Lisa Campbell & Nazlee Maghsoudi
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oday’s morning plenary session was one that many NGOs had been eagerly (and perhaps anxiously) awaiting. Now that the Special Segment of the UNGASS has ended, the first order of business at the 58th Commission on Narcotic Drugs was voting on the scheduling of several substances, including ketamine. As we outlined in Tuesday’s blog post, the possibility of scheduling ketamine has been an important issue, as it would undermine global health, international law, and the role of science in the international drug control regime. CND member states were set to vote on China’s request to put ketamine in Schedule IV this morning. Instead, at China’s request, the CND voted unanimously to postpone the decision to a future date when “more information could be provided.” Ketamine was not scheduled today, but the issue has not been put to rest.
The sentiment of NGOs in response to the CND decision on ketamine was a mix between relief and frustration. At least we were not taking a step back. Ketamine will be easily available for medical use in developing countries for the time being. Yet, we have certainly not taken a step forward and the justification for doing so is inaccurate. The research is already in. Like it didn’t for the last three critical reviews, the recommendation of the WHO to not schedule ketamine will not change. Ketamine should not be scheduled, and putting it off for another year will not alter what should be done on the basis of evidence. NGOs accepted this mediocre outcome today and noted that is was another example of a “step to the side” at the CND.
Substances scheduled today at the CND included the following: mephedrone, BZP, synthetic cannabinoids (JWH-018, AM-2201), MDPV, and methylone (bk-MDMA) in Schedule II, and N-bombs (25B-NBOMe, 25C-NBOMe and 25I-NBOMe) in Schedule I. Due to concerns about their prominent use in the manufacturing industry, GBL (gamma-Butyrolactone) and 1,4-butanediol were not scheduled today, despite the WHO recommendation to put them in Schedule I. New psychoactive substances (NPS) is a general term used to describe the explosion of substances available globally over the past 5+ years. In around 2009, the world saw an explosion of NPS, with 102 new drugs identified. It’s important to note that these substances are not necessarily “new.” They’re just new to the global drug control monitoring system.
Many of them were developed in the 70’s by Alexander Shulgin, the chemist responsible for MDMA, and many of its various analogs. Alexander Shulgin and his wife Sasha Shulgin are the authors of two psychoactive “bibles” called Tryptamines I have known and Loved (TiKAL) and Phenethylathamines I have known and Loved (PiKAL). These two books are full of chemistry formulas that include recipes to create the majority of popular synthetic drugs. Alexander Shulgin is responsible for discovering, synthesizing, and personally bioassaying over 230 psychoactive compounds in his lifetime. On top of the variety of tryptamines and phenethylamines created by Shulgin, other substances have been labeled NPS by international bodies, including ketamine, synthetic cannabinoids, cathinones, and hundreds of other molecules with not much in common besides being new to the UNODC’s monitoring systems.
Many youth harm reduction services saw a spike in NPS in 2010, after the initial rise in innovation. While over the years 2010-2012 there were 85 new substances, another boost was experienced in 2013 when 97 new substances were identified. Between 2013 and 2014 the number of NPS reported increased cumulatively from 348 to over 540. There is no doubt that the rate of new drugs being produced is now happening faster than governments can schedule them. There are real health concerns associated with NPS, including high potency, mislabeling, and adulteration. It is a challenge for health services to keep up with the trends, as drug epidemiology is now globalized with very poor data on what substances are prevalent in which regions. While one NPS might be popular one month, a new one pops up by the time harm reduction resources are created. There is a lack of information and training available for service providers, including EMS, hospitals, physicians, and social workers. There is no doubt that this diversity of substances creates barriers for enforcement, harm reduction, prevention, and treatment, but what is the solution?
Like last year, CSSDP returned to ChEckiT to get an update on their programs. We began the presentation by looking at epidemiological data collected through ChEckiT’s drug checking service, including MDMA and speed samples. Currently Europe is experiencing a wave of very potent pure MDMA, but speed is more likely to be adulterated. NPS is still prevalent, with spikes detected in samples in 2010 and now again in 2013, which correlate with the UNODC’s drug monitoring data. By collecting drug monitoring data from the front lines, ChEckiT provides harm reduction information directly to young people who use drugs, and shares the data with public health units.
On the tour SSDP, SSDP UK and CSSDP all swapped stories about drug trends in our communities, realizing that similar trends occurred at the same time. Pure MDMA powder became popular in 2006, when the international scheduling of safrole oil (a precursor used in MDMA) meant a massive blow out sale for manufacturers, with MDMA prices dropping and purity increasing. When the markets reached equilibrium and quality resumed to regular levels, the perception of powdered MDMA as a pure substance remained (the cause of the current misperception). We also saw an explosion of NPS in our respective communities in 2010. This was correlated with a rise in the number of online vendors, such as Silk Road. Young people around the world were now able to easily purchase NPS at the click of a mouse. Any effort to cut off the dark net has sprung into a hydra effect, with spin off sites created to fill any unmet market demand.
In Canada and globally, a variety of NPS sites exist where you can purchase unscheduled substances ranging from research chemicals to generic pharmaceuticals. There is no doubt that the number of fentanyl overdoses in Canada is related to the availability of cheap generic synthetic super opiates available online. Just a simple google search of “fentanyl buy” generates over 48,000 results. Thus, the ability of the international drug control system to regulate substances is failing miserably. This leads us to question the likely effectiveness of the scheduling efforts this morning to eliminate production, trafficking, and consumption. It’s time to take a public health approach to drug policy reform. ChEckiT is just one component.