Early this week another drug alert was issued, this time by the Victorian government, warning that a highly potent synthetic opioid, protonitazene, was detected in the Melbourne cocaine supply.
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Then police announced that this was the cause of the four deaths linked to synthetic opioids that occurred in Broadmeadows last week.
The nature and increasing frequency of these alerts and deaths involving highly potent synthetic drugs in the illicit drug supply, in a country where 47 per cent of people aged 14 and above report use of an illicit drug in their lifetime, is truly frightening.
Victorians should be aware that synthetic opioids have been detected with increasing frequency in Australia since 2021.
Internationally, synthetic opioids like nitazenes have most commonly been sold as heroin and falsified prescription pain medicines.
In Australia they have also been detected in a wide range of other drugs including MDMA, ketamine, and this week the Victorian health department issued an urgent public alert about locally sold cocaine which has been mixed with protonitazene, a synthetic opioid drug thought to be 100 times more potent than heroin.
Australians are the one of the highest per capita users of cocaine in the world. In 2023, the Australian Criminal Intelligence Commission conservatively estimated that Australians consume more than four tonnes yearly, and Australian Institute of Health and Welfare statistics indicate that more than a million Australians tried the drug in the past year.
Those in public health and addiction services across Australia are preparing for a large increase in nitazene overdoses - having already seen what is happening with the rise of synthetic opioid deaths in the US and Europe.
If nitazenes compounds are present in the cocaine supply then we need to adopt the following as soon as possible, mainly widescale provision of take-home naloxone, drug testing, and overdose prevention centres.
The most effective antidote to an overdose is naloxone, which reverses the effects of opioids, and has been used in hospitals and by paramedics for decades to treat overdose. Importantly, there is good evidence that trained laypeople can also administer naloxone to treat overdose successfully.
With the increasing detection of drugs like nitazenes, providing access to take-home naloxone, alongside opioid overdose education is critical.
We know that at least 60 per cent of pharmacies are providing naloxone for free without a prescription for overdose reversal, in addition to a large range of harm reduction services. This makes this life-saving drug more accessible than ever.
Naloxone is easy to administer - literally one spray with the intranasal spray, repeated after 2-3 minutes if there is no response - so naloxone should be broadly accessible. And this needs to happen across a range of settings, from homes, to entertainment venues, hotels, music festivals - really anywhere where people may use drugs.
Drug use - including cocaine - in Australia crosses all socioeconomic and geographic boundaries, from Melbourne and Sydney city centres to outback WA.
If we are to properly prepare for the incoming threat of highly potent contaminants in illicit drugs like nitazenes, then we need to be more open and educate a wide range of people about the signs and symptoms of opioid overdose.
Most of these populations at risk are not familiar with or tolerant to opioids, so there is a lot of information sharing needed in a short space of time.
Drug checking has most recently been announced for Victoria, following the lead of the ACT and Queensland.
In the absence of a regulated drug market (such as we have for alcohol, cannabis, pharmaceutical drugs and nicotine), drug checking services are the next best way for people to have information about the drugs they plan to take, and often lead to people deciding not to take drugs where toxic containments are identified.
And while it's a divisive issue - the reality is that most deaths from these potent drugs internationally are from contamination in the heroin supply, so we will need more supervised injecting facilities, where someone who overdoses from tainted drugs can get emergency care on site.
There are just two of these centres operating in Melbourne and Sydney.
We need more locations to be established in different geographic areas to be effective if nitazenes become an issue in Australia. We have already had deaths from nitazenes among people who use opioids in Australia. We urgently need to act to avoid a situation like the US where more than 75,000 people died from synthetic opioid overdoses just in the past year.
- Professor Suzanne Neilsen is acting director of the Monash Addiction Research Centre.