NZNEP Harm Reduction Lead Jason George and Dr Rhys Ponton from the University of Auckland co-authored a letter published in the New Zealand Medical Journal on 13/3/20 warning of a possible increase in opioid overdoses in New Zealand due to a change to the morphine products available in New Zealand. The changes will see Arrow long acting (LA) morphine discontinued in New Zealand leaving m-Eslon morphine capsules as the only long acting morphine formulation available. The change will have minimal impact on patients but there are potential consequences for the illicit opioid scene.
Traditionally, people who inject morphine have converted the morphine (MSTs) using acetic anhydride into a crude form of heroin themselves. The changes have resulted in some dealers extracting and converting the morphine to heroin which is then sold in powder form. A shift to a powdered opioid market would be a significant change for New Zealand and comes with its own risks. These risks include the potential for the pre-converted heroin powder to be cut with Fentanyl, something that commonly occurs in other western nations with a powder opioid / heroin market where the opioid overdose rates are much higher than in New Zealand. The heroin powder is also sometimes marketed to people to smoke rather than inject which could lead to a new generation of people using opioids.
Jason George and Dr Rhys Ponton stressed they were not calling for a return to tablets, or promoting the misuse of pharmaceutical products. Instead, they wanted to raise awareness among healthcare workers. They also said there maybe the need to increase the availability of naloxone in New Zealand, a drug used to counter opioid overdose.