New Zealand’s emergent opioid trends - the influences and impacts: Consumer and clinician understanding of New Zealand’s changing patterns of opioid use, availability and impacts

This thesis explores opioid users and addiction service providers’ understandings of the changing patterns, availability and impacts of opioids and opioid use in New Zealand with a particular focus on the last two decades. Throughout history, the availability of substances of abuse have waxed and waned. Their emergence and availability is influenced by social, legislative and political circumstances. Extensive literature exists related to the use of opioids such as morphine and methadone in New Zealand, and heroin overseas. However, few studies have examined the emerging trends of opioids that are often used as adjunctively to these substances; examples of which in recent years include poppy seed tea (PST), over-the-counter codeine-containing analgesics and most recently some prescribed pain medications. Information regarding the use, availability and impacts of these adjunct opioids from the consumers who use them, and the clinicians who work with these consumers could usefully inform service provision and public policy. This qualitative study, adopting a Husserlian phenomenological philosophy was used, to gain an understanding of the use, access to and implications of these emergent opioid trends. Nine opioid users and five service providers were recruited through purposeful sampling as key informant participants. Their stories were elicited through in-depth interviews and analysis allowed for descriptive interpretation of participants’ experiences to emerge. The experiences described by participants were varied, although a general pattern indicated the ebb and flow of the adjunctive use of a range of opioids in New Zealand. The diverse and at times, localised sources of supply of these opioids are described. The roles of legislative processes and policy, government agencies, pharmaceutical companies, prescribers, pharmacists, and the users themselves as creative and flexible people are discussed. The findings of this study offer insights into the ways in which opioid availability is inextricably interwoven with the impacts that availability can have on the user. Reference is made to mortality and morbidity, as well as the impacts of displacement; the unintended consequences of stigma, discrimination, and criminalisation; and the accessibility of some opioid formulations, notably metered doses and abuse deterrent formulations (ADF). Overarching these descriptions is the sense that opioid users are in the main resourceful and adaptable, and that opioids hold a persistent place in the lives of dependent users. Recommendations from this study fit within a harm minimisation perspective that considers the needs of the dependent user, alongside the general population and a context of ‘public good’. These findings and recommendations support the need to appreciate the challenges facing opioid users who access treatment or support for their substance use; to consider the availability and access to a range of opioids from the perspective of minimising harm; to carefully consider the responsibilities of a number of stakeholders; to inform treatment delivery, workforce development and in the consideration of policy development and implementation