International Overdose Awareness Day, being marked today (31 August), is proclaimed as the world’s largest annual campaign to end overdose, remember without stigma those who have died and acknowledge the grief of the family and friends left behind.
But it also comes with an urgent demand for action on a number of fronts, as Professor Dan Lubman and Associate Professor Suzanne Nielsen, from Turning Point and the Monash Addiction Research Centre, write below.
Dan Lubman and Suzanne Nielsen write:
Year after year, thousands of Australians fatally overdose. Every year we remember them on International Overdose Awareness Day — the global campaign that began in Melbourne 20 years ago to raise awareness and end the stigma associated with drug-related deaths.
Raising awareness about overdose and remembering those we’ve lost is important, but awareness of a problem without action to solve it can be disheartening.
That’s why International Overdose Awareness Day is about more than just raising awareness, it’s about demanding action that will save lives.
In recent years, prescription opioid deaths have been twice as likely to be identified as intentional than heroin-related deaths.
Chronic pain and mental health issues are common contributory factors. This finding is consistent with high rates of suicidal ideation and behaviours among Australians prescribed opioids for chronic non-cancer pain, highlighting the need for targeted suicide prevention efforts.
Coping with physical and emotional pain is a key driver of people taking opioids at higher doses than prescribed or without a prescription. That’s why a recent Australian study recommended pharmacists consider not just dose, but a range of other risk factors for opioid-related harms, including mental health as well as younger age and a history of substance use disorder.
The introduction of prescription drug monitoring programs, reduced pack sizes and indications for prescription opioids, and the rescheduling of the low potency opioid codeine so it is no longer available over the counter, are all important steps we’ve taken to limit the number of Australians who develop opioid dependence and experience opioid-related harms.
But these changes do not respond to the fact that heroin-related deaths in Australia have doubled in just five years. In fact, these changes have been associated, among many other factors, with increased heroin-related harms. Indeed, recent Australian data shows shifts to heroin use may partly reflect moves to make some prescription opioids harder to inject.
The focus on reducing harms of prescription opioids is good, but given growing heroin-related deaths, we also need to focus on reducing heroin-related harms by investing in strategies we know work.
1. Naloxone must be freely accessible everywhere
We must urgently increase access to the life-saving overdose reversal drug naloxone, which is available as an easy-to-use nasal spray.
Through the Federal Government’s take home naloxone pilot, naloxone is freely available to anyone who takes opioids, or knows someone who does, through a range of settings including custodial release programs, hospital and community pharmacies, primary care, and alcohol and other drug services.
However, this pilot program currently only covers New South Wales, South Australia, and Western Australia – it should be made permanent and expanded to cover every state and territory.
2. We need more medically supervised injecting centres
Medically supervised injecting centres save lives, help people access treatment, reduce public drug use and related harm, and take the pressure off our health care system. A review of Victoria’s medically supervised injecting room in Richmond found that in its first 18 months it had treated 217 serious overdoses and saved at least 21 lives, helping to reduce heroin-related overdose deaths in Victoria by 12% from 2019 to 2020.
Australia’s only other medically supervised injecting centre opened in Kings Cross, Sydney in 2001, the same year International Overdose Awareness Day was launched.
The Victorian Government has committed to establishing Victoria’s second medically supervised injecting centre, and it can’t come soon enough. These services should be available across Australia, wherever there is a clear need.
3. We need better treatment options
Evidence-based pharmacotherapies such as injectable opioid agonist treatments and sustained-release oral morphine should inform local implementation studies to broaden treatment options in Australia beyond methadone and buprenorphine.
The COVID-19 pandemic has caused major changes to the way opioid treatment is delivered in Australia, including reduced requirements for daily attendance for dosing, which are a key barrier to treatment. Positively, data released by the Coroners Court of Victoria confirmed this has not led to any increased harm or diversion. Changes like this to make treatment more flexible could be retained post-pandemic to reduce barriers to opioid treatment.
4. We need to humanise addiction
Stigma and shame perpetuate negative stereotypes and demonise people living with addiction. The result is few people feeling able to tell their stories of recovery, and a critical delay in seeking help, which can often take decades.
If people can get help and support earlier, they will be less at risk of overdose. That’s why one of the most important things we can do in combatting overdose, and responding to the harms of drug use more broadly, is to tackle stigma and create space to hear the real stories of people touched by addiction, including messages of hope.
The national campaign to Rethink Addiction does exactly that. A bigger and better-funded Rethink Addiction campaign is needed to help change the conversation on addiction.
5. A call to action
The need for action on overdose is as urgent as ever. Data released last month by the Coroners Court of Victoria revealed an increasing trend in the overdose death rate over the last decade. If we are to avoid the dramatic death toll seen in the 1990s, where one in eight deaths for young Australians was due to heroin overdose, our response to overdose must address both prescription opioid and rising heroin-related harms.
Unfortunately, the number of Australian deaths from unintentional overdose remains higher than the national road toll, and deaths involving heroin are climbing. We build safety barriers on our roads to reduce fatalities, but too often our response to drug use is just to park the ambulance at the bottom of the cliff. As heroin harms increase, we need to rapidly upscale a broader range of treatment options, and remove as many barriers to care as possible.
Pilots and trials are welcome, but we’ve had evidence-based solutions to the problem of overdose for a long time. They should be implemented everywhere and without further delay. As we’ve seen with other public health responses, small, slow steps in the right direction are not enough in the race to save lives.
Professor Dan Lubman AM is Executive Clinical Director of Turning Point, Director of the Monash Addiction Research Centre, and a current NHMRC Leadership Fellow. His research investigates the harms associated with alcohol, drugs and gambling and the relationship between substance use, gambling and mental disorder, as well as the development of targeted intervention programs.
Associate Professor Suzanne Nielsen (BPharmSc[Hons] PhD MPS) is the Deputy Director of the Monash Addiction Research Centre in Melbourne, and is a current NHMRC Career Development Fellow. Her research focuses on understanding prescription, over-the-counter and emerging drug-related problems, and identifying effective policy and practice interventions to reduced opioid-related harm.
For free, confidential alcohol and other drug advice, counselling or referral, call 1800 250 015 or contact www.counsellingonline.org.au.
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