Dr Marianne Jauncey with client at Uniting Medically Supervised Injecting Centre. Photo: supplied.

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BY JOHN MOYLE

Fentanyl is a powerful opioid 100 times stronger than morphine, first synthesised in 1960 and is used legally as a pain medication.

In North America the illegal use of fentanyl is of epidemic proportions and in 2017 played a role in over 42,000 deaths across the United States and 2,800 deaths in Canada.

Fentanyl was a contributing factor in the deaths of musicians Prince and Tom Petty.

Many of these deaths were due to prescription abuse, but a growing amount of illicit fentanyl is finding its way to injecting drug users.

Health Canada reported that in 2012, sample testing of 120,000 batches of seized street drugs showed that just 217 tested positive to fentanyl, but in 2017 with this jumped to 4,568 samples testing positive, an increase of 2,005%.

Knowing that illicit drug trends in  Australian tend to follow those of North America, the big question across our drug and alcohol minimisation and drug enforcement agencies is, “could the same thing happen here?”

“We are at the earlier stages of fentanyl use in Australia, and if we go down the similar road (as North America) there will be many more deaths than we have at present,” Dr Alex Wodak, President, Australian Drug Law Reform Foundation said.

“What’s happening across North America and what is driving the epidemic is fentanyl and fentanyl analogues and illicitly manufactured fentanyl making its way into heroin and other drugs,” Dr Marianne Jauncey, Medical Director, Uniting Medically Supervised Injecting Centre said.

A drug analogue is a designer drug of a controlled substance that is designed to mimic the effects of the original drug, and can often avoid classification or detection in a standard drug test.

“Illicit pharmaceutical deaths in the States outnumber the number of heroin deaths and a large portion of that is thought to be fentanyl analogues,” Ms Amanda Roxburgh, Senior Research Officer, National Drug and Alcohol Research Centre said.

“Whereas in Australia, the deaths we are seeing related to fentanyl are as a result of prescription products that people have bought on the black market or as a result of doctor shopping,” Dr Jauncey added.

In 2012, data collected by the National Drug and Alcohol Research Centre showed that 45 people died of fentanyl use, mainly as a result of prescriptions misuse.

Each year the National Drug and Alcohol Research Centre survey around 1,000 drug users across Australia about their drug use and use the data collected to pick up on trends.

The demographic surveyed is predominately male, from a disadvantaged background, with a medium age of 43 years and with a long history of opioid substance abuse.

“The latest data that we have on the injecting of fentanyl out of that group is that around seven per cent of the sample people were injecting fentanyl in the last year, and we asked them if they were also using fentanyl analogues such as carfentanil, but we are not seeing that among the people we are talking to,” Ms Roxburgh said.

Many of these analogues found in Australia are manufactured in legal drug labs found in China, such as Wonda Science, which was busted by Chinese authorities last year for selling fentanyl into the USA.

Wonda Science was considered a properly licensed chemical company located in the National Innovative Technology Industrial Park in Changzhou.

“The ABF has made more than 50 detections of suspected fentanyl over the past five years, the majority via international mail,” spokesperson, Australia Border Force said.

This number of fentanyl seizures compares with 242 detections of heroin in 2016-17.

“We also monitor a lot of illicit drug markets on the dark web, looking at the number of retailers and what substances they are selling,” Ms Roxburgh said.

We all know about Silk Road, the drug supermarket launched on Tor, or the darknet, in 2011, but since its closure by the FBI in 2013, a number of other sites quickly took its place.

Among these were AlphaBay and Hansa, both shut down by joint international law enforcement operations in July 2017.

And then there is the granddaddy of drug supermarkets, Dream Market, that in July 2017 had 57,000 listings for drugs, including 4,000 for opioids.

In late 2017, fentanyl rated number eight of all the drugs on offer on the site, with cannabis being the highest, followed by pharmaceuticals, MDMA, cocaine, methamphetamines, new psychoactive substances and LSD.

Dream Market is currently overcoming the embarrassment of swallowing up its customer’s bitcoins, its preferred method of payment.

But a quick Google search shows that you don’t have to navigate the darknet to find fentanyl.

Within 30 seconds, City Hub found six sites offering fentanyl, fentanyl analogues or patches with prices ranging from US$90 for 3gms to US$450 for 100 msg/h patches.

One site based in China spruiked its product as “China White – similar to heroin”.

The debate about fentanyl in Australia is not helped by a hysterical media that shouts “Fentanyl Crisis”, such as the ABC News on 30th November 2017, when there is little current evidence that we are following North American trends.

“We have three people out of a thousand that are using the pharmaceutical formulation of fentanyl, so that is very low,” Ms Roxburgh said, referring to her current drug use survey.

“From our perspective it is important to stick to the data, but if people are using heroin contaminated with fentanyl, that is a whole other ball game.”

If a fentanyl epidemic is about the sweep Australia, Uniting Medically Supervised Injecting Centre is in the front line with a program already in place to detect any spikes in fentanyl and fentanyl analogue use.
“We have started a surveillance program where we offer a free urine test that can tell if fentanyl is present in the drug that they are using, as we want to know early if and when there is fentanyl finding its way into the illicit drug supply so we can scale up a response accordingly,” Dr Jauncey said.

The Centre is also training first line responders and the people closest to drug users such as family and peers in the use of naloxone, a drug that reverses the effects of an overdose.

Due to a number of factors that differentiate us from North America, including isolation, tight controls of legal prescriptions and the slow decline in the use of heroin due to its decreasing supply, Australia may just avoid a fentanyl blizzard. But, in the event it comes, we are prepared.