The synthetic opioid fentanyl left 70,000 dead in the US last year. Photo / 123rf
Fentanyl has wreaked havoc in the US and after a powdered version of the drug was found in New Zealand for the first time last week, there are fears it could spell the start of more overdoses here. Katie Harris asks what we can learn from the US experience?
Dr Susan Gail Sherman was surprised when I told her powdered fentanyl had been found in New Zealand.
The Johns Hopkins University public health professor was shocked when she saw my email, not because of the discovery, but because it had taken so long to reach us.
"It's just gotten so bad here, and so widespread, so it's a very different world to what it was before," Sherman told me over the phone.
For the past few decades, an opioid epidemic has lashed the US, overdoses and deaths tearing families and communities apart.
The crisis worsened in 2015 when a drug far stronger and deadlier than its contemporaries like morphine began making waves on the illicit market.
That drug was the synthetic opioid fentanyl, which left 70,000 dead in the US last year.
One expert I spoke to this week said it was about 50 to 100 times stronger than morphine or heroin. And New Zealand police have warned just one pure gram of the substance contains 20,000 safe doses.
Given that, it's no wonder Kiwis are worried.
But the two country's situations are completely different.
For starters, the rate of overall opioid prescribing is high in North America, and while trying to curb overdoses, legal opioid prescriptions were reduced. This produced a fresh consumer base in the illicit market, leaving space for heroin and fentanyl use to expand.
Back in Aotearoa, illicit opioid use is not a large issue.
Dr Fiona Hutton, a Victoria University associate professor who studies drugs, says it's estimated about 29,000 people use opioids here, compared with 635,000 New Zealand adults using cannabis last year.
Thankfully, our country's geographic location, among other things, has bought us time when it comes to fentanyl. Like with Covid-19, we've seen the devastation play out in other nations and, if decision-makers are smart, we can learn from them.
For a country seeing the powdered drug on the street for the first time, Sherman tells me its emergence here is "super dangerous" if people are not prepared.
The first thing she says we need to do is to ensure naloxone, a medication that reverses the effects of opioids, is available easily and a large awareness campaign is undertaken.
Other than naloxone, which the NZ Drug Foundation says is low in stock here, changing the way in which we speak about drug use in society can help destigmatise users and enable people to get support.
Sherman believes this is part of a collection of "low-hanging fruit", including making testing information available to users and creating safe areas for people to use drugs, that can make a substantial positive difference.
The sage advice regarding testing comes at a good time for New Zealand as last year the Government passed a bill allowing harm-reduction organisations such as KnowYourStuffNZ to check and handle illicit substances at events openly and without fear of prosecution.
Like teaching abstinence-only sex education, many see trying to fight all drug use as futile, instead experts I've talked to emphasise that taking a health-based approach will save lives.
This is even more important with drugs such as fentanyl which, if it proliferates without greater health interventions, could kill thousands.
Importantly, Sherman says we need to use tools in our tool kit, and follow the evidence from around the world to put drug testing machines in high-use areas.
"Just being smart around what services are available where people use drugs so people have much less of a chance of dying."
Overall, and like many other drug academics, she looks at decriminalisation as a key step to reducing drug harm.
Hutton too says prohibition, like we have now, is a problem because if we had a legal safe supply of drugs then users would know exactly what they were getting and what dose to have, instead of turning to the thriving underground supply.
Perhaps unsurprisingly many policymakers are not there yet and as evidenced by the referendum on legalising recreational cannabis, which was narrowly lost in 2020, the public may not be ready to hear it either.
To their credit, Labour has improved access to support in some areas for drug users and amended the Misuse of Drugs Act to allow police discretion when prosecuting drug use and possession that allows a health approach when it is in the public interest.
However, some researchers don't think this goes far enough and even their former leader, Helen Clark, backs decriminalisation saying last year the criminalisation of most drugs was "fundamentally misguided, with devastating consequences".
"The destructive power of punitive and stigmatising drug laws continues to impoverish communities, continues to prevent people who use drugs from accessing life-saving services, and drives countless acts of police brutality and state violence in general," she said at the time.
Decriminalisation has long been championed by Green Party drug spokesperson Chlöe Swarbrick but it is not an option Labour has largely, bar medicinal cannabis, come to the table on.
During Covid-19, the party stuck to the line of following "expert advice" with the virus, but when it comes to drug use, we are yet to see their ministers take a punt on overall decriminalisation, which may initially be a hard change to sell to the public.
The opposition isn't there yet either, National leader Chris Luxon confirmed to Today FM's Tova O'Brien this week the party did not support the decriminalisation of drugs.
What research does show us, from areas that have made the step, is it does reduce harm and save lives.
There are no winners in the war on drugs, but there are losers. In New Zealand, Māori have been disproportionately affected by the criminal justice system when it comes to drug convictions.
Regardless of which party lawmakers sit in, the discovery of powdered fentanyl which left 12 in hospital in Wairarapa last weekend will have been a shock.
But the decision now sits with those in power, how long can we put up with the consequences of unregulated illicit drug use in Aotearoa and who is brave enough to follow expert advice this time round?
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