New Zealand is in the grip of a synthetic drugs crisis, with the coroner "currently investigating up to 45 deaths" in the past year.

She wipes her face with her sleeve and stares at the door. We are outside the Christchurch house where 47-year-old Jason Watene, who she knew on the street as "Uncle" Gummie, died from a heart attack in June, thought to be the result of synthetic cannabis use.

Her hands are black with grime, eyes expressionless, mannequin-like.

Matted in knots, her hair is piled loosely on top of her head, held in place with a rubber band she found lying outside a shop on Hereford St.

"Chop was there, eh, when it happened, and one of the girls," she says. "He was our street brother, he died in the hallway. Freaky sh--."

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​Gummie, she says, started sniffing glue on the streets 20 years ago. He moved on to alcohol, then synthetic cannabis - "synnies". He called a tarpaulin in a tree near the former saleyards home.

A toy car pokes out of the dirt in the garden by a crooked letterbox stuffed with junk mail.

She shuffles her jandal back and forth and makes a haphazard beat out of the noise it makes on the pavement.

"Guess we all gotta go sometime, eh".

****

CHRIS SKELTON/STUFF The chief coroner is currently investigating 40-45 deaths linked to synthetic cannabis.

Our nation's illicit drug market has become a chemical minefield and some experts warn New Zealand is in the middle of a "synthetic drug crisis".

Our most commonly used illicit drugs are cannabis, meth, MDMA and synthetic cannabis.

A wide group of synthetic, or man-made, designer drugs, is being manufactured every day, largely in China.

Some Kiwis are opting to cut out the middle man, ordering potent cocktails of synthetic drugs from the black market online. It's as easy as Googling the right words and shipping it here in the mail for personal use.

Synthetic cannabis, the drug of choice for the poor, starts with a bag of white powder - cannabinoids - which is smuggled into the country.

A couple of spoons of powder is mixed with acetone and sprayed onto Damiana plant matter which looks "a bit like potpourri", a friendly policeman tells me.

The Damiana is chopped up so it looks like cannabis and put in little bags.

Problems arise when those doing the spraying are not diluting it enough and spraying too much on the plant material. Sometimes they might spray too many times in one spot, making a particularly potent hot spot in the batch.

CAMERON BURNELL/STUFF Ross Bell, NZ Drug Foundation director, says we as a nation ''can't arrest our way out of '' of the synthetic drug crisis.

"One week it might be fine," says Ross Bell, Drug Foundation executive director. "They might have sprayed it evenly at the right dosage. But next week they might not because there's no quality control."

People buy from the same dealer expecting the same result.

"But that's not the case and people are dying... The coroner is doing a big inquiry right now and currently investigating up to 45 deaths in the last 12 months, compared to two deaths in the last five years, so something is bad."

When someone dies, rumours spread of "bad batches" containing weed killer, rat poison or fly spray, but this is untrue.

"The ESR have been testing drugs seized by police," says Bell. "They have not found extra poisons - the issue is the chemicals themselves are so dangerous, they don't need weed killer added, they are dangerous chemicals in their own right."

He recounts a conversation with drug dealers in Wellington.

"They thought it was full of fly spray. We sent it to the ESR and the chemical we found had been responsible for 10 deaths in Japan."

The new reality is that there is a "ton of new substances".

"A United Nations report said they had discovered between 300 to 400 new substances around the world," says Bell. "That's happening here ... Not just cannabinoids but a lot of new stimulant drugs which are being sold as ecstasy or cocaine. but it's just chemicals. People don't know from one week to the next what it is and a lot of these things are very potent, very dangerous."

The broad family these drugs are in is a range of specific chemicals called cathinones. Synthetic cathinones are mimicking ecstasy, cocaine, LSD. More recently, synthetic drugs are being hidden in vaping liquid.

​"The new group of hallucinogens is very dangerous."

From testing drugs at music festivals, Bell has found high dosage ecstasy pills.

"Three or four doses in one, that's what the market looks like."

The first deaths from synthetic cannabis were men living rough.

"In those scenarios," he says, "they might have had alcohol problems and their health is already compromised so when they add a highly toxic substance like synthetic cannabis, I think heart failure is one of the consequences of it.

"People with money can afford better drugs," says Bell.

Supplied Jan Spence, Manager Alcohol & Other Drug Services at Christchurch City Mission, says says the city is in a drug crisis with synthetic drugs and soaring methamphetamine use among people of all ages and "all walks of life".

Does New Zealand have a synthetic drug crisis?

"You can't deny the problem, New Zealand has nearly the highest death rate from the drug in the world - is that a definition of crisis?," says Dr Vicki Macfarlane, Auckland-based lead medical officer CADs Detox.

"A literature search revealed that around the world there have been 15 deaths in Russia in 2015, three deaths in Australia, three in Germany, 28 in Europe (from 2016), in the UK two deaths and the US maybe around 20. For a small country like New Zealand, 45 is a lot of people. Clearly alcohol causes a lot of harm but the number of people dying from synthetic cannabinoid-related deaths is very high."

'CLEANING UP THE METH'

It's 9.30am on a Wednesday and the waiting room at the Christchurch City Mission is full of people wanting help with food, homelessness, addiction or a combination of all three.

Jan Spence, mission manager of alcohol and drug services, says the city is in a drug crisis with synthetic drugs and soaring methamphetamine (meth) use among people of all ages and "walks of life".

Last year her segment of the mission helped 1960 Cantabrians and people from other South Island regions with addictions.

Numbers are higher this year. From January to July 2017, the mission had 1280 people through its addiction services. This year, it was 1500.

"Cheap meth is flooding the market," says Spence. "It's widely available and it's cheap so more people are using it."

Fiona Bell, a youth and adult AOD case manager, agrees.

"It used to be that people would pass around a joint at parties, now it's a meth pipe."

Shaking his head, youth and adult AOD case manager, Brian Johnson, says he regularly meets 20-year-olds who are dealing meth.

"It's not like THC, you have to have it more often so because you're using a lot, you've got to fund it and you end up dealing it," he says. "I see 20-year-olds dealing meth so they can afford it. It's across the board, high-functioning people in the community. A lot of workmen are pawning their tools to access their drugs. It's dangerous because gangs control it, if they don't toe the line..."

Bell agrees New Zealand has a major meth problem.

"Many treatment centres around the country are now saying meth is the main drug causing the problems. Alcohol is still the number one cause of harm in many places. Meth used to be further down the list but now it's at number two or is number one, the main drug of problems."

'URINE TROUBLE'

Addiction specialists say the introduction of workplace drug-testing has seen users move from cannabis to synthetic substances.

"Young people who are working... males will use it because it can't be identified in a drug test, that's a biggie for people," says Johnson. "They would rather use natural THC but because they get drug-tested they use synthetics, which can be 380 times stronger than natural cannabis, very powerful, very dangerous and often we don't know what's in it."

Users can buy Quick Fix fake urine, for $55 including GST, from sites like Wicked Habits, where it is advertised as "unisex, undetectable and guaranteed".

Raewyn Birkett, a detox nurse who works in the community and also at Thorpe House in Christchurch, says synthetic cannabis use is a "huge issue".

"We are always busy," agrees Jan Wheeler, adult AOD case manager. "We also see walk-ins in a roster system and it's my turn today from 1-4pm. It's only 10am but I've been told there's already someone waiting to see me."

A matter of "serious concern", adds Birkett, is young pregnant women using synthetic cannabis.

"I've just had a referral for a woman who is 35 weeks pregnant... it used to be that we were just worrying about alcohol pregnancies, now it's meth pregnancies, synthetic cannabis pregnancies too."

Those addicted to synthetics range in age from 13 or 14 to people in their 60s and over.

One man I meet is 84 and trying to detox from the drug. His body is skin and bone.

A man recently had a seizure in Birkett's office.

"He was smoking synthetics on top of alcohol," she says. "For me, as a nurse, the big thing is always alcohol. Seizures are quite a big thing for us. Most of my patients are over 50 and some of them are dying.

"We have got people having seizures in the streets, ... usually alcohol-related, synthetic people also are having seizures... it's terrible and unfortunate but as a whole they are not dropping dead all around me, whereas with alcohol they are having quite life-threatening events, bleeds. It puts a lot of pressure on the hospital system; the hospital is inundated with alcohol-related people."

123RF New Zealanders are snorting everything from cocaine to ''Ritz'', Ritalin.

'BORDER TO GRAVE SURVEILLANCE'

The Unknown Substance use in Emergency Departments' (USED) programme is a unique pilot ESR runs in conjunction with district health boards.

It involves testing patients who show specific symptoms of intoxication at the Emergency Department (ED) to identify any substances that may be present. The focus is on identifying new synthetic recreational drugs as they emerge.

The programme is part of ESR's wider Border to Grave drug surveillance activities, established to identify new synthetic drugs as they enter New Zealand and track their real-time use in the community.

The insights gained from Border to Grave will be important in informing health, police and justice sector responses to new drugs, and an important part of the development of a drug early warning system.

Christchurch Hospital emergency medical specialist Paul Gee agrees alcohol remains the biggest problem in the ED but meth is quickly catching up.

"The new crop of synthetics is lethal and addictive versus meth, which is so addictive it destroys lives and families."

Gee says people aged from "13 to 60" present to the ED with health problems related to the use of meth or synthetics.

"It is very common to see seizures and collapse after synthetic use. Occasionally I see heart problems, palpitations, chest pain - serious heart problems are rare but they collapse and die so don't make it to ED."

Some days, the ED can deal with "three to five" cases.

"We can only identify patients who are in ED because of direct drug use. It's the tip of the iceberg," says Gee.

Macfarlane has presented seminars around New Zealand on new synthetic drugs for addiction sector workers.

"Following the deaths in Auckland last year I was asked to do something to upskill everybody. The first presentation was held in September last year, have done it again at Auckland Hospital and Hillmorton."

She says some of the synthetics that emerged in Auckland last year were "incredibly potent", particularly the so-called Zombie drug AMB-FUBINACA.

"The seizures from synthetics are prolonged, terrible ... they typically last for four or five minutes. People are agitated, throwing themselves around, not alert or awake.

"I would imagine that a lot of the people were dying of asphyxiation due to the seizures, I could imagine they would obstruct their airways during one of those seizures."

Any short-acting, potent drug like synthetic cannabis means people become physically dependent quickly and it is really hard to stop.

"It's so short-acting they need to use every hour of the day and night."

123RF Roseanna* says she prefers to smoke meth but others choose to inject it. Meth use is becoming an increasing problem in New Zealand.

'CRYING ON A METH PIPE'

Roseanna is in her early 30s. A high-functioning meth user, she hid her addiction while working in a government sector job.

"I smoked meth because it is easier to get meth than it is to find weed."

In a relationship with a gang member, and dealing meth herself, she observed the way meth united gangs.

"There is no rivalry in the gangs when it comes to meth," she says. "Cobras, Tribesmen, Mobsters... At the end of the day if they have got none they end up picking up some. I was involved with Black Power, Killer Beez, Mobsters, those were my go-tos. Often the Killer Beez would drop off meth to the Mobsters to help them start off again."

A gram of meth, at street value at top end, is $600.

"If you were closer to the cook or, say for the likes of higher-up gang members, it is $450 bottom end. A dollar bag, a point, is $80 in some places."

The home of one Christchurch dealer was raided twice by two different gangs, she says.

"Her son showed me the bulletholes in her fence."

She's been clean for two months but has "slipped up". When she did she found herself "crying on the end of a meth pipe".

When you are burning the pipe, she says with a hungry glimmer in her eyes, if it is yellow or brown it's been cut.

"Sometimes they might have added glucose or a bit of Ritalin in there to make the size heavier for the scales. Ritz is big in Christchurch with people snorting it. Meth, if it's pure, should come back clear, it should be a pillowy white. You should get a feijoa taste come back, then you know you're close to the pure."

She admits she's had some "funny-tasting" meth.

"Some tasted like battery acid, some tasted like perfumes... A meth user's game is to get close to the cook, the closer you can get to the cook the cheaper it is and the more pure it is, the further down the chain the more cut it is going to be."

Gang members are manufacturing meth themselves but they are also paying, and sharing, meth cooks.

"I know in a particular case a cook wasn't assigned to a gang but he had different gangs coming to him, paying him top dollar, to make the cook so he was cooking for a load of different gangs."

She recalls sitting in car in a driveway of one gang's Wellington headquarters when, past the windows, she saw arch-rivals the Mongrel Mob walking past the car.

"I thought 'shit, something is going to go down now'," she says. "But they were just there to buy meth."

Those in debt to the gangs have their cars or, as she'd seen in Wellington, their homes taken from them.

"Go to the police and you face a boot ride," she says. "I've seen that happen over a $3000 debt."

FLUSHING OUT DRUG USE

Supplied John O'Keeffe, manager of the National Drug Intelligence Bureau, says one of the major benefits of its Border to Grave project is that provides identification of new drugs entering the market and trend analysis in a "dynamically changing drug environment".

Manager of the National Drug Intelligence Bureau (NDIB) John O'Keeffe, says the drug market is "dynamic and changing all the time".

"Unfortunately countries around the world create synthetic drugs quite easily and quickly."

O'Keeffe cites manufactured "synthetic drugs, pills and powders" as the biggest change in our nation's drug environment. His biggest concern is the harm they are causing. He works closely with the Ministry of Health to minimise the harms they cause.

He is particularly concerned with synthetic cannabis: "people do not know what they are taking". They don't know its strength or effects and these drugs are leading to deaths among the synthetic cannabis-using community.

Working closely with the New Zealand Customs Service, O'Keeffe says there is no standard MO to smuggling drugs. "Pens... children's toys... computer equipment…. tinned fruit…. they will use any commodity, any way shape or form."

In 2016, an enormous horse's head statue covered with diamante and stuffed with 35kg of cocaine with a street value of $14 million was seized in Auckland. It led to the arrest of a 29-year-old Mexican man in Christchurch.

O'Keeffe says the drugs most frequently seized in 2017 by volume were:

* Methamphetamine precursors (Ephedrine 697.7kg and Pseudoephedrine 25.2 kg) – 722.9kg

* Cannabis head/leaf – 637kg

* Methamphetamine – 477.4kg

* Cocaine - 108.2kg

* Synthetic cannabis (52.8kg) and synthetic cannabinoids (11.4 kg) – 64.2 kg

This year to date 32.1kg of synthetic cannabis and 1.7kg synthetic cannabinoids has been seized by police and customs.

O'Keeffe states that the three agencies of NDIB - police, health boards, customs - work closely with ESR who provide identification of illicit substances seized at the border and domestically. One of the major benefits of the Border to Grave project is that it provides identification of new drugs entering the market and trend analysis in a "dynamically changing drug environment".

To assist in understanding the drug environment, NDIB, on behalf of New Zealand Police, initiated a pilot programme for testing drugs in the wastewater.

Wastewater analysis is a technique for detecting substances consumed by a population. The method functions on the premise that human bodies transform drugs into metabolites once consumed.

The value of testing wastewater is cumulative; meaning greater insight is provided as more data is collected because long-term trends and deviations become evident, which facilitates harm reduction activity.

"Results in Christchurch shows that 87 grams of meth is being used on average per day," says O'Keeffe. "Wastewater analysis shows us that drug consumption for meth in Christchurch has shown a slight increase in usage. The price of methamphetamine is decreasing, no doubt about that."

The purity of methamphetamine arriving in New Zealand is "very high".

FENTANYL FUTURE?

The United States is in the grip of a drug epidemic. Drug overdoses killed around 72,000 Americans last year. By comparison, in 2016, 40,200 deaths in the US were attributed to car crashes.

Fentanyl, the drug Prince overdosed on, is 50 times stronger than heroin and is causing havoc in the US.

An analysis of opioid-related overdose deaths found synthetic opioids, such as illicit fentanyl, have surpassed prescription opioids as the most common drug involved in overdose deaths in the US.

Could that happen here?

"There's nothing to stop that happening," says Ross Bell.

"If fentanyl did make its way here onto the black market we are not prepared. We would see the same problems as Canada and North America. New Zealand is not prepared - the synthetic cannabinoid deaths have highlighted that."

However, there are reasons fentanyl may not hit these shores, largely due to the pattern of drug-use around prescription drugs in the United States.

"It isn't the same here... there are a few reasons why the fentanyl crisis may not happen here but there is nothing stopping it from coming here."

O'Keeffe is well aware of the danger of fentanyl.

"New Zealand is not America or Canada, we don't have a large opioid-using community... we have very good controls around prescription prescribing and border controls," he says.

"However, we are continually monitoring the drug markets overseas, working with offshore partner agencies to ensure this drug does not enter the illicit drug market in New Zealand."

WEAPON OF CHOICE

A spokesperson for the European Monitoring Centre for Drugs and Drug Addiction said its new drugs experts "don't have overall figures on synthetic cannabinoid deaths in Europe".

However, synthetic cannabinoids it has risk-assessed recently over deaths include AB-ChMINACA, 5F-MDMB-PINACA, CUMYL-4CN-BINACA, ADB-CHMINACA and MDMB-CHMICA.

The Euro-DEN Plus network monitors hospital emergency presentations. In 2016, the number related to synthetic cannabinoids increased from 28 to 282.

Vienna-based Reka Furtos, of the United Nations Office on Drugs and Crime (UNODC), said while data on deaths related to synthetic cannabinoids may be available at the national level in some countries, it is not systematically reported to UNODC.

"The two countries from where we have such information are Hungary and Turkey. In 2016 Hungary had reported seven deaths and Turkey 137 deaths due to synthetic cannabinoids. For the year 2016, Italy reported a total number of 117 fatal drug overdoses for drugs under national but not international control. This category includes many of the synthetic cannabinoids, in addition to several other drugs, such as synthetic cathinones that are not under international control."

In New Zealand a Coronial Services spokesperson says there are 40-45 cases nationally which provisionally appear to be attributable to synthetic cannabis toxicity, since June 1, 2017.

KATY JONES "Point bag" or ''dollar bag'' of crystal methamphetamine which New Zealanders pay around $80 for.

Asked if Christchurch man Jason Watene was included in those 40-45 cases, the spokesperson replied: "This case is active before the coroner."

There is a joint inquiry into a number of the deaths. Investigations are continuing and no decisions have yet been made in regards to a hearing.

The spokesperson added that the police and coronial investigations are at any early stage, and the exact causes of death have yet to be established. All of these cases have been assigned to Coroner Morag McDowell, to ensure all of the available information is before one coroner who can then liaise with other agencies.

While the Chief Coroner approved the release of updated numbers to the media, this is the only data that has been approved to be made publicly available. The Chief Coroner has not approved the release of the data broken down by location.

FINDING A FIX

"This is a health issue. These problems are concentrated among poorer New Zealanders," says Ross Bell. "Do I think the response would be different if the people who were dying were rich? Sadly, yes I do."

He says we need to support those on the frontlines.

"Maybe we will realise we can't arrest our way out of the problem. We need a different approach and maybe that will emerge as a result of the current health crisis."

*****

A grimy hand reaches up, pulls the rubber band free from her hair, which tumbles loosely around her face.

Strands of hair are caught in the rubber band and, as she disentangles them, the strands of hair float gently to the ground.

With a deft motion she sweeps her hair up again into a ponytail.

She shouts defiantly to someone across the street that she is on her way to the City Mission to get "a feed".

A man with leathery skin and tattooed tears cascading down his face walks up and they slap their hands together in greeting.

That morning she had talked to me about how frightening it was to have a friend die from synthetic cannabis.

Now it's the afternoon and she's looking to score.

SEIZURES:

The Red Cross free first aid app has a video on their app around seizures and how to respond https://www.redcross.org.nz/first-aid/first-aid-app/

https://www.stjohn.org.nz/First-Aid/First-Aid-Library/Seizures-or-Convulsions/

https://www.drugfoundation.org.nz/news-media-and-events/did-you-know-the-facts-about-synthetics/

WHERE TO GET HELP:

The Mental Health Foundation's free Resource and Information Service (09 623 4812) will refer callers to some of the helplines below:

* The Alcohol Drug Helpline - 0800 787 797

• Lifeline (open 24/7) – 0800 543 354

• Depression Helpline (open 24/7) – 0800 111 757

• Healthline (open 24/7) – 0800 611 116

• Samaritans (open 24/7) – 0800 726 666

• Suicide Crisis Helpline (open 24/7) – 0508 828 865 (0508 TAUTOKO). This is a service for people who may be thinking about suicide, or those who are concerned about family or friends.

• Youthline (open 24/7) – 0800 376 633. You can also text 234 for free between 8am and midnight, or email talk@youthline.co.nz.

• Your local Rural Support Trust – 0800 787 254 (0800 RURAL HELP).