There is global attention on the optimal use of opioids. Life expectancy in the United States dropped for three successive years from 2015 – the longest sustained reduction in expected lifespan since the period 1915 to 1918 when World War I and the Spanish influenza pandemic made a dramatic impact on life expectancy globally.

Addiction medicine specialist, Dr Richard O’Reagan.

Addiction medicine specialist, Dr Richard O’Reagan.

Significant drivers of the reduction were drug overdoses and suicides. Overdose rates in the US peaked in 2017 with more than 72,000 deaths registered, of which 47,600 (or 130 people dying each day) were opioid-related.

Australia’s Annual Overdose Report[1] is released to coincide with International Overdose Awareness Day on August 31. This year’s figures continue to show more Australians are dying, with 1612 unintentional drug induced deaths (UDIDs) recorded for 2017 (8.9 per 100,00 population).

Between 2001 and 2017, Australia’s population rose by 28% and the number of UDIDs increased by 64%. Most deaths result from multiple drug toxicity, rather than a single substance causing fatality. The age group 30-59 years have the highest incidence of unintentional drug-induced mortality, and males account for 71.5%. UDIDs among Aboriginal people are three times the rate of non-Aboriginals (19.2 compared to 6.2 per 100,000).

Opioids continue to cause the highest number of deaths, with 904 opioid-related unintentional deaths reported nationally in 2017, while stimulants, anticonvulsants and antipsychotics show the highest rate of increase over the past 10 years.

Benzodiazepines are the second most common group of drugs associated with overdose death, and are usually associated with deaths involving multiple drug use. While heroin-related deaths have increased substantially since 2012, the likelihood that an overdose death was related to prescription opioid remains significantly higher than for heroin.

In 2017, 64.7% of all opioid-induced deaths were related to prescription opioids, and 26.2% were related to heroin[2].

In 2017 WA recorded 208 UDIDs, with 132 of these being opioid-related[2]. Between 2012 and 2017, WA recorded the greatest increase in rate of UDIDs nationally, rising from 6.4 to 8.1 deaths per 100,000 population. Perth has the highest rate of UDIDs among the state capitals at 8.5, while regional and rural Victoria has the highest rate of all regions in the country at 9.6. WA recorded the highest rates of deaths involving oxycodone, morphine and codeine, and for fentanyl, pethidine and tramadol, and the second highest rate of heroin-related deaths.

Why is this significant?

Most UDIDs in Australia occur in relation to prescription medication, which means prescribers can influence these figures. The terms ‘medication stewardship’ and ‘universal precautions’ are increasingly being heard in association with the goal of improving our prescribing habits. Both refer to the safer prescribing of medications with the intent of creating a balance between patient access to appropriate and necessary medications and minimising non-intended use.[3]

Prescribers need education and support towards safer use of medications. Recent publications such as those produced by the RACGP on prescribing opioids in pain management[4] provide comprehensive advice on the topic. With WA’s prescription drug monitoring system expected to launch in 2020, prescribers will have a tool with which to make informed prescribing decisions.

Further, access to best practice treatment for opioid dependence needs to be readily available and affordable. Medication assisted treatment comprising of buprenorphine or methadone maintenance is the mainstay but is restricted to authorised practitioners, and few GPs undertake this work.

Out-of-pocket costs make the treatment unattractive and difficult for patients to afford. WA needs to maintain and expand provision of this vital treatment to ensure those in need are able to enter treatment. We must explore sustainable means of attracting, retaining and supporting GPs to provide addiction treatment, particularly in regional and remote areas.

Other initiatives such as the provision of take-home naloxone for people likely to experience or witness an overdose are growing, and WA is a leader in Australia with the WA Naloxone Projects. While no single activity alone is sufficient to rein in our rate of opioid and other pharmaceutical UDIDs, the combined application of the above can certainly move WA in the right direction.

References:

  1. Penington Institute, Australia’s Annual Overdose Report 2019. 2019, Penington Institute: Melbourne.
  2. Chrzanowska, A., et al., Trends in drug-induced deaths in Australia, 1997-2017. 2019, National Drug and Alcohol Research Centre, UNSW Sydney: Sydney.
  3. Gourlay, D.L., H.A. Heit, and A. Almahrezi, Universal precautions in pain medicine: a rational approach to the treatment of chronic pain. Pain Med, 2005. 6(2): p. 107-12.
  4. Practitioners, T.R.A.C.o.G., Prescribing drugs of dependence in general practice, Part C2: The role of opioids in pain management. 2017.

 

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