Bloomberg Línea — The tentacles of the illegal fentanyl trade are extending into Latin America with Mexico as the main port of entry, while other markets such as Colombia and Ecuador are already participating in production or trafficking as the alert spreads to other countries.
Latin America is on high alert following multiple police operations that have resulted in the seizure of fentanyl in different forms and the warning by US State Department counter-narcotics chief Todd Robinson about the alleged involvement of Andean markets, such as Colombia and Ecuador, in the supply chain.
The involvement of Mexican cartels such as the Sinaloa and Jalisco New Generation in the illegal production of fentanyl and fentanyl-based tablets destined for the US market is believed to be influencing the increase in shipments to North America and the expansion of the business to the rest of Latin America.
Julián Quintero, a sociologist, drug researcher and director in Colombia of the Corporación Acción Técnica Social (ATS), explained to Bloomberg Línea that fentanyl has been legally present in Latin America for 30 years, having been used in hospital operating rooms. And that black market sales of legally manufactured, low-concentration, pharmaceutical-grade fentanyl in ampoules and liquid form began to be registered at least a decade ago.
But with the massification of cases and seizures in Latin America, it can be said that the illegal fentanyl market has been officially installed in Latin America, warned the representative of the United Nations Office on Drugs and Crime (UNODC) for the Andean Region and the Southern Cone, Candice Welsch in an interview.
“Pharmaceutical fentanyl for medicinal purposes has been in the region for a long time, but it is true that we are now seeing seizures of diverted fentanyl and sales on the illegal market recently. We know that fentanyl is a highly dangerous drug, and also highly addictive. We have seen the crisis in North America, in the US and in Canada, so I think there is a lot of tension in trying to prevent this same challenge in the region,” she said.
As a synthetic opioid, a fentanyl overdose causes respiratory depression and decreased consciousness, which puts the person at risk of respiratory arrest, which is the cause of death in overdose..
Colombian Association of Medicinal Companies (Acemi)
Welsch states that South America has so far seen seizures of medical fentanyl diverted from the health system, but says there is no evidence of illicit production in laboratories in the region.
What worries him most are the combinations that are appearing with fatal outcomes for consumers, so he considers that this is an important signal for the region on which action must be taken to prevent a crisis.
“There are larger markets for synthetic drugs in general in the southern cone. In Argentina, in Chile, in Uruguay, in Brazil. So, I think these countries are concerned to see what is going to happen and they are trying to see exactly the current consumption, to reinforce the knowledge, to reinforce the capacity of the medical system. We also have in the whole region the need to reinforce their capacities of early warning systems to know exactly what is happening in the countries,” Welsch said.
Quintero explained that the difference between South America and the crisis in North America lies in the fact that the opioid consumption epidemic in the United States is mainly related to synthetic analogues of fentanyl that are manufactured clandestinely in countries such as Mexico and China, among other markets, in an attempt to replace other drugs.
The illegal market has been responsible for the mass production of such compounds by introducing changes in the chemical structures of the product, making it more difficult to track and control opioids globally.
The attention of authorities in Latin America is now focused on these networks in Mexico, which are attempting to increase their influence in the illegal market and the use of fentanyl as a precursor of synthetic drugs.
Quintero, who has more than 15 years of experience in the investigation of the drug problem, explains that so far in Latin America “small and isolated” cases have been registered with synthetic analogues of fentanyl, but he warns that the threat is real for public health in the region due to the dependency generated by opioids in a black market.
He explained that the illegal business of synthetic fentanyl analogs has found fertile ground on the U.S.-Mexico border due to the high migratory flow in that area and the extension of criminal networks dedicated to the manufacture of these products.
But for the arrival of synthetic analogs of fentanyl to become a reality, he believes that there are certain conditioning factors, such as the fact that in a certain country there is a high consumption of opioids and a high tolerance has been generated: “And that is only in the US. Nobody in Latin America has that context”.
Olga Melo, president of the Colombian Association of Clinical Toxicology (ATCC), says that in countries like Colombia the proven medical use of fentanyl is as an analgesic and anesthesia inducer, so its use is exclusive to ICU and operating rooms.
That is, it is not a drug that is used as an analgesic with patients at the outpatient level or general floor management. “The cases we have seen of fentanyl dependence over the lifetime that I have cared for patients are generally healthcare workers. Anesthesiologists, physicians, who have been dependent on fentanyl, who somehow get access to it and become dependent,” he said.
He went on to say that in the Andean country there have been no deaths caused by illegal fentanyl yet, citing reports from entities such as the Ministry of Health, the National Health Institute (INS) and Legal Medicine.
“What has been found is the diversion of fentanyl for pharmaceutical use that is in the ICUs and operating rooms, because some health worker steals it and injects it.”
In any case, he stated that fentanyl for pharmaceutical use should not be demonized because of these cases, but it is necessary to be vigilant. In this regard, he said that one of the proposals that has emerged since 2017 is that consumers of both legal and illegal products, as well as their relatives and caregivers, could have access to naloxone, which is the antidote in cases of intoxication, and which is already being used in the US. But the path of its adoption in Latin America is still incomplete and has not been effective due to the lack of availability of these products.
The battle against opioids begins in Latin America
With the dissemination of alerts about the presence of fentanyl in the region and the spread of criminal networks that deal in this drug, a fight has officially begun in Latin America against the dreaded effects of opioids.
Mexico is now considered the main gateway for fentanyl in Latin America and there have been reports since at least 2018 of police operations against this drug, since in that year a clandestine laboratory producing this synthetic opioid was dismantled in the country’s capital.
This case was followed by several others that same year with the seizure of fentanyl tablets in quantities ranging from hundreds to several thousand. In addition, in 2019 the state of Baja California made a seizure of 1,000 fentanyl tablets that were concealed in a DVD player, according to a UNODC document. In 2021, 118kg of paste containing fentanyl were seized and a clandestine synthetic drug laboratory was dismantled in Mexico.
According to Mexican government figures, more than 1.4 million tons of precursor chemicals have been seized, 7.6 tons of fentanyl and almost 2,000 clandestine laboratories have been destroyed so far during this six-year term.
In South America, the records related to this synthetic opioid are more recent and in Brazil, for example, the police made the first seizure of fentanyl in February in the state of Espiritu Santo, seizing 31 vials.
In Argentina, the mixture between fentanyl and cocaine, a practice that was associated with the death of 24 people and the intoxication of more than 80 in January 2022 in Buenos Aires, has been the main cause of concern.
An increase in consumption of these substances cannot be ruled out as it is a global phenomenon. Trends indicate that opioid consumption is increasing not only in North America, but worldwide. We are no strangers to this.
Dennis Ocampo of the Universidad Nacional de Colombia
A total of 24 deaths from overdoses of cocaine adulterated with fentanyl were counted in Argentina between 2017 and 2019, according to figures from the Argentine Drug Observatory, cited by news portal Ámbito. This is despite the fact that in Argentina the sale is controlled by prescription by the National Administration of Medicines Food and Medical Technology (ANMAT).
The tentacles of fentanyl also extend to Venezuela, where the first seizure of the drug (45 doses) was made in September in the state of Táchira, according to governor Freddy Bernal. “We are the border containment wall,” said the official, referring to the need to strengthen actions to prevent this drug from continuing to spread in South America.
In Chile, this synthetic opioid was also detected in a solid state during an anti-drug operation in November 2022 in which a powder made from the mixture of fentanyl with other substances such as morphine, heroin, among others, was detected, for which the Early Warning System (SAT) of Drugs of that country has already been activated.
In Central America there have been reports of addictions to this substance in Costa Rica and the seizure of 120 barrels of fentanyl in a Guatemalan port.
Federico Moncada, a Honduran and member of the Toxicology Network of Latin America and the Caribbean, warns Bloomberg Línea that countries like Guatemala, El Salvador and Honduras should think about prevention actions as they are in the path of drug trafficking: “Eventually it is going to arrive here”.
“In the case of Honduras, we have a National Defense Council, where there is an intelligence directorate that already has a committee for the investigation of fentanyl cases and not necessarily because we have found people intoxicated with fentanyl, but because certain indications have already been found that there are precursors of the different fentanyls in these laboratories that have been made, that have been closed. So, these are things that we have to foresee eventually if it is happening in our countries or if it is being produced in these countries”, he said.
Mexico and Colombia
In view of the global alert, Mexico’s President Andrés Manuel López Obrador has warned that his country has “the moral and humanistic obligation to participate in the fight against fentanyl consumption in the US.”
“We have to act with humanism and understand that regardless of our differences (...) there are human rights”, stressed the Mexican president during the Latin American and Caribbean Conference on Drugs held earlier this month in the Colombian city of Cali.
For López Obrador, if there is consumption of fentanyl, “something is wrong in that society, because it may disappear, but another substance will emerge that is just as harmful or worse”.
The Colombian government has already acknowledged its concern about the consumption of fentanyl in the country and Justice Minister Néstor Ozuna, said in an interview with local media that it is the “most dangerous chapter in the fight against drugs”; however, the administration has defended that there are no indications that this drug is being produced locally.
“We cannot ignore the fact that the consumption of fentanyl in Colombia has increased, and above all that it is a drug with a very high mortality risk, an overdose can lead to death, almost immediately, we are for now making great efforts to train officials of the health system, hospitals, pharmacies, judicial operators, so that they learn to distinguish such people who have consumed this substance to provide immediate help,” Ozuna said in August.
Colombia is a strategic enclave for criminal networks that traffic drugs and has been fighting against this historic scourge for decades.
In this context, the Andean country has already presented a strategy for the fight against this scourge based on international cooperation, prevention and knowledge, co-responsibility, integration and intelligence, investigation, among others, said the director of the Colombian Police, General William Salamanca.
After presenting this strategy, the Police informed about the first Colombian extradited to the US for distributing fentanyl in the states of Pennsylvania and New York in the period between 2017 and 2019.
Dabinsson Niño Meyer, 39, was captured in Acacías (in Meta department) and is charged with the crimes of drug trafficking, distribution and possession of fentanyl.
What we see in North America, the US and Canada, is that it is true that fentanyl is replacing or is being mixed with heroin or other opioids. It’s different than thinking about cocaine, because it’s another type of drug.
Candice Welsch.
Colombian President Gustavo Petro said during the 78th session of the General Assembly of the United Nations (UN) in New York that “fentanyl, which no longer kills 4,000 but 100,000 young people a year, is the great result of drug prohibition”.
Petro acknowledged that “there may be attempts” to produce fentanyl in Colombia and that therefore the country must have a health prevention policy for consumers, “who do not even know what they are consuming”.
His hypothesis is that opioids would be displacing cocaine, but he clarified that “that still needs to be examined over time”.
“The reality is that it is highly probable that these industrial processes will be done in the United States itself, perhaps on the Mexican border, taking advantage of a lower value of the labor force. Colombia is not going to have a privileged position there, and that gives us the opportunity for peace, to take the violent gasoline away from the base of our society,” he said.
High risks
Specialists from the World Health Organization (WHO) told Bloomberg Línea that the public health risks for Latin America are related to the power of fentanyl, a synthetic opioid much more potent than heroin or morphine.
On the one hand, appropriate medical use of fentanyl in pharmaceutical preparations constitutes an important therapeutic option in the treatment of (severe) pain.
The Colombian Association of Integral Medicine Companies (Acemi) complemented in response to a written consultation that the main use of pharmaceutical or medical use of fentanyl is as an anesthetic in prolonged surgeries, as well as in the treatment of chronic pain that is difficult to manage (in its fast-acting patch presentation).
Meanwhile, illegal fentanyl is produced in illicit drug factories and distributed in the illegal drug market. It is fentanyl that is associated with overdoses and with more than 150 deaths per day in the United States, it states.
In this regard, the WHO warned that its non-medical use is associated with serious risks caused by the high potency of fentanyl, including a possible fatal overdose due to respiratory depression.
“Fentanyl is a special control medicine that has long been used for legal therapeutic purposes in Latin America. However, what we observe is the misuse that is being given to it, referring to the potentialization of synthetic drugs in the region, as a mirror of what is happening in the US, where there is undoubtedly a crisis of opioid consumption as in the case of fentanyl and derivatives of this substance,” said Dennis Ocampo, a professor in chemistry at the National University of Colombia, in an interview with Bloomberg Línea.
He agrees that the opioid phenomenon in Latin America is very different from what happens in North America, since in those countries part of this problem can be explained by the way in which the health system manages the pain of its citizens and, therefore, consumption for therapeutic purposes is quite high.
