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Foreign military attaches inspect drugs, vehicles, laboratory accessories and chemicals on display at a football field for invited journalists and military personnel in Kawnghka, at Shan State on March 6, 2020.

YE AUNG THU/AFP/Getty Images

When Pascal Tanguay found traces of fentanyl in a small batch of heroin in Bangkok last fall, he was appalled but not surprised – he had suspected that the deadly synthetic opioid was causing overdoses all across Southeast Asia for months. When authorities in Myanmar found almost 3,800 litres of a particularly potent form of the drug during a raid in the spring, he was shaken.

The bust marked the first time fentanyl production had been discovered in Asia’s Golden Triangle and confirmed the worst fears of activists and experts: The powerful drug was already in the region and, if left unchecked, could spread to countries wholly unprepared for it.

“It’s not really a question of if there is going to be an Asian opioid crisis. It’s not even a question of when any more. It’s clearly here,” said Mr. Tanguay, who was born in Laval, Que., and has worked in the harm-reduction sector in Thailand for 16 years. His discovery of the drug in Bangkok came after a friend overdosed on fentanyl-laced heroin during a community meeting.

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Amid an opioid crisis that has changed how many people in Canada think about drug policy, Mr. Tanguay and other Canadian experts are trying to help Thailand and other countries in the region get ready for an epidemic. It will require governments to change their approaches – and look to places such as Canada for lessons.

shift in regional SoutheasT asia

drug market

Though a major crackdown on poppy cultivation

has caused opioid production to decline, the

drug market in Soutrheast Asia is quickly being

replaced with synthetic drugs like methamphet-

amine and new psychoactive substances.

Opium poppy cultivation

In Myanmar, 000s hectares

70

60

50

40

30

20

10

0

‘14

‘15

‘17

‘18

‘19

Methamphetamine seizures

In E/SE Asia, tons

140

120

100

80

60

40

20

0

‘13

‘14

‘15

‘16

‘17

‘18

Emergence of New Psychoactive Substances

with opioid effects in E/SE Asia

Number

Reported in previous years

Newly reported in that year

30

25

20

15

10

5

0

2014

‘15

‘16

‘17

‘18*

‘19*

*Preliminary

THE GLOBE AND MAIL, SOURCE: UNOdC

shift in regional SoutheasT asia

drug market

Though a major crackdown on poppy cultivation has

caused opioid production to decline, the drug market in

Soutrheast Asia is quickly being replaced with synthetic

drugs like methamphetamine and new psychoactive

substances.

Opium poppy cultivation

Methamphetamine seizures

In Myanmar, 000s hectares

In E/SE Asia, tons

70

140

60

120

50

100

40

80

30

60

20

40

10

20

0

0

‘14

‘15

‘17

‘18

‘19

‘13

‘14

‘15

‘16

‘17

‘18

Emergence of New Psychoactive Substances

with opioid effects in E/SE Asia

Number

Reported in previous years

Newly reported in that year

30

25

20

15

10

5

0

2014

‘15

‘16

‘17

‘18*

‘19*

*Preliminary

JOHN SOPINSKI/THE GLOBE AND MAIL, SOURCE: UNOdC

shift in regional SoutheasT asia drug market

Though a major crackdown on poppy cultivation has caused opioid production to decline,

the drug market in Southeast Asia is quickly being replaced with synthetic drugs like

methamphetamine and new psychoactive substances.

Opium poppy cultivation

Methamphetamine seizures

In Myanmar, thousands of hectares

In E/SE Asia, tons

70

140

60

120

50

100

40

80

30

60

20

40

10

20

0

0

2014

‘15

‘17

‘18

‘19

2013

‘14

‘15

‘16

‘17

‘18

Emergence of New Psychoactive Substances with opioid effects in E/SE Asia

Number

Reported in previous years

Newly reported in that year

30

25

20

15

10

5

0

2014

‘15

‘16

‘17

‘18*

‘19*

*Preliminary

JOHN SOPINSKI/THE GLOBE AND MAIL, SOURCE: UNOdC

Jeremy Douglas, the Southeast Asia representative for the United Nations Office on Drugs and Crime (UNODC), was dismayed when fentanyl was introduced to the Canadian market.

“The forceful nature of how fentanyl hit North America so fast and so hard was very dramatic. … That really shocked everyone, including myself,” said Mr. Douglas, who was born in Port Perry, Ont. That experience has informed his urgency now.

At the end of May his department ran a virtual workshop with the Mekong countries – Myanmar, Laos, Cambodia, Thailand and Vietnam – partially to discuss the seizure in Myanmar. Participants sometimes struggled to understand each other between translators and the crackle of the Microsoft Teams network. The session was emblematic of how difficult Mr. Douglas’s work can be as he tries to bridge ideologies and cultures to convey potential danger and brainstorm solutions.

Precursor chemicals used to make illicit drugs such as methamphetamine, ketamine, heroin and fentanyl seized by Myanmar police and military are seen in this undated photo near Loikan village in Shan State, between February and April, 2020.

Myanmar Police/UNODC/Reuters

“It was actually kind of comical, because the lack of ability to communicate together really hampers co-operation as well,” he said.

But co-operation is crucial, because what is produced or stored in Myanmar is often trafficked to neighbouring countries; global distribution is still a concern, but the pandemic has made trafficking closer to home appealing to crime syndicates.

A quarter of the world’s opioid users are in North America, but about half – more than five million people – are in Asia, according to the UN. For more than a year now, the UNODC has been warning about the impact fentanyl could have on such a large population, pointing to troubling reports of the drug to the UN’s Early Warning Advisory, a system that aims to identify the presence of new psychoactive substances. (The Myanmar find is classified by the UN as suspected methyl fentanyl, after testing by local authorities. A UN team will be heading to the country when its borders reopen to conduct tests of its own, according to Mr. Douglas.)

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These early discoveries of fentanyl are “a canary in the coal mine kind of thing,” Mr. Douglas said.

The region has failed to grasp the warning signs as it tries to address other concerns such as poverty, gender inequality and access to education – factors that could increase the severity of an overdose crisis.

Between January, 2016, and December, 2019, 15,393 Canadians died from opioid overdoses – about one every two hours. In Southeast Asia, such data is not available, because no country in the region routinely monitors drug-related deaths.

New Psychoactive Substances (NPS)

reporting in Asia

0

1,000

KM

MONGOLIA

N. KOR.

S. KOR.

JAPAN

CHINA

INDIA

Philippine

MYAN.

Sea

LAOS

THAI.

VIET.

PHILIPPINES

CAMB.

KEY: 2014-2019

Reporting NPS with

opioid effects

SINGA.

Not reporting NPS

with opioid effects

(Assumed not testing)

INDONESIA

JOHN SOPINSKI/THE GLOBE AND MAIL, SOURCE:

TILEZEN; OPENSTREETMAP CONTRIBUTORS; HIU;

UNODC

New Psychoactive Substances (NPS)

reporting in Asia

0

1,000

KM

MONGOLIA

N. KOR.

S. KOR.

JAPAN

CHINA

INDIA

MYAN.

Philippine

LAOS

Sea

THAI.

VIET.

PHILIPPINES

CAMB.

KEY: 2014-2019

SINGA.

Reporting NPS with

opioid effects

Not reporting NPS

with opioid effects

(Assumed not testing)

INDONESIA

JOHN SOPINSKI/THE GLOBE AND MAIL, SOURCE: TILEZEN;

OPENSTREETMAP CONTRIBUTORS; HIU; UNODC

New Psychoactive Substances (NPS) reporting in Asia

0

1,000

KM

MONGOLIA

N. KOR.

S. KOR.

JAPAN

CHINA

INDIA

MYANMAR

Philippine

LAOS

Sea

THAILAND

VIETNAM

PHILIPPINES

CAMBODIA

KEY: 2014-2019

SINGA.

Reporting NPS with

opioid effects

BRUNEI

Not reporting NPS

with opioid effects

(Assumed not testing)

INDONESIA

JOHN SOPINSKI/THE GLOBE AND MAIL, SOURCE: TILEZEN; OPENSTREETMAP

CONTRIBUTORS; HIU; UNODC

Kanna Hayashi, a researcher with the BC Centre on Substance Use and the St. Paul’s Hospital chair in substance use research, has tried to fill that hole in the data throughout her career, producing dozens of academic papers between 2009 and 2018 in partnership with the Mitsampan Community Research Project in Thailand. Her work is some of the only research on opioid overdoses there and the trickle-down effects of what she calls violent, “draconian” policies.

In 2012, when summarizing the results of five years of research on people who use drugs, Dr. Hayashi and colleagues at B.C.’s Urban Health Research Initiative pointed out that 78 per cent of study participants reported a history of imprisonment. Thirty-two per cent reported they had been through a program at a compulsory drug detention centre, a technique used across Southeast Asia that has been found ineffective and harmful. Not much has changed, she said.

Yaba pills, which contain methamphetamine, seen here in Lashio, in the northern Shan State of Myanmar on April 2, 2019.

Minzayar Oo/The New York Times News Service

“I think this kind of research is really valuable for bringing the voices of people who use drugs to the policy table,” said Dr. Hayashi, emphasizing the community-led aspect of her work. Now she needs policy makers to look at her findings and take action.

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In North America, Mr. Douglas explains, it was public-health agencies that first picked up on fentanyl in the market – not the RCMP, not the DEA.

“There have been hard lessons learned in Canada about the importance of having a really balanced response,” he said. But in Southeast Asia, a “paramilitarized” drug policy has taken hold, and “[police] don’t really particularly care about drug users or prioritize their rights.”

Mr. Tanguay says the region must adopt a multifaceted approach with harm reduction at its core.

“It all starts with a therapeutic relationship that is built on trust. And unfortunately, because drug users are criminalized and stigmatized [and] discriminated, that trust has systematically been sabotaged,” he said.

He argues that the widespread availability of fentanyl test strips and naloxone kits was an important step for Canada – and that Southeast Asia needs both desperately.

Drug users in Lashio, in the northern Shan State of Myanmar on April 2, 2019.

Minzayar Oo/The New York Times News Service

He was hopeful that the federal government’s legalization of cannabis was a precursor to more meaningful involvement. But now “it’s frustrating to see that Canada is a leader globally in terms of harm reduction but they’re not interested, not willing, not capable of sharing their expertise with the rest of the world.”

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The UNODC would welcome the Canadian government’s participation. Canada’s knowledge of precursor control – monitoring the chemicals used to make illegal drugs – and testing of street drugs could convince Southeast Asia to take fentanyl more seriously, Mr. Douglas said.

“Countries that have gone through what Canada has gone through definitely need to share that experience.”

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