Drug Information and Alerts NZ said judging the role opioids played in overdose deaths could be difficult due to limitations in the way accidental poisoning deaths were recorded.
While a regional breakdown of deaths is unavailable for privacy reasons, Northland is not immune to the problem.
In 2021, a Whangārei woman died unexpectedly of accidental multiple drug toxicity from prescription painkillers. She had been prescribed substantial amounts of codeine and morphine (both types of opioids) for her chronic back and hip pain between 2016 and 2021.
A coroner’s report described how the woman took the prescription medicine before bed and, unusually, slept through the night. She remained sleeping the next morning.
Around 2pm, the woman was found unresponsive in bed.
Last year’s coronial inquest into her death found no proof she had been given written advice about the dosage of Sevredol (morphine), or a warning about combining Sevredol and codeine together or with other drugs.
Coroner Tania Tetitaha recommended the Ministry of Health facilitate the production of written advice on preventing opioid overdosing for patients and whānau. This included reviewing unused opioid medications, including seeking disposal.
Te Whatu Ora Mental Health and Addictions Services manager Ian McKenzie said misuse of sedative and opioid medication is seen with some regularity in Northland, as with the rest of the country.
Between January and November last year, 74 patients were seen in hospital emergency departments in Whāngarei, the Bay of Islands and Kaitāia because of opioid overdoses. Another 51 patients were treated for sedative overdoses in the same timeframe.
“Any opioid use can be problematic if it is abused, even with opioids with less strength, such as codeine and tramadol pain relief medication,” McKenzie said.
Te Whatu Ora Te Tai Tokerau has recently begun to offer a life-saving treatment, Naloxone, widely used in the United States, to all at-risk patients in Northland via the Opiate Substitution Treatment Service.
Opioid overdose medication Naloxone works by reversing the effects of opioids and, in New Zealand, it can come as an injection or a nasal spray.
McKenzie said Naloxone kits are also being supplied to needle exchange services and pharmacies throughout the region.
The NZ Drug Foundation wants better access to Naloxone, as it is an expensive prescription-only medicine restricted to healthcare professionals to order and dispense.
Opiates are supplied to patients in allotments of 10 days to a limited period of one month in New Zealand.
NZ Drug Foundation principal science adviser Emily Hughes said New Zealand generally had tighter prescribing requirements when compared with international requirements, but that could still present unintended problems.
“Although we are seeing a small growth in opioid prescriptions over the last few years, mainly for weaker opioids like codeine, New Zealand has been relatively protected from the kind of prescribing in North America that has led to widespread fatalities in that region. Although, this does not mean that it doesn’t occur in New Zealand.”
Hughes said opioids were a leading factor in overdoses, but it can’t be differentiated whether they were diverted, prescribed and/or not used as intended.
“If people are prescribed opioids for a period of time and then their access is rapidly removed, without support for slowly reducing their dose, they may be at risk of accessing illicit/black market opioids - which come with a much higher risk of overdose and contamination,” Hughes said.
In Northland, Te Whatu Ora has provided education and training initiatives for hospital staff who prescribe opiates in recent years, with measures in place to attempt to restrict drug abuse by patients.
“Supporting people to slowly withdraw from medicines is likely to have a much more positive outcome than just cutting off their access. However, this requires training and support,” Hughes said.
Drug authorities are clear that the market in New Zealand is low for synthetic opioids like fentanyl, which was discovered in New Zealand for the first time last year.
On June 26, 12 people were hospitalised in Wairarapa over 48 hours following using fentanyl being sold as methamphetamine or cocaine.
A drug with a potency greater than fentanyl, metonitazene, was also detected in New Zealand for the first time by authorities in October last year.
The National Drug Intelligence Bureau distinguished between legally and illicitly produced opioids and the different risks they hold.
“Synthetic opioids have long been among the most deadly drugs in New Zealand,” a police spokesperson said.
