Estonia won its war on fentanyl in 2017, but the trouble was just starting. Drug users who couldn't get fentanyl didn't go back to using heroin. Instead, they began using combinations of different synthetic drugs, including amphetamines and alpha-PVP.
A woman walks past a methadone treatment center in Estonia's capital Tallinn on Friday, June 28, 2019. The tiny Baltic state has battled nearly two decades a fentanyl epidemic so severe its overdose death rate was almost six times the European average. Although police won the war on fentanyl the market shifted further towards synthetic drugs.
There are signs that the U.S. is on a similar path, tipping from plant-based drugs like heroin to synthetic ones like fentanyl and methamphetamine. That could herald big changes in global narcotics supply chains and cement the role of China -- an important source of illicit synthetic drugs -- as a vital link in the worldwide drug trafficking business.
“Something fishy is going on. They don’t like heroin after this. They prefer stimulants,” said Katri Abel-Ollo, a researcher at the center for addiction prevention of Estonia’s National Institute for Health Development. “They use different types of drugs, it’s like Lego construction. Our harm reduction workers say the mental state of patients is becoming worse and worse. They are unpredictable in how they behave.
Supply and demand drivers are fueling the rise of synthetics in other countries as well, according to a sweeping 2019 analysis by the RAND Corporation, a nonprofit policy research group headquartered in Los Angeles. It’s a global trend. Illicit drug markets in Latvia and parts of Canada also appear to be tipping from heroin toward fentanyls, while in Finland, heroin has been largely replaced by the semi-synthetic opioid buprenorphine, according to RAND.
The U.S. Drug Enforcement Administration says China’s vast, freewheeling chemicals industry is the largest source of synthetic opioids that end up in the U.S., either via mail directly or through Mexico.
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