Swedish National Threat Assessment on fentanyl analogues and other synthetic opioids National Operations Department Contents Contents Summary ........................................................................................4 Recommendations ................................................................... 36 Definitions .....................................................................................6 Amendment to the Postal Act concerning the obligation of secrecy ........................................................ 36 Introduction ..................................................................................7 New sections of law ................................................................ 36 Aim ...............................................................................................8 Revision/relaxation of the Swedish Public Access Delimitations................................................................................8 to Information and Secrecy Act, providing the History ............................................................................................9 police with increased possibilities to disclose information to the Social Services concerning Current legislation ................................................................... 10 suspected users ........................................................................ 37 Legal status ................................................................................ 11 Needs ......................................................................................... 38 Classification ............................................................................. 11 Appendix .................................................................................... 40 Threat to society ...................................................................... 15 The prevalence of fentanyl and fentanyl analogues Deaths ....................................................................................... 15 in post-mortem cases ............................................................. 40 Other risks ................................................................................. 17 Statistics of seizures ................................................................. 42 National picture........................................................................ 19 Controlled fentanyls and fentanyl analogues in Sweden 10.04.2018............................................................ 43 The market ................................................................................ 19 Strategic analysis ...................................................................... 25 Actors ........................................................................................ 26 Measures taken ........................................................................ 30 Conclusions ................................................................................ 32 3 Swedish National Threat Assessment on fentanyl analogues and other synthetic opioids Summary The fentanyl epidemic has been affecting Sweden powder form directly from the supplier by Swedish since 2015. Since April 2015, 369 individuals have actors and are put on the market through Swedish died1, most of them men in the ages 25–38. The web sites and subsequently distributed through youngest victim is a three-year-old girl. This develop- Post Nord, the national postal service. This is how ment has prompted a special effort against the phe- the postal packages containing drugs reach the end nomenon at the Intelligence Division of the National customer. In the majority of cases, the substances are Operations Department of the Swedish Police taken at home, in solitude. In most cases, the sub- Authority (the NOA Intelligence Division) and is also stances have been produced legally, as they have not what prompts the need for this national picture. been classified as narcotic substances in the producer Even if the prevalence of fentanyl analogues and country. They are typically unregulated according the number of users are marginal, the situation is to Swedish legislation when introduced into the assessed to be the most serious development to date Swedish drug market. Once a substance has been in the Swedish drug market. It is estimated that one classified, the producers make minor changes to the in ten users die as a result of intoxication, and in structure to obtain a new chemical compound which October 2017, a higher number of individuals died of can then be sold legally. This presents a challenge to fentanyl toxicity than in road traffic. In addition, the law enforcement authorities. In many countries there fentanyl group (including the analogues) has sur- is no relevant/adapted legal basis and when the drug passed heroin as the most lethal substance. Fentanyl legislation is not applicable, an alternative legislation analogues are generally extremely potent (up to 4 000 is required in order to restrict trade. times as potent as pure heroin) and pose a danger also In Sweden, the sale of fentanyl analogues takes to individuals other than the users. Handling fentanyl place almost exclusively on the internet. The most analogues or brief exposure to the substances may frequent type of marketing consists of nasal spray pose a life-threatening danger to other individuals in bottles, which risks attracting new opioid users. The proximity to the user. European Monitoring Centre for Drugs and Drug The prevalence of fentanyl analogues in Sweden is, Addiction (EMCDDA)2 notes that fentanyl and to a large extent, dependent on international devel- other types of synthetic opioids have the potential opments. Like other new (novel) psychoactive sub- of becoming attractive commodities for organised stances (NPS), including synthetic opioids, fentanyl crime in Europe in the same way as in North Ameri- analogues are produced in powder form in China ca. Thousands of intoxicating doses can be manufac- and are distributed to Europe. They are ordered in tured out of small amounts of fentanyl, which makes it easier to conceal smuggling and avoid detection as 1 Data from the National Board of Forensic Medicine refer to compared to traditional drugs such as heroin. There the time period 2015 – March 2018. These figures refer to the is to date no evidence of street-level drug-trade in number of post-mortem cases where fentanyl and fentanyl fentanyl in Sweden or of heroin mixed with fentanyl. analogues have been deter-mined, alone or in combination with other substances, to be the cause of death. Taking into account only the fentanyl analogues, the number of deaths 2 EMCDDA (European Monitoring Centre for Drugs and is 212. Drug Addiction). 4 Summary There is, however, a certain likelihood that the drug- examined for the first time in Sweden. The outcome trade will take on this same aspect in Sweden as well. of a district court was a conviction for eight counts of There has also been an extensive increase in illegal aggravated manslaughter. The decision of the higher trade in narcotics for medical use in Sweden. If the court will have a bearing on future forms of trade in user group using various types of opioids increases, fentanyl analogues in Sweden. Overall, experience there is a risk that the demand for fentanyl and its show that the measures taken to date have contribut- analogues will increase as well. What is particularly ed to limiting the availability of the substances. The alarming is the development involving counterfeit police see opportunities to further limit the trade. pharmaceutical products containing fentanyl However, there are no legal instruments with which analogues. Users who think they are using e.g. benzo- to take measures against the trade in the often lethal diazepine (tranquilliser) are in fact taking substances fentanyl analogues. The report, therefore, makes a which may pose an immediate danger to life and number of recommendations directed at the Ministry health. of Justice related to legislative changes or to the need Drug-trade actors supplying fentanyl analogues in for revised interpretations of existing legislation. Sweden are currently few in number. The profits are The future development of fentanyl analogues in substantial and business is conducted systematical- Sweden needs to be closely monitored and assessed ly within a legal structure where the substances are in relation to a possible change of the legal situation, marketed as research chemicals. So far, the trade has the ongoing targeted work and priorities of public been made up mainly of a domestic market involving authorities and to international developments. This Swedish actors, but a likely development would be a police effort requires a high degree of international shift in trade flows where trade takes place in inter- cooperation as the market for synthetic opioids, national market places. The limited number of including fentanyl, tends to be growing in Europe. Swedish vendors means that a small number of actors Clusters of deaths will be a recurring feature on the are behind a very large number of deaths. Currently, Swedish drug-market and will continue to present a there is an ongoing legal case where the offence challenge for the police and cooperating authorities. ”aggravated involuntary manslaughter” is being 5 Swedish National Threat Assessment on fentanyl analogues and other synthetic opioids Definitions Below you will find the definitions of recurring New (novel) psychoactive substances (NPS) The term concepts