A new report from the Australian Institute of Health and Welfare (AIHW) shows that deaths involving opioids have nearly doubled in a decade, but remain lower than the peak in the late 1990s, while more than 1 in 10 Australians have used illegal opioids or misused prescribed ones in their lifetime. The report is the first to provide a comprehensive, national snapshot of opioid use and harm in Australia, contributing to our understanding of the scale of this global issue.
The report, Opioid harm in Australia and comparisons between Australia and Canada was produced in collaboration with the Canadian Institute for Health Information (CIHI). The report focuses on current national data relating to Australia, while drawing comparisons to Canadian results in light of increasing opioid harm in much of the developed world.
Opioids are a group of pain-relieving drugs. Some opioids are illegal (such as heroin and opium), while others are available with a prescription (such as codeine and morphine). These prescription opioids can also be used illicitly—for example, taking more than is prescribed, using somebody else’s prescription, or using prescribed medication for non-medical purposes.
The report shows that in Australia in 2016–17, 3.1 million people had 1 or more prescriptions dispensed for opioids, about 715,000 people used pharmaceutical opioids for illicit or non-medical purposes, and about 40,000 people used heroin.
‘Every day in Australia, there are nearly 150 hospitalisations and 14 presentations to emergency departments involving opioid harm, and 3 people die from drug-induced deaths involving opioid use,’ said AIHW spokesperson Dr Lynelle Moon.
The number of deaths involving opioids has nearly doubled in the decade to 2016, from 591 to 1,119. Put another way, this is a rise from about 3 deaths involving opioids in every 100,000 people, to about 5.
‘The number of deaths in 2016 is the highest recorded since a peak of 1,245 in 1999, when the rate was around 7 deaths per 100,000 people,’ Dr Moon said.
Between 2006 and 2016, there was also a 25% rise in the rate of hospitalisations where opioid poisoning was recorded as the main reason for admission.
‘In the case of both deaths and hospitalisations, pharmaceutical opioids were more likely to be responsible than illegal opioids,’ Dr Moon said.
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, followed by codeine and tramadol. Oxycodone is prescribed to treat moderate to severe pain, and includes brands such as Endone and OxyContin. Codeine and tramadol are used to treat milder pain. Codeine is often used in combination with other drugs (for example, Panadeine Forte, a combination of paracetamol and codeine).
‘Looking across Australia and Canada, we see some similarities in the harm caused by opioids. In both countries, there were more hospitalisations involving side effects from intended use of pharmaceutical opioids than from misuse or use of illicit opioids,’ Dr Moon said.
However, the data shows some differences in the type of opioids used. For example, while the rate of prescriptions for fentanyl were similar in both countries, evidence suggests that illicit use of fentanyl is more common in Canada, while heroin use is comparatively higher in Australia.
‘Different patterns of opioid use have different impacts on users and the health system. For example, fentanyl is more potent than heroin and is more likely to be lethal, meaning there is a higher risk of death before they can receive health care services,’ Dr Moon said.
Dr Moon said the report was an important step in highlighting the increased harms associated with both pharmaceutical and illegal opioids, and showed the benefits of international collaboration.
‘Comparing Canada and Australia was a natural choice. Our countries have similar demographics and similar health care systems, including government-funded pharmaceuticals,’ she said.
‘This study also helps us understand the benefits and limitations of international collaboration, including better appreciation of different countries’ data holdings and practices so we can look for other opportunities to work together and explore current and emerging global issues.’
The Canadian Institute for Health Information has also released its report on opioid harm, focused on the data relating to Canada.