Governments must wake up to the crisis of unintentional overdose deaths, with older Australians increasingly at risk, says the nation’s leading independent drug policy organisation, the Penington Institute.
New figures show that Australians aged 50-plus accounted for more than 40 per cent of all unintentional overdose deaths in 2018.
Australia’s Annual Overdose Report 2020 shows that 2070 Australians died of overdose in 2018, the fifth consecutive year with more than 2000 deaths.
“This is a crisis. And what’s worse is these deaths are preventable,” says Mr John Ryan, CEO of the Penington Institute. “We simply can’t accept, nor should we, that 2000 sons and daughters, mums and dads, and brothers and sisters die every year from a drug overdose.
“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.”
Opioids continue to be the drug type most commonly associated with overdose deaths, with 900 Australians losing their lives due to unintentional opioid-related overdoses in 2018.
Unintentional overdose deaths occur at higher rates in rural and regional Australia. There were 7.3 unintentional overdose deaths per 100,000 people in rural and regional areas, compared with 5.8 per 100,000 in the capital cities in 2018.
“We want Australia’s Annual Overdose Report to encourage Australians from all walks of life to talk more about overdose and drug issues,” says Mr Ryan. “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 report was released today on International Overdose Awareness Day, which aims to reduce stigma surrounding drug-related deaths and help people identify and respond to signs of an overdose.
The report also found that unintentional overdose deaths involving four or more substances – often referred to as polydrug use or polypharmacy – continued to escalate. Numbers had almost quadrupled from 163 in 2013 to 582 in 2018.
The Royal Australian College of General Practitioners (RACGP) acknowledges that opioids remain the main cause of accidental overdose death in Australia.
“Opioid-related deaths hovered at around 450 per year at the turn of the century, but these numbers have risen sharply since 2006 to hit over 1100 per year since 2014.”
It says that in the late 1990s, prescription opioids seemed like an “ideal answer” to chronic, non-malignant pain.
“There was an increased demand to treat chronic pain. There were very few options and very little research that had been done on this problem,” says opioid expert Dr Evan Ackermann.
“This was mixed with a situation of some fairly aggressive drug company marketing of opioids and a change of clinical attitude towards pain. Normally, pain would be part of the healing process, but people started to say we should be looking at pain as the ‘fifth sign’ and treating it aggressively.
“It was a cultural shift across the healthcare sector, across the board, from pharmacy right through to general practice, specialists and hospitals.”
Associate Professor Mark Morgan, chair of the RACGP Expert Committee – Quality Care (REC–QC), told newsGP that prescribing of opiods should include a plan for de-prescribing.
“There needs to be a cultural shift away from the use of opioids for most chronic non-cancer pain because there are enormous personal risks, identifiable harms and societal costs from having such high levels of use,” he said.
“Before starting, and at each review of opioid prescriptions, there should be a careful weighing up of pros and cons. This should include a discussion with the patient about the potential harms and risks, and realistic expectations from using the medication.
“Prescribing for acute nociceptive pain – for example, after an injury or surgery – should be for just a few days with close review. Smaller pack sizes will help this shift.”
Dr Simon Holliday, a GP with a special interest in pain management, says opioids are ‘cure-alls’. “We all feel great when we use these drugs and they relieve our symptoms. But the problem is, it’s all short term and we now know that our problems will come back worse if we take this approach.”
The Australian Institute of Health and Welfare (AIHW) reports that in 2018, opioids were present in nearly two-thirds of drug-induced deaths (64.5 per cent or 1123 deaths) – a rate of 4.6 per 100,000 people. Eighty per cent of opioid-induced deaths were accidental.
“Over the past decade, drug-induced deaths were more likely to be due to prescription drugs than illegal drugs, and there has been a substantial rise in the number of deaths with a prescription drug present,” the AIHW report states.
Safe opioid use
Opioids are drugs used to treat moderate to severe pain. Common prescription opioids include oxycodone, hydrocodone, morphine and methadone. Fentanyl is a synthetic opioid approved to relieve severe pain.
Older adults are more likely to suffer from chronic pain and physical illnesses making them more susceptible to the addictive properties of prescription opioids.
- Take pain relievers only as directed. If you are taking opioid pain relievers, be sure to tell your doctor about all other medicines you are taking because some medicines, when taken together with pain relievers, can cause an overdose.
- Never take opioids in greater amounts or frequency than prescribed
- Don’t sell or share opioids
- Store opioids in a safe place, where others can’t access them
- Properly dispose of unused opioids
- Keep a list of your medicines
- Follow directions
- Ask questions
- Keep up with any blood testing recommended by your doctor.
Signs of an opioid overdose
- constricted pupils
- loss of consciousness
- laboured breathing
- choking or gurgling sounds
- limp body
- pale, blue, or cold skin.
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