Australia faces rising threats from synthetic opioids

Reports of synthetic opioids contaminating Australia’s drug supply highlight the concerning pace at which they are entering the country. The Australian Federal Police recently raised concerns after detecting nitazenes in counterfeit pharmaceutical products seized at Australian borders.

Nitazenes are synthetic opioids similar to fentanyl, with some compounds up to 50 times more potent. They act rapidly (within 2 minutes), leaving less time to respond to overdoses compared to drugs like heroin.

To better understand the emerging threat of nitazenes and other new synthetic opioids (such as fentanyl analogues), a new study published today in the Drug and Alcohol Review explores what we currently know about these substances and their related harms in Australia.

The study, entitled ‘A scoping review of the emergence of novel synthetic opioids in Australian drug markets: what does this mean for harm reduction responses?’ outlines several key findings:

• Detections across the country: new synthetic opioids were reported in every jurisdiction in Australia except for Tasmania, at the time of writing.
• Mortality: there have been 22 confirmed deaths in Australia attributed to fentanyl analogues since 2013 and at least 22 confirmed nitazene-related deaths just in Victoria since 2021.
• Monitoring capacity: Australia has capacity to monitor harms caused by new synthetic opioids but more needs to be done to detect these substances before people use them. The rapid evolution of nitazene variants makes it difficult for health and other surveillance systems to keep up.
• Supply: availability and harms related to these substances are rapidly changing. There is limited understanding of whether people are knowingly seeking these substances.

Burnet senior research fellow and senior author of the paper, Dr Amanda Roxburgh, said Australia has seen increasing reports of these substances in the last couple of years.

“Public drug alerts are now picking up nitazenes as contaminants in drugs like MDMA, cocaine, and 3C-P, and increasingly in counterfeit pharmaceuticals,” she said.

“That’s what makes them particularly worrying, as people without any history of using opioids may be consuming nitazenes without realising it.”

The paper highlights the importance of harm reduction responses such as drug checking services, also known as pill testing, where people can voluntarily submit drug samples for analysis to check for hidden or dangerous ingredients.

Three jurisdictions in Australia have drug checking available — the Australian Capital Territory, Victoria and New South Wales. The Queensland government closed its drug checking service in April this year.

The paper also emphasises the need to expand the availability of take-home naloxone to a broader group of people who use drugs.

Naloxone is proven to be effective in reversing synthetic opioid overdoses.

“Now is the time to strengthen how we respond on the front line.”