America's opioid epidemic is starting to hit Australia's shores

There’s no such thing as a typical drug addict. The stereotype paints them as depraved, corrupt degenerates and criminals, but this fails to acknowledge that people from all walks of life battle this brain disease, or that too many die as a result of their addiction.

Indeed, there’s increasing opposition to the terms ‘drug addict’ and ‘drug abuser’, as they’re considered pejorative, stigmatising and reinforce the notion that the person is to blame.

A report by the Global Commission on Drug Policy last year called for an urgent change in language, one that frames addiction as a health issue and not a personal and moral inadequacy.

Similarly, the stereotype of a typical drug overdose needs to be challenged. It’s not just the heroin user, destitute and young, slumped over and unconscious in an inner-city alleyway.

The reality is more mainstream, suburban and regional. The reality is also white-collar and includes the misuse of prescription medications, in particular pharmaceutical opioids such as OxyContin, on a huge scale.

And it’s a reality being felt across the developed world.

Escalating use of opioids in America has been described as one of the worst drug epidemics in the country’s history. Its Centers for Disease Control and Prevention (CDC) estimates that more than 115 Americans die every day after overdosing on opioids, and that emergency room visits and deaths related to opioid overdose have more than tripled in the past 15 years, and continue to rise.

In 2016, more than 63,000 people in America died from drug overdoses – more than 42,000 of those involved prescription or illicit opioids.

Three waves

This rise in opioid overdose deaths in America came in three waves, according to the CDC. The first, in the 1990s, coincided with an increase in prescription opioids. The second wave, in 2010, showed a rapid increase in heroin overdose deaths, following restrictions in prescription opioid supply. The third, around 2013, was driven by a significant increase in overdose deaths associated with illicitly manufactured synthetic opioids, such as fentanyl, which have contaminated illicit opioid supplies.

Health authorities, police and the Trump administration in October last year declared it the biggest health emergency facing the nation.

“As Americans, we cannot allow this to continue,” President Trump said. “It’s time to liberate our communities from this scourge of drug addiction.”

Australia hasn’t been spared, with increasing opioid-related harms also beginning to sweep across its shores.

According to the Australian Bureau of Statistics, a drug-induced death in 2016 was “most likely to be a middle-aged male, living outside of a capital city who is misusing prescription drugs such as benzodiazepines or oxycodone in a polypharmacy [the use of multiple drugs] setting”.

“The death was most likely to be an accident,” it said.

Professor Dan Lubman is the director of Turning Point, Australia’s national addiction treatment and research centre, as well as director of the Monash Addiction Research Centre at Monash University. He’s acutely aware of the developing opioid crisis here.

“There’s no doubt we’re headed for a crisis,” he said. “What’s happening in America is a tragedy, with almost 1000 opioid-related deaths every week, and if we don’t respond appropriately, we will be on a similar trajectory here.”

Growing evidence of harm

Opioids are one of the main types of medications used to treat acute severe pain, and are commonly prescribed after surgery or an injury . Although they’re also commonly used to treat chronic pain conditions such as back pain, there’s no research to support their use long-term, and growing evidence that they actually are harmful.

Common naturally derived opioids available legally by prescription include codeine, morphine and oxycodone. Synthetic opioids available by prescription include pethidine, fentanyl and tramadol. 

It’s also a class of drug that includes heroin.

Opioids work by binding to and activating opioid receptors on cells located in the brain, spinal cord and other organs in the body, especially those involved in feelings of pain and pleasure. When opioids attach to these receptors, they block pain signals sent from the brain to the body and release large amounts of dopamine, which can lead to a feeling of euphoria.

A grim picture

A new report from the Australian Institute of Health and Welfare (AIHW) paints a grim picture of rapidly increasing opioid overdoses and misuse.

In its report Opioid harm in Australia: and comparisons between Australia and Canada, the institute says the number of deaths in Australia involving opioids has nearly doubled in the decade to 2016, from 591 to 1119. The rate of hospitalisation where opioid poisoning was recorded as the main reason for admission rose by 25 per cent during the same period.

“Every day in Australia, there are nearly 150 hospitalisations and 14 presentations to emergency departments involving opioid harm, and three people [a day] die from ... opioid use,” AIHW spokeswoman Dr Lynelle Moon says.

“In the case of both deaths and hospitalisations, pharmaceuticals opioids were more likely to be responsible than illegal [heroin, opium] opioids.”

“In the case of both deaths and hospitalisations, pharmaceuticals opioids were more likely to be responsible than illegal [heroin, opium] opioids.”

In 2016, the most common types of opioids responsible for deaths were naturally derived opioids (oxycodone, codeine and morphine), which were attributed to 550 deaths, followed by heroin (361 deaths).

In 2016-17, 15.4 million opioid prescriptions were dispensed under the Pharmaceutical Benefits Scheme (PBS) to 3.1 million people. Oxycodone was the most commonly dispensed prescription opioid (5.7 million), followed by codeine (3.7 million) and tramadol (2.7 million).

Oxycodone is prescribed to treat severe pain, and includes brands such as Endone and OxyContin. Codeine and tramadol are used to treat milder pain.

Need to raise awareness

Samanta Lalic is a Monash University PhD student who’s analysed the dispensing of opioids through the PBS between 2013 and 2017.

Her research, conducted through the Centre for Medicine Use and Safety at the University’s Faculty of Pharmacy and Pharmaceutical Sciences, found that 1.9 million Australian adults begin taking prescription opioids every year and that 2.6 per cent of them – around 50,000 – become long-term users.

The research was recently published in the British Journal of Clinical Pharmacology.

Ms Lalic said the medical community needed to change its prescribing culture regarding opioids.

“Opioids do have an important role in managing cancer pain and acute non-cancer pain; however, their use remains less well-established for chronic non-cancer pain,” she said.

“For the treatment of chronic pain, we need to raise the levels of awareness of other treatment options among patients. In many cases, the safest and most effective way to treat chronic pain involves a combination of therapies, including exercise, physiotherapy and non-opioid painkillers.”