Fentanyl—Australia must learn from the tragic toll in the US and Canada
24 Jul 2017|

There are lessons for Australia in the soaring death toll across the United States and Canada from the potent opioid fentanyl. Over the past five years, easy availability at relatively low prices has made this synthetic drug much more accessible on the streets and it has replaced heroin for many users and addicts.

Believed to be 25 to 50 times stronger than heroin, fentanyl was designed as a prescription drug to relieve the intense pain of patients such as cancer sufferers. The fentanyl causing carnage on the streets is primarily produced in illegal laboratories and sold on street corners.

Since 2014, the US and Canada have recorded steep increases in illegal fentanyl use, resulting in accidental overdoses and deaths and triggering fear in the drug use community as well as among law enforcement and health professionals. Some jurisdictions have identified a 400% to 700% rise in opioid overdose deaths. Government, law enforcement and health officials have responded on several fronts. It’s now illegal to possess precursor chemicals (ingredients) for fentanyl in Canada, and health agencies like the Centers for Disease Control and Prevention in the US and Health Canada are providing strategic advice to state and provincial authorities on how to combat the drug’s impact.

The US Drug Enforcement Agency and Royal Canadian Mounted Police have focused considerable effort on reducing the volume of precursors being shipped from China, a key source of ingredients. At the urging of US officials, China has taken steps to stop exports, at least to the US.

Few in Australia would have registered that illicit fentanyl was such a problem until it was implicated in the accidental overdose death last year of pop star Prince.

Meeting the challenge Australia faces in combatting fentanyl won’t be easy. The Australian Border Force has warned that the drug’s potency could cause a wave of unintended overdose deaths here, on a similar scale to those in North America.

The president of the Australian Drug Law Reform Foundation, Alex Wodak, said last year that the deaths of 13 drug users in Sydney could be related to the arrival on that city’s streets of drugs boosted with fentanyl. NSW Coroner Michael Barnes issued a warning about a deadly batch of heroin that appeared to be causing overdoses. Victims were overwhelmed very quickly and were found with syringes still in their hands.

There’s much to be learned from the tragedy in the US and Canada. They were slow to take the threat seriously; local authorities raised concerns but national authorities ignored the country-wide impact fentanyl would ultimately have. Australia has one key advantage, as it has been combatting a flow of illegal methamphetamine and precursors from China for many years. With China continuing to be an exporter of fentanyl precursors into a number of countries, the head of the Australian Border Force, Roman Quaedvlieg, has warned that the ‘dark net’ is being used to provide the same access into Australia.

The fentanyl precursors typically being shipped from China are in powder form and are used by illicit Australian manufacturers to either lace the narcotics they already produce or to manufacture other opioids, sometimes using pill presses to simulate prescription drugs such as oxycodone. The manufacturing and sale of counterfeit pills is also resulting in accidental deaths since they’re being made without the pharmacological scrutiny that controls production of legitimate medication. The challenge with more commonly used illicit drugs being laced with material such as fentanyl is that the user seldom knows what they are taking, which increases the chances of accidental overdoses and death. Users who believe they are buying a genuine drug may inadvertently take too high a dose because of the inexact production methods.

Australia has a head start in dealing with this scourge, in that it can immediately urge Chinese authorities to stem the flow of precursors now being sourced by illicit manufacturers. Australia can also look to Canada and the US for strategies that have helped ease the damage there, including improving access to naloxone, which can temporarily reverse the impact of an opioid overdose, saving the victim’s life. It has been used thousands of times in the past year in Canada and is now widely available—police, paramedics, fire services, and even schools and the public commonly carry kits that contain the life-saving drug.

Educating the broader Australian public will also be crucial. Many of the victims of fentanyl overdoses are occasional drug users, not hardened addicts.

Sometimes, law enforcement and health authorities are given the opportunity to learn from other nations’ fatal mistakes. If Australia is willing to engage, learn and take this challenge on early, it will have a good chance of saving lives.