Media attention on fentanyl has increased due to Prince’s passing and the NSW Coroner’s remarks regarding 13 drug injector deaths in one month that were thought to be tied to heroin. Michael Farrell, the director of NDARC, discussed the medication with many media outlets.
According to Professor Farrell, fentanyl has a concentration of 50–100 times that of morphine. “It’s challenging for individuals to accurately gauge how much they inject and withdraw from the patch. People are injecting this highly potent opioid without being able to manage their dosage.
Like all opioids, including heroin, fentanyl interferes with breathing, acting as respiratory depression. People may dangerously miscalculate their dose because it is so concentrated.
According to Professor Farrell, polydrug use, which is highly widespread with heroin use and other opioids, poses a serious risk to users.
“Users frequently combine fentanyl and other opioids with alcohol and benzodiazepines, which also have respiratory depressive properties, increasing the risk of death.”
There is currently no evidence in Australia supporting the media’s assertion that the recent opiate overdoses in NSW may be linked to heroin laced with fentanyl, according to Professor Farrell.
“We have no proof that any heroin in Australia is laced with fentanyl. However, according to Farrell, it frequently contributes to overdose deaths in the US.
The Pharmaceutical Benefits Advisory Scheme originally included fentanyl transdermal patches for treating chronic cancer pain in 1999.
The rise in fentanyl-related mortality in Australia from 2011 to 2013 was noted in a study by NDARC senior research officer Amanda Roxburgh.
According to the study, an increase in overdose mortality among Australians in their middle years was associated with a more than fivefold increase in fentanyl prescriptions in Australia over the five years leading up to 2011.
The rate of prescriptions written for people over 80, who made up 25% of all prescriptions, surged fivefold from fewer than 50 per 1000 people in 2005/06 to more than 250 per 1000 people in 2010/11. Rates for people aged 40 to 49 more than doubled during that time, but from a significantly lower base of about 2.5 per 1000 to almost 16 per 1000. Fentanyl poisoning was the primary factor in slightly over half of the fatalities, and just under half required additional medicines.
Most of the prescriptions were written for people over 80. However, the majority (75%) of overdoses occurred in Australians under 47. Only 36% of the fatalities (36%) included patients prescribed fentanyl. Drug injectors were involved in more than half (54%) of the fatalities (95 percent of whom had injected fentanyl before death).
The bulk (95%) of fentanyl prescriptions written during the study period were for patches, and users must remove and dissolve the substance before injecting it.
The age gap between those receiving the majority of fentanyl prescriptions and those passing away from an overdose related to fentanyl suggests that these deaths are happening among those misusing the drug and for whom it was not initially prescribed (64% of deaths had no record of fentanyl being prescribed).
This study’s lead author, Amanda Roxburgh, stated that “considered restrictions around prescribing are needed to reduce the capacity of patients to hoard these medicines and obtain them through ‘doctor shopping'” (visiting several doctors to obtain more prescriptions). Real-time monitoring, which enables medical practitioners to keep track of prescription histories, makes it more difficult for people to “doctor shop” and could help lower the amount of fentanyl being diverted.
Fentanyl-related deaths were higher than oxycodone-related deaths (another prescription opioid), which accounted for 465 deaths during the period and were between two and five times more frequent than fentanyl-related deaths relative to the number of prescriptions written, even though the rates of fentanyl-related deaths had increased over time relative to prescription rates.