Drug-related deaths rising

A new report from NDARC has highlighted the importance of helping people at risk of overdose from pharmaceutical drugs

The National Drug and Alcohol Research Centre at UNSW Sydney has released a new report which shows there were more than five drug-induced deaths per day in Australia in 2019.

The report identified significant concerns about illicit drugs, with an increase in deaths involving amphetamines and cocaine, and with heroin-related deaths surpassing those from natural and semi-synthetic opioids such as morphine or oxycodone.

“This is the first year the number of opioid-induced deaths involving heroin (474) has surpassed that of natural and semi-synthetic opioids (460),” said Dr Amy Peacock, Program Lead for Drug Trends at NDARC.

The report found that in 2019, 56% (632 deaths) of opioid-induced deaths were attributed to pharmaceutical opioids only, 32% (356 deaths) to illicit opioids (heroin and opium) only, and 11% (118 deaths) to both pharmaceutical opioids and illicit opioids.

The remaining 0.6% (7 deaths) were attributed to other and unspecified opioids.

“This represents an increase in the percentage of deaths attributed to illicit opioids only since 2014 when 17% of opioid-induced deaths involved illicit opioids only, 75% pharmaceutical opioids only, 4.7% both illicit and pharmaceutical opioids, and 2.9% other and unspecified opioids,” the report noted.

“The vast majority of opioid-induced deaths involving illicit opioids involve heroin (more than 99.5% in 2019).”

While deaths involving heroin have been relatively stable for the last three years, the report says that preliminary estimates suggest a decrease in deaths involving natural and semi-synthetic opioids.

Opioids were the most common class of drugs involved in drug-induced deaths.

Next were antiepileptic, sedative-hypnotic and anti-parkinsonism drugs (944 deaths, 3.8 deaths per 100,00 people), which predominantly comprised benzodiazepines (811 deaths, 3.3 deaths per 100,00 people).

“Other cited drug classes included antidepressants (568 deaths, 2.2 deaths per 100,000 people), amphetamines (478 deaths, 2.0 deaths per 100,000 people), antipsychotics and neuroleptics (356 deaths, 1.5 deaths per 100,000 people), alcohol (310 deaths, 1.2 deaths per 100,000 people), non-opioid analgesics, antipyretics and antirheumatics (299 deaths, 1.2 deaths per 100,000 people) and cannabinoids (207 deaths, 0.87 deaths per 100,000 people),” the report said, noting that these observations are largely consistent when examining only unintentional deaths in 2019.

“The rates for all drug classes have increased since the mid-to-late 2000s to around 2016, and from then the rates have mostly declined (noting that estimates from 2017 onwards are not finalised, and will be only revised upwards).

“The exceptions comprise drug-induced deaths involving amphetamines and cocaine which, despite being preliminary, demonstrated an increase from 2018 to 2019 (1.8 versus 2.0 deaths per 100,000 people for amphetamines, respectively; 0.25 versus 0.35 deaths per 100,000 people for cocaine).”

Dr Peacock told the AJP that “It’s concerning to see the rise in drug-induced deaths involving pharmaceutical medicines like opioids, benzodiazepines, antipsychotics and pregabalin”.

“The findings presented are not adjusted for changes in prescribing over this time, and there have been improvements in routine screening and identification of these medicines in deaths which may contribute to the findings,” she pointed out.

“Regardless, these results reinforce the importance of identifying, educating and monitoring individuals prescribed and dispensed depressant medicines (e.g., opioids, benzodiazepines) at risk of overdose.

“They also highlight the importance of take-home naloxone provision for people prescribed opioids who may be at risk of overdose.”

She noted that estimates as to number of opioid-induced deaths occurring in 2017-2019 are not yet finalised “because of the time for coronial processes to be closed and the final cause of death recorded”.

“For that reason, it is difficult at this stage to speculate as to the impact of recent regulatory changes on rates of opioid-induced deaths at this stage, although this is a priority for us as updated estimates become available.”

Only one in four (24%) of drug-induced deaths were considered intentional.

“The most frequent psychosocial risk factor identified in coroner-certified drug-induced deaths was personal history of self-harm,” said Dr Peacock.

“Other frequently identified psychosocial factors in 2019 were: disruption of family by separation and divorce, disappearance and death of a person in the primary support group, problems in relationship with spouse or partner, and problems related to other legal circumstances.”

The report has also found that there has been a shift over time in the age demographic of drug-induced deaths.

“Those in the 45-54 and 35-44 age groups are now experiencing the highest rate of drug-induced deaths where previously in the late 1990s the rate was elevated in the 25-34 age group,” said Dr Peacock.

In 2019, the rate of drug-induced deaths was similar in major cities, inner regional and outer regional areas, and lowest in remote/very remote areas.

Read the full report here.

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