Jacinta Bowler
Jacinta Bowler is a science journalist at Cosmos.
They were published in the Best Australian Science Writing 2023.
The Australian Federal Police (AFP) and Border Force have just announced the seizure of 11 kilograms of fentanyl in February – the largest seizure of the drug in Australia’s history.
If this isn’t a one-off, it could mean that fentanyl use is becoming more common in Australia, which has historically seen almost no issues with the potent and highly addictive medication in the illegal drug trade.
“It has actually been used for a long time medically. In terms of medical use there are some risks but in known doses it’s less of a concern,” says Professor Suzanne Nielsen, the Deputy Director at the Monash Addiction Research Centre.
“But when the dose is unknown, and people aren’t aware that they’re taking fentanyl, then it can be incredibly dangerous.”
Fentanyl was created in 1959 and is used as a pain reliever similar to morphine or oxycodone.
But according to the CDC it’s up to 50 times stronger than heroin and 100 times stronger than morphine. This increased strength means that people can be more likely to overdose if taking the wrong amount.
This has been a huge issue in the United States, where last year there were more than 70,000 deaths caused by fentanyl. This is very high compared to Australia, where there were just over 1000 opioid deaths all together in 2020, and none caused by fentanyl.
“We’ve actually been monitoring for fentanyl in the heroin market in Australia since 2017,” says Nielsen. “We haven’t seen any signal that there is fentanyl in the market.”
But she adds, “we don’t know what we don’t know.”
Read more: Humanity’s relationship with opioids
With this shipment of fentanyl being seized, and the drug posing a potential problem on the horizon, researchers suggest the most important thing to do is making sure that Australia has harm minimisation strategies in place.
“Have we got all of the systems in place? Are people aware of the kinds of risks that they need to be thinking about?” says Nielsen.
“We have the tools like Naloxone. We know what works. We don’t need to reinvent the wheel.”
Harm minimisation strategies reduce the potential damage caused from risky activity like drug taking. Harm minimisation does not condone drug use but suggests some strategies can limit the worst outcomes of drug use, like injury or death.
Naloxone is a medicine which can temporarily reverse the effects of an opioid overdose. In July the government started the “Take Home Naloxone” program, where the drug can be picked up at a pharmacy without a prescription.
Nielsen stresses there is a supply shortage, so there isn’t enough for everyone to carry one around ‘just in case’, but it is recommended for those who take opioid drugs or know people who take them.
The second suggestion for harm minimisation is drug testing. The ACT has recently started a six-month pilot program for a fixed pill and drug testing site. It is currently the only state or territory in Australia which provides drug testing, despite countries like New Zealand making it a permanent, legal, service last year after a successful 12-month trial.
Drug testing or checking allows people to identify the main substances in drugs. It also allows support workers to be able to talk to the drug user to chat about the results and risks.
“Being able to actually test what’s in drugs can be a really effective strategy to save lives,” says Nielsen.
Another proposed harm minimisation strategy requires more long-term solutions. Currently there are not enough drug rehabilitation places in Australia and many have long wait lists.
Nielsen suggests we need to double the number of beds available to treat everyone who wants help.
“Treatment is one of the most effective ways to save lives yet many people can’t afford it, or they can’t access it in their local area, or they don’t want to come forward and access it because we have so much stigma around treatment.”
Misinformation is rife. Some police in the US are being trained to understand that fentanyl will not cause an overdose just by being touched.
This directly contradicts the AFP, whose members wore biohazard suits to remove the powder in the operation “to protect against any inadvertent skin contact with the drug which could cause harm, loss of consciousness and even death.”
“This is one of the most dangerous myths that we’ve heard. You cannot overdose from fentanyl from just touching it,” says Nielsen.
“Pharmaceutical companies go to great trouble to get fentanyl into a format where it can be transdermally absorbed in patches. It’s not easy to do.
“It seems like there’s been mass hysteria around police officers and fentanyl.”