In South America, drug-related harms look quite different from most other regions. The prohibition of crops like cannabis and coca has sparked violence and political instability in many countries—conflicts stoked by international interference. But unlike North America—or, to a lesser but increasing degree, Europe—South America largely has not experienced an overdose crisis related to synthetic opioids and drug combinations.
However, a recent study published in Harm Reduction Journal warns that change is coming. Reviewing data across three key countries, the authors chart a potentially dangerous turn in South American drug markets. Synthetic opioids, ketamine and Tusi (known as “pink cocaine,” but typically including a mix of synthetic substances) have all rapidly increased in popularity—on a continent where harm reduction services, especially for opioids, are sorely lacking.
According to the study’s lead author, Ignacio Bórquez of New York University’s Grossman School of Medicine, these new trends are a stark departure from the traditional local drug supply.
“What we’ve been seeing since, I would say, 2010 onwards in Latin America is the emergence of synthetic drugs.”
“Latin America and the Caribbean really have a history using cannabis and cocaine,” he told Filter. “[T]hey’re locally produced, so they’re very cheap. A gram of cocaine is around $10 in Latin America—here in the US, it’s $100.”
Bórquez and his team compared multiple data sources, including forensic analyses, law enforcement seizures and surveys of people who use drugs, to get a pulse on substance use in Brazil, Chile and Colombia. Clear trends quickly emerged.
“What we’ve been seeing since, I would say, 2010 onwards in Latin America is the emergence of synthetic drugs. Particularly in the party scene, things like MDMA, ketamine,” Bórquez said. “And then we’ve also been seeing seizures of synthetic opioids and some evidence of diverted opioids from pharmaceuticals.”
In Chile, the volume of ketamine seized annually by law enforcement rose by over 5,000 percent from 2017 to 2023, and that trajectory was corroborated in Chilean wastewater analysis. Oral samples from Brazilian nightclub attendees also showed ketamine use rising—often along with cocaine, in the combination known as Tusi.
The data tell a similar story for opioids. According to a nationally representative Chilean survey, opioid use has nearly quadrupled since 2002. While fentanyl is not a major factor in Chile or Colombia, law enforcement seizure data show a dramatic rise in other synthetic opioids like nitazenes.
“We are a continent torn by violence … because with crops like cocaine or cannabis, you really need territorial land.”
Globalization and online connectivity have propelled these new substances’ popularity, with rapid distribution available on social media platforms like the gay dating app Grindr. And relative to the region’s traditional plant-based drugs, these new options require far fewer resources to produce.
“We are a continent torn by violence … that has been very linked to drug trafficking and drug production, because with crops like cocaine or cannabis, you really need territorial land,” study co-author Francisco I. Bastos, of Brazil’s Fundação Oswaldo Cruz, told Filter. “And with these new substances we’re looking at, they don’t need that.”
In part because South America has not faced a major overdose crisis, the continent’s harm reduction infrastructure is vastly underdeveloped. Citing the Global State of Harm Reduction 2024, the authors note that of the 34 countries in this region, only three have syringe service programs, and only four offer opioid agonist therapy. Naloxone is also largely inaccessible.
The solution, however, is not simply to import North American and European harm reduction models, because South American patterns of drug use remain very different. While these new substances are on the rise, they still represent a minority of drug use, which continues to be dominated by stimulant smoking and concurrent alcohol use. Injecting remains largely taboo.
Bórquez loses sleep at night thinking about how to adapt harm reduction models like supervised consumption sites to communities in South America.
“It would need to be a place where stimulant use, which is very different from opioid use, could be contained in a non-harmful way,” he said. “[Y]ou’re not gonna have 30 people using stimulants together in a room … it’s hard to think of a [harm reduction] service for people who use stimulants and alcohol.”
“It is a very different balance from the US. The US is the largest producer and importer of opioids in the world … Brazil is on the other side of the balance.”
Meanwhile, attempting to combat synthetic opioid diversion by restricting importation of medical opioids would threaten the availability of these substances for their clinical uses, such as pain relief for cancer patients and palliative care.
“If we just put pressure on the supply, we cannot have medicines for the people who need the medicine,” Bastos explained. “It is a very different balance from the US. The US is the largest producer and importer of opioids in the world, so there are opioids for everything—opioids for cancer patients, opioids for the streets. Brazil is on the other side of the balance.”
Yet there are still many promising paths forward. The authors highlight drug checking, overdose prevention training and naloxone accessibility as relevant harm reduction services. They also suggest increasing investment in nonintrusive surveillance, such as local wastewater monitoring programs, to stay abreast of this rapidly shifting market and target harm reduction efforts accordingly.
“[These efforts] will be essential to mitigate future harm and prevent another synthetic drug epidemic from taking hold in the Americas,” the study concludes.
Photograph of Rio de Janeiro by Rafael Rabello de Barros via Wikimedia Commons/Creative Commons 3.0
