Opioid overdoses following use of cocaine and methamphetamine in New South Wales, and the public health responses

Abstract

Objective: Recent years have seen sporadic reports in Australia of stimulants being contaminated with opioids. Since late 2023, there has been an increase in opioid overdoses among individuals in New South Wales (NSW) using substances believed to be cocaine or methamphetamine. We analysed the frequency and characteristics of these cases and describe our public health responses. Methods: The Prescription, Recreational & Illicit Substance Evaluation (PRISE), operated by NSW health since July 2018, is a statewide surveillance, epidemiology, and toxicity response programme. We did a retrospective analysis of each case of opioid toxicity following use of cocaine or methamphetamine submitted to the PRISE programme from January 2022 to June 2024, categorising cases into confirmed, probable, and suspected. Results: Thirty-four cases were found, 19 involving cocaine and 15 involving methamphetamine. Twenty-two (65%) were classified as confirmed, and 12 (35%) as probable. There were two deaths (6%). Twenty-three cases (68%) were in Sydney. Multiple stakeholders reviewed trends and formulated public health responses, leading to the distribution of public drug warnings and media releases in November 2023 and February 2024 because of ongoing case detections. Conclusions: The increase in detections, which continued in the months following the public health responses, underscores the need for comprehensive surveillance, response, monitoring, and reporting of this phenomenon in NSW. Engagement with clinicians and the community is essential for the success of this programme.