Accidental opioid deaths among older Australians appear to be one of the key drivers of an increase in opioid deaths reported recently by the National Illicit Drug Indicators Project. (Roxburgh A and Burns L (2012). Accidental opioid-induced deaths in Australia 2008. National Drug and Alcohol Research Centre, UNSW, Sydney).
In our bulletin we noted that deaths due to accidental opioid overdose in Australia have increased for the first time since the interruption to the heroin market occurred in 2001. The increases have occurred across all age groups except young Australians aged 15 to 24, among whom deaths have remained low and stable. Opioid overdose deaths have increased among older Australians aged 45 - 54 to levels higher than recorded in 2000.
There are likely to be a couple of things going on in the deaths data. We’re seeing an older group of injecting drug users in Australia who are supplementing their heroin use with drugs like oxycodone and morphine. So in part the deaths may be occurring among this group. It’s also likely that a proportion of these deaths are occurring among older Australians who are being prescribed opioid analgesics for pain conditions. What complicates the picture for this group is that they may be on a number of medications, as well as have underlying health complications such as cardiac or breathing problems. These factors undoubtedly increase the risk of overdose.
Oxycodone prescriptions have increased in number over time, particularly among older Australians 80 years and over. This upward trend is likely to continue. We have an ageing population and more people are surviving major accidents, major surgical interventions and medical treatments. This in turn will lead to an increasing prevalence of chronic pain and an increasing number of prescriptions to manage that pain.
Clearly it will be important to have considered and appropriate prescribing of these drugs, to monitor their use and to increase education aimed at prescribers and users. However we should not lose sight of the fact that opioid analgesics are important drugs in pain management and access to effective treatment for pain is an important human right. While we need to continue to monitor the harms related to prescription opioids, we also need to continue providing effective treatment to Australians who are opioid dependent and to Australians who suffer from chronic pain. Sometimes these people are one and the same.