The number of Australians dying from accidental drug overdoses has climbed by almost 40 per cent in the last decade, and now exceeds the national road toll by several hundred people each year.
The latest figures, released today as part of Australia's 2019 Annual Overdose Report, reveal a dramatic spike in the number of overdose deaths involving heroin or illicit stimulants such as methamphetamine (or ice) in the last five years.
But it's prescription opioids that continue to cause the majority of overdose deaths; they were involved in 53 per cent of all accidental drug-induced deaths in 2017.
"It's time to call this what it is: Australia's very own overdose crisis," said John Ryan, CEO of not-for-profit public health organisation the Penington Institute, which commissioned the report.
"Make no mistake, it's a crisis that's getting worse," he said.
Most overdose deaths involve multiple drugs. In fact, the report found that 2017 was the first year in which more accidental deaths were caused by a combination of four or more drugs than by a single drug.
Of particular concern is the use of sleep and anxiety medications benzodiazepines (or "benzos"), which remain the second most common group of drugs found in accidental overdoses, behind opioids — and their death toll has doubled since 2008.
Accidental deaths involving other prescription medications, such as anti-convulsant medications (sometimes used to treat neuropathic pain) and anti-psychotics, have also increased markedly in recent years.
While the preliminary findings show a slight decline in the overall number of accidental drug deaths from 2016 to 2017, Mr Ryan said the final number — currently pending coronial decisions — is expected to surpass 2016's record high.
"The overdose picture in Australia is sort of diversifying," he said, "but the overall trend is up."
The rise of opioids
The number of drug-induced deaths involving opioids has nearly tripled in the last 12 years, increasing from 338 in 2006 to 904 in 2017.
Within that number, deaths involving heroin have increased more than four-fold, from 67 to 358.
Mr Ryan said the rise of heroin and methamphetamine overdoses in Australia was reminiscent of the worsening of the North American opioid epidemic in 2012, when people increasingly turned from prescription opioids to illicit substances like heroin, fentanyl and ice.
"There's inadequate research to say that is happening conclusively [in Australia]," he said.
"But certainly, there's been indications from America that clamping down on prescriptions and not at the same time dealing with peoples' underlying issues, whether that's pain management or substance dependence, is a recipe for failure."
In 2017, the Federal Government committed $16 million to the rollout of real-time monitoring of prescription drugs. The purpose of the system is to provide an instant alert to pharmacists and doctors if patients receive multiple supplies of dangerous prescription-only medicines.
Notwithstanding, the increased vigilance around pharmaceutical prescribing still didn't go far enough, he said.
"It's true that doctors especially have become increasingly concerned not to follow the American path into what is a terrible overdose epidemic.
"But it's inadequate — because pharmaceuticals are still a major driver of overdose deaths."
In 2017, the rate of drug-induced deaths in Australia was 8.9 per 100,000 people, compared to 21.7 per 100,000 people in the United States in 2017. The current rate of deaths in Australia is equivalent to the rate of deaths in the United States in 2003.
Amy Peacock from the National Drug and Alcohol Research Centre said it was important to consider the increase in heroin overdose deaths in the context of changes in total population size.
Mixing opioids with other drugs, including sedative medicines such as pregabalin and benzodiazepines, can be dangerous.
"Population-level estimates of heroin use from the National Drug Strategy Household Survey continue to suggest low, stable rates of heroin use," said Dr Peacock, who was not involved in the report.
"The majority of opioid-induced deaths continue to involve pharmaceutical opioids only."
While drug use is typically associated with younger people, the report found it's middle-aged Australians (30-59 years) who have the highest incidence of accidental drug-induced mortality.
It also showed rates of accidental overdose remained higher for men and for Aboriginal Australians — and this gap is widening.
"A story that's also worth telling is that unintentional overdose deaths are not skewed as heavily toward lower socioeconomic areas as so many other public health issues like smoking or obesity," said Stephen McNally, deputy CEO of the Penington Institute.
He added that the situation in regional and rural Australia was a major cause for concern.
"As recently as the beginning of the decade, Australians in rural and regional areas faced the same risk as Australians living in metro areas," Dr McNally said.
"Today, the rate of unintentional overdose deaths is significantly higher in rural and regional areas.
"It's yet another echo of the American opioid crisis, right here in our own backyard."
Expanding access and education
Expanding access to drug treatment services and increasing drug education in the community is key to addressing the rising rates of overdose, Mr Ryan said.
"There is a lack of understanding the community about the risk, particularly the risks of combining substances," he said.
"There's also a lack of understanding about how to identify an overdose and how to respond to an overdose."
But it is Australia's broader approach to drug policy that he said needed fundamental change.
"We've had a pretty simplistic approach to drug issues, which is basically we try and ban them.
"But as the police would say: you can't arrest your way out of this problem."
My Ryan said a focus on law-enforcement and controlling drug supply had come at the cost of community education and access to healthcare for people with substance use issues.
"There's a terrible lack of access to drug treatment in Australia, as there is a terrible lack of access to [the drug] naloxone, which reverses opioid overdoses."
Dr Peacock agreed that the report's findings reinforced the need for action.
"We know what strategies work to save lives," she said.
"We need to see better investment in affordable, accessible treatment for all Australians who are experiencing problems as a consequence of drug use.
"People need access to treatment to ensure improvements in health and wellbeing; criminalisation and punishment will not reduce drug-induced deaths."
The Department of Health was contacted for comment.
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