Naloxone saves lives, so where is it?

June and July saw 13 people hospitalised from fentanyl overdoses. Those folk were sold what they were told was cocaine, and in at least one case, methamphetamine; but their substance turned out to be fentanyl bulked out with fillers. They were all given Naloxone on the way to hospital and were revived after falling unconscious and unresponsive.

Naloxone is a life-saving drug that reverses opioid overdose almost instantly. You can read about how it works in the body in our Fentanyl 101 blog post from a couple of weeks ago. Everyone in the media agrees that Naloxone is THE substance to keep on hand to stop people dying.

According to the Ministry of Health, we currently have enough Naloxone in hospitals and emergency services to keep us going for 60 weeks ‘at normal usage’.

What’s our ‘normal usage’?

According to the Ministry of Health’s OIA team, there have been 4,552 people released from hospital where the primary diagnosis was poisoning by opium, heroin, other opioids, or methadone from 2000 to 2021.
Read the rest of the figures in the OIA release on the Ministry of Health’s website

The NZ Drug Foundation’s 2022 State of the Nation report states that approximately 46 people per year die of opioid overdoses. So if we take the average of 46 people per year and subtract it from the number of folk being discharged per year, we can come up with a number of live people that, theoretically, responded well to Naloxone.

In the last 10 years there’s been an average of approximately 230 overdoses per year that people have recovered from. That’s about 4 opioid overdoses per week that are severe enough to put people in hospital but don’t kill them, likely because of the medical treatment they receive. .

For the sake of maths and in lieu of any official reporting about the use of Naloxone in NZ hospitals, let’s say it’s one dose per human to revive them to a state where they’re responsive. Realistically it could be anywhere between one dose and 10, depending on how badly the patient is doing.

If what the Ministry of Health says about the amount of Naloxone we have in store as of July 2022 being enough to last us for 60 weeks is accurate, we have enough for approximately 258 overdoses. Which is fine, so long as absolutely nothing changes in our opioid overdose situation.

Except things are changing. Now what?

Our rate of opioid overdoses are increasing. This is in keeping with overseas trends. If overseas trends are anything to go by, the overdose rate is going to keep increasing, too. More worryingly, we’ve seen that our overdose rates can spike upwards in as little time as a weekend.

Australia’s synthetic overdose death rate is on the way up since the temporary drop in 2019:

England and Wales are much in the same boat:

And America? Well….Yikes.

So we have a rising trend of opioid overdoses, both here and overseas, but the Ministry of Health isn’t going to get any more Naloxone for DHBs because apparently we have enough to hold us steady for another year.

Why is this bad?

If we get a spike in opioid overdoses, we’re in trouble because we don’t have enough Naloxone to go around.

Why would opioid overdoses go up here?

We found a sample of fentanyl at a festival in 2018. This was the first time we’d seen it. We hadn’t seen it again, either in the media or in our checking days, until June. In late June and early July, 13 people were hospitalised due to fentanyl overdose. They were revived with Naloxone, and survived the ordeal.

Now, it’s early days yet and we’re still collecting data to see if this is an isolated spike or potentially something that’s long-lasting in the community. If fentanyl is something that’s appearing in peoples’ substances more regularly, and we have more fentanyl-related overdoses, those 258 doses of Naloxone won’t last.

Mo’ fentanyl hidden in other drugs, mo’ overdoses

If more fentanyl is being mis-sold as other substances, people taking what they think is cocaine or something else will be taking high to dangerous doses of fentanyl. They’ll be measuring their substances to what they think they have, rather than what they actually have.

If we take the numbers from the recent overdose spike in June and July and add them to our existing average, the average goes up to 10 overdoses per week.

Our current stash of Naloxone will only last for 6-ish months. And that’s providing everyone has their overdoses in an orderly fashion and we don’t see clusters of mass hospitalisations like we did with the eutylone flood of 2019. Are you holding your breath on that one? We certainly aren’t.

Ok, but even at a higher overdose rate we’ve got enough to last 6 months, right?

Depends.

A big spike in overdoses could see us burn through existing Naloxone supplies in very much less than six months. Our current plan is to get more from overseas but, if Covid has shown us anything, it’s that overseas supplies can’t be relied upon. The only way to guarantee that we have enough Naloxone in New Zealand is to have enough Naloxone in New Zealand.

But the fentanyl flood might not even happen so why are we stressing?

Because there’s a high likelihood that it might. If not this year, then soon, if the overseas trends are anything to go by.

Y’know how you’ve got earthquake water and a first aid kit just in case? Having an adequate supply of Naloxone is an extension of that just in case. It’s just on a national scale. And when it comes to a substance that saves peoples’ lives, it’s always better to have it and not need it than to need it and not have it.

So…why aren’t we getting more Naloxone?

According to the Ministry of Health, we don’t need to get more Naloxone because we apparently have enough, except we don’t. But we’re not getting more. Because reasons. And we’ll be able to get more if we need it. Except we might not.

It seems like the Ministry’s banking on fentanyl not making as big a splash here as it has overseas and our current supply doing the job. This is basically the supply version of saying ‘what could possibly go wrong?’ before hitting the big red button that says DO NOT TOUCH.

Checking drugs for fentanyl BEFORE taking them is a really good idea

Using a fentanyl test strip to make sure there’s no opioids in your substance is a great plan.

If you find fentanyl in your substance before you decide to take it, you eliminate the risk of accidentally overdosing because you can adjust the amount of substance you take.

If your risk of accidentally overdosing is lowered, then your potential need for Naloxone is lowered and the national stash gets to keep the dose you would have had for someone else.

You can get fentanyl test strips online at The Hemp Store or The NZ Needle Exchange.

And we put some instructions on how to use the fentanyl strips on our Instagram feed