Katie Harris examines fentanyl, a synthetic prescription drug 100 times more potent than morphine. Video / NZ Herald / Getty / NZ Drug Foundation
Drug overdose deaths in New Zealand have increased by more than 50 per cent in the last five years, a new report has found, as calls mount for the Government to “get New Zealand better prepared for a widespread opioid crisis like we’re seeing in other parts of the world”.
The report finds opioid overdoses as clearly the top killer at 333 deaths since 2017, and comes after the importation of two “worrying” batches of synthetic opioids into New Zealand in recent months.
One resulted in the hospitalisation of 12 people who overdosed over a 48-hour period after unknowingly consuming cocaine cut with fentanyl in Wairarapa in June.
The NZ Drug Foundation and the New Zealand Customs Service confirmed to the Herald they believe this importation was accidental and was likely smuggled into the country in a batch of cocaine that had already been cut with the opioid fentanyl before it entered the border.
“It is literally nothing short of a miracle that there have been no fatalities in the Wairarapa outbreak,” Drug Foundation executive director Sarah Helm said of the people aged 31-71 who overdosed.
It is understood authorities suspect that whoever was dealing this contaminated batch “did the right thing” and stopped selling once the overdoses started flowing into hospitals on the weekend of June 25 - 26.
“When you look at the Wairarapa case, the mix of Fentanyl was more than enough to kill people,” NZ Customs manager of intelligence Bruce Berry said.
“We strongly suspect that was a small amount of what was purported to be cocaine but with fentanyl that was imported pre-cut.”
But what was not accidentally imported was a yellow powder believed to be from crushed tablets of the illicit synthetic opioid metonitazene identified by police on October 22.
Metonitazene is estimated to be 113-121 per cent more potent that the licitly produced fentanyl - the synthetic opioid that has caused an epidemic of overdoses and deaths in the US.
The crushing of metonitazene tablets into powder is a process which enables the direct absorption of the drug into the bloodstream via snorting and is far more dangerous than the slow release absorption of the tablets.
The National Drug Intelligence Bureau [NDIB], which is an arm of the New Zealand Police, has revealed to the Herald they believe the metonitazene was intentionally imported and could be a sign of a pattern of increased synthetic opioid smuggling over the New Zealand border.
“It’s almost certain the importer knew they were importing a non-fentanyl synthetic opioid,” a police spokesperson from NDIB said.
“As the consignment was not stopped at the border it is not known how this batch entered the country. Typically, small consignments are imported via air mail or air cargo streams. The NDIB assess many non-fentanyl illicit opioids are likely manufactured in the People’s Republic of China but are often pressed into tablets in consumer markets such as North America.”
Detective Inspector Paul Newman and Customs manager of intelligence Bruce Berry. Photo / NZME
Yet, police would not comment on who was responsible for bringing in the illicit synthetic opioid metonitazene into the country, indicating “we are unable to discuss the specifics of an ongoing investigation”.
What the NDIB was clear on was that they are not ruling out the importation of this licit synthetic opioid as the beginning of a pattern to these shores.
“The NDIB note this is an increasing trend internationally that has caused significant harm. We are therefore concerned that any increase in availability internationally may create additional supply and/or demand for these substances in New Zealand,” a police spokesperson said.
“It is likely similar non-fentanyl synthetic opioids will be imported [to New Zealand] in the future. They are cheaper than pharmaceutically produced and diverted opioids on the black market. There appears to be a small market for these substances among people willing to take illicitly produced opioids to experience a similar or stronger high at a cheaper price.”
Such worrying forecasts come as the NZ Drug Foundation today releases a report that analyses coronial data from 2017 to 2021. The data shows 171 people died from drug overdoses in 2021, up from 111 in 2017.
Overdoses over the five-year period rose 54 per cent across New Zealand - an increase that in no way was accounted for by a 6 per cent increase in population in that time.
Māori are also disproportionately affected by drug harm and fatal drug overdose in New Zealand, making up 27 per cent of the total closed coronial overdose cases despite being only approximately 15 per cent of the population. This makes Māori three times more likely to die of an overdose than Pākehā.
Alcohol-related deaths have also increased considerably since 2017, from 16 deaths in 2017 to 42 deaths in 2021. There was also a sharp increase in alcohol deaths in 2020 and 2021 - more than doubling in that time - as New Zealand and the world was swept into lockdowns and social restrictions in response to the Covid-19 pandemic.
The report also shows that mixing substances is a major contributor to fatal overdoses. Toxicology reports showed that 42 per cent of people who died of an overdose over the past five years had five or more substances in their system.
Prescription and over-the-counter medications also feature heavily, with at least one medicine listed on the toxicology report in 77 per cent of cases.
NZ Drug Foundation Executive Director Sarah Helm said she “lives in fear” of a dramatic and rapid change to New Zealand’s drug profile that could leave “people dying on your doorsteps”.
Frustratingly, the non-profit charity has had to procure its own supply of the life-saving opioid reversal drug Naloxone, in the form of the easier-to-use nasal spray Nyxoid, by itself.
“Currently Nyxoid costs $92 for a box of two. We decided to take matters into our own hands because we could not continue to wait to get this out there,” Helm said.
Restrictions around injectable naloxone were also recently relaxed by Medsafe following an application by the Drug Foundation. A funding application to Pharmac for the nasal spray form of naloxone has also been made.
“Our hard work on the red tape is finally making in-roads. As of this week, my team began the process to procure some naloxone. The injectable kind, the ampoules,” Helm said.
“It’s taken about seven years to get to that point. I cried when I got the legal advice to say the new regulations we applied for were sufficient for us to be able to give it out.
Metonitazene is more potent than fentanyl. Photo / Supplied
Drug Foundation chief executive Sarah Helm. Photo /Supplied
“You have to understand, if we had a fentanyl outbreak that spread like eutylone did, we would need to be handing out naloxone far and wide. In that kind of a scenario we would be seeing young people die rapidly. We have known in that scenario, we would be buggered. My team’s hands would be tied because we haven’t had naloxone that we are allowed to give out. All we would be able to do is hope our testing prevents some of the fatalities.”
About 71,000 people died from overdosing on synthetic opioids like fentanyl in 2021 in the US, up from almost 58,000 in 2020, according to the US Centers for Disease Control and Prevention.
Since the Wairarapa fentanyl overdoses, the Drug Foundation has obtained fentanyl test strips. A proposal for a three-year pilot for an overdose prevention centre in Auckland CBD was also sent to the Government in August.
“If fentanyl becomes endemic, we will really, really need this. If that happens, and we don’t have these things in place, there will be people will be dying on your doorsteps and nothing we can do about it,” Helm said.
A meeting between the the Drug Foundation and a Government minister occurred this week, but Helm says they need Cabinet to pass a motion – an Order in Council – to give permission to set up such an overdose prevention centre.
“In the Wairarapa, a fire engine was the first on scene to one incident,” Helm said.
“Waiting for an ambulance carrying this stuff [naloxone] can be too long. The person may be dead before they get there. That is why we need all first-responders equipped with it. And it’s why, in the US they literally hand this stuff out at nightclubs and bars.”
But at this stage all drug authorities are clear that the market in New Zealand for synthetic opioids like fentanyl is low, despite being deadly.
The National Drug Intelligence Bureau was keen to distinguish between licitly and illicitly produced opioids - the different risks they hold.
“Synthetic opioids have long been among the most deadly drugs in New Zealand,” a police spokesperson said.
“The crucial distinction to make is that they have been from licitly produced and diverted synthetic opioids such as methadone, tramadol, oxycodone and fentanyl. Illicitly produced opioids pose a significantly increased risk of harm for a number of reasons. They are far more potent than many licitly produced opioids. Different tablets can have wildly varying doses both within one tablet, and between tablets in a batch.”
While the majority of the 333 opioid deaths in New Zealand since 2017 are not from synthetic opioids, both the NDIB and the Drug Foundation are open about the potential risk in the near future.
Helm indicated the Drug Foundation has been lobbying the Government to take the risk of an opioid crisis more seriously and implement an overdoes prevention policy - but it has so far fallen on deaf ears.
“New Zealand has sleepily been able to pretend it’s not going to happen. If it happens, and we face a North American-style crisis, it’ll be too late,” Helm said.
“The Drug Foundation has been trying to get New Zealand better prepared for a widespread opioid crisis like we’re seeing in other parts of the world.”
Drug Information and Alerts Aotearoa New Zealand website, High Alert, has provided a list of how to recognise symptoms of synthetic opioid metonitazene. These effects are likely similar to other synthetic opioids, and include:
