dependent, or fentanyl dependent (UNINTELLIGIBLE). More than one-third of them have methamphetamine in their urine which means that these sort of mixed use to balance the effect of opium and living a so-called normal life. The people risking overdose are among those who have opioid dependency in North America. The people are at risk for overdose are 2.8 fold times increase in reported overdose if they at the same time use methamphetamine, which means that these are the most severely affected patients with more risky conditions. We have an increase in our (UNINTELLIGIBLE). The people dependent on methamphetamine almost doubled in the last decade, and you have an increase in fatal auto accidents where there are 89% alcohol and drugs in the blood, as well as a large amount of methamphetamine in their blood. We cannot forget that methamphetamine and using terrible psychology or regulating psychologists – we cannot forget that methamphetamine in the last decade is not only taken orally but it is also injected, provoking terrible endocarditis, or viral endocarditis. In Europe there was a shortage some years ago of heroin so people started injecting methadone and (UNINTELLIGIBLE) provoking a resurgence of HIV in countries where HIV had been at one time defeated. HIV or Hepatitis is also among people who are not injecting, but using methamphetamine (UNINTELLIGIBLE) because of their mental condition they are not having safe sex, they are having unprotected sex. Arrhythmia’s induced by methamphetamine and cardiovascular disorder can be fatal and they want to conclude with lies. As a practitioner when I think of the people affected by heroin, fentanyl, synthetic opioids, (UNINTELLIGIBLE) I think that the depressant of the central nervous system is making my target patient in a certain sense a (UNINTELLIGIBLE).

These people are injecting or using these drugs, sleeping and waking up with a negative effect, regret, and withdrawal searching for new heroin to inject, and sleeping again. Clearly these patients have their personality characteristics and cultural background, but we cannot say that they are equal to each other but they are all (UNINTELLIGIBLE). If you look to what happens when you have to treat or to approach people affected by psychostimulants and NPS, you find this (UNINTELLIGIBLE) from drivers to poly-drug abuse from (UNINTELLIGIBLE) starting from brain enhancing party drugs, mental health problems, unsafe sex, doping in bodybuilding, religious experience and so on. Imagine going out with a normal outreach unit as we think normally. In Europe for example, it would be completely ineffective and we should have a differentiated and personalized and specific approach, taking in to account and tailoring the intervention on the basis of the culture and needs of this population. Thank you for your attention.

DOUG MCVAY: That was Gilberto Gerra, MD., Chief of the UNODC Drug Prevention and Health Branch. He was speaking before the Commission on Narcotic Drugs during its 6th Intersessional Meeting on October 16th. You are listening to Century of Lies, I am your host, Doug McVay, Editor of www.drugwarfacts.org.

DOUG MCVAY: Now let’s turn to that 2019 EU Drugs Market Report. There was a news conference November 26th to discuss the release. Here is EMCDDA Director, Alexis Goosdeel discussing the reports’ findings.

ALEXIS GOOSDEEL: First I would like to thank all of the staff at the EMCDDA and the staff of Europol that have been working for three years collecting information and making all of the analysis. I owe a special thanks to my close colleague Catherine De Bolle who is the Executive Director of Europol for her support and for close and fruitful cooperation.

The report covers trends along the supply chain from production and trafficking to distribution and sales. Today we are going to speak more about the market than about the problems associated with the use of those substances. As the Commissioner said, this puts us in a challenging position because together we launched the previous report. What’s new is that the European Drug Market is changing faster than before both under the influence of internal and external drivers and you will find in the report a very detailed and holistic analysis of those changes. What we observe today is the hyper production of drugs within and beyond EU borders, which is leading to higher availability of natural and synthetic substances. This means that now consumers have access to a diverse range of highly potent and pure products at a very affordable price. As the Commissioner mentioned, a mounting concern is the rising drug related violence and corruption within the EU and this is a very worrying evolution of the situation over the last five years.

First of all, the drug market remains a major source of income for organized crime groups. In the EU we estimate that the Europeans are spending around 30 billion in euros every year for the (UNINTELLIGIBLE). It doesn’t encompass the value or the potential values of seizures or any interference with the drug business. Here we talk only about the money that is spent by people who are using drugs in Europe.

Around two-fifths of this total or 39% is spent on cannabis, 31% on cocaine which has now taken second place not only as the second most used drug but also in terms of market value. Heroin is the third with 25%. Finally, amphetamines, methamphetamines, MDMA/Ecstasy represent 5% of that market.

Let’s have a quick look at the key drug markets and put them under the microscope. Cannabis is the largest drug market in Europe worth at least 11.6 billion in Euro, with some 25 million Europeans who have used cannabis at least once in the last year. While cannabis (UNINTELLIGIBLE) still dominate, we see new products that are appearing on the drug market and this makes monitoring of the potency and potential effects essential. We also observed increased violence that is associated with the cannabis business between organized crime groups and this is putting an added strain on law enforcement activities.

Let’s have a look at heroin and other opioids. Opioids still account for the largest proportion of harms associated with drug use and the heroin market is estimated at least 7.4 billion in Euros per year. There are approximately 1.3 million people who are considered to be problem opioid users and are mainly heroin users. Talking about market and trafficking; the Barcon route remains the key corridor for heroin in to the EU, but there are signs of increased heroin trafficking along the southern route particularly through the Suez Canal. There is also evidence of the diversion of the chemical precursors that are needed to produce those drugs and those precursors that are being produced in Europe and they are being smuggled from EU to heroin producing areas. We also noticed, although not in the same proportion, that in the United States there are highly potent synthetic opioids like the fentanyl derivatives that are responsible in the U.S. for the big wave of drug related death, while they represent in Europe a growing health risk, it is still not in the same proportion. These are increasingly (UNINTELLIGIBLE) and dispatched by (UNINTELLIGIBLE). Let’s come now to a drug that has gotten a lot of attention in the recent years, which is cocaine.
There is a record production and corresponding expanding markets for cocaine with a market retail value that is estimated at a minimum of 9.1 billion euros. This is the second most common commodity consumed of the illicit drugs in the EU, we have around 4 million Europeans that report having used the drug in the past year, but you need to add to those people those who have more recently joined and are consuming not only cocaine, but also crack cocaine and there are worrying signs in the increased use of crack cocaine in Europe as well. Use is still concentrated in south and west Europe but the market appears to be spreading, including outside of Europe in places like the Western Balkan’s. Recalled production in Latin America has intensified trafficking to the EU, mainly through maritime containers where RICO seizures have been recorded. The presence of European organized crime groups in Latin America is also changing the dynamic allowing them to manage the supply chain end to end. It is also disrupting the market not only in Europe but in Latin America and there are a lot of changes intervening in the organization of those trafficking routes between the sources and the EU. It seems that the EU is emerging as a transit area for cocaine that is destined to other markets such as Middle Eastern Asia. For amphetamine, methamphetamine, and MDMA the estimated value is 1.5 billion euro a year and they are produced for domestic production and export. They make up for around 5% of the total EU market. More recently, we have noticed that not only the market is controlled but there are also other organized crime groups that are intervening in the market. For instance, Mexican cartels who are controlling the entire logistic chain.

Finally, with regard to the NPS, we discovered 55 new substances which equates to one per week on the European market last year and the source countries are China and India. The total of substances that have been detected and that are monitored by the EMCDDA together with Europol and with the support of other EU agencies amount to 731 substances. The NPS continue to represent a very important threat to health with the potency in synthetic cannabinoids, synthetic opioids, and fake benzodiazepines appearing on the market. These create the surging of more health emergencies such as acute intoxications and death.

Dear Commissioner, Dear Colleagues, Ladies, and Gentleman; the contemporary drug market is increasingly complex, adaptive, and dynamic and it is also more global in nature and more interlinked than in the past. In addition, as the Commissioner highlighted of the direct impact on health and security, the drug market also has indirect and wide ranging negative consequences on other important policy areas, including violence and community safety, economy development and governance, and the environment.

Finally, the human and societal cost associated with the drugs market remain considerable. The reduction of the harm associated with the drug market should remain a priority. If you were to ask me what we can do as well as what was done, as the Commissioner explained we made some good progress in the recent five years, we still have a lot of work in front of us. The work in that area must remain an absolute priority, and this report is a clear wakeup call for policy makers to address the rapidly growing drug market. Our message is that important progress has been made but more needs to be done. At the time we are in a new European Commission, we take its duties in the coming days when the EU and the Member States are discussing the political priorities and actions for the next European budget for 2021 – 2027. We jointly call together with Europol for an upgrade of priorities and resources proportionate to the importance of the emerging threats. Thank you very much.

DOUG MCVAY: That was Alexi Goosdeel, Director of the European Monitoring Center on Drugs and Drug Addiction. He was discussing the 2019 EU Drug Markets Report, which was released on November 26th.

Now while we still have a few minutes left let’s hear from Nuria Calzata, Coordinator of the Spanish Harm Reduction Organization Energy Control.

NURIA CALZATA: Drug checking services are (UNINTELLIGIBLE) marked monitoring tools that are complimentary to other sources of information and their added value lies in the fact they allow contact with hard to reach populations. They not only provide information about the composition but also on other aspects such as acquisition roads, prices, forms of use, experienced problems, and so on. They also allow the early detection of emerging phenomenon of its use and the periods of time of reaction. In the case of NPS, drug checking has made important contributions to the European Early Warning Systems. They inject credibility among drug users and allow early warning to be more effective than official institutions. Finally, they have contributed to the improvement of our knowledge through publications and scientific papers. These are other valued elements have allowed information from drug checking services to be considered by public institutions such as European Monitoring Center or United Nations Office on Drugs and Crime. However, we know that drug taking can be controversial like other harm reduction interventions such as supervised consumption rooms, naloxone distributions, or syringe exchange programs. This may be difficult for those countries that despite seeing the relevant drug taking may not want to face a heated debate around them. In any case, our accumulated experience during the last two decades allows us to recommend to other countries the incorporation of drug checking to the monitoring tools with appropriate financing and the integration in the National Health Systems and the encouragement of scientific research to evaluate (UNINTELLIGIBLE).

To conclude, we would like to make a global call for a self-critical reflection. We are agreed that never before in our history have we had so much quantity, quality, and diversity of drugs and the easy access to them. It is clear that we are doing something wrong and yet we continue to insist on the same approaches. It is time for political courage and to take action by applying a number of different strategies without fear of being judged as crazy because as someone once said, “Insanity is doing the same thing over and over again expecting different results”.

DOUG MCVAY: That was Nuria Calzata. She was addressing the Conference on Narcotic Drugs on October 16th during its 6th Intersessional Meeting. That is all the time we have this week. I want to thank you for joining us.

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