Let’s not wait for this to get worse

Opinion: There are over 12,000 defibrillators available in New Zealand. There are lifeguards at beaches and pools. People with severe allergies carry epi-pens in case of anaphylaxis. They are there for the day when a person needs them most. They are there because we accept that, despite all efforts at prevention, drowning and heart attacks still occur. So why don’t we have naloxone widely available, for when someone experiences an opioid overdose?

It was encouraging to read recently about a Dunedin bar stocking naloxone. They should be commended for their commitment to patrons’ wellbeing. But we can’t rely on individuals and businesses to take up this lifesaving drug one by one. New Zealand needs a government-led and government-funded rollout of naloxone. We need it now, before powerful opioid drugs become widespread.

Opioid drugs depress the respiratory system. Someone who has taken too much, or inadvertently taken opioids due to a contaminated drug supply, can stop breathing. They will show symptoms such as limpness, blue or purple-coloured lips, and they cannot be awakened.

If someone nearby has naloxone, these effects can be quickly and safely reversed. One of the best things about naloxone is if it is administered, and the person hasn’t overdosed, it won’t do them any harm.

Naloxone is a powerful tool in our harm reduction arsenal. Sadly though, it is not accessible enough in New Zealand. The reality is we could soon be facing an opioid crisis that we’re simply not ready for.

Neil deGrasse Tyson famously said “every disaster movie starts with a scientist being ignored”. Experts in New Zealand are repeatedly ringing the alarm bells, and while the Government delays, there are increasing signs of trouble.

Nitazenes, a type of synthetic opioid, are increasingly being found worldwide. I assume you’ve heard of fentanyl? Nitazenes are about 10 times more potent. And they’ve been detected in New Zealand.

On top of that, there has been a 95 percent reduction in opium cultivation in Afghanistan, which will have far-reaching global effects on the heroin market. On the face of it, that might sound like good news, but in drug policy there is an effect called ‘the iron law of prohibition’. Richard Cowan, who coined the term, explained it simply as “the harder the enforcement, the harder the drug” – or the idea that increased law enforcement creates strong incentives for more potent and compact drugs.

The US opioid crisis continues to worsen, with over 100,000 deaths a year. On top of the unthinkable human toll, there is also an immense economic impact felt by everyone – nearly $1.5 trillion in 2020 alone. In New Zealand, 171 people died from drug overdoses in 2021. That’s 171 sons, mothers, brothers and friends.

Let’s not wait for this to get worse. We can’t allow ourselves to look the other way or wring our hands while the death toll rises and we absolutely must not give into a temptation to finger-pointing and moralising. We live in a world where drugs are freely available – whether legal or not, people continue to take them. The war on drugs has failed.

What we need is harm reduction; practical strategies that reduce the harms associated with drug use. The good news is, we have tools in our harm reduction toolkit. Evidence-based strategies that are safe and effective, like naloxone.

We can look to Australia and their take home naloxone programme. Naloxone is available free, without a prescription, to anyone who needs it. The Australian government piloted this programme and evaluated it; finding it saved an estimated three lives per day. As a result, the programme was rolled out nationally from July 2022.

We need a take-home naloxone programme in New Zealand. This needs to include not only free and easy naloxone access, but also training and awareness for the public. A person who has overdosed cannot administer naloxone themselves. Their lives depend on the people around them recognising the signs of an overdose, having naloxone on hand, and the knowledge and confidence on how to use it. This training was undertaken at the Woof! bar in Dunedin and has given their staff the skills they need to save lives. Think of naloxone as an emergency first aid tool – just like the defibrillator in many of our workplaces – there for the day that one of our colleagues or friends needs us.

The best news is, there is a plan, ready and waiting. The New Zealand Drug Foundation published an Overdose Prevention Plan in 2023. Now it’s over to our Government to act and commit to implementing this plan. We must have our overdose prevention systems in place and ready, before the opioid situation worsens in New Zealand. Trying to build these systems while we’re in a crisis will cost lives. There is a saying, “It wasn’t raining when Noah built the ark”. When it comes to opioids in New Zealand, we might not be in a deluge yet, but the clouds are gathering and we’re feeling the drops. There’s no more time to waste.