www.tepou.co.nz

www.matuaraki.org.nz

Emergent opioid trends

The Importance of Relationships The Sense of Whānau

Trends to Relationships

Methodology

• Qualitative: (Husserlian phenomenology)

• Understanding of participants perspective

• Participants: ◦ Service Users n=9◦ Age 35-56; 10-30+ years use

◦ Service Providers n=5◦ 10-35 years working in addiction

NZ Context• Dominated by use of pharmaceuticals:

◦ Morphine and methadone as the ‘mainstays’ (Robinson et al, 2011)

◦ Cough syrups (Griffiths et al, 1982)

◦ Homebake (Bedford et al, 1987)

◦ Opium poppy heads (Dore et al, 1997)

◦ Poppy seed tea (Braye et al, 2007)

◦ Over the counter codeine analgesics (Robinson et al 2010)

◦ Oxycodone (BPJ, 2011)

◦ Fentanyl (Shauer & Reynolds, 2015)

Reporting“…morphine and methadone is used predominantly, but then that’s because its asked about. They don’t

actually ask about the more OTCs or...”

KnowledgeUsers invariably know what's new and emerging way

before any clinicians and researchers do

Emergent Trends

Localised trends “…it’s a comparatively small market, it only needs one dealer to get put out, one big bust and

the whole things changes, there will be a recalibration of what people use and what is

available”

Ongoing availability“There is always something that will replace

something that goes”

Availability and Accessibility

PharmaceuticalsThe pharmaceutical industry

“They keep supplying and supplying, and keep the opiate users going...”

“Growing market share is what they do”

Deterrents, potentiators and precursors“they are not deterrents, yeah. To an addict there

is always a way...”

“...they’ll say we’ll put that in, that will stop them. But if they knew the client that wouldn’t bloody

stop them”

Systemic Influences

Border controls“Small country. Small market. Island. Good border control. Lots of sea,

no warring countries on our borders”

Legislation enforcement“basically, it stops, you know, the people that are not as clued up from damaging

themselves”

Health systems“Guidelines exist- but are not necessarily adhered to”

The role of PHARMAC and MoH- cost containment

Pharmacy restrictions

Unsanctioned controls“They cracked down on it [poppy seeds] because too

many young people were getting into it. And blab blab blab blab telling everyone... “

Relationships

• Participants• Age 35-56; 10-30+ years use:

◦ 1 x Grown up family/children◦ 3 had long term partners/married◦ 2 x 2 chose to meet me/introduce me to

their friend◦ 7 chose to see me in their own/friends

home

Prescribed opioids‘Aroha’

“You see, these doctors, they are human like every one else…they want to help…a lot of it is misguided help”

‘Ignorance’“A lot of the discharge prescribing, scripts, summaries etc. are done by junior doctors, who aren’t sufficiently aware of these sorts of issues”“it was the pharmacist that recommend I try…I think he knew what we were up to…”

‘Arrogance’“The surgeons, you could just get anything you want off them really, …”

The art of ‘lying, cheating and manipulation’

...if I go into a pharmacy and I say, ‘Panadeine Plus please’, ‘Ah, sorry, sir, why don't you try some of this'. 'No, no,

it’s the only thing that relieves the inter cranial pressure’. And they sort of go “whoa”, OK, so he has obviously

spoken to his doctor, ‘alright, no problem, here you go’. As long as you have done a

little bit of research”

“you’ve got to think about what they’re going to come back at you with. So you’ve got to work it out, closed up all the loopholes, so they can’t say ‘no’”

Information sharing“recipes, whilst available on the internet, do not

come with the teaching and sharing skills that are intrinsic to making a good bake”

• Impacts on:◦ Safety-emerging pharmaceuticals ◦ Informed choices◦ Support systems◦ Access to services

“I don’t know if that is because there is more availability of other stuff or maybe the new generation just doesn’t have that kind of chemistry knowledge”

Apprenticeships“the elders taught the younger ones, and it came through. I don’t get a sense that that is happening so much anymore.

There’s not those tight communities of drug users”

◦ NZ’s homebake notoriety◦ A complex, respected process◦ Requiring an “apprenticeship”◦ Decline in opportunities

“I don’t know if its because there is more availability of other stuff or maybe the new generation just doesn’t have that kind of chemistry knowledge…”

ImpactsAssociated harms• harms of opioid use generally • dependence cycle• some emergent trends more harmful• unintended consequences:

• Lifestyle and wellbeing• Accessibility (pricing, dosing formulations)• Stigma and discrimination• Displacement• Criminalisation

Harms are exacerbated if there is not good information

“safe, as long as you know what you are doing”

“it’s the dumb arses, that don’t know what they are doing” that cause harm –

for every one”

Minimising Harm‘Carefully considered and executed exercise to maximise effect and minimise harm’

• Substance users are creative and adaptive• Work to gain control over a situation• Stabilising effect of some opioids• Seeking out of alternatives• Use of contacts and resources to be informed• Concerns over the ‘young’ or ‘naïve’ user

“knowledge is passed down… someone new to the scene, as long as they are with someone who is

responsible and been around for a while, they will be shown a way that is safe”

How do we respect these relationships; ensure the skills and resources of users are

valued; that the ‘supportive relationships’ and wisdom

are available to our opioid using population