Overdose report reveals hidden health crisis

Australia’s Annual Overdose Report 2020 reveals that — for the fifth year running — more than 2000 Australians lost their lives due to overdose. The Penington Institute report highlights an alarming trend driven by deaths involving opioids, stimulants and the use of multiple substances at the same time (known as polydrug use). The overdose death toll is reported to cost the Australian economy more than $13 billion every year.

“Overdose is our hidden health crisis — and it’s a crisis that is costing us billions. And what’s worse is these deaths are preventable,” Penington Institute CEO John Ryan said.

“We simply can’t accept that 2000 of our sons and daughters, mums and dads, and brothers and sisters die every year from a drug overdose.

“Over 400 more Australians die of unintentional overdoses than on the roads every year — and the gap is widening. Concerted campaigning, investment in evidence-based policies and community education has done a great job of bringing down the road toll. We must tackle our overdose crisis in the same way,” Ryan said.

Ryan explained that, in response to the report findings, Penington Institute is calling on the federal government to bring down the overdose toll by committing to the following policies:

1. A National Overdose Prevention Strategy that comprehensively examines the drivers of overdose risk, access to proven interventions and the adequacy of existing efforts.
2. Expansion of the current pilot of Take Home Naloxone from NSW, SA and WA to every state and territory. “Naloxone is a safe, proven intervention that saves countless lives,” Ryan said.
3. A realistic approach to the planned rollout of national real-time prescription monitoring.

Ryan said, “A deep-rooted social, health and legal problem can’t be fixed with technology alone. Real-time prescription monitoring carries real risks of locking people out of receiving the care they need and diverting them to unsafe illicit drugs. Stopping access to pharmaceutical drugs without proper treatment will result in more deaths.”

The most vulnerable

Penington Institute Deputy CEO Dr Stephen McNally commented, “The overdose crisis is felt at all levels of our society. However, the most recent data again shows that some Australians are more vulnerable than others.”

Age remains a risk factor for overdose death, with over 40% of all unintentional overdose deaths in 2018 suffered by Australians aged 50 and over, while those in their 40s accounted for 27% of the total.

The 2020 report shows, yet again, that unintentional overdose deaths occur at higher rates in regional areas than in our capital cities. In 2018, there were 7.3 unintentional overdose deaths per 100,000 people in rural and regional Australia, compared with 5.8 per 100,000 in the capital cities.

“We want Australia’s Annual Overdose Report to encourage Australians from all walks of life to talk more about overdose and drug issues,” Ryan said.

“That’s vital if we’re to bring this hidden crisis out of the shadows. The rich, middle and poor are all impacted by overdose. City and country too. It is not someone else’s problem. It is an Australian problem that we must collectively face up to.”

The Australian Injecting and Illicit Drug Users League (AIVL) has also called for a greater focus on key prevention and harm reduction initiatives to address rates of overdose. In particular, AIVL is calling for the implementation of widespread peer distribution of the opioid overdose reversal drug naloxone and enhanced resourcing for peer-based overdose prevention programs across the country.

“The National Drug Strategy refers specifically to the need to prevent and respond to overdose ‘including increased access to naloxone’^[1]. On International Overdose Awareness Day, the focus is on those initiatives that prevent overdoses and save lives,” AIVL CEO Melanie Walker said.

“In the context of rising rates of overdose across the country, there really needs to be an enhanced focus on the implementation of evidence-based prevention and harm-reduction measures.”

Australia’s Annual Overdose Report 2020 reinforces previous research by the National Drug and Alcohol Research Centre, showing that heroin is now once again the leading opioid underlying opioid-induced accidental deaths. There have also been increases in deaths involving synthetic opioids such as fentanyl and tramadol over the past decade.

An increasing rate of deaths involving psychotropic medicines (eg, benzodiazepines, antipsychotics) and non-opioid medicines used for treatment of certain pain conditions (eg, pregabalin) is of concern. It is important to note that these medicines are often identified alongside other drugs such as in cases where opioids are the underlying cause of death and benzodiazepines are an associated cause of death)^[3].

“International Overdose Awareness Day is a global event held on the 31st of August each year, aiming to raise awareness of overdose and reduce the stigma of drug-related deaths,” Walker explained.

“It acknowledges the grief felt by families and friends remembering those who have met with death or permanent injury as a result of drug overdose. As part of International Overdose Awareness Day, AIVL’s member organisations around the country will be undertaking activities to promote awareness and prevention and remember those lost.

“A key message is that the tragedy of overdose deaths is preventable. In this context, it’s important to focus on practical things that can be done right now in Australia to save lives. People who use drugs have an important role to play as part of broader prevention and harm reduction efforts. Enabling greater access to naloxone and peer-based overdose prevention programs are practical ways that governments can help people to protect themselves and prevent overdose deaths — which would be a wonderful outcome for individuals, families and the broader Australian community,” Walker said.

Key findings of Australia’s Annual Overdose Report 2020

• There were 1556 unintentional overdose deaths in Australia in 2018, accounting for more than three-quarters (75.2%) of all overdose deaths.
• Opioids were the drug group most identified in unintentional overdose deaths in 2018 (involved in 900 deaths), followed by benzodiazepines (involved in 648 deaths) and stimulants (involved in 442 deaths).
• Unintentional overdose deaths were most common among the 40–49 age group, which accounted for 26.9% of all unintentional overdose deaths in 2018. Fewer than one in ten (9.6%) deaths recorded was among those aged under 30 years.
• Men were almost three times more likely than women to suffer an unintentional overdose death in 2018, accounting for 71.5% of deaths.
• Aboriginal Australians were almost three times more likely to die from an unintentional overdose death in 2018 than a non-Aboriginal person, with a rate of deaths of 17.3 per 100,000 population, compared with 6.0 deaths per 100,000 population for non-Aboriginal people.
• Since 2011, the rate of unintentional overdose deaths in regional Australia has surpassed the rate seen in capital cities. From 2011 to 2018, the rate of unintentional overdose deaths in rural and regional Australia increased by 15.9%, while the rate in capital cities increased by 3.6%.
• The number of unintentional overdose deaths that involve four or more substances (polydrug use) has almost quadrupled from 163 in 2013 to 582 in 2018.
• There were 442 unintentional overdose deaths involving stimulants in 2018, up from 87 in 2008 — an increase of more than 400%.
• While the overall number of unintentional overdose deaths involving anti-convulsants is low (128 deaths in 2018) the number has increased markedly since 2015, when there were only 11 deaths.
• Rates of unintentional overdose deaths involving antipsychotics have increased markedly since 2013 (when there were 15 deaths involving anti-psychotics) to 223 such deaths in 2018, representing 14.3% of all unintentional overdose deaths.

Image credit: ©stock.adobe.com/au/radachunskyi