CND 2026 — 69th Session

Host (Moderator)

Hello everyone. We welcome you to this technical consultation hosted by Agora in collaboration with the International Network for People Who Use Drugs and Students for Sensible Drug Policy. Today we're addressing one of the most pressing challenges: the transition from botanical production and stability to a toxic synthetic drug supply. We have two specialists: Dr. Ben, who will ground us in the long-term history of the opiate crisis, and Dr. Jade Boyd from the British Columbia Center on Substance Use, who will share evidence on route switching.

Benjamin R. Siegel (Historian, Global Commodity Economics)

Thank you. I'm a historian of global economics of commodities. Much of this is drawn from my book that's out very soon: Markets of Pain: Opium Capitalism and the Global History of Painkillers.

When we talk about opium gum, it's easy to lose sight of the fact that this was for most of the 19th and 20th century really the foundation of the global pharmaceutical economy. In the United States throughout the 19th century, physicians dispensed hundreds of thousands of pounds every year. Most came from the Ottoman Empire, from Turkey.

The story of how we got from this world to the world of synthetic opioids — mass overdose death and a drug supply so toxic it requires adaptation for survival — I think of as having three chapters:

First: Technical isolation and substitution. Beginning with the isolation of morphine in 1817, chemists broke down opium into constituent alkaloids and created new compounds — heroin (1874), oxymorphone, oxycodone, hydrocodone. By 1959, the synthesis of fentanyl — 100 times more potent than morphine — marked a high-water moment. The dream was to produce a fully synthetic substitute to sever the world's dependence on the poppy altogether.

Second: Dismantling of global agricultural infrastructure. By the 1970s, American policymakers pressured Turkey to ban poppy cultivation and pushed India to convert from labor-intensive scraping to mechanized processing. The peasant cultivators who had been central to pharmaceutical supply became irrelevant. The infrastructure maintaining some relationship between agricultural labor and state oversight fell apart.

Third: The rise of the synthetic surge — we're living through this now. The infrastructure that stabilized global trade in licensed opium collapsed right when demand for opioids was surging, driven by aggressive marketing of synthetics. When legal supply was tightened, users turned to heroin. When heroin became adulterated and displaced by fentanyl, the result was the toxic drug supply driving mass overdose deaths.

The progressive isolation of alkaloids and the drive towards synthetic substitutes has moved the world further from the plant itself, with severe consequences for end users. This history is shaped by imperial science, US diplomatic pressure, and commercial imperatives of pharmaceutical companies profiting from patentable synthetics rather than an agricultural commodity anyone can grow.

Dr. Jade Boyd (British Columbia Center on Substance Use)

I was asked to speak on qualitative research in Vancouver, British Columbia, documenting recent trends in transitions from injecting to smoking unregulated drugs, primarily opioids. My work focuses on community-based research and centering the expertise of people with living experience of substance use.

In 2016, a public health emergency was declared in Vancouver due to rapidly increasing overdose deaths from opioids adulterated with fentanyl. In Canada, we've had over 50,000 overdose-related deaths since then. It's the leading cause of death in British Columbia between ages 19 to 59. It's primarily driven by illicit fentanyl, but we're seeing adulterants like benzodiazepines and tranquilizers causing quick sedation, increasing overdose risk and gender-based violence.

Since 2016, there has been a notable shift in route of consumption. In 2025, 65% of overdose deaths in British Columbia were related to smoking, whereas only 9% were related to injecting opioids. We spoke to people who smoked instead of injecting:

One major reason is to address overdose risk — many felt smoking meant drugs hit the body slower, so they could deal with high potency by taking smaller hits. Others felt they had increased control. Most talked about switching for safety, even though many acknowledge people also overdose from smoking.

Women expressed additional reasons: addressing gender-based violence, particularly sexual assault. Smoking was seen as more protective — less likely to lose consciousness from benzodiazepine-adulterated drugs. It also allowed for greater autonomy; women didn't need assistance from someone who may expect something in exchange. And smoking is less visible on the body — no track marks.

Straightforward things that could be supportive: expanding sanctioned spaces for drug smoking; expanding advanced drug checking technologies; widespread distribution of smoking-related harm reduction supplies; and access to smokable prescribed alternatives to the unpredictable drug supply.

Host

If we want to focus on users of opium gum, we would have to consider outdoor places where users can use responsibly. How can we transition from raw opium gum smoked through pipes to a modern version that fulfills user needs without disturbing others?

Benjamin R. Siegel

When I'm thinking about traditional consumption, I'm thinking of practices that are fundamentally social ones. The shift from smoking to injection is a really deleterious one. I'm curious what sites might look like that account for different ways people use — both for the somatic effect and the social function they play.

Sylvia (Austrian Drug Policy Professional)

We don't have consumption rooms in Vienna. It's terribly conservative because they're always afraid of right-wing parties. But there is one example in Hamburg — a female-only consumption room. A lot of sex workers use this. Sometimes it's easier to establish something for "vulnerable folks" that nobody is really afraid of. It's really important to get women into these sites.

Dr. Jade Boyd

In Vancouver, we do have an indoor overdose prevention site that allows for smoking — a different room with safety regulations and vents. But we've had a lot of backlash from the conservative government. They were so concerned about people smoking in public that now we've gotten rid of decriminalization. We've also switched to "forced witnessing" — people accessing alternatives now have to be witnessed by a pharmacist or doctor.

Benjamin R. Siegel

Historically, anyone who had access to opium gum was always worried about it being adulterated with wax or coal. The difference today is probably the toxicity. That was a question about purity and efficacy versus the question of fatality we see today.

Sylvia

In Austria, everything has been cut down a third. The only space where things are still expanding is the university clinic of psychiatry. I have projects there with ketamine and psilocybin. Laughing gas is extremely effective. There are a lot of studies going on in Europe and the US. We have to rely on this because communities don't have the money anymore. It needs to be funded through research.

Dr. Jade Boyd

In Vancouver, overdose deaths are really tied to broader social structural factors like poverty and lack of housing. Synthetic and semi-synthetic drugs which are adulterated in our supply still aren't necessarily working either.

Host (Closing)

The technical consultation highlights a critical turning point: the transition from a stable, botanical-based drug economy to a volatile and toxic synthetic supply. Future policies must be built on an interrogation of inherited categories and a commitment to centering the expertise of those with living experience.