Will Australia repeat America’s opioid blunder?

Australian policymakers must be careful not to repeat America’s mistake when it comes to synthetic opioids like fentanyl, John Coyne writes.

Analysts, police, strategists, and policymakers like to believe that they get it right all the time, or at the very least all the times when it counts. The release this week of the Australian Criminal Intelligence Commission’s (ACIC) latest Wastewater Monitoring Program quarterly report seems to indicate that many have got it wrong in terms of fentanyl: the dangerous and highly addictive synthetic opioid.

The Commonwealth Government and Australia’s medical profession will now need to tread carefully, lest we see a repeat of the disastrous decisions that American authorities have made to address synthetic opioids over the last several years.

To be frank, Australians have long had a large appetite for illicit drugs. However, this hasn’t always meant that we follow the global trends. On at least two occasions in recent history, our illicit drug users have defied global trends and proven analysts wrong.

In the 1980s and 1990s, North America was wracked by a crack cocaine epidemic. The situation spiralled into a full-blown humanitarian catastrophe with soaring overdose rates and alarming infection rates for HIV and Hepatitis amongst drug users.

More on this: Is the US exporting its opioid crisis to Asia?

At the time, Australian authorities were staring down a growing heroin problem. Unsurprisingly, analysts continually raised the alarm to the government that crack cocaine would be alluring to illicit drug users. Fortunately, they were wrong – crack cocaine failed to gain even a toehold on our shores.

By 2010, Australian law enforcement authorities, like their partners all over the world, became concerned about a class of drugs categorised as ‘drug analogues and novel substances’.

‘Analogue substances’ are variants of a parent compound which is a prohibited or scheduled drug. By contrast, criminals develop ‘novel substances’ to imitate the pharmacological effects of prohibited drugs while attempting to avoid existing drug control measures. Both sorts of drugs entered the illicit market as substitutes for other existing illicit drugs.

Authorities behind, and outside of, the closed doors of government warned of an impending drug crisis, while the media told us stories of face-eating cannibal attacks. Today analogues and novel substances continue to be detected, however, they have so far failed to garner a wide following amongst Australia’s illicit drug users: crisis averted.

Over the last several years, Canada and the United States have been devastated by a synthetic opioid crisis. The crisis arguably finds its origins in a medical system, overseen by the Drug Enforcement Agency (DEA), which between 1993 and 2015 allowed production of oxycodone to increase 39-fold, hydrocodone to increase 12-fold, hydromorphone to increase 23-fold, and fentanyl to increase 25-fold. This, in turn, paved the way for easier access to prescription synthetic opioids and created a large population of people addicted to prescription painkillers.

In 2015, in response to a growing overdose problem, the DEA drastically reduced the production of synthetic opioids. Those addicted to the synthetic opioids were quickly displaced to heroin: now a burgeoning illicit market in North America.

More on this: Make drugs a health issue

At the same time, organised crime groups from China to Mexico have started manufacturing fentanyl to meet the demands of a newly created illicit market. In 2016 drug overdoses killed roughly 64,000 people in the US. Now more than 800 Americans a week die of opioid-related overdoses.

Many Australian authorities, including myself, assumed that domestic drug controls were such that Australia would avoid a similar crisis, and that the strength of drugs like fentanyl would limit recreational drug experimentation.

The release of the National Wastewater Drug Monitoring Program Report – August 2018 points out that we may have been wrong. The report shows that fentanyl consumption is at its highest levels for two years. Regional average consumption is roughly double the capital city average. Sampling also indicates that consumption is consistent throughout the week.

The consistent consumption could support a hypothesis that much of its use could be associated with prescribed medical purposes. Given the strength of fentanyl, this kind of usage pattern is still a health concern.

In light of the American experience, Australian governments would do well to approach the problem with caution. Any sudden policy or legislative measures that restrict access to fentanyl could well displace users to other illicit drugs.

In the first instance, responding to the report’s findings is not a law enforcement issue.

As a first step, the Commonwealth Departments of Health and Home Affairs should convene a consultative group that engages with subject matter experts from the private and not-for-profit sectors to explore the issue further. Bringing groups like the Australian Medical Association voluntarily to the table will be key to developing a response.