State’s top doctor raises alarm as Sydney vapers develop opioid addiction

The state’s top doctor pushed Premier Chris Minns to consider drug responses beyond pill-testing after young people in Sydney unknowingly inhaled synthetic opioids through vapes.

Minns last month announced NSW would hold its first pill-testing trial following recommendations from his government’s drug summit.

The trial was scheduled to begin in early 2025. The music festivals taking part are yet to be named.

Chief Health Officer Kerry Chant pushed for NSW to consider drug-checking measures beyond pill-testing. Credit: James Brickwood

But in September, weeks before the summit began, Chief Health Officer Kerry Chant and Centre for Alcohol and Other Drugs executive director Daniel Madeddu asked Minns to consider pill-testing “and other responses to new and emerging drugs”, raising concerns about increasing harm from nitazenes, a synthetic opioid 100 times more powerful than heroin.

“Any discussion on drug-checking models should consider the capability of different technology to test for nitazenes and other novel synthetic opioids,” the brief, obtained under freedom-of-information laws, read.

It said checking for these substances was in the “public interest” after NSW’s first cases of nitazene dependence at Fairfield Hospital in July.

Withdrawals were observed in four young adult patients who were previously “opioid naive” and developed a nitazene addiction after inhaling illicit vape liquid that contained protonitazene, a synthetic opioid.

Three of the four unknowingly inhaled the nitazene. The vapes were sold as non-nicotine vapes through an online chat group used by up to 100 young people.

Patients with nitazene withdrawal require complex medical attention, which can include administering prescribed opioids to wean patients off illicit substances.

The cases prompted NSW Health to revise its nitazene treatment advice, recommending doctors enquire about vape use and side-effects, particularly if “opioid-like”.

NSW Health has issued six public nitazene warnings since December 2022.

The advice was forwarded from Minns’ office to Health Minister Ryan Park, who – in an October response – refused to be drawn on the role pill-testing could play to reduce synthetic opioid harm.

“NSW Health is committed to addressing alcohol and other drug-related harms and is concerned about the emergence of potent synthetic opioids such as nitazenes,” Park wrote. “The issues you have raised, including drug checking, may be discussed at the upcoming drug summit.”

Two months later, Park and Minns announced a pill-testing trial, following advice from summit co-chairs Carmel Tebbutt and John Brogden.

Testing will occur at up to 12 music festivals in 2025. Services will test for synthetic opioids. Police may still prosecute drug use at these festivals.

Park said the decision to implement pill-testing was based on advice of Tebbutt and Brogden, and meetings with advocates such as John Gordon, whose son died of an accidental nitazene overdose from a fake oxycodone pill in 2022.

“These are complex issues, and we will be guided by what delivers in the best interests of the health of the community,” Park said.

By September, six patients had been treated in Sydney hospitals for nitazene withdrawal. Updated figures were unavailable as NSW Health does not routinely collect this data.

The Morning Edition newsletter is our guide to the day’s most important and interesting stories, analysis and insights. Sign up here.