Prescription painkillers such as oxycodone, morphine, fentanyl and codeine now account for 70 per cent of accidental opioid deaths in Australia a report from the National Drug and Alcohol Research Centre (NDARC) at UNSW has found.
The report Accidental drug-induced deaths due to opioids 2012, published this week, found that 564 Australians aged 15-54 died from accidental opioid overdose in 2012 – the latest year for which national coronial data is available. Of these deaths 394 were due to pharmaceutical opioids such as oxycodone, codeine, morphine, fentanyl and methadone. While there was a slight dip in the number of deaths from 2011 to 2012, the report warns that projections suggest that the number of deaths due to prescription painkillers will further increase for 2013 and 2014.
The increase in opioid related deaths accompanies a significant increase in prescribing of opioid painkillers in Australia over the past decade. A separate report published in the Lancet earlier this year and produced by NDARC on behalf of the International Narcotics Control Board (INCB) found that use of common opioid painkillers such as codeine, morphine and oxycodone has more than quadrupled in Australia over the past decade and doubled worldwide over the same period.
The pharmaceutical opioid oxycodone, whose use has increased between three to four times over the past decade, accounted for the highest proportion of accidental opioid overdoses.
Fentanyl, accounted for significantly fewer deaths than oxycodone but its use and its involvement in accidental overdose is increasing, says NDARC’s Professor Louisa Degenhardt.
Fentanyl a powerful painkiller, which is 100 times the strength of morphine, was responsible for 136 deaths among middle aged Australians in the five years to 2011, according to earlier NDARC research. People aged over 80 accounted for the majority of the prescriptions. However Australians aged under 47 years accounted for the majority (75%) of the overdoses. Only a third (36%) of the deaths involved people who had been prescribed fentanyl. More than half (54%) of the deaths involved people who inject drugs (95 per cent of whom had injected fentanyl prior to death).
Fentanyl transdermal patches were first listed on the Pharmaceutical Benefits Advisory Scheme in 1999 for use in the management of chronic cancer pain. The rapid increase in prescribing rates post 2006 appear to be driven by the extension of its listing to include use in management of non-cancer pain.The results and anecdotal reports from drug and alcohol workers suggest that it’s very difficult for people to know just how much they are extracting from the patch and injecting. It is already a very powerful opioid and people are injecting it without being able to control how much.
Professor Degenhardt who is leading UNSW’s POINT study, following more than 1,500 Australians prescribed opioids for non-cancer pain, said that the study has found that a significant proportion of Australians prescribed oxycodone over the long term have expressed major concerns about their ability to control their use of the drug, “But as well as oxycodone we now know that deaths related to other prescribed opioids are also increasing and we need to be vigilant to the risk for dependence and death related to a wide range of prescribed painkillers.”