How NZ avoided an opioid crisis
Through a combination of good policy, good policy changes and good luck, New Zealand has so far avoided the opioid crisis that has engulfed North America, a new study has found.
‘‘Widespread misuse or overdose appears largely moderate in New Zealand, and a major opioid crisis appears unlikely to unfold in the present scenario,’’ wrote the researchers, led by Benedikt Fischer of the University of Auckland.
But they warned that we cannot be complacent. The country was ‘‘rather unprepared’’ if opioid misuse rises significantly, they predicted.
The opioid crisis in the United States and Canada started in the 1990s when doctors increasingly prescribed drugs such as oxycodone (traded as OxyContin), hydrocodone (Vicodin), morphine, and methadone to patients for treatment of cancer, chronic pain, arthritis and other conditions.
These are highly addictive drugs and cause death. American drug overdose deaths were four times higher in 2018 than in 1999, and nearly 70 per cent of the 67,367 deaths in 2018 involved an opioid, reported the American Centres for Disease Control and Prevention (CDC).
In the Canadian province of Ontario, 14 per cent of the population filled an opioid prescription in 2015-16.
These sorts of numbers forced authorities to crack down on legal use of these drugs. But often the addicted turned to the black market for heroin, fentanyl and various ‘‘home bake’’ concoctions. Deaths and treatment numbers spiked, as did imports of illicit drugs. Crime linked to opioid reliance also rose.
New Zealand, by contrast, presents a ‘‘distinctly different
picture’’, Fischer and colleagues wrote in the International Journal of Drug Policy.
Although the country’s opioid prescriptions rose from 2011-17, most of these were ‘‘weak opioids’’ that included codeines.
Many prescriptions were written for people older than 65, a group less prone to dangerous behaviour.
Moreover, there are indications that New Zealand’s opioid prescriptions were mostly given in hospitals, where doses and repeat prescriptions are easier to control.
In North America, by contrast, many prescriptions were made out in the community – GP offices and pain clinics – and were less controllable.
None of this suggests New Zealand doesn’t have large illicit drug problems, but Fischer and colleagues make clear that the situation could be much worse.
New Zealand authorities were also alert to the problems arising in Canada, the US and to a lesser extent Australia and Europe.
Education for doctors, including junior doctors, was implemented. ‘‘Active
interventions’’ were used to reduce or avoid strong opioid prescriptions.
Authorities targeted users who went ‘‘doctor shopping’’ for a steady supply of prescriptions, for example, and monitored doctors who may have been prescribing poorly.
And because New Zealand opioid prescriptions were generally moderate, cracking down didn’t create the sorts of ‘‘supply gaps’’ that were filled by the black market, the researchers found. In addition, heroin has been hard to buy here for many years.
New Zealand’s isolation and small population also helped, they suspect.
‘‘New Zealand may have, all along, engaged in the kind of restrained opioid utilisation practice, which most recent North American guidelines for chronic pain management have been advising and reactively seeking to achieve.’’
But it would be ‘‘prudent’’ for New Zealand to improve its resources for problematic drug use, lest the situation takes a turn for the worse.