Background: Fentanyl is a powerful synthetic and short-acting painkiller that is 50- 100 times more potent than morphine,1 meaning that 1/10th of a gram of fentanyl is equivalent to between 5-10g of morphine*. It was first synthesized by Dr. Paul Janssen in December 19602,3 and has become one of the world’s most important and frequently used opioid analgesics, used also as a pre-medication for general anaesthetic, partly because of its rapid action and multiple routes of administration. While pharmaceutical fentanyl can be diverted for misuse, cases of fentanyl-related mortality in the US have been linked to illicitly manufactured fentanyl and a variety of fentanyl analogues.4 These newly-synthesized fentanyls are being sold as a standalone product, as a low-cost additive to increase the potency of heroin and even as counterfeit medicines.5,6,7 The overdose death rate from synthetic opioids (excluding methadone but including fentanyl and tramadol) continues to increase in the US with a 72.2% increase from 2014 to 2015, with a total of 9,580 deaths in 2015.8
(Consistent heroin user at the Cross which the shooting gallery, E.R, and health only focused Medical Treatment, all seemed to fail John?)
JOHN O'CONNOR was a stick of a man, so tiny and emaciated that when he wove down the centre of Darlinghurst Road in Kings Cross he looked like an apparition…
And when he died last Saturday in Victoria Street, after more than 20 years of being homeless, hundreds mourned. Yet for years he had been death-on-legs, so sick his survival past his 45th birthday in March was a miracle. His chosen poison was drugs, not drink. He would inject heroin or anything else he found in bins or could glean from others.
Mr O'Connor was reputed to have been the most frequent user of the emergency department at St Vincent's Hospital. The Mission Beat van delivered him there about every second day. Paramedics knew him well and so did the police. They would scrape him off the pavement, where he would lie spreadeagled, oblivious to pedestrians, and gently take him to the emergency department or his GP, or the intoxicated persons' unit in Surry Hills.
If you added up the cost of hospital bills, the ambulance rides, the outreach workers, the mental health and addiction treatment staff over the 20 years, it is likely that it cost the state between $500,000 and $1 million to keep John O'Connor homeless. Felicity Reynolds, chief executive of Mercy Foundation, a philanthropic organisation that aims to end chronic homelessness, has conservatively calculated, based on available information, that about $60,000 was spent on Mr O'Connor in the past year.
"That money didn't solve his problems," she said. "There has to be a better way."
The NSW Bureau of Crime Statistics & Research has revealed a strong correlation between the reduction in the supply of heroin, an increase in the number of heroin users seeking treatment and a significant reduction in crime particularly burglary, theft and break and enter.
Reducing drug users leads to a reduction in crime.
Drug treatment is a great investment in crime prevention.
(Source: Aust. National Council on Drugs Media Release 21 April 2005)
The term drug treatment is vague and can be applied to any program that maintains illicit drug users on drugs or changes the drug from an illicit drug to a pharmaceutical or provides syringes to maintain drug use.
Our Council defines drug treatment as detoxification and rehabilitation so as to get the users off drugs permanently.
The benefits of crime reduction and better health and less drug deaths and less illicit drug users is more successful when rehabilitation gets users drug free.
Detoxification is important before rehabilitation in order to eliminate the effects of illicit drugs on users and to bring them to rationality.
Rehabilitation programs must be based on the criteria that users need to stay drug free for at lease 5 years after rehabilitation ceases.
Rehabilitation providers need to be audited to ensure worlds best practice of at lease an 80 per cent success rate in getting users drug free permanently.
The criteria for detoxification and rehabilitation should be drug use not abuse nor dependency nor addiction.
Australia does not have the worlds best detoxification and rehabilitation programs but they do exist overseas.
Almost two babies a week are born addicted to illicit drugs at one hospital in Adelaide alone.
Most of the mothers are addicted to heroin but most of the babies were addicted to medically prescribed methadone as the mothers tried to get off heroin during their pregnancy.
The addicted babies withdrawal symptoms are vomiting, diarrhea, uncontrolled crying and extreme irritability.
The addicted pregnant women tended to come into care later in the pregnancy because of anxiety and chaotic life styles.
Heroin addiction in pregnant women and their babies had become worse due to a recent increase availability of heroin from Afghanistan.
(Source: The Advertiser, Adelaide, 7 February 2008)
This report in Adelaide mirrors other reports of drug addicted newborn babies in other parts of Australia.
There are grave concerns for these babies that leave medical care to be taken home by a mother still in her addiction.
With the recent United Nations Office on Drugs and Crime report that Afghanistan heroin production is now at record levels there is likely to be more babies born with addictions.
The most effective way of reducing the number of drug addicted babies is to divert them and their mothers into detoxification and rehabilitation.
Early intervention and diversion into detoxification and rehabilitation programs will ensure mothers and babies get off drugs.
Lets ditch harm minimization for what works.
A continuing decline in opium production in South East Asia creates the potential for traffickers to look to Afghanistan as a potential source of heroin in the future.
The total weight of heroin seized at the border increased nearly threefold but this is much lower than figures seized just two years ago.
The street and wholesale price of heroin remained stable with easy availability except in Tasmania and Northern Territory.
Heroin purity continued to fluctuate within states and territories with Queensland reporting an increasing level of purity.
West African and Asian organized criminal networks were the main traffickers using couriers from many ethnic backgrounds.
(Source: Illicit Drug Data Report 2004-05, Australian Crime Commission April, 2006)
The recent heroin drought may be over with increasing seizures in Australia.
The United Nations Office on Drugs and Crime is warning that opium production is now increasing in Afghanistan through the influence of the Taliban and this additional heroin may make its way to Australia.
Demand for heroin and the number of heroin users makes Australia a target for heroin supply in the future.
Australia must reduce the demand for heroin by diverting users into detoxification and rehabilitation to get them drug free.
Countries that have successfully reduced the number of illicit drug users have cut off money flowing to criminal and terrorist groups by using their courts to direct users into detoxification and rehabilitation.