Fentanyl causes 11 deaths but drug’s market ‘not expanding’ Defence chief to stand down
Powerful painkiller fentanyl has been linked to thousands of deaths overseas, and now 11 in New Zealand.
Coronial reports released to Stuff under the Official Information Act showed fentanyl had claimed 11 lives since 2011, with a further six cases before the coroner.
In most instances the person’s death was ruled an ‘‘accidental’’ or ‘‘inadvertent drug overdose’’ or the result of ‘‘multiple drug toxicity’’.
The reports show three deaths by self-administering fentanyl intravenously or by inhaling it, accidentally overdosing. Among those was Arrowtown chef Nils Scott, who died after obtaining and inhaling an acquaintance’s discarded fentanyl patches.
Last month drug-testing body Knowyourstuff announced they found fentanyl being distributed in a white powder form at a festival. It was the first time the drug – which killed Prince, Michael Jackson and Tom Petty – had been identified in a recreational drug here, sparking fears New Zealand could soon fall victim to the opioid epidemic sweeping North America and the United Kingdom.
Fentanyl is an opioid used for pain relief and anaesthesia, often prescribed for those in palliative care.
It is 100 times more potent than morphine and 50 times stronger than heroin, according to the US Drug Enforcement Agency.
Fentanyl has been available in New Zealand for a few years. It was originally only available under special authority, meaning doctors had to apply to prescribe it, before becoming fully funded in 2011.
Since then prescribing rates have more than doubled. In 2011, 3410 people were prescribed fentanyl compared with 8368 in 2017.
WHAT’S THE DANGER? Like morphine, fentanyl works by binding to the central nervous system receptors in the brain.
When the drug binds to these receptors they drive up dopamine levels, creating a state of euphoria and relaxation.
Used properly, it is a useful and ‘‘relatively safe’’ medication, particularly in people who cannot tolerate morphine, Royal New Zealand College of General Practitioners medical director Dr Richard Medlicott said.
But these receptors also control breathing rate: high doses can cause breathing to stop completely.
The high potency of fentanyl increases the risk of overdose, especially if a person is unaware of what they are taking.
‘‘Because it’s so powerful it’s being mixed in with things, and people don’t know what they’re getting which is really dangerous,’’ Medlicott said.
In America, non-pharmaceutical fentanyl is being cut with heroin to increase the drug’s effect.
A lethal dose of heroin is equivalent to about 30 milligrams – but just three milligrams of fentanyl could be fatal.
HOW WORRIED SHOULD WE BE ABOUT AN EPIDEMIC?
While prescribing rates have increased, they are still ‘‘orders of magnitude lower’’ than in countries facing opioid problems, Medlicott said.
The last published Ministry of Health survey on illicit drug use was carried out in 2007-08, and 1.1 per cent of the population said they used opiates that year.
Clinical toxicologist Dr Paul Quigley said there is very little chance of fentanyl becoming a major problem here because we do not have the same ‘‘driving forces’’ behind the issues in the US and Australia.
Quigley, who heads the emergency department at Wellington Hospital, said we have only a small population using opiates and no active heroin market to speak of.
New Zealand has relatively low rates of addiction to prescription medication and easy access to opiate treatment programmes, he said.
‘‘The opiate drug use market has been small for a number of decades and doesn’t seem to be expanding.
‘‘Illicit drugs are driven like a business, there needs to be a perceived need and that drives the market . . . we don’t have that force there at the moment,’’ Quigley said.
Auckland pathologist Dr Paul Morrow wrote an article for the New Zealand Medical Journal, published in February, on what we can learn from America’s battle against fentanyl.
‘‘Opioid drug misuse appears to be increasing worldwide, and therefore New Zealand is at risk for an opioid drug death epidemic, whether on the American scale or not.’’
In New Zealand, drug overdose deaths fall under the coroner, who ultimately reports cause of death to Births, Deaths and Marriages – a process that takes several years from time of death to published statistics.
Our death reporting system may be inadequate to warn us of a sudden rise in opioid deaths, or of the introduction of new deadly illicit opioids into our illicit drug use scene, he said.
Morrow said a rapid reporting system on drug overdoses, including data from coroners and pathologists, emergency departments and St John, would enable medical professionals and law enforcement to co-ordinate a response plan to a developing opioid death epidemic.
‘‘Because it’s so powerful it’s being mixed in with things, and people don’t know what they’re getting, which is really dangerous.’’ Richard Medlicott, Royal New Zealand College of General Practitioners medical director
‘‘Illicit drugs are driven like a business, there needs to be a perceived need and that drives the market . . . we don’t have that force there at the moment.’’ Paul Quigley, clinical toxicologist
The Chief of Defence Force Lieutenant General Tim Keating is stepping down, announcing the move in an email to Defence staff yesterday.
He stressed it was not due to the allegations about Operation Burnham in 2010 which was the subject of the book Hit & Run.
That book, by investigative journalists Jon Stephenson and Nicky Hager, alleged civilians had died during an SAS operation in Afghanistan. It said SAS soldiers failed to help those wounded, then covered up their actions.
The Defence Force originally said the allegations in the book were not credible as the location of the villages where they were to have taken place was not the site of Operation Burnham. However, in March, it confirmed the location of a village in the book was the same place where the operation took place.
In the email, Keating said it had been his ‘‘absolute privilege’’ to have served in the role since January 2014.
‘‘One thing I wish to place on record is that my departure had nothing to do with the recent spurious publicity about Operation Burnham – a 2010 NZSAS operation in Afghanistan,’’ he wrote.
‘‘The allegations contained in the book Hit & Run effectively alleging war crimes and indiscriminate destruction of property, are wrong. There has been no recent ‘admission’ by the NZDF which reverses the position we carefully set out . . . when the book came out.’’
Keating’s term will end on June 30.