The lack of readiness to deal with synthetic opioids like fentanyl, nitazenes and their analogues has prompted Australian harm reduction organisations to launch the Potent Synthetic Opioids Plan in the state of Victoria, along with calls for other states to prepare before it’s too late.
While Australia has not seen the same levels of opioid-related harms and deaths witnessed across North America, advocates have been wary of the potential contamination of drug supplies with potent opioids.
The recent detection of nitazenes entering Australia has raised alarms within the government and harm reduction organisations. The Australian Federal Police and Australian Border Force issued a joint warning in May 2024 highlighting that multiple shipments of nitazene analogues had been intercepted in the previous year. At this moment, nitazenes have been detected in all Australian states and territories, with at least 16 related deaths confirmed in Victoria alone. A lack of nitazene-specific testing means the real numbers may be even higher.
Authorities are concerned that the presence of nitazenes in the drug supply may compromise their successes in reducing synthetic opioid consumption in Australia. First detected in Australia in small amounts in 2013, a federal investigation in 2022 led to the seizure of 28 kilos of powdered fentanyl. Operation Ailsace, as it was known, was the largest seizure of a synthetic opioid in Australia to date. Since then, fentanyl consumption has remained low in the country, with the Australian Criminal Intelligence Commission noting that fentanyl consumption was at a record low by 2022.
Preparing for the worst
It is within this context that the Potent Synthetic Opioids Plan was launched in July. Produced by the Victorian Alcohol and Drug Association (VAADA) – which represents over 80 drug and alcohol services across Victoria – and Harm Reduction Victoria, the plan was driven by concerns that health systems are unprepared to deal with a surge in synthetic opioid-related deaths.
“When crises or natural disasters occur, having a plan that can support those most at risk and those most likely to respond first is crucial,” Chris Christoforou, CEO of VAADA, said in a press release.
The paper’s main recommendation is to establish a Synthetic Opioids Taskforce which would be directed by the Chief Alcohol and Other Drugs Officer in Victoria, alongside multidisciplinary experts. The Taskforce would enable the development of a rapid plan to prevent further opioid-related harms, as well as prepare the health system to adequately monitor and respond to changes in drug markets. This includes scaling up drug checking, expanding access to naloxone, improving treatment services and legislative reform to enable safe supply “in an emergency.”
Speaking with TalkingDrugs, Christoforou explained that while Australia has thus far avoided many of the health harms related to synthetic opioids, overdoses in Western Sydney and recently in Melbourne rung alarm bells across organisations.
“Our public warning health systems are not very good – we’re still reliant on people presenting in hospital, or through an autopsy if something dangerous is circulating,” he said.
The Victorian Government, which faced criticism earlier this year for scrapping plans for a second supervised injection site in Melbourne, has yet to respond to the plan.
“The Victorian Government has not responded to our plan yet, but is currently finalising its appointment of a Chief Addiction Medicine Adviser who we have suggested should have carriage in developing a Potent Synthetic Opioids Plan,” Christoforou told TalkingDrugs.
“We hope that this appointment is announced soon, and that creating a Taskforce to develop an emergency preparedness plan is one of their first actions and priorities,” he added.
The plan is just the beginning
While the regional plan is an essential document, a federal policy is needed to prevent harms across the whole nation. This is particularly important given the regional discrepancies in state’s levels of preparedness to respond to a surge in synthetic opioid consumption and potential health issues. However, there is no evidence of a public facing plan to respond to the risks of synthetic opioids.
Some states are woefully under-prepared to deal with new drug and their risks. The state of Queensland, for example, does not have a fully functioning early warning system for drugs, meaning nitazenes could be across communities before health systems are aware.
In Western Australia, recommendations to establish a drug early warning system were made as early as 2019; when contacted for this story, Julia Knapton, Mental Health Commissioner from the Government of Western Australia, stated that an early warning system is “a priority”, but was seemingly still in development.
Christoforou said that while the paper was met with enthusiasm from across the alcohol and drugs sector, more needs to be done.
“Our concern is that most [alcohol and other drugs] policy is developed following a crisis; it is rare that harm reduction policies are developed as safeguards in anticipation of a crisis.
Ultimately, a rapid response alongside community and state buy-in will be essential to ensure lives are saved.
“We do not want the community to be grieving any more friends and family in the coming months and years,” Sione Crawford, the CEO of HR Victoria, added.
The Synthetic Opioid Plan can be read here.
