What’s your poison?
How do we stop fentanyl, the most lethal of the new designer drugs, from killing young New Zealanders?
How do we stop fentanyl, the most lethal of the new designer drugs, from killing young New Zealanders?
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.
Fentanyl is the drug that has cut a swathe through the music industry, killing Prince, Tom Petty, Michael
Jackson, 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.
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
“People are dying without even realising they are taking it.”
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 painrelieving 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.”
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
“The chemical formulas can be tweaked slightly and then you’ve got a brand-new drug.”
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 mediumsized 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”.
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 harmreduction 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
With BZP, emergency department patients experienced insomnia, anxiety, nausea, vomiting, palpitations and toxic seizures.
As soon as one substance is outlawed the manufacturers produce a different version, then carry on.
resources, although critics have countered that it is too little, too late.
In May, China reclassified fentanyl as a “controlled s ubstance”, al l owing 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.”
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 legalhighs 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
“It’s a really frustrating story,” says Dunne. “We had it in our grasp to have this resolved and have a regulated market.”
“Pill testing is one of the best harm-reduction methods you can use. Ecstasy is almost a meaningless word now; it can have so many different chemicals in it.”
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.
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.”
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.
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.”
“We forget that we did a good job of informing people about methamphetamine. It was seen as a dirty drug, and the use dropped.”
Cahill doesn’t see a more workable act as the best way to make the drug scene safer.
As summer approaches, the team of volunteers at KnowYourStuffNZ are gearing up for another season of festivals. Last year, they were at 13 events offering the facilities for people to test their drugs and find out exactly what is in them. Wendy Allison, the organisation’s managing director, says it keeps a record each year and the drugs of choice for young people are pretty much always the same. No 1 is
MDMA (ecstasy), followed by LSD, cocaine and ketamine.
However, 70 different substances have been found in drugs sold under the names of those
What was claimed to be MDMA contained pesticides, antibiotics and traces of paint.
four illegal highs. “In the past few years, we’ve seen a lot of a stimulant called N-ethylpentylone,” says Allison. “People buy it thinking they are getting [ecstasy], but it’s active in much smaller doses, so it is easy to take too much.”
Also known as “brown sugar” or ephylone, N-ethylpentylone is one of the new wave of “novel psychoactive substances” (NPS) invading the festival and dance-music scenes that are designed to mimic estab
Seventy different substances have been found in drugs sold under the names of the four most common illegal highs.
lished drugs but are much more powerful. It is often found as a white or coloured powder that looks exactly the same as ecstasy.
KnowYourStuff’s testing at festivals has shown that about a quarter of the drugs that people believe to be ecstasy are not as expected. The most common substitutions come from the cathinone family of stimulants, known as “bath salts”, including N-ethylpentylone, which can also be used to mimic cocaine. Cathinones are chemically similar to amphetamines.
So far, there haven’t been any deaths linked to N-ethylpentylone in New Zealand, but it has led to some hospitalisations, including 13 people who attended the Electric Avenue festival in Christchurch last year, prompting police to issue a warning.
Last month, four people at the Listen In concert at Auckland’s Mt Smart Stadium were hospitalised, three in a critical condition, after consuming what was presumed to be ecstasy. The concert drew 20,000 people into what was billed as “the largest marquee in Australasia” to watch international acts Flume, Diplo and ScHoolboy Q. The event gained added notoriety after video footage was posted on social media showing patrons “gallivanting” on the marquee roof, up to 25m off the ground, and climbing support pillars. High as kites.
KnowYourStuff, a volunteer group that relies on donations, posted on its website afterwards: “We are not going to speculate what those people might have taken, but we are concerned for this coming summer about three big risks: people taking too much MDMA, people taking cathinones and people taking new and unknown substances.”
Although synthesised to mimic drugs that have been around for a long time, many of these novel psychoactive substances are much stronger and more dangerous – and if users aren’t aware of the difference in strength, they can be in flirting with disaster.
FEAR OF FENTANYL
Most worrying is the prospect that fentanyl, responsible for thousands of deaths in the United States, could gain a foothold in New Zealand. Fentanyl is most commonly manufactured into a powder that is injected like heroin, but it is up to 50 times more potent. Investigative journalist Ben Westhoff says fentanyl is “basically a cheap filler” that can be cut into not only heroin but also cocaine, methamphetamines and other pills. Much of it originates from China.
KnowYourStuff detected fentanyl at a festival in New Zealand in 2018, but it remains an outlier in this country.
N-ethylpentylone, on the other hand, has become more prevalent over the two summers since it was first detected here in
Fentanyl, responsible for thousands of deaths in the US, could gain a foothold here.
A quarter of the drugs people believe to be ecstasy are not as expected.
early 2017. KnowYourStuff’s website says the stimulant produces some of the same effects as MDMA, but users have described the experience as “seedy”, “cracky” and much less pleasant. Physical effects can include raised pulse and blood pressure, high body temperature, convulsions, acidosis and rapid muscle breakdown. Psychological effects include agitation, paranoia, compulsion to
redose, difficulty sleeping for up to 36 hours and temporary psychosis. “A particular risk is that N-ethylpentylone is significantly more potent than MDMA, so it is very easy to take too much. A common dose for MDMA is around 100 milligrams, whereas a dose for N-ethylpentylone can be as little as 30 milligrams. If people believe they have
MDMA and take 100 milligrams of N-ethylpentylone, then they are going to be in a very risky situation.”
Adding to the risk is what else goes into the pills. Last summer, organisers at the Rhythm and Vines festival near Gisborne issued a warning via the festival app after intercepting drugs laced with pesticides in a bag at the entrance.
“Tests indicated that the seized substance claimed to be MDMA was in fact various non-psychoactive compounds, pesticides, antibiotics [and] other industrial reagents,” festival organisers said. Police said traces of paint were also detected.
STAYIN’ ALIVE
Generally, the young people who turn up at the KnowYourStuff tent at a festival aren’t regular users. What they want is to have a recreational experience with drugs at festivals maybe two or three times a year.
The volunteer group’s first principle is that the safest approach is not to take drugs. “That’s literally the first thing we say to our clients,” Allison says.
“Most people grow out of this behaviour. We just want to help them stay alive so they get the chance.”
The evidence is that if the drugs they have tested are not what they are purported to be – either because they’re adulterated or simply another substance altogether – about two-thirds of people will decide not to take them, many choosing to put them in the disposal jar to be destroyed. Those who persist are told about the risks and appropriate dosage.
Volunteers make sure medics at the event are briefed on what sorts of drugs are circulating so they can treat any patients appropriately.
After the Rhythm and Vines interception in January, Police Minister Stuart Nash said he would like to see testing at all festivals this coming summer. That isn’t looking likely. For a start, KnowYourStuff has only three spectrometers, the instrument needed to identify drug constituents. But the main obstacle is that the service is operating in a legal grey area. The Misuse of Drugs Act makes it a crime for an event organiser to knowingly provide a venue for the taking of illegal drugs, and having testing facilities onsite acknowledges that drugs are being used. For this reason, high-profile events such as Rhythm and Vines, which last year attracted 21,000 people, aren’t prepared to take the risk of having a testing service until it is legal.
After Listen In last month, Auckland Stadiums director James Parkinson told the NZ Herald organisers had considered inviting KnowYourStuff to the event. “However, these drugs are illegal substances and are prohibited items in our venues. The concept of testing and returning illegal substances to patrons places us, as a venue operator, in a very difficult legal position.”
Allison says the idea that drugs are “handed back” is a persistent misconception. The organisation’s volunteers never handle the drugs being tested – a tiny sample is placed for testing by the person holding them. It is destroyed as part of testing.
Following an inquest into the deaths of six young people at music festivals in New South Wales in the past two summers, the state’s deputy coroner, Harriet Grahame, has called for the introduction of pill testing and a move away from hard-line policing tactics, such as strip-searching and drug dogs. The deaths were all attributed to “MDMA toxicity or complications of MDMA use”, though five of the six had other drugs in their system.
INTERIM TESTING ON CARDS
Here, the Government is understood to be considering an interim programme of drugs testing this summer, which would be supervised and/or run by a team of qualified researchers. The exercise would be monitored to provide data, including on the incidence of adulteration, the willingness of potential drug-takers to seek a test of their drugs and the percentage of those who chose not to take the drugs after advice from the on-site tester.
The New South Wales deputy coroner has called for pill testing after six deaths at music festivals.
Rhythm and Vines organisers aren’t prepared to take the risk of having a testing service until it is legal.
Hudson says legalised festival testing would be read as further evidence that taking drugs is okay.
That data would be used to develop a permanent testing strategy, if the programme showed it had the potential to be effective.
New Zealand First has been reluctant to sanction on-site testing because its policy is not to liberalise drug laws. It has expressed concern that on-site testing would encourage more drug-taking. However, after a close vote at its annual party conference last month in favour of testing, the caucus has reconsidered the issue, and may accept an interim testing regime. Its youth wing made a strong case in favour of urgent testing intervention, arguing it was not a signal that drug-taking was okay, but quite the opposite.
The party may also recognise the political risk of being seen to block the Government taking at least interim action, given the likelihood of further incidents this summer.
National is adamantly against festival drug-testing, saying the best harm-reduction policy is to discourage drugs, full stop. Its drugs law spokesperson, Brett Hudson, says any festival testing regime would be bound to be read as further evidence that taking drugs is okay, and that police will turn a blind eye. He says the simple message, “Don’t”, is still the best.
In the meantime, KnowYourStuffNZ is getting ready for the biggest night of the year, New Year’s Eve, and says she expects to have a team out somewhere in New Zealand every weekend this summer.
“We would like to move to a user-pays model so events would pay for the service, as they do with Portaloos and security, then cover it with the ticket price. But for that to happen, what we do has to be explicitly legal and section 12 of the Misuse of Drugs Act is getting in the way. We want this law clarification to happen before someone dies.”