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How can we stop the rise of new psychoactive substances like fentanyl?

Experts are concerned about a new generation of designer drugs that are more powerful than the familiar drugs they mimic and often contain unknown ingredients.

It was the number of young people dying at raves that first caught Ben Westhoff’s attention. Living in Los Angeles and working as a music editor at LA Weekly, he started investigating the spate of deaths for an article.

“I had been in the rave scene myself back in the late 90s and people always were taking ecstasy then, but it was never killing anyone,” he says. “Now, someone was dying at every single one of these raves. The deaths were always attributed to ecstasy, but it turns out there was almost no actual ecstasy in these pills; they were adulterated. I wanted to find out what these new adulterants were.”

His hunch that this was a significant story took Westhoff down a rabbit hole of research, talking to drug takers, manufacturers and law enforcers around the world, including New Zealand. Four years on, he has turned the material he gathered into a new book, Fentanyl Inc: How rogue chemists are creating the deadliest wave of the opioid epidemic.

Read more: The legal grey area of drug testing at NZ's upcoming festivals

Fentanyl is the drug that has cut a swathe through the music industry, killing Prince, Tom Petty, rapper Lil Peep and more. “It is 50 times stronger than heroin and it takes only about two grains of rice worth to overdose and die,” says Westhoff.

US law enforcement agencies describe fentanyl as the game-changer, the most dangerous substance in the history of drug trafficking. Even a small amount overwhelms the respiratory system, causing users to stop breathing, and it has driven up overdose deaths in the US dramatically, even as the abuse of heroin and other opioids has fallen.

Ben Westhoff. Photo/Yana Hotter/Supplied

In 2017, fentanyl was responsible for 29,000 fatalities in the US (total overdose deaths were 72,000). Although we don’t have anywhere near the same problem in New Zealand, it has been detected here – one way for police to monitor any spikes in use is by wastewater testing – and authorities remain vigilant.

Fentanyl is one of a new generation of chemicals that are changing the drug landscape. Formerly called designer drugs, they are now collectively known as novel, or new, psychoactive substances (NPS).

“It’s kind of a strange term,” admits Westhoff. “But basically it just means any drug you hadn’t heard of until recently.”

These new drugs are synthetic, made in a laboratory, and many were developed for legitimate reasons. For instance, fentanyl was invented in 1959 by a Belgian chemist who was experimenting with the chemical structure of morphine. It has excellent pain- relieving properties and is widely used in anaesthesia. It also gives a fast and addictive high. Long-time heroin addicts often turn to it for the euphoric rush that heroin no longer provides.

“But the biggest problem is that a lot of people don’t want fentanyl at all,” says Westhoff. “Because it’s so much more potent and cheaper to make, it is cut into all these other drugs, like heroin, cocaine, meth, pills. It is basically a cheap filler and drug dealers use it to increase their profits. So, people are dying without even realising they are taking it.”

In this country, the psychoactive substances causing the most deaths are known as synthetic cannabinoids, because they target the same receptors in the brain and body as marijuana and are often sprayed onto dried, shredded plant material to be smoked. Numerous iterations of these drugs exist and more than 70 New Zealanders are thought to have died as a result of using them since mid-2017.

The issue with banning these new synthetic drugs is that as soon as one substance is outlawed, the manufacturers produce a different version, then carry on.

“It’s an endless cat-and-mouse game because the chemical formulas can be tweaked slightly and then you’ve got a brand-new drug,” says Westhoff. “When you think about traditional plant-based drugs such as marijuana, cocaine and heroin, they come from nature and there is one of them. But with these new NPS drugs, there are an infinite number of possibilities.”

Victims of fentanyl: Lil Peep and Prince. Photos/Getty Images

Big in China

As Westhoff discovered, the chemical ingredients necessary to make synthetic highs come from legitimate pharmaceutical companies in China, where their manufacture is not illegal. And these companies are not too difficult to find.

“I just googled ‘buy drugs in China’ and a bunch of different companies came up,” he says. “They had the email addresses of the salespeople and sometimes even the address of the company right there on the website.” Westhoff decided he needed to travel to China, gain access to the laboratory of a supplier and meet one of the rogue chemists. He created a fake identity, claimed he was in the market to buy recreational drugs, and got a quick response in English to his emails. “No journalist had ever gone inside one of these fentanyl labs and so it was important for me to investigate the situation,” he says. “I was really scared, and my wife and parents weren’t too thrilled, either, but luckily I got out in one piece.”

In Shanghai, he talked his way into a company called Chemsky and took a tour of its facilities. “I thought it was going to be a seedy underground lab with guys with AK47s guarding the door, but no, to some extent, it looked like a traditional lab from a high-school chemistry class. It was fairly clean and people seemed as if they knew what they were doing.”

What struck him was the scale of production – enough drugs, he says, to get entire small countries high. “It was a fairly small operation, only about five or six employees, so I was really shocked, especially by the synthetic cannabinoids. They had 1kg bags of them filling these big barrels and piles on sheets of aluminium foil were drying on a lab table. I couldn’t believe the quantity.”

After that visit, Westhoff concluded that the worldwide market for these synthetic drugs must be bigger than he had imagined. Then he discovered that small- to medium-sized companies, such as Chemsky, that sell drugs via the internet and then post them, are only part of the problem. The Mexican cartels that source fentanyl precursors, then prepare and distribute the finished drug through the US, are supplied in the main by a single large Chinese corporation, Yuangcheng. Having had some contact with its perky young sales team, Westhoff describes Yuangcheng as “a poison factory operating in plain sight”.

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Plea for realism

Tracing the journey of these toxic synthetic drugs, from manufacture to the inevitable tragic conclusion of overdose deaths, has been especially concerning for Westhoff as the father of two young boys who will one day be exposed to whatever new versions are flooding the market. “Thankfully, they are not teenagers yet, but I’m already thinking very hard about how to prepare them for this drug climate,” he says. “My personal belief is honesty is the best policy. If you tell kids that all drugs are bad and everything is going to kill you, they probably won’t believe you. But if you tell them certain drugs are worse than others, and fentanyl can be in many different drugs, they’re more likely to heed your warnings.

In Fentanyl Inc, Westhoff argues for harm- reduction strategies, making a strong case for approaches such as supervised injection sites and drug testing at concerts and festivals. “I think pill testing is one of the best harm-reduction methods you can use because, right now, so many drugs are adulterated,” he says. “Ecstasy is almost a meaningless word now; it can have so many different chemicals in it. So, especially for the rave scene, it makes sense that it should be allowed.”

Although he fears things are going to get worse before they get better, Westhoff is hopeful that, in the US, people are waking up and starting to look for better ways to tackle the problem than the hard-line tactics that failed to prevent the fentanyl crisis. In October 2017, President Donald Trump labelled it a public-health emergency and signed legislation pledging US$6 billion to help users get better treatment and to give law enforcers and border agents more resources, although critics have countered that it is too little, too late.

In May, China reclassified fentanyl as a “controlled substance”, allowing authorities to act faster, honouring an undertaking given to Trump last December. This month, nine members of a smuggling ring were sentenced in Xingtai, in the northern province of Hebei, after a rare example of cross-border co-operation between Chinese and US narcotics agencies. The sentences ranged from six months to a suspended death sentence.

“I would encourage New Zealand to learn from the mistakes of the US,” says Westhoff. “These very strong war-on-drugs policies have really not got us anywhere. We’re spending billions and billions of dollars yet the crisis keeps getting worse.”

Matt Bowden. Photo/Getty Images

Opportunity missed?

Westhoff maintains that the threat posed by fentanyl and other new substances is one that New Zealand very nearly averted. His research led him to Matt Bowden, the Kiwi who became known as the godfather of the legal- highs industry, and whose high-profile bid for what he claimed was a safer, regulated drug scene came close to succeeding.

“You don’t often meet a drug lord who fancies himself as a harm-reduction activist,” says Westhoff. “He’s a really interesting guy, super-smart, and he helped guide me through the whole situation in New Zealand.”

Not everyone would agree with that assessment of Bowden. This is the man who dominated New Zealand’s legal-high experience for years – first as the businessman who introduced “party pills” containing the stimulants BZP and TFMPP, which were effectively legal because they were sufficiently different from established illicit drugs that they weren’t covered by the Misuse of Drugs Act. The market was already raging by the time a 2005 amendment to the law provided for age limits and restrictions on where they could be sold – which, thanks to a clash with another law, were never put in place. Although party pills didn’t kill anyone, they caused enough problems – especially in combination with binge drinking – that the Government’s Expert Advisory Committee on Drugs recommended they be banned outright in 2006.

Bowden was also involved in a new industry that was brewing even then: so-called synthetic cannabis. Substances that aimed to mimic the effects of natural cannabis appeared in shops from 2006 – and again, most of them were so different that they didn’t fall under the existing law. As fast as Associate Health Minister Peter Dunne could ban them, new variants emerged – and the new ones were almost always more dangerous than the ones that had been banned.

Dunne tried a new approach with the Psychoactive Substances Act 2013, which regulates the sale and manufacture of new psychoactive drugs. It means that if you want to sell a legal high in New Zealand, it needs to be tested to the same standards as a pharmaceutical drug and proved to have a low-risk threshold. But to the frustration of Bowden, the Government, under pressure during an election campaign, amended the act to prevent data from animal testing being used in the approval process. It made the act unworkable. (Dunne says his best advice at the time was that alternative testing methods would soon be available, but this hasn’t transpired.)

With his products banned, Bowden went bankrupt and moved to Thailand. Westhoff believes an opportunity was missed to control the drug scene in New Zealand and lead the world with a new approach to the problem.

“By all accounts, the synthetic cannabinoids developed by people like Matt Bowden were safer – there was better quality control, the dosages were controlled,” he says. “It is very clear that since then, the market has been flooded by all these new synthetic cannabinoids; they’re much stronger, they’re much more dangerous and people are dying.

Peter Dunne. Photo/Getty Images

Game of skittles

The now-retired Dunne gets a little tired of the popular narrative that he tried to legalise synthetics and flooded the market with them. In fact, the 2013 act was a bid for control at a time when legal highs were being sold in dairies and petrol stations around the country and people were worried.

“There was a particular problem with a drug called Kronic,” Dunne recalls. “The question was, what to do. The prevailing view was you can ban these things but they are combinations of substances and as soon as you ban one product, the manufacturer tweaks it and produces another. It’s like a game of skittles; you put them up and I’ll knock them down; you can carry on doing it forever.”

At the time it was introduced, says Dunne, there were thousands of shops selling hundreds of products in an unregulated way. That dropped immediately to a small number of stores that qualified as R18 – mostly sex shops – selling 41 drugs that were permitted under an interim licensing scheme because they had no record of causing harm. “In retrospect, that was a mistake. We should have taken everything off the shelves, but we were trying to ease the transition.”

There was what Dunne describes as a moral panic, particularly in small-town New Zealand. At the same time, the issue of animal testing blew up. The act was dead in the water. “It’s a really frustrating story,” says Dunne. “We had it in our grasp to have this resolved and have a regulated market.”

Wellington clinical toxicologist Paul Quigley agrees it was a lost chance to recognise the inevitability of people taking recreational drugs and take a proactive approach by regulating the market. He points out that by the time the act was amended, the list of allowed drugs was already being whittled down to the safer options.

Some of the synthetic cathinones have low-risk profiles and Quigley also believes there is a strong case for ecstasy to be legalised. “It should be put through the process because I think it would pass. There have been human-based trials, so we have a safety profile and dose evidence and don’t need to do animal experiments.”

Clinical toxicologist Paul Quigley: alcohol is the bigger problem. Photo/Hagen Hopkins/Listener

Toxic seizures

On the other hand, BZP, contrary to Bowden’s claims, proved far from low risk. Christchurch Hospital alone treated 61 emergency patients experiencing a range of symptoms including insomnia, anxiety, nausea, vomiting, palpitations, dystonia and urinary infections. Fifteen suffered toxic seizures, and two had life-threatening toxicity symptoms.

“Having a seizure is one of the more serious things that can happen to you as a result of taking drugs; you can get hurt quite badly,” says Quigley. “An example in Wellington is someone who had a fit while driving through the Terrace Tunnel. BZP definitely had problems.”

In his work in the emergency department at Wellington Hospital, Quigley sees patients suffering the ill effects of alcohol, rather than drugs, after most big events – All Blacks matches, for instance. He believes there is little doubt that alcohol would fail to meet the criteria of the Psychoactive Substances Act or the Misuse of Drugs Act.

“There is overwhelming evidence of addiction and chronic health harms. It would easily be a Class A drug.”

On the whole, emergency departments in this country don’t see as many serious drug cases as those in Australia, largely because we don’t have the same dance-party scene. Quigley says it tends to spike around festival season – in Wellington, the Homegrown music festival guarantees about a dozen hospital admissions each year.

“In New Zealand, a lot of drug takers are Friday-to-Sunday users,” he says. “In emergency departments, we don’t see as many of the extreme cases that they do in other countries.”

Even deaths linked to synthetic cannabinoid use seem to be dropping off. “But that’s not because it’s not out there,” says Quigley, who reckons that the people who make these drugs have simply got better at producing non-lethal doses.

Chris Cahill. Photo/Hagen Hopkins/Listener

Education needed

Synthetic cannabinoids are the closest we have come so far in this country to the fentanyl and opioid crisis, according to Police Association president Chris Cahill, who maintains this is a tragedy that has never been understood by mainstream New Zealand, largely because the deaths have happened in a lower socio-economic group.

“If this was middle-class New Zealanders dying, I think you’d see a hell of a lot more interest and concern,” he says.

Cahill doesn’t see a more workable Psychoactive Substances Act as necessarily being the best way to make the drugs scene safer.

“There are still issues,” he says. “People react differently to these substances; what may be fine for some won’t be for others.

“And you’re relying on them taking the recommended dose. If there’s a delayed reaction, they may think it hasn’t worked and so take another one.”

Given that recreational drugs can be easily bought online and mailed to New Zealand – and in quantities small enough that Customs officers have no hope of seizing them all – Cahill believes more resources are needed for drug education so users are aware of the risks.

“We forget that in the early 2000s, we did a good job of informing people about the use of methamphetamine. It was seen as a dirty drug, not a social drug, and the use dropped. But then came the global financial crisis, funding dried up and we took our foot off the pedal.

“The real concern we have is fentanyl and if that was to take hold here,” says Cahill. “The evidence is that any trend from overseas will reach New Zealand, so it would be naive to think it’s not a threat.”

Fentanyl Inc: How rogue chemists are creating the deadliest wave of the opioid epidemic, by Ben Westhoff (Scribe, $40)

This article was first published in the November 23, 2019 issue of the New Zealand Listener.