Deaths from opioids on the rise: report

Pharmaceutical opioids together with benzos are a deadly combo for Aussies, a new report has found, as NSW Labor commits to introducing real-time monitoring

Deaths related to opioid use are on the rise among Australians aged 15-64 – with 1,045 of these occurring in 2016 alone (6.6 per 100,000 people).

Compared to 3.8 per 100,000 people in 2007, this represents an increase over the last 10 years, according to a new report from UNSW’s National Drug & Alcohol Research Centre.

In 2016, two-thirds (65%) of opioid deaths were attributed to pharmaceutical opioids, and a further one quarter (24%) to heroin.

About 11% of deaths were due to both pharmaceutical opioids and heroin combined, up from 4% in 2007.

The majority (85%) of these deaths were considered accidental, while one-tenth (12%) were intentional and 3% had undetermined intent.

Breaking down the figures:

  • About half of deaths (48%) were attributed to natural and semi-synthetic opioids (e.g. morphine, codeine, and oxycodone).
  • About one-fifth (21%) were attributed to synthetic opioid analgesics (e.g. fentanyl and tramadol).
  • A further one-fifth (20%) were attributed to methadone.

Unfortunately the data does not include a breakdown between prescription medications and diverted medications, however NDARC confirms the opioids are of pharmaceutical origin.

The NDARC team says it is looking into undertaking further analyses of these data using other more detailed sources to ascertain what proportion of deaths can be attributed to use of pharmaceutical opioids directly prescribed to the person versus not prescribed to them.

Almost half (45%) of opioid-induced deaths recorded benzodiazepines as contributing to the death – up from 35% in 2007.

Nearly one-quarter (23%) had antidepressants as a contributing factor, 14% alcohol, 14% antipsychotics (up from 7% in 2007) and 10% paracetamol.

In comparison to opioid deaths surpassing the 1,000 mark, there were 105 amphetamine-induced deaths in 2016, and fewer than 20 cocaine-induced deaths.

“One of the most important and effective strategies to reduce overdoses is increasing the availability of opioid substitution therapy for people who have developed opioid dependence and encouraging engagement and retention in this treatment, suggests Dr Amy Peacock, program lead for Drug Trends at UNSW and NDARC Senior Research Fellow.

“We also need to encourage Australians at risk of having or witnessing an overdose to carry and administer naloxone. This is available over-the-counter in pharmacies and easily administered to temporarily reverse the effects of an opioid overdose, allowing time to seek medical help.

“This situation of increasing deaths due to pharmaceutical opioids in Australia has generated a response in the policy space. State and federal governments are considering a range of strategies, rolling out prescription monitoring programmes and other interventions intended to reduce risky opioid prescribing.”

NSW Labor’s call to action

In the face of increasing deaths due to prescription opioids, NSW Labor has announced that if elected, it will introduce real-time monitoring in pharmacies.

NSW Opposition Leader Luke Foley said their announcement follows a NSW Coroner’s report released last month which criticised a lack of State Government action on the matter.

After conducting an inquiry into the accidental prescription drug overdose death of young Sydney mother Alissa Campbell in 2015, the NSW Coroner described her death as preventable.

Deputy State Coroner Harriet Grahame recommended implementing a system that has the capacity to immediately identify a patient’s current prescriptions to clearly assist doctors and pharmacists to prescribe and dispense more safely.

She added that this would have been “particularly useful in caring for complex patients like Alissa who accessed a number of doctors and pharmacies at any one time.”

Mr Foley joined Shadow Health Minister Walt Secord at a pharmacy in Sydney’s CBD on Sunday to announce that a NSW Labor government would invest $30 million over four years to introduce real-time monitoring, which will allow for prescription histories to be transmitted in to doctors, nurses and pharmacists during their consultations with patients.

The NSW software will reportedly be patterned on Victoria’s SafeScript scheme, which is due to go live later this year.

The system will link pharmacies and GP surgeries via a database to reduce patients doctor- or pharmacy-shopping and abusing prescription medications at high risk of misuse.

It will monitor the prescriptions of all Schedule 8 medicines (opioids, painkillers and stimulants), as well as tranquilisers, sleeping tablets, anti-psychotics and codeine.

“I urge the NSW government to introduce real-time prescription monitoring, if it doesn’t act on this Labor will, if elected in 2019,” said Mr Foley.

PSA welcomed the announcement.

“The Pharmaceutical Society of Australia fully supports the announcement by NSW Labor that if elected to Government they will introduce a real time prescription monitoring system into NSW,” said PSA NSW President Professor Peter Carroll.

“Deaths from prescription opioids continue to rise, and PSA has been advocating with the NSW Government to introduce a real time prescription monitoring system to prevent these deaths, along with a number of coroners’ reports indicating that such a system is needed.

“Unfortunately the current NSW Government has not introduced such a system. In fact, the NSW Chief Pharmacist has stated that a real time prescription monitoring system is ‘years away’.

“This is a completely unacceptable situation as without a real time prescription monitoring system for drugs of misuse such as opioids, deaths will continue to occur in NSW, which could have been prevented.”

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