A Scoping Review of the Emergence of Novel Synthetic Opioids in Australian Drug Markets: What Does This Mean for Harm Reduction Responses?

Abstract

Issues: Rising synthetic opioid deaths in North America, and the emergence of nitazene harms has driven concern about novel synthetic opioids (NSO) in Australia. This scoping review aimed to map what is known about NSOs in Australia.

Approach: Scoping review of peer-reviewed and grey literature on NSO detections and harms.

Criteria: studies describing NSO market indicators and harms in Australia.

Key findings: Overall, 912 peer-reviewed studies were identified; 40 met criteria. Monitoring systems identified NSOs (e.g., β-U10, nitazenes) for the first time in Australia. Nitazene toxicity appeared in emergency departments (N = 11, 2021-onwards), two involved intentional consumption. NSOs for sale to Australia on cryptomarkets comprised < 1% of drug listings. Mortality studies identified fentanyl analogues (furanylfentanyl, acetylfentanyl) (N = 22, 2013-2021), and other NSO U-47700; (N = 12, 2016-2021) deaths. Thirty-three nitazene deaths were reported; 24 in Victoria (2021-onwards); 7 in SA (2022-onwards); two in NSW (2024). Australian Federal Police reported 47 nitazene seizures since July 2023. Fifty-one drug alerts were identified (2019-2024); 18 (34%) involved NSOs; 12 (24%) for nitazenes. Overall, 12 alerts were for NSO-contaminated stimulants; at least two fatal overdoses were confirmed due to NSO-contaminated stimulants.

Implications: Australia has strong monitoring capacity for NSOs post-consumption. Harms occurring among opioid-naïve people unknowingly purchasing NSOs suggest a role for drug checking and cautious use of nitazene testing strips. Expanding take-home naloxone availability in entertainment settings, and to all who use drugs, is warranted.

Conclusion: This review demonstrated the recent and limited emergence of NSOs in Australia. Demand for NSOs is not yet clear; availability and harms are rapidly changing.