VIENNA, Austria – March 2020: Flualprazolam and Etizolam are two of the twelve substances placed under international control at the 63rd session of the Commission on Narcotic Drugs. Their scheduling followed recommendations put forward by the World Health Organization (WHO) after the substances were reviewed at the 42nd Meeting of the WHO Expert Committee on Drug Dependence (ECDD).

Data from the UNODC Early Warning Advisory (EWA) illustrates the emergence of Etizolam from 2015 to 2018, covering 51 countries in 4 regions. Furthermore, recent toxicology information from the EWA shows Etizolam associated with over 40 post-mortem cases, more than 90 driving under the influence of drugs (DUID) cases and 19 clinical admission cases. Similarly, Flualprazolam was associated with 5 post-mortem cases and 36 DUID cases. The scheduling of Flualprazolam and Etizolam follows other benzodiazepines such as Alprazolam, Bromazepam, Brotizolam, Clobazam, Clonazepam and so forth, in Schedule IV of the Convention on Psychotropic Substances of 1971.

Figure 1: Most reported NPS in DUID cases in 2018 and 2019 reported to UNODC

Source: UNODC, Current NPS Threats, Vol. II (January 2020).

Note: Illustrated by the relative size of substance name displayed in relation to the number of reports

For further information please see:

Current NPS Threats, Vol. II (January 2020)

EWA news clip on substances recommended for scheduling by the WHO Expert Committee on Drug Dependence: WHO recommends 12 NPS for scheduling.

Non-medical use of benzodiazepines: a growing threat to public health?

VIENNA, Austria – March 2020: At its 63rd regular session from 2 to 6 March 2020, the Commission on Narcotic Drugs decided to place twelve substances and one precursor under international control. Following recommendations by the WHO, twelve substances were added to the relevant schedules of the Single Convention on Narcotic Drugs of 1961 as amended by the 1972 Protocol and the Convention on Psychotropic Substances of 1971. Additionally, following recommendations by the INCB, one precursor was added to Table I of the Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances of 1988.

Added to the Single Convention on Narcotic Drugs of 1961, as amended by the 1972 Protocol:

          1. Crotonylfentanyl- Schedule I
          2. Valerylfentanyl - Schedule I

Added to the Convention on Psychotropic Substances of 1971:

          3. DOC (2,5-Dimethoxy-4-chloroamphetamine) - Schedule I
          4. AB-FUBINACA - Schedule II         
          5. 5F-AMB-PINACA (5F-AMB, 5F-MMB-PINACA) - Schedule II         
          6. 5F-MDMB-PICA (5F-MDMB-2201) - Schedule II         
          7. 4F-MDMB-BINACA - Schedule II         
          8. 4-CMC (4-chloromethcathinone, clephedrone) - Schedule II         
          9. N-ethylhexedrone - Schedule II         
          10. alpha-PHP - Schedule II         
          11. Flualprazolam - Schedule IV         
          12. Etizolam - Schedule IV

Added to the Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances of 1988:

          1. Methyl alpha-phenylacetoacetate (MAPA) (including its optical isomers) - Table I 




For further information please see:

EWA news clip on substances recommended for scheduling by the WHO Expert Committee on Drug Dependence: WHO recommends 12 NPS for scheduling.

For detailed information on the forty-second meeting, substance evaluation and previous committees of the WHO ECDD, please click here.

VIENNA, Austria – February 2020: The current Global SMART Update Volume 23 -“An expanding synthetic drug – Implications for precursor control” provides insight to how the expansion of the synthetic drugs market is driven by recent key trends and developments in precursor chemicals used in illicit drug manufacture. The Update documents the use of non-scheduled and “designer” precursors in recent years, especially in the manufacture of amphetamine, methamphetamine and fentanyl, and how these developments pose significant challenges to international and states’ precursor control regimes. These significant challenges include timely detection of and agile response to new developments in illicit manufacture; and identification of additional measures to complement and/or enhance present control regimes in response to these new phenomena. The Update also outlines possible options that Member States may wish to adopt in order to develop an effective response to these challenges, that is, understanding clandestine manufacturing through drug profil­ing, undertaking new national legal approaches to precursor control, establishing public-private partner­ships and enhancing international/regional cooperation.

As the discussion on new precursor chemicals continues, methyl alpha-phenylacetoacetate (MAPA) and its optical isomers, a “designer precursor” frequently used in the illicit manufacture of amphetamine and methamphetamine, was recently recommended by the International Narcotics Control Board for possible inclusion in Table I of the United Nations Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances of 1988 at the upcoming 63rd Session of the Commission of Narcotic Drugs in March 2020.

The Global SMART Updates are a biannual publication of the Global Synthetics Monitoring: Analyses, Reporting and Trends (SMART) programme, implemented by the UNODC Laboratory and Scientific Section.

For more information, please see: 

Global SMART Update Vol. 23: “An expanding synthetic drugs market – Implications for precursor control”

Global SMART Update Vol. 22: “The ATS market 10 years after the 2009 Plan of Action” 

Recommendation from the International Narcotics Control Board concerning the inclusion of methyl alpha-phenylacetoacetate (MAPA) in Table 1 of the 1988 Convention

WASHINGTON DC., United States – November 2020: We are pleased to announce the Seventh International Conference on NPS to be held from 17 to 19 November 2020 in Washington DC. The conference is jointly organised by the International Society for the Study on Emerging Drugs (ISSED), the United Nations Office on Drugs and Crime (UNODC), the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), the World Anti-Doping Agency (WADA), University of Hertfordshire (UH) and the Center for Forensic Science Research and Education.

The main objectives of the seventh event are to share evidence-based information on NPS, including fentanyl and derivatives; improve understanding of clinical treatment and management of NPS use; explore policy and legislative responses to NPS; develop innovative prevention measures for vulnerable individuals; share analytical approaches to NPS detection and identification; explore motivations and socio-cultural factors underlying NPS use; networking and providing the opportunity meet leading experts in the field. The two-day scientific meeting program will be preceded on 17 November by a series of half day workshops covering clinical, treatment or toxicological topics, which will be an opportunity for networking and problem solving in an interactive environment.

The International Novel Psychoactive Substances (NPS) conference series, which started in Budapest in 2012, aims to share knowledge and strengthen collaboration on NPS among multidisciplinary professionals at the international level.

To attend this conference please register on the conference webpage. Abstract submission is open until Thursday, 30 April 2020.

Source: VII International Conference on NPS

 

For more information, please see:

Conference webpage: www.novelpsychoactivesubstances.org/

Registration: www.novelpsychoactivesubstances.org/registration/

Abstract submission: www.novelpsychoactivesubstances.org/abstract-submission/

LISBON, Portugal – February 2019: A new report of the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) finds that in comparison to other established illicit drugs (66.9%), NPS only accounted for 6.2% of the drugs involved in all emergency presentations recorded in the European Drug Emergencies Network (Euro-DEN) Plus (see Table 1), based on almost 24,000 drug-related hospital emergencies presented at 32 sentinel hospitals in Europe. The two most common categories of NPS involved were cathinones (most commonly mephedrone) and synthetic cannabinoids. There was a significant change in the proportions of presentations involving these two NPS categories over the study period, with the predominant type of NPS changing from cathinones in 2014 (76.9%) to synthetic cannabinoids (69.5%) in 2017. The increase in synthetic cannabinoid presentations indicates their potential for severe toxicity. 

These findings are consistent with the analysis of toxicology cases reported to the UNODC Early Warning Advisory on NPS (EWA), where synthetic cannabinoids feature prominently in toxicology cases reported globally between 2016 and 2019. As the discussion on the international control status of several NPS continues, four synthetic cannabinoids including AB-FUBINACA, 5F-AMB-PINACA (5F-AMB, 5F-MMB-PINACA), 5F-MDMB-PICA (5F-MDMB-2201) and 4F-MDMB-BINACA were recently recommended by the World Health Organization (WHO) to be added to Schedule II of the Convention on Psychotropic Substances of 1971 at the upcoming 63rd Session of the Commission of Narcotic Drugs in March 2020.

Table 1: Frequency distribution of the main drug groups among all drugs identified in Euro-DEN Plus presentations, 2014-17

For more information, please see:

EMCDDA (2020), Drug-related hospital emergency presentations in Europe: update from the Euro-DEN Plus expert network, Technical report, Publications Office of the European Union, Luxembourg.

UNODC (2019), Current NPS Threats Volume I.

UNODC (2020), Current NPS Threats Volume II.

WHO (2019), Recommendations of the 42nd Expert Committee on Drug Dependence.

WHO (2019), Summary of the rationale for the recommendations of the 42nd Expert Committee on Drug Dependence.

UNODC (2018), “Understanding the synthetic drug market: the NPS factor”, Global SMART Update Volume 19.

VIENNA, Austria – February 2020: The second volume of the Current NPS Threats was published with information from the UNODC Early Warning Advisory on NPS. Data from seizure reports, post-mortem toxicology cases, clinical admissions, and other casework allowed the identification of some key recent developments regarding health threats posed by NPS. Similar to volume I, the new report illustrates that poly-drug use continues to feature highly in cases of fatalities associated with NPS. In some countries, benzodiazepine-type NPS are increasingly associated in cases of driving under the influence of drugs (DUID) (Figure 1). Incidents of kratom identification in poly-drug use cases are also being reported in a number of countries.  

Figure 1: Most reported NPS in DUID cases in 2018 and 2019 



Note: Illustrated by relative size of substance name displayed in relation to number of reports

For more information, please see:

Current NPS Threats Volume II, February 2020

UNODC Early Warning Advisory (EWA) Toxicology Portal leaflet (2018)

 

LONDON, United Kingdom – January 2020:  The Advisory Council on the Misuse of Drugs (ACMD) issued a report highlighting the pharmacology and toxic effects of fentanyl and related analogues, details of the misuse potential of both pharmaceutical and illicitly manufactured fentanyl compounds, and a summary of the associated harms as documented internationally and in the UK.  ACMD states that despite robust generic control on fentanyl analogues, the rates of registered deaths involving fentanyl and its analogues in the UK has increased over the past decade, with deaths likely to be under-represented. They conclude that there remains an ongoing risk of fentanyl and its analogues as well as other synthetic opioids infiltrating the UK heroin market and resulting in increasing rates of drug-related deaths. ACMD recommends research into and monitoring of trends (e.g. supply, demand, precursors, drug products etc.) and drug strategies relating to fentanyl and its analogues. ACMD also recommends training of health professionals in the appropriate therapeutic use of strong opioids and to include analysis of fentanyl and its analogues for all deaths related to drug poisoning.

At the global level, NPS with opioid effect including fentanyl analogues accounted for only 2% of the total NPS reported the UNODC Early Warning Advisory (EWA) while in 2019, their number has grown to more than 75 substances representing 8% of the total.  The WHO Expert Committee on Drug Dependence (ECDD) has recently reviewed two fentanyl analogues and recommended their inclusion in Schedule I of the Single Convention on Narcotic Drugs of 1961 as amended by the 1972 Protocol (see UNODC Early Warning Advisory news on NPS December 2019) – a decision the  Commission on Narcotic Drugs may take at their 63rd meeting in the first week of March 2020.

Figure 1: Annual number of unique synthetic NPS with opioid effects, 2009 – 2019*

Source: UNODC Early Warning Advisory on NPS (as of Dec. 2019).

*Note: 2019 data is not complete

For more information please see:

Misuse of fentanyl and fentanyl analogues

World Health Organization 2019 recommendation for 12 NPS for scheduling

VIENNA, Austria – January 2020: As of December 2019, a total of 950 unique new psychoactive substances (NPS) have been reported to the UNODC Early Warning Advisory on NPS. Stimulants continue to account for the largest proportion of synthetic NPS at 36 percent, followed by synthetic cannabinoid receptor agonists (31 percent) and classic hallucinogens (15 percent). Significantly, the proportion of synthetic NPS with opioid effects saw an increase from 2 to 8 percent from 2015 to 2019. The proportion of dissociatives and sedatives/hypnotics remained stable at 3 percent. 

Figure 1: Proportion of synthetic new psychoactive substances, by psychoactive effect group, as of December 2019

Source: UNODC Early Warning Advisory on new psychoactive substances.

Note: The analysis of the pharmacological effects comprises synthetic NPS registered up to December 2019.
Plant-based substances were excluded from the analysis as they usually contain a large number of different substances, some of which may not have been known and whose effects and interactions are not fully understood.

 

PENNSYLVANIA, United States – December 2019: Between 2018 and 2019, 30 reports of flualprazolam identified in seized material from 8 countries were recorded to the UNODC early warning advisory on new psychoactive substances. Moreover, 76 toxicology case reports associated with flualprazolam in post-mortem and driving under the influence of drugs (DUID) cases were reported to UNODC. Flualprazolam, a benzodiazepine with no known therapeutic use, was reviewed at the 42nd World Health Organization Expert Committee on Drug Dependence in October 2019 and has been recommended to be scheduled under the Convention on Psychotropic Substances of 1971.

A recent public announcement published by the Center for Forensic Science Research and Education (CFSRE) highlighted the detection of flualprazolam in at least 44 biological specimens associated with post-mortem death investigations and DUID investigations in the United States since June 2019. It was noted that, although flualprazolam was first identified in a case in March 2018, the substance has recently become more widely used. The public announcement also provides recommendations to public health and public safety officials, law enforcement, clinicians, medical examiners and coroners and laboratory personnel.

For more information, please see:

World Health Organization critical review of flualprazolam

Public Alert: Flualprazolam - Potent Benzodiazepine Identified Among Death and Impaired Driving Cases in the U.S.

GENEVA, Switzerland – December 2019: The World Health Organization (WHO) has announced the scheduling recommendations on psychoactive substances reviewed at the 42nd Meeting of the WHO Expert Committee on Drug Dependence (ECDD) held in Geneva from 21 to 25 October 2019. In total, thirteen substances were critically reviewed by the ECDD and twelve substances were recommended for scheduling:

Single Convention on Narcotic Drugs of 1961, as amended by the 1972 Protocol:
Crotonylfentanyl – Schedule I
Valerylfentanyl – Schedule I 

Convention on Psychotropic Substances of 1971:
DOC (2,5-Dimethoxy-4-chloroamphetamine) – Schedule I
AB-FUBINACA – Schedule II
5F-AMB-PINACA (5F-AMB, 5F-MMB-PINACA) – Schedule II
5F-MDMB-PICA (5F-MDMB-2201) – Schedule II
4F-MDMB-BINACA (4F-ADB) – Schedule II
4-CMC (4-chloromethcathinone; clefedrone) – Schedule II
N-ethylhexedrone (NEH, Hexen, Ethyl-Hex) – Schedule II
Alpha-PHP (PV-7, α-pyrrolidinohexanophenone) – Schedule II
Flualprazolam - Schedule IV
Etizolam - Schedule IV

The WHO recommended that APINACA (AKB-48) should be kept under surveillance. Further, the WHO recommended proceeding with a critical review for the preparations of acetyldihydrocodeine, codeine, dihydrocodeine, ethylmorphine, nicocodine, nicodicodine, norcodeine and pholcodine; which are listed in Schedule III of the 1961 Single Convention on Narcotic Drugs.

For more information, please see:

Recommendations of the 42nd Expert Committee on Drug Dependence

Annex 1: Summary of the rationale for the recommendations of the 42nd Expert Committee on Drug Dependence

VIENNA, Austria – November 2019: The decision of the Commission on Narcotic Drugs (CND) during its 62nd Session from 18 to 22 March 2019 to add ADB-FUBINACA , FUB‐AMB (MMB‐FUBINACA, AMB‐FUBINACA), ADB‐CHMINACA, CUMYL‐4CN-BINACA and N‐Ethylnorpentylone (ephylone) to Schedule II of the Convention on Psychotropic Substances of 1971 has entered into force on 19 November 2019. Similarly, the decision to place the precursors 3,4-MDP-2P-methylglycidate (PMK glycidate) (all stereoisomers), 3,4-MDP-2P-methylglycidic acid (PMK glycidic acid) (all stereoisomers), Alpha-phenylacetoacetamide (APAA) (including its optical isomers) to Table I of the Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances of 1988, has entered into force.

Previously, on 23 May 2019, the decision adopted by the CND during its 62nd Session to add Cyclopropylfentanyl, Methoxyacetylfentanyl, Orthofluorofentanyl (2-Fluorofentanyl) and Parafluorobutyrylfentanyl (4-Fluorobutyrfentanyl) to Schedule I of the Single Convention on Narcotic Drugs of 1961 entered into force.

 

For more information, please see:

Commission on Narcotic Drugs decision on international control of four fentanyl analogues enters into force

Nine substances and three precursors “scheduled” at the 62nd Session of the Commission on Narcotic drugs

World Health Organization recommends 9 NPS for scheduling

CND International Drug Conventions

LOS ANGELES, United States - November 2019: The US Drug Enforcement Administration (DEA) has issued a public alert on dangerous falsified prescription pills manufactured by Mexican drug cartels that were found to contain fentanyl. Based on a sampling of pills seized nationwide between January and March 2019, the DEA found that 27 per cent contained potentially lethal doses of fentanyl. A lethal dose of fentanyl is estimated to be about two milligrams, but can vary according to an individual’s body size, tolerance, amount of previous usage and other factors.

The alert also refers to the latest Fentanyl Signature Profiling Program (FSPP) report released on 28 October 2019, which detailed the results and conclusions derived from in-depth chemical analyses on a sample of 344 fentanyl and fentanyl-related exhibits seized in the United States in 2019. The average fentanyl purity for powder exhibits was 9.7 per cent (ranging from 0.05 per cent to 98.1 per cent). Exhibits were primarily diluted with sugars and heroin was detected in 21 per cent of them. The average tablet exhibit contained 1.7 mg of fentanyl. The predominant synthetic route for majority of the fentanyl seizures was determined to be the Janssen Method. Twenty-eight exhibits contained fentanyl-related compounds including carfentanil, valerylfentanyl and 2-furanylfentanyl.

In view of the growing public health threat posed by synthetic opioids, UNODC launched an integrated strategy to support countries in addressing the on-going synthetic opioids crisis affecting mainly North America with fentanyl and its analogues, and in parts of Africa, Asia and the Middle East with tramadol.

Table: Fentanyl-related compound seizures in the United States, 2019

Source: U.S. Department of Justice, Drug Enforcement Administration, Special Testing and Research Laboratory, 2019.

For more information, please see:
DEA, 2019. DEA Los Angeles issues warning over counterfeit prescription pills from Mexico. Los Angeles, United States.
DEA, 2019. Fentanyl Signature Profiling Program Report. Virginia, United States.
UNODC, 2019. Global SMART Update 21 – Understanding the global opioid crisis. Vienna, Austria.
UNODC, 2017. Global SMART Update 17 – Fentanyl and its analogues – 50 years on. Vienna, Austria.

SIDNEY, Australia – October 2019: IDRS released a new report on Australian drug trends in 2019, highlighting that the use of NPS remained low and stable over the period of monitoring, with one in ten respondents (11 per cent – the sample consisted of 902 respondents in total) reporting recent use in the past 6 months in 2019. However, 2 per cent of all respondents reported the use of NPS that mimic the effects of opioids, a significant increase over 2018. Moreover, one in three (32 per cent) respondents used non-prescribed benzodiazepines, a group of substances, which can pose a significant health risk if used non-medically, particularly in combination with opioids. Benzodiazepine-types accounted for example for almost all NPS-related deaths in Scotland in 2018 (NHS, 2019).

Table: Past six month use of new psychoactive substances in Australia, 2013-2019

Note: Values suppressed due to small cell size (n≤5 but not 0). / denotes that this item was not asked in these years. # In 2017 respondents were asked about use of ‘new drugs that mimic the effects of ecstasy or psychedelic drugs’. *<0.050; **p<0.010; ***p<0.001 for 2018 versus 2019.

Source: Peacock et al., 2019.

 

For more information please see:
Peacock, A. et al., 2019. Australian Drug Trends 2019: Key Findings from the National Illicit Drug Reporting System (IDRS) Interviews. Sydney: National Drug and Alcohol Research Centre.
National Records of Scotland, 2019. Drug-related deaths in Scotland in 2018.
UNODC, 2017. Non-medical use of benzodiazepines: a growing threat to public health? Global SMART Update, Vol. 18.
UNODC Opioid Strategy and United Nations Toolkit on Synthetic Drugs
UNODC, 2019. Understanding the global opioid crisis. Global Smart Update, Vol. 21.

GENEVA, Switzerland – October 2019: The World Health Organization (WHO) evaluates the dependence-producing properties and potential harm to health of psychoactive substances. Recommendations from the WHO regarding international control under the International Drug Control Conventions are made to the Secretary-General of the United Nations and are subject to a vote by the United Nations Commission on Narcotic Drugs (CND).

Thirteen new psychoactive substances (NPS) will be considered for review at the 42nd meeting of the WHO Expert Committee on Drug Dependence (ECDD), including two benzodiazepines, five synthetic cannabinoids, three synthetic cathinones, two fentanyl analogues and one phenethylamine. The ECDD meeting will be held in Geneva from 21-25 October 2019. 

Benzodiazepines
Flualprazolam
Etizolam

Synthetic cannabinoids 
APINACA (AKB-48)
AB-FUBINACA
5F-AMB-PINACA (5F-AMB, 5F-MMB-PINACA)
5F-MDMB-PICA (5F-MDMB-2201)
4F-MDMB-BINACA (4F-ADB)

Synthetic cathinones
4-CMC (4-chloromethcathinone; clefedrone)
N-ethylhexedrone (NEH, Hexen, Ethyl-Hex)
Alpha-PHP (PV-7, α-pyrrolidinohexanophenone)

Fentanyl analogues 
Crotonylfentanyl
Valerylfentanyl

Phenethylamines
DOC (2,5-Dimethoxy-4-chloroamfetamine)

For more information, please see:

World Health Organization 42nd Expert Committee on Drug Dependence

KUWAIT – October 2019: Between 2008 and 2017, 20 different new psychoactive substances (NPS) were reported to the UNODC Early Warning Advisory from countries of the Gulf Co-operation Council, including 10 synthetic cannabinoids. Recent information on synthetic cannabinoids seized and consumed in Kuwait in 2018 (Al-Matrouk et al., 2019) brings the total number of different NPS in the sub-region to 32, including 19 synthetic cannabinoids.

The study reviewed and analysed seizure cases from the Narcotic and Psychotropic Laboratory, Toxicology Laboratory and from the Forensic Medicine Department containing synthetic cannabinoids in Kuwait in 2018. This included 434 synthetic cannabinoid samples of seized material, 70 urine samples from suspected users and 6 urine specimens from deceased individuals.

The study revealed that the most frequently synthetic cannabinoids identified in the urine samples were 5F-ADB, FUB-AMB, and 5Cl-AKB-48 (see Figure 1). Moreover, combinations of two, three, or four types of synthetic cannabinoids were identified in the urine samples analysed, in addition to combinations of synthetic cannabinoids with other drugs including methamphetamine, tramadol, heroin, THC, and ketamine. The most common combination of synthetic cannabinoids in urine samples found by the researchers was FUB-AMB with 5F-ADB.

Figure 1: Number of cases of synthetic cannabinoids identified in urine samples in Kuwait, 2018

Note: The number of cases refers to different types of synthetic cannabinoids found in the urine of synthetic cannabinoid users.

Source: Al-Matrouk et al., 2019.

 

For more information, please see:

Al-Matrouk et al., 2019. Identification of synthetic cannabinoids that were seized, consumed, or associated with deaths in Kuwait in 2018 using GC–MS and LC–MS-MS analysis. Forensic Science International, Vol. 303.

UNODC, 2019. Current NPS Threats - Volume 1. Vienna, Austria.

UNODC, 2018. Global Smart Update 19 - Understanding the synthetic drug market: the NPS factor. Vienna, Austria.

VIENNA, Austria – October 2019: The current Global SMART Update Vol. 22 “The ATS market - 10 years after the 2009 Plan of Action” takes a look at the ATS market ten years after the 2009 Plan of Action was adopted by the United Nations and the UNODC Global SMART programme was initiated. Since then, the ATS market underwent significant changes. Affordability, availability and purity of ATS have increased, trafficking patterns have become more globalized and international criminal organizations collaborate across continents. The global quantity of ATS seizures increased more than four times, from 60 tons in 2008 to 261 tons in 2017, with methamphetamine becoming the primary ATS drug of concern. Moreover, new trends appeared, for instance changes in the range of precursors used. As more information on the dynamics of the synthetic drug market becomes available, this knowledge can be used to develop balanced responses, including global monitoring and trend analysis, national capacity building for data and for drug identification, early warning systems, legal responses as well as knowledge sharing.