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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 • Amanda Roxburgh, Wayne D Hall, Lucinda Burns and Louisa Degenhardt
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.
Opioids in context - international 22,941 31,453 13,440 Source: INCB 2011-13 data Berterame et al, Lancet (2016)
Opioid use Australian contextHeroin and pharmaceutical opioid injecting Source: Illicit Drug Reporting System
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
Findings: Opioid deaths in Australia Source: NCIS; Roxburgh et al, Drug and Alcohol Dependence 2017; ABS deaths data 2017
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
Findings: Opioid deaths in Australia Source: NCIS; Roxburgh et al, Drug and Alcohol Dependence 2017; ABS deaths data 2017
Pharmaceutical opioid deaths (by opioid) per million population Source: NCIS; Roxburgh et al, Drug and Alcohol Dependence 2017
Pharmaceutical opioid deaths (by opioid) per million population Source: NCIS; Roxburgh et al, Drug and Alcohol Dependence 2017
Pharmaceutical opioid deaths (by opioid) per 100,000 OME grams dispensed Source: NCIS; Roxburgh et al, Drug and Alcohol Dependence 2017
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
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
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
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