INTER-AMERICAN DRUG ABUSE CONTROL COMMISSION C I C A D

GROUP OF EXPERTS ON CHEMICAL SUBSTANCES AND PHARMACEUTICAL PRODUCTS CICAD/SRU/GoE/ May 29 - 31 2018 QUIM/doc.6.1/18 Panama City, Panama Original: English

INTERNATIONAL NARCOTICS CONTROL BOARD GLOBAL OPERATIONAL PARTNERSHIPS TO INTERDICT OPIOIDS' ILLICIT DISTRIBUTION AND SALES (OPIOIDS) PROJECT International Narcotics Control Board

Global Operational Partnerships to Interdict Opioids' Illicit Distribution and Sales (OPIOIDS) Project

Group of Experts on Chemical Substances and Pharmaceutical Products 29 - 31 May 2018 Panama City, Panama International | Overview CONSUMPTION INCREASING OVER PRESCRIPTION & DIVERSION

• Increased prescribing of opioids and diversion leading to abuse, initially in high income countries

• Use of licitly manufactured opioids increased steadily over past 20 years (3x)

• Fentanyl use increased exponentially (graph)

• Illicit markets expanded to fill synthetic opioids demand as of 2013 (deadly illicit fentanyls) International | Overview SYNTHETIC OPIOIDS OVERVIEW

Video International | Overview MORE NPS, MORE DEADLY OPIOIDS MORE POTENT THAN HEROIN

Examples of potentially fatal dosages of heroin, fentanyl and carfentanil. Source: DEA FENTANYL, FATAL UNDER 2mg

Fentanyls are a cheap added to heroin, cocaine and falsified pills sold as medication

Inconsistent mixing lead to overdose for unsuspecting user.

Overdose may also result from improper handling by officers, K9 units etc. INCB President Dr. Sumyai, demonstrates a 2mg dose to the UPU Operations Council International | Overview A VARIETY OF SOURCES

• Sources of synthetic opioids varies NPS Opioids Counterfeit Manufacture Pharma (Illicit/ • Regional demand Preparations Infringed?) for substances varies

Pharma • Laws lacking as Preparations Manufacture new analogues Diversion NPS Opioids emerge Illicit (Novel) Manufacture of Scheduled • Trace amounts Substances difficult to detect

• Very potent (2mg deadly) International | Global Problem Increasing GLOBAL OPIOIDS SEIZURES, 2000-2016 GROWTH New deadly synthetic opioids are emerging each

NEW OPIOIDS

25

20

15

10

Number of Opioids NPS Number of Opioids 5

0

Source: UNODC 2009 2011 2012 2013 2014 2015 2016 International | Limited Controls INTERNATIONAL CONTROLS CONTROLLED

PRECURSORS Added to 1988 Convention in 2017 • 4-anilino-N- Commission on Narcotic Drugs, added Ocfentanil, Furanylfentany, phenethylpiperidine Acryloylfentanyl, 4-Fluoroisobutyrfentanyl, Tetrahydrofuranylfentanyl, (ANPP) and Carfentanil to the 1961 Convention. • N-phenethyl-4- piperidone. (NPP) Facilitation | New Fentanyls Formulas FENTANYL ANALOGUES AND PRECURSORS NOT SCHEDULED

• 2-fluorofentanyl • 3-fluorofentanyl • 3-phenylpropanoyl fentanyl • 4-fluoro-butyrfentanyl • 4-methoxybutyrfentanyl • Acetyl norfentanyl • alpha-methylbutyryl fentanyl • Benzodioxole fentanyl • Benzyl fentanyl (HCl) • Cyclopentyl fentanyl (Cyclopentanoyl fentanyl) • Cyclopropyl fentanyl • Despropionyl 2-fluorofentanyl • Isobutyryl fentanyl • isobutyryl-F-fentanyl N-benzyl analogue • Methoxyacetyl fentanyl (HCl) • ortho-Methyl methoxyacetyl fentanyl • para-Chloroisobutyryl fentanyl • Tetramethylcyclopropanefent anyl • U-48800 • U-49900 • U-51754 • Valeryl fentanyl • W-15 • W-18 • β-Hydroxythiofentanyl + more on the drug market…. INCB Restricted: Law Enforcement & Facilitation | Internet & Darkweb Regulatory Intelligence Purposes Only ILLICIT USE OF INTERNET (DARKWEB) DARKWEB MARKET

38%

• Analysis of 1.5M trades over 2 months from: AB, Hansa, Traderoute, Valhalla (June –July 2017)

• Top 5 countries account for more than 70% of global trade: USA (27%), UK (22%), Germany (8%), Australia (8%), and Holland (7%) TOR USERS - More than 2.2 million • Darkweb trade of opioids largely independent of users both national production and consumption– it’s a - 60,000 onion sites global marketplace - 57% illegal activities

Source: Drugs (Dittus et al. 2018) Regional | Existing Markets UNITED STATES CANADA

NUMBER OF SYNTHETIC OPIOID DEATHS AND OPIOIDS-RELATED OVERDOSE DEATH RATES FENTANYL EXHIBITS BY YEAR, 2011-2016 2017, BY PROVINCE

• +117% increase in identifications in 2017 (over 2016); 18 different • 2017, Canada overdose rate increased to synthetic opioids seized 10.6 opioids-related deaths per 100,000

• Entering USA via China (chemicals via • Opioid overdose is now the leading cause of post) and Mexico (fake preparations via deaths for Canadians aged between 30 and land border) 39. Sources: CDC and DEA Special Testing Labs, February 2018 Source: Health Canada, on Apparent Opioid-Related Deaths, 2018 Regional | Emerging Markets SEIZURES OF SYNTHETIC OPIOIDS IN EUROPE, 2006-2016 OVERDOSE RATE 2016

Overdose rates lower than North America

TREATMENT 2016 Main opioids ranked by treatment services in Europe: • Heroin • Methadone • Buprenorphine • Fentanyls • Codeine • 25 new opioids & fentanyls detected since 2009 • Morphine • Estonia, Sweden and UK of particular concern • Tramadol Source: UNODC, annual report questionnaire; EMCDDA Drug Report 2017 • Oxycodone Regional | Emerging Markets OPIOIDS IN AFRICA AND NEAR/ MIDDLE EAST SEIZURES 2014-16 Alarming quantities Tramadol and of unregistered/ codeine account for fraudulent tramadol the bulk of synthetic at 120 mg, 225 mg, opioids reports 250 mg strengths seized. Seizures are found throughout especially common in Near/ Middle East Near/ Middle East and Africa. and Africa.

GLOBAL THREAT

Tramadol abuse in Customs reports Ghana became an Central African issue of interest Republic, Togo, Mali, when in 2016, when and the Democratic intelligence Republic of the gathered across the Congo all reported country pointed to exclusively tramadol scattered seizures. Additionally, incidences. 75% of the seizures in Cameroon and Source: Data, Ghana Food and Drugs Authority, March 2018. Niger were tramadol. Photos: Egypt National Council for Source: WCO Illicit Trade Report Drug control 2017 INCB Global Projects | OPIOIDS Projects OPERATIONAL PARTNERSHIPS TO INTERDICT OPIOIDS' ILLICIT DISTRIBUTION & SALES

1. Develop international agency and industry partnerships, 2. Increase awareness regarding the nature and global scale of synthetic opioids and fentanyls problem, 3. Support international initiatives that enhance information- sharing and facilitate co-operation for detection and communication of trafficking incidents, 4. Promote tools, task forces, and training that helps ensure safety and security. INCB Global Projects | Projects Prism+Cohesion & OPIOIDS PRACTICAL APPROACH AT EACH STAGE PARTNERSHIPS Illicit Manufacture • ICPO/ Interpol • WCO Precursors • EUROPOL Equipment Plan and Actions Tableting • Industry Cooperation Trainings (on-going) machines • International Special Surveillance List (ISSL) Updated/ Circulated Projects PRISM & • INCB Scheduled 2 precursors ANPP and NPP in ION 2016

Task Forces, • PICS equipment module expansion (underway) Special Operations & Intel • Equipment Survey (May 2018) Sharing • Expert Working Group on Equipment (Summer/ Expert Working Fall 2018) Groups INCB Global Projects | OPIOIDS Projects & Project ION PRACTICAL APPROACH AT EACH STAGE PARTNERSHIPS Illicit Manufacture • ICPO/ Interpol Online Sales • UNODC Precursors • WCO Equipment Open Internet • EUROPOL Plan and Actions Tableting Darknet • Expert Working Group machines B2B online actions on Internet/ Platforms Darknet (Jan 2018)

Projects • Industry cooperation PRISM & Projects (internet trading ION ION & companies OPIOIDS participated)

Task Forces, Special OPIOIDS • Internet monitoring of Operations Expert fentanyls & Intel Working Sharing Group on Internet (Jan • Fentanyls interdiction & Expert 2018) Working analogues list Task Force & Groups Intel Exercise Photo: Online test purchase for newly controlled fentanyls. INCB, 2018 INCB Global Projects | OPIOIDS Projects & Project ION PRACTICAL APPROACH AT EACH STAGE PARTNERSHIPS Illicit Manufacture • UNODC Online Sales • UPU Precursors Distribution • WCO Equipment Open Internet Darknet Postal Tableting Plan and Actions machines B2B online Express • Universal Postal Union Cooperation Couriers Platforms Agreement (April 2018) Air Cargo Projects • Expert Working Group actions on PRISM & Projects Trafficking via Post and Courier (April ION & Projects ION 2018) OPIOIDS ION & OPIOIDS Task Forces, • Industry cooperation (express mail Special OPIOIDS courier shipping participated) Operations Expert & Intel Working OPIOIDS Sharing Group on nd Expert • 2 INCB Fentanyls situation Internet (Jan Working Expert 2018) operational assessment (underway) Working Group Group on Task Force & Postal (April Equipment Intel Exercise 2018) • Expand IONICS for all opioids/ fentanyls intel and expand access INCB Global Projects | OPIOIDS Projects PRACTICAL APPROACH AT EACH STAGE PARTNERSHIPS Illicit Manufacture • ICPO/ Interpol Online Sales • UNODC Precursors Distribution • UPU Open Internet Equipment Financial Flows • WCO Tableting Darknet Postal • WHO machines B2B online Express Money Platforms Couriers Transfers • CICAD Air Cargo Crypto • EUROPOL Projects currencies PRISM & Projects ION ION & Projects OPIOIDS ION & OPIOIDS TDB Task Forces, Special OPIOIDS Operations Expert & Intel Working OPIOIDS Sharing Group on Expert Internet (Jan Working Expert 2018) Working Group Group on Task Force & Postal (April Equipment Intel Exercise 2018)

Photo: INCB, 2018 INCB Global Projects | New Partnerships INCB/ UPU Cooperation Agreement BACKGROUND Universal Postal Synthetic opioids trafficked among the billions of Union letters and e-commerce packets annually. Cooperation Agreement responds to these challenges by: 192 members states and territories– • Sharing specific intelligence on sources of every place in the world dangerous drugs and trafficking patterns, • Provides access to IONICS for postal security Signed at officers, Operations Council • Circulate information and alerts on dangerous April 2018 substances of concern, • Promote technical assistance and safety training BACKGROUND for officers

INCB is strategic partner positioned with tools, task forces, technical expertise and training options.

Photo: UPU, 2018 INCB Global Projects | Intelligence Sharing OAS MEMBERS RECEIVING/ SENDING IONICS ALERTS NO ALERTS

Access IONICS Antigua and Barbuda Bahamas Country Subregion IONICS Comms? Barbados Argentina South America Yes Yes Belize Brazil South America Yes No Bolivia Canada North America Yes Yes Dominica Chile South America Yes Yes Dominican Republic Colombia South America Yes No El Salvador Costa Rica Central America Yes No Grenada Ecuador South America Yes No Guatemala Jamaica Caribbean Yes No Guyana Mexico North America Yes Yes Haiti Saint Vincent and the Honduras Grenadines Caribbean Yes No Nicaragua Trinidad and Tobago Caribbean Yes No Panama United States of America North America Yes Yes Paraguay Peru Venezuela (Bolivarian Rep. of) South America Yes No Saint Kitts and Nevis Only 13 of 34 OAS members access IONICS to receive alerts on Saint Lucia trafficking. Suriname Uruguay Access and training will be expanded for Police, Customs, Postal, Health and Regulatory focal points. [email protected] @MatthewNiceUN