Barriers for life-saving antidote questioned as opioids kill as many people as synthetic cannabis

Around 35 people die annually accidentally overdosing on opioids, including prescription drugs such as morphine, codeine, tramadol and fentanyl. Photo / 123RF

During the discussion around how to reduce synthetic cannabis deaths, another family of drugs has been killing just as many people, every year.

Around 35 people die annually accidentally overdosing on opioids - the group which includes prescription drugs such as morphine, codeine, tramadol and fentanyl, as well as their illicit analogue, heroin.

The legal ones are used as pain relievers, and administered commonly in hospital after surgeries or injuries.

They're work as pain relief well, but they're also addictive, at varying levels, and at high enough doses, deadly. Effects include a feeling of relaxation, and endorphins are released. There's a small black market for opioids.

The Drug Foundation says about one person a week is dying from these overdoses while a life-saving antidote is stuck behind Government bureaucracy and excuses.

Naloxone, known by its brand name Narcan, quickly reverses an opioid overdose. It buys people time to get to a hospital for more treatment.

"It's essentially a miracle drug," said Ross Bell, executive director of the Drug Foundation.

Opioids are the centre of a crisis in the United States. In 2017, they killed 50,000 people - five times as many as in 1999. President Trump's declared it a national public health emergency.

About half of US opioid overdoses involve fentanyl, which was involved in the deaths of Prince, Tom Petty, Heath Ledger, and recently Mac Miller.

Here, the victims of opioid overdoses are most commonly men between the ages of 40 and 60.

New Zealand doesn't have the same rates - 353 known, accidental deaths between 2006 and 2015 - but we do have the same reversal agent available in Naloxone to stop some overdoses, wihch St John paramedics have on hand when needed.

About 50 people have died from synthetic cannabis in the past 18 months.

Bell said while we're grappling with that, tragically, the same number are passing away from opioids, which attracts far less attention.

The Ministry of Health's Medicines Classification Committee recommended in 2016 that naloxone be made available at Needle Exchange Programme locations without a prescription.

This is where people who inject drugs - often opioids - get clean and safe needles, and have done since the 1980s - exactly the place an antidote for those drugs would be worthwhile to have on hand.

But it hasn't happened, two years on.

In a letter to Bell, the Health Minister David Clark said there are legal obstacles for doing so, and that the Ministry was trying to work through these.

"I agree that the availability of naloxone through Needle Exchanges and OST (Opioid Substitution Treatment) services would be advantageous," Clark wrote in the letter.

"The barrier to supply by this method is they cannot hold, repack or dispense prescription medicines under the current Medicines Act 1981."

To make it happen, Clark said Ministry officials are trying to work with pharmaceutical companies, who might offer naloxone in a different form, so it can be reclassified more easily.

"However for commercial reasons, companies may still decide not to supply due to New Zealand's very small market size."

The Ministry is trying to attract private offers, but two years on, no company has taken up the offer.

Former associate health minister, Peter Dunne, worked on removing the restrictions before he left office and the Labour-led Government took power last year. He was hopeful, with more time, that he and his officials would have been successful.

"I think these obstacles could been overcome, and should have been overcome," he said. "I didn't see that as unable to be resolved.

Police Minister Stuart Nash has warned that we must prepare for the high-potency fentanyl arriving here in greater, illicit quantities. He's taken it seriously enough to travel to Mexico and the US to learn about it.

"It is cheap, it is nasty, it's highly addictive, it's synthetic, and it will kill people. We've got to make sure that we're ready," he said on his return in February.

Dunne says making naloxone available is exactly the sort of preparation this Government should be making now.

"I began work on this over two years ago. What might have been reasonable excuses at the beginning certainly aren't excuses any more. It should now be resolved, and naloxone made more freely available."

The executive director of the Needle Exchange Programme, Kathryn Leafe, has been crying out for naloxone to be available for a long time.

"Every overdose death is preventable," she said.

"We've been arguing and advocating for a long time that naloxone should be free and widely available in New Zealand.

"It needs to be in the hands of people who use drugs, and their families and friends."

Bell said in the two years naloxone hasn't been available after the recommendation, there have been "many, many deaths".

"More than we've had with synthetic cannabinoids.

"There's been a real bureaucratic problem. Why isn't there urgency? Is it because we actually don't care about people who use drugs?"