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Description : United Nations Office on Drugs and Crime (UNODC) World Drug Report 2020 is presented in six separate booklets. The report gives detailed information and analysis to support the international community in implementing operational recommendations present in the outcome document of the special session of the General Assembly on the world drug problem, held in 2016 Booklet 4 of the United Nations Office on Drugs and Crime (UNODC) World Drug Report 2020 has five sub-booklets and addresses a number of crosscutting issues, including the macrodynamics that are driving the expansion and increasing complexity of the drug markets. These booklets also describe some of the rapidly evolving drug-related concerns including, multifaceted global opioid crisis, rapid market changes, the market for new psychoactive substances, the use of the darknet for supplying drugs, and developments in jurisdictions t

Tags : United Nations Office on Drugs and Crime, UNODC, summary, World Drug Report 2020, General Assembly, world drug problem, Opioid crisis

Published on : Jun 30, 2020 | Views : 2700 | Downloads : 2

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Slide 1-

Vienna, 25 June 2020 World Drug Report 2020: Opioid crisis
Slide 2-

Ease of manufacturing, easy accessibility and low-cost production Large-scale manufacture of tramadol and fentanyls for the illicit market started in a context of an absence of international regulations Interchangeability (or substitution) of fentanyl and tramadol within the pharmaceutical and illicit drug markets makes it more difficult to address their misuse Fentanyl is supply drive – tramadol is not clear drug preference is related to availability of the drug more than individual liking Opioid crisis in North America and Africa: common threats and different dynamic
Slide 3-

High rates of prescriptions for pharmaceutical opioids leading to diversion and an increase in the non-medical use Regulations introduced to reduce diversion and non-medical use Partial resurgence of heroin use, resulting in an increase in heroin overdose deaths from 2010 Fentanyl and analogues emerge as adulterants in heroin, stimulants and as falsified pharmaceutical opioids Fentanly emerge as the dominant opioid in overdose deaths Overdose deaths attributed to heroin and pharmaceutical opioids stabilize or show small decrease Fentanly related deaths main contributor to total opioid overdose deaths Opioid crisis in North America: market dynamics
Slide 4-

Gains in the reduction of overdose deaths attributed to pharmaceutical opioids partly offset by the continuing increase in deaths attributed to synthetic opioids Developments in the United States: overdose deaths
Slide 5-

Source: United States, Centers for Disease Control and Prevention, National Center for Health Statistics, Wide-ranging Online Data for Epidemiologic Research (CDC WONDER), “Multiple cause of death 1999–2018”. United States: reduction in overdose deaths attributed to pharmaceutical opioids and heroin (1998-2018) offset by increase in deaths involving fentanyls
Slide 6-

United States: Regional variations in synthetic opioid overdose deaths
Slide 7-

Source: United States, Department of Justice, DEA, Diversion Control Division, National Forensic Laboratory Information System, reports for different years. Uneven spread of fentanyl in the United States is also visible in supply indicators
Slide 8-

Source: United States, Centers for Disease Control and Prevention, Wide-ranging Online Data for Epidemiologic Research, “Multiple cause of death (Detailed mortality), 1999–2018”. United States: fentanyls also contribute to increase in overdose deaths involving stimulants
Slide 9-

Sources: United States, Substance Abuse and Mental Health Services Administration, Key Substance Use and Mental Health Indicators in the United States: Results from the 2018 National Survey on Drug Use and Health (Rockville, Maryland, 2019); United States, Centers for Disease Control and Prevention, National Center on Health Statistics, “Provisional drug overdose death counts”. United States: Opioids use appears to be stabilizing
Slide 10-

United States: overlap between past year misuse of pharmaceutical opioids and heroin, 2018 Source: United States, Substance Abuse and Mental Health Services Administration, Key Substance Use and Mental Health Indicators in the United States: Results from the 2018 National Survey on Drug Use and Health.
Slide 11-

Characterization of past and current fentanyl crises in the United States
Slide 12-

Diffusion of simpler, more effective methods of manufacture of synthetic opioids and their analogues Availability on the Internet of instructions for their manufacture Shift from preparation by a limited number of skilled chemists to preparation by basic “cooks” Discovery of ever more fentanyl analogues Lack of effective control of precursors and oversight of the industry expanding Distribution networks that reduced the risk of detection through the use of postal services and Internet Increased licit trade including e-commerce What has driven the fentanyl crisis In US that began in 2013?
Slide 13-

Source: Canada, Public Health Agency, Special Advisory Committee on the Epidemic of Opioid Overdoses, “National report: apparent opioid-related deaths in Canada (January 2016 to March 2019)”, September 2019. Opioid overdose deaths in Canada, 2016-2018 2 per cent reported nonmedical use of pharmaceutical opioid opioid overdose deaths in Canada increased by 50 per cent in the past three years (4398 deaths or 11.9 deaths per 100,000 population North-eastern states are most affected by the misuse of fentanyls and related overdose death
Slide 14-

Source: UNODC, responses to the annual report questionnaire. Quantitates of fentanyl seized in North America, 2010-2018
Slide 15-

Trends in high-risk opioid use in countries in Western and Central Europe Opioids in Europe: are there indications of a fentanyl-led crisis?
Slide 16-

Opioids in Europe: are there indications of a fentanyl-led crisis? In Western and Central Europe, there are an estimated 1.3 million high-risk opioid users127 (0.4 per cent of the population aged 15–64). Purity of heroin is reported as relatively high and its price relatively low. Increase in drug overdose deaths, with 8 or 9 deaths of every 10 overdose deaths in the European Union involving heroin
Slide 17-

Indications that other opioids such as methadone, buprenorphine, fentanyl, codeine, morphine, tramadol and oxycodone are being increasingly misused One of every five people entering drug treatment for an opioid-related problem in 2018 reported a synthetic opioid as their main problem drug instead of heroin. Since 2012 more than 30 fentanyl analogues have been detected and reported. Available on Internet, through the darknet and at street level Sold as heroin, other illicit opioids and cocaine but also as a substitute for pharmaceutical drugs such as Xanax Opioids in Europe: are there indications of a fentanyl-led crisis?
Slide 18-

Fentanyl overdose deaths in Europe
Slide 19-

Seizures of fentanyls in EU
Slide 20-

Non-medical use of tramadol is of particular concern among young people in many countries in Africa In Nigeria tramadol appears to be a more accessible opioid than heroin In Nigeria, use of tramadol appears to cost about one third the price of heroin ($3.60 versus $10 per day of use in the past 30 days) Non-medical use of tramadol: the other opioid crisis
Slide 21-

Non-medical use of tramadol is of particular concern among young people in many countries in Africa In North Africa, tramadol is reported as the main opioid used non-medically in Egypt. An estimated 3 per cent of the adult population misused tramadol in 2016 while 2.2 per cent were diagnosed with tramadol dependence. In drug treatment, tramadol was also the main drug, accounting for 68 per cent of all people treated for drug use disorders in 2017 Non-medical use of tramadol: the other opioid crisis
Slide 22-

Many young people and some categories of workers misuse tramadol to boost their energy, to be able to work long hours at physically demanding and tedious jobs, or for “sexual ecstasy and performance” perceived euphoria attentiveness and self-medication and to relieve pain. Concerns about the non-medical use of tramadol have also arisen as there is an increasing number of people entering treatment for tramadol use disorders Non-medical use of tramadol: the other opioid crisis in Africa
Slide 23-

Context of lack of access to opioid pain medication under international control in many countries where tramadol is used In Africa, there is a chronic shortage of pain medications. General lack of access to opioid-related pain medications under international control is a specific problem for developing countries Against the background of de facto non-availability of internationally controlled opioids for pain medication for large sections of the population in West and Central Africa, tramadol is in fact a widely available opioid in those countries, used for both medical purposes (including outside prescription) and for non-medical purposes
Slide 24-

Is the non-medical use of tramadol and other pharmaceutical opioids emerging in Europe?
Slide 25-

Opioid overdose deaths in Europe: Sweden, Scotland and Northern Ireland
Slide 26-

Quantities of tramadol seized globally

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