American opioid crisis part 3

 

Is New Zealand prepared or able to cope with an impending opioid crisis or are we doomed????

So far NZ has escaped the opioid crisis that has claimed thousands of lives overseas, but should that change we are grossly underprepared. So what is holding up the supply and availability of the overdose reversing medication Narcan?????

NZ appears not much closer to widespread availability and distribution of the life saving drug Narcan ( Naloxone) which reverses the opioid overdoses, despite years from lobbying agencies and harm reduction experts and efforts from the ministry of health ( MOH).

4yrs ago opioid overdoses in NZ were 40 lives a year, last year that number jumped to 156. There is a risk NZ will most likely face an opioid crisis like America, Canada and Europe are currently experiencing.

Overseas there are tens of thousands of deaths caused largely by prescription opioids, heroin, and the alteration of other drugs like MDMA and meth with a powerful opioid called fentanyl and it’s sister off set versions.

In NZ we risk a similar situation emerging without the capacity to respond in time because of a lack of Narcan being available. Recent reports of a local doing home bake heroin also added urgency to the issue.

Overseas you have widespread take-home Narcan kits for people, for those who use opioids, all first responders including police and firefighters. In NZ St John ambulance staff carry Narcan but the police do not.

In Australia a 3yr pilot program has seen positive results. Narcan distribution has also meant helpful conversations and relationships have been formed between people who use drugs and the pharmacy , doctor, or non profit giving it out for free.

Since covid -19 lockdowns all ambulance staff carry Narcan and there is some broader supply available largely thanks to a swift one-off funding measure. As a result Narcan was able to be purchased by the opioid treatment services ( OTS) around the country and in turn distributed to about ¾ of needle exchange clinics.

“This interim supply is welcome and will help reverse overdoses and save lives”. However we have nowhere near the kind of widespread availability we need to deal with the kind of events being witnessed overseas. Even the availability we do have is temporary because the funding source is now closed and the existing stocks will expire. The situation is a mix of terrifying and baffling.

Usually in these situations an organization like the drug foundation might simply lobby a minister or ministry and garner action that way, but lack of support isn’t standing in the way, although much more could be done. The main problem is the disjuncture in our health system between MOH, medsafe, Pharmac, pharmaceutical companies and those who may be able to distribute and /or use it like DHB’s, police and the needle exchange or St John.

A recent reports in the international journal of drug policy also said New Zealand was “grossly underprepared” for when the opioid crisis hits.

A glance of Narcan availability in NZ …

In 2019 nasal spray was approved and made available for some crown agencies.

In 2020 – emergency measures were put in place leading to a limited temp supply of narcan in OT’S and ¾ of all needle exchanges.

Also an emergency kit containing 2 nasal sprays were approved for sale without prescription. However because Narcan kits aren’t funded it costs $92 and therefore making it out of reach for many people, it’s also difficult to source.

Narcan injections continue to be available by prescription only which means they can’t be distributed widely to the populations who need them and in most cases not funded by pharmac, St John’s vehicles staffed by paramedics carry Narcan but NZ police even now have not yet obtained a supply.

Overseas warnings….

Frustrations at the failure to get Narcan to be more freely available has intensified with concerns NZ could face a rapid onslaught of overdose deaths as seen in America as of recent.

In Canada there has been an uptake in deaths due to fentanyl laced drugs, people took what they thought was MDMA and it was actually a stronger opioid laced with fentanyl and they start overdosing immediately.

A sharp increase in deaths in the space of a few weeks meant Canada upscaled the distribution of Narcan quickly training whole groups of people on what to do if their friends were overdosing.

NZ could face a similar destructive crisis when the supply of drugs like MDMA, meth and cocaine start to become altered with fentanyl ( which will happen soon since NZ's drug supply is coming directly from the Mexican Cartel and they are mixing all their drugs now with fentanyl). Altered drugs will cause a rapid increase in hospitalizations and deaths among people who weren’t expecting to take a powerful opioid, a situation our current Narcan arrangements would leave us poorly prepared for, the current situation means we wouldn’t have enough Narcan in the community or the ability to rapidly distribute it if we needed to.

When the solution to a health issue is likely to be less lucrative, as in this case the system just doesn’t work. The MOH has tried a number of things to push supply forward, but the nation is not significantly closer to getting Narcan out to all the people who need it. Among problems still remaining is that while Narcan nasal spray doesn’t need a prescription as part of an emergency kit, it’s expensive and isn’t funded if we want to take disaster preparedness seriously.

In NZ decisions about funding medicines go thru Pharmac, there seem to be endless hurdles to get through, we also need DHB’s to be legally able to purchase and distribute emergency kits – at the moment the rules around who can buy them and distribute them seems “complicated” to say the least.

Even though Narcan nasal spray emergency kits are apparently available as ‘general sales’ when we rang several pharmacies recently 98% hadn’t even heard of it, 2% had but they all said their wholesalers also didn’t stock it, - so it’s not necessarily easily available even when you go hunting for it.

 In Australia they’ve got outreach workers who wander the streets dishing out Narcan kits and this is a general approach in most other countries. People who use illegal drugs are discriminated against and many believe that this is the reason holding up resolution. Many people who use banned drugs usually have pre-existing issues – they may have been abused, in care, fostered, some have learning difficulties, some are suicidal or homeless and some are people who got addicted to pain medication and when those were no longer able to be obtained they turned to illegal drugs. ( NZ still gives out oxicotin in strengths 20, 40, 60 and 80 – this drugs is illegal and banned in most other countries around the world cos of how addictive and dangerous it is this is the drug that started the opioid crisis)

And then those that admit they use opioids or have used them have consequences they face. A man admitted to hospital for a broken bone admitted he had used opioids before and the nurses withheld opioids for his pain. We also need the ‘Good Samaritan Law’ bought in to end potential arrest for helping a person who uses drugs. A man took someone to a phone box who was overdosing called for an ambulance and then left stating he didn’t want to be arrested when the police arrived.

Narcan is the ‘miracle drug’ that saves lives and is harmless. Just like other life saving equipment we need to have it available. “There is someone dying every week of this – this is a life-saving issue”, it’s a no brainer.

Most people are going to feel comfortable using Narcan nasal spray if they’re coming to the aid of someone who is overdosing.

The Australian pilot program ( Take home Naloxone) was funded by the Australian government after the pilot program was estimated to be saving 3 lives a day between 2019 and 2021. Nasal Narcan is free to anyone without a prescription in Australia, who may experience or witness an opioid overdose.

PTAC – is a committee of senior health professionals that provide clinical advice to help Pharmac make funding decisions. It’s recommended actions from last months meeting will be published sometime in June, at which point Pharmac will consider funding.

Statistics…

1179 people died of accidental drug overdoses between 2016 -2023

Over 1/3 of all Opioid overdoses were cases involving fentanyl.

Ages of data collected is from people 15+yrs

Between 2014 to 2023,

6,5214 people died in hospital from drug poisoning.

Young people are more likely to need a hospital for drug poisoning ages 15-24 had the highest rate of poisoning with 12,040 from the years of 2016-2023.

As of August 31st 2024 studies show that NZ is losing 3 people a week to drug overdoses. Overdoses that could be prevented if Narcan nasal spray kits were readily available.

The opioid crisis is coming to NZ it’s just a matter of when….

As a country that still hands out oxicotin for pain we should be considering banning it like other countries besides it being highly addictive the side effects when people try to withdraw from taking it is the reason why people turn to street drugs – they get cant handle the withdrawl symptoms their body also creates phantom pain so they feel they need it. The big Pharma company that created oxicotin was sued 6 billion dollars for their part in the making of the opioid crisis.