Dangerously adulterated batches of the drugs cocaine and ketamine are circulating in NSW. They have already caused multiple hospitalisations.
NSW Health has issued a warning as acetylfentanyl and fentanyl may be being used as an adulterant in cocaine and ketamine – or be misrepresented as one of these drugs.
Acetylfentanyl has a similar potency to fentanyl. Both may cause serious harm and death.
People who do not use opioids regularly (‘opioid naïve’) may be unintentionally exposed and are at high risk of overdose.
Even people who regularly use opioids are at risk due to the relatively high potency of fentanyl and acetylfentanyl that has been detected.
Health practitioners are asked to be on the lookout for unusual presentations and overdoses. Serious adverse effects may include:
- Drowsiness
- Loss of consciousness
- Vomiting
- Slow, shallow and/or erratic breathing
- Face being very pale or clammy
- Change in skin tone: bluish/purple for lighter skinned people, greyish for darker skinned people..
Case management protocol:
- Have a high index of suspicion for illicit fentanyl and fentanyl analogues in suspected opioid overdose. This includes people who deny opioid use or report use of other non-opioid illicit drugs including ketamine or stimulants such as cocaine, but who present clinically with signs of an opioid overdose.
- Airway management, oxygenation, and ventilation support take precedence over naloxone, where appropriate.
- Cases may require titrated doses of naloxone with a higher total dose of 800 micrograms or more. Balance this against the risk of precipitated withdrawal in an opioid-dependent person.
- The duration of effects from acetylfentanyl and fentanyl are longer than for heroin. Cases may require repeated doses of naloxone or a continuous infusion. Contact the Poisons Information Centre (13 11 26) or local toxicology service for advice or notify the PIC prior to discharge.
- Be aware that most urine drug screens do not detect synthetic opioids such as fentanyl.
- Consider supply of take-home naloxone on discharge if available
Notify the NSW Poisons Information Centre (13 11 26) for all suspected opioid overdoses where the patient reported taking a stimulant or ketamine or required high doses of naloxone. Ensure that urine and blood samples are collected and retained. The notification will be passed on to the NSW Ministry of Health.