From Science Media Centre, New Zealand
February 4, 2018
Dr Jeremy McMinn
Consultant Psychiatrist and Addiction Specialist
The United States is in the midst of an epidemic of deaths due to opioids and a New Zealand pathologist says that we should be taking heed.
He says that opioid drug misuse appears to be increasing worldwide and that puts New Zealand at risk of a similar drug death epidemic.
Because drug overdose deaths currently fall under the jurisdiction of the coroner, there is a lag before statistics of such deaths are publicly available.
This could slow down a public health response if there was a sudden rise of opioid-related deaths or a new, deadly illicit opioid was being used in New Zealand.
Early warning system
An early warning system designed to trigger a rapid public health response sounds good in principle. It could be conceived as a feedback loop in a system waiting in readiness to respond quickly and flexibly to a new threat.
If this is a priority, it suggests that we are already sufficiently good at responding to the more substantial known threats. This is not the case.
Despite our efforts, the evidence suggests we have not stemmed New Zealand’s steadily increasing prescription of potent opioids. We are slow to learn the lessons from abroad, unthinkingly accepting Oxycodone into our prescribing despite over a decade of warning signs from the US.
Kiwis behind Australians
We are behind the Australians in making steps to restrict our rising codeine use, when this has been an obvious step for the last five years.
We can have no confidence that we have made headway with the 1000 deaths per year directly attributable to alcohol.
We allow our suicide rates to rise, knowing the crucial part alcohol plays in so many.
There are obvious ways crying out already to reduce drug harms but left undone.
Let us pay attention to what we already know needs to be done.
Dr Paul Quigley
(Emergency Medicine Specialist, Wellington Hospital)
“This is very interesting work, though already very well-known information. The ‘opioid crisis’ has dominated international conferences for the last 2 – 3 years and is regarded amongst the Drug and Alcohol community as the leading prescribing-based problem of the 2000s.
Varied and Proportional
Opiate-related presentation is very variable throughout New Zealand and is proportional to the prevalence of users in the community and the level of access to opiate treatment programs. In Wellington, for example, it is very rare for us to have opiate over-dose presentations, Auckland has more.
However, it is very important not to confuse the issue with casual recreational drug use and the rise of the new psychoactive substances.
The opiate crisis overseas was almost completely created from prescription-based opiate addiction from doctors. The rapid rise of the prescribing of synthetic opiates like oxycodone for simple injuries without taking into account the potential for addiction led to the mass of prescription-based addiction.
Then, particularly in the USA, knee-jerk prohibitive legislation after some high-profile celebrity deaths aimed at preventing and penalising prescribers was done without also providing treatment services. For those users now cut-off from prescription opiates, it saw a huge swing from controlled use to street use. The rise was so great that the dealers struggled to provide enough heroin, morphine etc. and started substituting with Fentanyl.
A very small dose goes a long way, but in naïve users leads to death.
Avoidable problem
Currently, we have a very stable opiate-using community that has traditionally stuck with morphine or diverted methadone. There are, of course, oxycodone and other users but these remain small due to diligent prescribing practices and a strong position from the specialist colleges on the harms of opiates.
As long as we continue to recognise that doctors are the biggest opiate drug dealers we will avoid many of these problems.
Key elements
A united change to the language of pain relief. We cannot make you ‘pain-free’ (only an anesthetic can do that) but we can make your pain manageable.
DHB- and MOH-led campaigns on safe prescribing both in hospital and on discharge. Limiting the accessibility of oxycodone and other synthetic opiates
College-based programs of a similar nature especially the support of the College of GPs.
Diligent management of restricted prescribing and dangerous drugs scripts through Medsafe and pharmacies.
Providing robust and easily-accessible opiate treatment clinics such as methadone or suboxone for those who are already addicted.
Providing Naloxone to high-risk users and to the needle exchange clinics and first responders significantly reduces the risk of death related to opiates.
As for early warning networks, they are invaluable for detecting changes in the drug market and for the dissemination of emergency information to first responders and enforcement agencies.
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Image Credit: Science Media Centre
