How synthetics became a public health crisis

The number of deaths linked to synthetics since July last year is now at 50, and counting. This is undeniably a health crisis. The unprecedented level of drug related deaths, the huge number of hospitalisations, and the significant harm for the most vulnerable in our community requires urgent action that we are yet to see.

How we got here was not by accident, but due to a series of legal changes with unintended consequences. The current synthetics on the market are much more harmful than most substances classified as illegal under the Misuse of Drugs Act. They are cheaper to produce, have high profit margins and are sold for much lower amounts.

As this problem balloons and changes, so too must our response.

Legalising cannabis when the first ‘synthetic cannabis’ products launched around 2004 likely would have stopped demand. Again in 2014 when all the products came off the shelves (which were now more harmful synthetic cannabinoids), legalisation of natural cannabis could have been the transition for people using these increasingly more harmful synthetics.

But now in 2018, demand for the most potent cannabinoid products we have seen is established and people are seeking the very strong effects as a coping mechanism for those living in crisis providing escape. The harm from synthetic cannabinoids is also a product of poverty - we need community development, housing and wrap-around support and reinforced efforts to address the social determinants of health.

It’s not just synthetic cannabinoids

This crisis is also growing in the background. Synthetics is a broad term that includes synthetic cathinones (bathsalts) and synthetic opioids. These mimics of ‘party drugs’ and opioids are similar to cannabinoids, in that they are more potent and toxic than already classified drugs and highly likely to cause death.

Both synthetic cathinones and synthetic opioids are more likely to be miss-sold as other drugs, as they are cheaper to produce and traffic, making the market for illicit drugs increasingly dangerous and unpredictable. We have seen the trajectory of this, with multiple hospitalisations from n-ethylpentylone earlier this year in the festival season. Some of the new synthetic opioids are so potent that they are resistant to naloxone. The overdose epidemic in North America is a cautionary tale. 

There is no simple solution to this crisis, but there are things that can be done.

An early warning system could help to alert the community if there is a new product or high dose batch and respond quicker to clusters of harm. Harm reduction should be made available to those currently using with options for support and housing easily accessible. Clinical advice around responding to acute ham can be developed and embedded in practice. Importantly, we as a sector can contribute to community responses by providing guidance around addiction, advocating strongly for greater action, making sure people don’t fall through the gaps of service criteria and refusing to sit by while the death toll rises.

We need to do things differently and with compassion, in a way that works for those in the community who are most vulnerable.