Opioid, benzo deaths still rising

A “very disturbing” new report shows that unintentional drug overdose deaths continue to rise – with pharmaceutical opioids and benzodiazepines a particular concern

Australia’s Annual Overdose Report 2019, issued by the Penington Institute, looked at drug-induced deaths in Australia in 2017. The report was compiled based on Australian Bureau of Statistics data.

There were 2,162 such deaths that year, a significant increase since 15 years prior – there were 1,231 drug-induced deaths in 2002.

Of the 2,162 drug-induced deaths in 2017, the majority (1,612) were unintentional. Fifteen years ago in 2002, the number of unintentional drug-induced deaths was 903.

The 2017 figures equate to more than four unintentional drug-induced deaths a day, or one every 5.4 hours, the report states.

From 2001 to 2017, the population of Australia increased by 27.8%. During the same period, the number of unintentional drug-induced deaths increased by 64.3%

Opioids were the drug group most commonly identified in unintentional drug-induced deaths in 2017 (involved in 904 deaths), followed by benzodiazepines (involved in 583 deaths) and stimulants (involved in 417 deaths).

The number of unintentional drug-induced deaths involving opioids has more than trebled in the last 10 years, the report noted. This included “sharp” increases in the last five years in the number of such deaths involving heroin and oxycodone/morphine/codeine.

Since 2013, the number of deaths involving heroin has increased from 195 to 358 – an 83.6% increase. Similarly, the number of deaths involving oxycodone/morphine/codeine has increased from 269 to 344: a 27.9% increase.

Meanwhile the number of unintentional drug-induced deaths involving benzodiazepines has continued to rise overall.

“There are significant increases in deaths involving stimulants, cannabinoids, anti-convulsants (used to treat neuropathic pain) and anti-psychotics,” the report says.

“In the last 15 years, unintentional drug-induced deaths involving stimulants have increased 11-fold. Recent trends have emerged involving anti-psychotic and anti-convulsant medications; in the last three years there has been a 6-fold increase in deaths involving anti-psychotics, and in the last two years a 5-fold increase in deaths involving anti-convulsants.

“Poly-drug use underlies many of these deaths, and deaths where four or more substances were detected are increasing dramatically.

“The number of unintentional drug-induced deaths that involve four or more substances has almost trebled, from 163 in 2013 to 445 in 2017. In comparison, deaths involving the detection of a single drug, or the detection of alcohol on its own, have not significantly increased over time.”

Most drug-induced deaths are caused by a combination of drugs, the report notes, not the result of a single drug.

Unintentional deaths were most common among the 40-49 age group, which accounted for 27.9% of all unintentional drug-induced deaths in 2017. Fewer than one in ten (9.4%) deaths recorded was among those aged under 30.

Males were more than twice as likely as females to suffer an unintentional drug-induced death in 2017, accounting for 71.5% of deaths.

Aboriginal people were more than three times as likely to die from an unintentional drug-induced death in 2017, with a rate of deaths of 19.2 per 100,000 population, compared with 6.2 deaths per 100,000 population for non-Aboriginal people.

The report compares unintentional drug-induced deaths to the road toll: the former are increasing by 3.4% per year, based on trends from the 2001-17 period.

“If nothing is done to alter this trend, it will equate to an additional 393 drug-induced deaths by 202, of which 293 will likely be unintentional,” it notes.
“In contrast, the road toll has decreased on average by 2.2% per year, equating to 131 fewer deaths by 2022.

“In 2017, 1,612 people died from unintentional drug-induced overdoses in Australia, compared to 1,246 people who died on our roads.”

A spokesperson for the Pharmacy Guild called the report “very disturbing,” particularly given the widespread increases in the rate of accidental overdose involving prescription medicines.

They noted the Guild’s opposition to longer script lengths and non-pharmacist ownership, saying that the current arrangements helped improve patient safety.

“This reinforces the point that prescription medicines can very often be life-saving, but they can also be life threatening,” the spokesperson said.

“That’s why prescription medicines are only dispensed under controlled conditions in a pharmacy – owned and run by a pharmacist who has the skills and knowledge – and the responsibility – to ensure they are properly dispensed and that the patient is appropriately advised on how to take the medicine and of risks.

“It is vital that medicines are taken as directed by prescribers, and as advised by pharmacists who are medicine experts and can help people avoid overdoses and other risks associated with some medicines.”

The spokesperson highlighted the fact that the dispense process is assessing whether a medicine is safe for that patient.

“Pharmacists oppose any proposal to increase the quantities of prescribed medicines supplied on each dispensing occasion,” they said.

“The current system of generally providing one month’s supply of a medicine strikes a practical balance between patient convenience and minimising the availability of medicines in a patient’s home, and hence the community.

“When a patient returns to their community pharmacy for a repeat supply of a prescription medicine pharmacists have the opportunity to access patient compliance with the prescribed medicine, and can intervene if confusion or adverse reactions to medicines are identified.”

The spokesperson also stressed the importance of real time monitoring.

“An important way for doctors and pharmacists to be alerted to the potential misuse of prescription medicines is through real time prescription monitoring. 

“It can help identify patients who may putting themselves at risk by over-using a medicine, combining it with other medicines that may not be appropriate or visiting multiple doctors and pharmacies to receive more prescriptions and their medicines dispensed.

“If a dependency is detected in a patient there are pathways for addiction therapy that a pharmacist can recommend for patients.

“In cases of emergency relating to addiction, it is a positive development that the life-saving overdose drug Naloxone is available from pharmacists over-the-counter as a pharmacist-only medicine.”

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  1. chris

    I am still getting my brain around this poly-drug overdose situation. What I am reading or misreading or not reading is that patients who go to the same doctor and get prescribed a plethora of ‘susceptible’ medications could somehow end up overdosing when taking the prescribed amounts that the doctor has recommended.

    I am also reading that if patients somehow procure extra medication from different sources so that doctors are not aware of this, then an overdose may occur.

    I also know that if I were to walk across Hoddle St without using the pedestrian crossing taking my chances, in all likely hood i could have an unintentional collision with a tonne of steel. Maybe I am still contemplating why that chicken from years ago wanted to cross the street in the first place.There was no ubers or olas then i guess.

    • Jarrod McMaugh

      Generally speaking, a person can overdose on many medicines – even at prescribed doses – based on different variables.

      For instance, a person using a dose of an opioid for whatever purpose may be “perfectly fine” until they get an unrelated chest infection, then die in their sleep due to inhibition of the breathing reflex coupled with poor oxygen exchange associated with the chest infection.

      When you consider this, all risky medicines become riskier in different situations – one of those is using multiple medicines together that have an additive effect. This is dangerous when prescribed by one person, let alone when multiple prescribers are working with a person without knowing about it (this is the purpose of Real Time Prescription Monitoring).

      As for crossing Hoddle street – you are correct, and if there were no pedestrian crossings, then everyone would be asking why regulators aren’t doing anything to create a system where drivers and pedestrians can both traverse with lowered risks.

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