Surge in deaths linked to pregabalin

Pharmaceuticals contributed to more than three-quarters of deaths last year, but SafeScript may have helped reduce methadone deaths, new coroner’s report reveals

Overdose rates in Victoria have gradually increased over the past decade while cases linked to anticonvulsants and antidepressants have surged, according to a new report from the state’s coroner’s court.

There were 4551 overdose deaths in Victoria between 2011 and 2020.

Last year pharmaceutical drugs remained the most frequent contributors to Victorian overdose deaths, playing a role in just over three-quarters of all deaths.

Illegal drugs contributed in just over half of overdose deaths, and alcohol in approximately 30%.

While these proportions remained consistent over the past few years, some types of drugs linked to overdose deaths have seen a notable increase.

Benzodiazepines were implicated in just over half of deaths, with those linked to diazepam rising by 75% over the decade.

The next most frequent pharmaceutical drug groups were opioids, antidepressants and antipsychotics.

Antidepressant-related overdose deaths also rose by 77% over the decade. This gradual increase over time “may potentially be explained by the increase over time in antidepressant prescribing in Australia,” said the Coroners Court of Victoria.

Meanwhile overdose deaths linked to antipsychotics also rose significantly, with quetiapine and olanzapine seeing the most change.

There was a sharp decline during 2020 in the frequency and proportion of Victorian methadone-involved overdose deaths where no doctor held a permit to prescribe Schedule 8 opioids.

“The finding suggests that during 2020 there may have been a substantial reduction in overdose deaths involving diverted methadone,” said the report.

There were 65 methadone-involved overdose deaths in Victoria in 2020, which was the lowest annual frequency in more than a decade.

This is despite changes during COVID-19 in opioid replacement therapy patients’ access to unsupervised (“takeaway”) methadone doses, which meant they could be consumed away from the dispensing pharmacy.

While there was a range of theories posed for lower methadone-related cases, the report noted that the SafeScript real-time prescription monitoring system “may have improved safety of opioid replacement therapy delivery”.

The coroner’s court said an interruption to the historical increasing trend in overdose deaths in 2019 and 2020, involving both monitored and unmonitored pharmaceutical drugs, coincided with the introduction of SafeScript.

This could be “cautiously be interpreted as a positive result”, it said.

However another notable trend in the data was the rise in anticonvulsant involvement over time, primarily driven by rising pregabalin involvement.

Pregabalin was linked to zero deaths in 2011 and 2012, rising steadily to 69 deaths in 2020. It is currently not monitored in the SafeScript system.

Victorian Coroner Darren Bracken has previously recommended that pregabalin be included in the SafeScript scheme in order to prevent deaths in the future, “by drawing the attention of clinicians to excessive prescribing of the drug”.

Following his investigation into the death of 33-year-old Victorian woman, Mr Bracken urged the Department of Health and Human Services to re-consider inclusion of pregabalin in the scope of drugs monitored by SafeScript.

See the full report, Victorian Overdose Deaths 2011-2020, here

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