Fentanyl prescriptions double in New Zealand despite warnings

The number of prescriptions of opioids like morphine are increasing. Photo / File

The prescription of strong opioids is continuing to rise in New Zealand with the use of fentanyl more than doubling, despite experts around the world warning of the dangers of the drug.

New data from the Health Quality and Safety Commission has shown the number of people who were prescribed a strong opioid (fentanyl, methadone, morphine, oxycodone or pethidine) at least once in a year had risen from 63,000 people in 2011 to 77,000 people last year.

Nationally, almost 17 people in every 1000 received a strong opioid, with most receiving morphine (11.2 per 1000). On average 1.8 people in every 1000 people received fentanyl – up from 0.77 in 2011.

Dr Alan Davis, chairman of the Health Quality and Safety Commission's opioid expert advisory group warned that while opioids were highly effective in managing certain types of pain, they could also cause harm.

"This might include nausea, constipation, delirium, hypotension, addiction or even potentially life-threatening over-sedation and respiratory depression.

"Strong opioids are very effective at managing pain – but evidence shows the longer they are used, the less effective they are."

Fentanyl, an addictive synthetic opioid more than 50 to 100 times as potent as morphine, has recently become the largest cause of drug death in America.

The death of popstar Prince in April last year was caused by fentanyl, sparking warnings from doctors about the drug.

Opioid addiction and abuse, including fentanyl, have become such a problem in America that President Donald Trump declared a public health emergency to combat the opioid crisis in October.

While the problem may not be as widespread in New Zealand, it is still an issue and new figures showed no slow down in the rate strong opioids were being prescribed by doctors around the country.

The commission's figures showed 8368 people were prescribed fentanyl last year with the figures steadily trending up from 3410 people in 2011.

Of the more than 8000 people prescribed fentanyl in 2016, almost 2000 were dispensed the drug for six weeks or more.

For the last three years, the rate of prescription of the drug was highest in the Whanganui District Health Board, followed by the Bay of Plenty then Capital and Coast.

In Whanganui last year, the rate of fentanyl prescriptions was 5.2 per 1000 people – almost triple the national average.

Executive director of the Drug Addiction Practitioners' Association of Aotearoa-New Zealand Sue Paton said the increase in the rate opioids were being prescribed was a concern, especially when it came to drugs like fentanyl.

While some people could use the drugs for pain management without issue, there would always be a percentage who developed an addiction to it, she said.

Paton said she believed the amount of opioid abuse in New Zealand was probably underestimated.

There were about 5300 people on the opioid substitution programme in New Zealand although she estimated there were about 50,000 Kiwis addicted to the drugs.

The increase in the rate of fentanyl prescription was of particular concern, she said.

"Fentanyl is a very powerful drug; it's quite easy to overdose on. It's certainly a drug that we should be wary of."

While she understood people in pain needed some sort of relief, she did not see the rationale behind the increase in fentanyl use. "Most people could be managed with other equally effective opioids that maybe are less high risk than that," she said.

She said attention did need to be given to the difference in rates of fentanyl prescription between district health boards to see why it was used so much more often in some areas than others.

Fentanyl
• A fentanyl high is similar to heroin providing reduced feelings of pain, euphoria and relaxation
• Respiratory failure is the most common cause of death in those taking the drug.
• It is usually administered using a patch. One patch lasts about three days.