Opioid adulteration is a pressing issue in Australia, even for party drug users, experts warn

Photo source: anonymous.

A friend taps you on the shoulder at a house party, their other hand frozen in suspended animation, bearing a gift. A snow-capped mountain of rack on a tectonic plate of brass hovers centimetres from your nose.

Or how about this: the crowd swells and expands. Waves of bass from the ten foot high speaker stack almost lift you off the ground. You reach for the bag of shard in your pocket and your house keys.

It’s a familiar scenario for residents in NSW; we undeniably adore stimulants. Sydney is a city where the waters run rich with stimulants. Literally. Wastewater testing by the Australian Crime Intelligence Commission has consistently shown that Sydney is the cocaine capital of Australia. According to the latest estimates, Sydneysiders have vacuumed up almost half of the total weight consumed nationally. On top of this, coke use is on the rise after a pandemic-era slump.

Those same findings demonstrated that meth use across the country has surged with those in regional areas favouring ice more than city slickers.

It puts users in NSW in a vulnerable position. As our bodies develop tolerance to stimulant drugs, we feel the need to consumer ever-larger quantities. But what happens when suppliers further up the chain have cut our stimulant drugs with opioids we don’t have experience taking? What happens when white powders and crystals that look remarkably similar are all mixed together?

Now, more than ever, the cross-contamination of drugs is something we should be worried about. According to NSW Health a number of people have died in recent weeks from opioid overdoses after taking drugs thought to be cocaine and methamphetamine, and drug experts are concerned that communities not normally exposed to drug harm reduction programs are now also at risk.

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In light of recent drug alerts, Dr Darren Roberts, NSW Poisons Information Centre Medical Director, said that “opioid overdoses can quickly result from a single line or point” of a perceived stimulant drug.

Professor Nicholas Lintzeris, an addiction medicine specialist at the University of Sydney and the South East Sydney Local Health District, expressed concern that there are “hidden populations” of drug users who don’t traditionally access drug harm reductions services in light of recent drug alerts and media coverage.

“They’re not people identified with drug cultures. They’re just people who like partying and doing bags of coke on the weekend,” Professor Lintzeris said.

“Harm reduction strategies really target opioid users: medically-supervised injecting rooms, take-home naloxone, methodone maintenance and buprenorphine [‘bupe’] treatment,” he explained.

The challenge for drug harm reduction organisations and health services, Professor Lintzeris suggested, is reaching new audiences and communities.

“It’s a real concerns that these [opioid] drugs also seem to be present in non-opioid drug supplies.”

Data indicates that the adulteration of street drugs in Australia with more harmful (and unexpected) drugs is widespread.

Directions Health Chief Operating Officer Stephanie Stephens, who oversees the operations of CanTEST, Australia’s only fixed-site pill testing facility, said the evidence is clear: “At CanTEST we’ve done tests on around 2300 samples over the past 21 months and about half of all samples have some kind or filler or adulteration.”

“There have now been four world-first [drug] detections at CanTEST.”

Associate Prof Anna Olsen (ANU lead evaluator), Rachel Stephen Smith (Health Minister), and Stephanie Stephens on the day the government announced an extension of the CanTEST pilot. Photo: supplied.

Stephens said that drug harm reduction groups in Canberra are concerned about synthetic opioids – opioids produced in a laboratory rather than from natural substances found in the opium poppy plant – entering unregulated local drug markets as both a cutting agent and a powerful standalone product.

While North America’s fentanyl crisis has dominated the front page of the internet in recent years, thanks to the efforts of gonzo journalists and Youtube documentarians like Andrew Callaghan, aka All Gas No Brakes, fentanyl, a synthetic opioid 50 times stronger than heroin, is largely absent from Australia’s illicit drug markets.

But recent detections of nitazenes in Australia, an even more potent synthetic opioid than fentanyl, has both Stephanie Stephens and Professor Lintzeris concerned.

“We need to be mindful of synthetic opioids because there are roughly 100 in the global unregulated market and they have different risk profiles, but all opioids come with the risk of respiratory depression,” Stephens stated.

“We are currently working on analytical methods to better detect nitazenes. Any synthetic opioid is a risk but nitazenes are cropping up in Australia and they’re stronger than fentanyl. They’re potent in a really low dosage.”

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I asked Alex* and Alexei* over for a “couple of drinks”. It was in 2020 during one of those nap-inducing intermission periods where you were able to see a small handful of designated mates.

Soon after arriving, Alex brandished a bag of shining white powder aloft, a holy grail amid the tedium of lockdown. A “friend of a friend” sold her a bag of “speed” suspiciously cheap after he realised that the drug was not MDMA as he expected. He told Alex he had tested the drug with a DIY home testing kit.

This was earth-shattering news. Speed? As far as I can tell, speed doesn’t exist anymore. Today, it’s nigh impossible to source old-school goey in Sydney. This wasn’t always the case; in fact, I spent innumerable nights in my younger years powering through bags of speed. It was my drug of choice.

Speed is an illicit amphetamine in powder form, although sometimes more of an off-white paste, with effects almost identical to dexamphetamine and lisdexamphetamine, the ADHD prescription medications (I use the present tense – is – optimistically). Produced by local bikie gang cooks, amphetamine sulphate, aka goey, aka whizz, once fuelled 90s gabber raves, late night hospo venues and long-haul truck journeys. But the proliferation of methamphetamine, a far more potent and profitable amphetamine, since the 00s has largely displaced the drug.

I told Alex confidently that I’d be able to tell right away if the drug she’d bought was indeed speed, so she poured out lines from the bag.

As soon as the powder shot through my nostrils, I realised this speed wasn’t speedy. Alex had unknowingly bought a strong-ass opioid. There were a few tell-tale signs. I immediately vomited – blissfully, I might add. Vomiting has never felt so heavenly. I felt like I was rolling in fields of fairy floss, as if there was sticky warm sugar absorbing through my skin, flowing through my veins and energising my body. This drug felt different. Unknown. My mind begged for more. We hoovered up the rest of the bag in quick succession with some lines of ket in between for good measure. Conversation died to a burble and the trance blaring from my speakers swamped the room, pushing us underwater into a shimmering realm of drug-induced splendour. Time dilation swallowed us whole and spat us out the other end, 6 hours later.

Then there are the photos I took with my phone: Alex and Alexie slumped against my bedroom walls in a state of semi-consciousness, their heads bent at unnatural angles, eyes empty, on the cusp of nodding out.

When I followed up with Alex more recently, while writing this story, she told me, “I was snorting the mystery powder semi-regularly for about a month until I realised it almost certainly contained opioids, and I think because I was only taking small amounts at first, I just thought it was pretty shit speed.”

While the experience resulted in no harm to Alex, who has some experience with opioids, or Alexei or I, she expressed reservations that she could have shared the drug with someone with a very low tolerance.

“That could have potentially had more serious consequences than it did for me.”

In a way, we were lucky.

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Drug harm reduction organisations, such as the NSW Users’ and Aids Association (NUAA), suggest that, if you’re trying a new batch of coke or ice, start with smaller doses than usual and make sure you are not alone. Watch out for unexpected drowsiness, loss of consciousness, slow breathing or snoring, and skin turning blue or grey as these are signs of opioid overdose.

Professor Lintzeris suggested that drug users always carry naloxone on them. Naloxone is a non-prescription nasal spray that rapidly and effectively reverses the effects of an opioid overdose. In short: it can be a life-saving medication. What’s more: some community pharmacies and needle and syringe programs supply naloxone for free.

“Education and awareness” is vital, Professor Lintzeris said. 

“Take-home naloxone is a really important strategy. But hardly anyone who is not a heroin user in Australia knows anything about naloxone.”

Emphasising the need for more drug testing services based on the Canberra CanTEST model – that is, drug checking sites outside of music festivals – and the absence of a permanent fixed-site pill testing in NSW, Professor Lintzeris underlined the importance of individuals obtaining fentanyl test strips.

“They’re legal and available now. Anybody can go get them,” he stated.

* Names changed to protect the identities of these individuals.