Barriers to use of lifesaving drug questioned
WELLINGTON: 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 each year from 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 surgery or injuries.
They work well as pain relief but are also addictive, at varying levels, and at high enough doses are deadly. Effects include a feeling of relaxation, and endorphins are released. There is a small black market for opioids.
The Drug Foundation says about one person a week is dying from these overdoses, while a lifesaving 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,’’ Ross Bell, executive director of the Drug Foundation, said.
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 has declared it a national public health emergency.
About half of US opioid overdoses involve fentanyl. It was involved in the deaths of Prince, Tom Petty, Heath Ledger, and recently Mac Miller.
In New Zealand, the victims of opioid overdoses are most commonly men between the ages of 40 and 60.
New Zealand does not have the same rates — 353 known accidental deaths between 2006 and 2015 — but we do have the same reversal agent available. St John paramedics have naloxone on hand when needed to stop some overoses.
,About 50 people have died from synthetic cannabis in the past 18 months.
Mr Bell said while the country was grappling with that, tragically, the same number were passing away from opioids but attracting 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 worth while to have on hand.
But it has not happened, two years on.
In a letter to Mr Bell, Health Minister David Clark said there were legal obstacles for doing so, and 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,’’ Mr 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, Mr Clark said, ministry officials were 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 no company has taken up the offer.
Former associate health minister Peter Dunne worked on removing the restrictions before he left office and the Labourled Government took power last year.
‘‘I think these obstacles could . . . 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 highpotency fentanyl arriving here in greater illicit quantities. He has 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.
Mr Dunne said making naloxone available was 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.’’
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.
Mr Bell said in the two years naloxone had not been available after the recommendation, there had been ‘‘many, many deaths’’.
‘‘Why isn’t there urgency? Is it because we actually don’t care about people who use drugs?’’