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Opioid overdose mortality trends in Australia

This paper examines the trends in opioid overdose mortality in Australia, including the use of heroin and pharmaceutical opioids. Findings indicate a significant increase in opioid deaths, particularly those involving fentanyl. Implications for response and prevention strategies are discussed.

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Opioid overdose mortality trends in Australia

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  1. Opioid overdose mortality trends in Australia • Amanda Roxburgh, Wayne D Hall, Lucinda Burns and Louisa Degenhardt

  2. Conflict of Interest Statement • Professor Louisa Degenhardthas received untied educational grants from Reckitt Benckiser for the post-marketing surveillance of opioid substitution therapy medications in Australia, and the development of an opioid-related behaviour scale. Professor Degenhardt has also received untied educational grants from Mundipharma to conduct post-marketing surveillance of the use of oxycodone formulations in Australia. The current paper design, conduct and interpretation of findings are the work of the investigators; these fundershad no role in this paper. • None of the other authors have anything to declare.

  3. Opioids in context - international 22,941 31,453 13,440 Source: INCB 2011-13 data Berterame et al, Lancet (2016)

  4. Opioid use Australian contextHeroin and pharmaceutical opioid injecting Source: Illicit Drug Reporting System

  5. Methods • Extracted data from the National Coronial Information System – 2001 to 2012 • Online database – all deaths that are reportable to Coroner • Not constrained by International Classification of Diseases Coding • ICD has Morphine and Oxycodone together – fentanyl and tramadol together • Only deaths where opioid toxicity was determined to have caused the death were included • Decisions around distinguishing between heroin and morphine deaths • Collected indicators of diversion, misuse, dependence

  6. Distinguishing between heroin and morphine deaths

  7. Findings: Opioid deaths in Australia Source: NCIS; Roxburgh et al, Drug and Alcohol Dependence 2017; ABS deaths data 2017

  8. Findings: Opioid deaths in Australia U.S. All opioid deaths 2015 – 103 per million U.S. Heroin deaths 2015 – 40.4 per million Source: NCIS; Roxburgh et al, Drug and Alcohol Dependence 2017; ABS deaths data 2017

  9. Findings: Opioid deaths in Australia Source: NCIS; Roxburgh et al, Drug and Alcohol Dependence 2017; ABS deaths data 2017

  10. Pharmaceutical opioid deaths (by opioid) per million population Source: NCIS; Roxburgh et al, Drug and Alcohol Dependence 2017

  11. Pharmaceutical opioid deaths (by opioid) per million population Source: NCIS; Roxburgh et al, Drug and Alcohol Dependence 2017

  12. Pharmaceutical opioid deaths (by opioid) per 100,000 OME grams dispensed Source: NCIS; Roxburgh et al, Drug and Alcohol Dependence 2017

  13. History of injecting drug use by opioid

  14. Injected drug prior to death, by opioid

  15. History of drug dependence by opioid

  16. History of chronic pain by opioid

  17. Opioid prescribed prior to death, by opioid

  18. Discussion • PO deaths significantly increased by 1.6 times the rate recorded in 2001. • Occurring at 2.5 times the incident rate compared to heroin • Morphine deaths remain highest when adjusted by OME grams dispensed • 1.7 times the rate of oxycodone deaths; 2.2 times the rate of fentanyl deaths • Fentanyl deaths when adjusted by OME grams dispensed • Continued to increase but from relatively low level • Increases in deaths appeared to exceed rates of prescribing • Suggests extra-medical use occurring: • High proportions injecting, drug dependence, Low proportions prescribed and chronic pain

  19. Discussion continued • Rates of heroin deaths remained relatively stable over longer term • Some indications that the heroin market is picking up again in Australia • Drug misuse and diversion more prevalent among fentanyl deaths. • Drug dependence was a less discriminatory marker across POs and heroin deaths

  20. Implications • Changing prescribing practices not likely to be the only response to reduce opioid overdose deaths • Diversion happening particularly among fentanyl deaths • Diversification of opioid market • Appearance of illicit fentanyl in North America • Fentanyl deaths in 2016 higher than heroin in North America • Pharmaceutical fentanyl remains predominant in Australia • Only 3 reported using an illicit opioid (other than heroin) in 2017 • Monitoring darknet markets for illicit fentanyl and fentanyl analogues

  21. Implications continued • Diversification in who develops dependence from PWID to those with chronic pain • Providing treatment for pain and dependence across both groups important • Increasing naloxone accessibility and affordability crucial in Australia • Particularly in the context of illicit fentanyl – much more potent than pharmaceutical fentanyl

  22. THANK YOU

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