Introduction by Croakey: Addressing the social determinants of health such as income, poverty and equality are paramount to tackling Australia’s opioid crisis, according to Associate Professor Jennifer Schumann from Monash University.
Expansion of preventive programs and harm reduction strategies such as medically supervised injecting rooms will also help in the shorter term.
“We must recognise that addiction is a public health issue – not a law enforcement problem,” Schumann writes below.
Schumann – Head of the Drug Intelligence Unit at the Victorian Institute of Forensic Medicine and Monash University’s Department of Forensic Medicine – shares some of the key lessons she learnt from a recent Churchill Fellowship when she visited USA, Canada, Germany and Switzerland to investigate public health policies for preventing opioid misuse.
Jennifer Schumann writes:
Australia is currently confronting an alarming public health crisis – opioid addiction. Opioid prescribing has steadily increased over the past three decades, leading to a surge in overdose and death.
The situation demands urgent attention – pharmaceutical opioids claim more lives in Australia each year than any other drugs, with deaths from fentanyl, pethidine or tramadol, increasing by almost 1300 percent between 2006 and 2020. Heroin deaths are also on the rise in Australia – increasing six-fold in the same period.
Rescheduling of codeine to prescription only in 2018 nearly halved Australia’s national codeine supply, reducing codeine misuse as well as rates of fatal and non-fatal overdose.
But, is restricting access the answer to rising opioid overdose in Australia? Not for the many thousands of Australians who rely on these painkillers to treat their pain. We need to find a balance.
It is clear that our traditional approaches to addressing drug problems have fallen short, necessitating a fresh perspective and a willingness to learn from countries that have effectively tackled opioid epidemics.
Lessons from overseas
In my recent report, inspired by my Churchill Fellowship research in the USA, Canada, Germany, and Switzerland, I present valuable insights into how other nations have successfully mitigated the harms caused by opioid addiction and misuse.
As fatal opioid overdose in Australia and North America has surged in recent decades, addiction rates in Germany have remained relatively stable, despite being one of the highest per-capita consumers of opioids globally.
This is largely due to stricter community prescribing of opioids in Germany compared with countries like Canada and Australia. Post-surgical prescribing contributes to a substantial amount of opioid initiation in Australia, with many people still using these potent drugs many months later.
While the USA takes a law enforcement-based approach to opioid misuse, countries like Switzerland have implemented health-centred strategies that have significantly reduced opioid-related overdose deaths, infectious diseases like HIV, and drug-related crime.
Australia has a unique opportunity to respond to its growing opioid crisis by adopting evidence-based practices from these nations.
The dire situation in North America serves as a stark warning of what can happen when addiction is not addressed through a public health lens.
Despite widespread attempts to address the epidemic with progressive drug policy, harm reduction and treatment practices, the problem is so entrenched in many parts of Canada that they have been unable to overcome rising opioid overdose rates.
In British Columbia, there are now more overdose deaths each year than motor vehicle crashes, drownings, fire-related deaths, homicides, and suicides, combined.
The potential impact of the fentanyl epidemic is a significant concern for Australia, given our proximity to illicit opioid manufacturers in Asia and the trajectory of opioid deaths in Australia to date which broadly reflects that experienced in the USA before illicit fentanyl contaminated their heroin supply.
It is crucial that we remain at the forefront of opioid harm prevention by adopting evidence-based interventions and policies, so that we are ready if illicit fentanyl hits our shores. And it may not be as far away as we think – a 2022 border seizure in Melbourne contained the equivalent of 5 million fatal doses of fentanyl.
Addiction is a public health issue
Australian governments at state, territory and federal levels must acknowledge the gravity of the situation and seize this opportunity to learn from the experiences of other nations. We must recognise that addiction is a public health issue – not a law enforcement problem.
The expansion of preventive programs and harm reduction strategies, as well as increased access to treatment, are some of the crucial steps we can take to combat the crisis in the shorter term.
Already, progress is being made in Australia, and we have the tools and resources to address this crisis head-on. Prevention programs are implemented at state and federal levels, focusing on promoting resilience and self-regulation among young people.
The Federal Government recently increased funding for opioid substitution treatment, making it more affordable for many people. This will save lives.
The Australian Commission on Safety and Quality in Healthcare has launched the Opioid Analgesic Stewardship in Acute Pain Clinical Care Standard, encouraging safer prescribing practices. Prescription Drug Monitoring Programs are also being rolled out, and drug checking services have been introduced in the ACT, with Queensland set to follow.
These initiatives, along with the establishment of medically supervised injecting rooms and collaborative networks for monitoring emerging drug problems, demonstrate Australia’s commitment to addressing the problem. However, we need to do more.
Challenges such as prohibitive insurance premiums for harm reduction strategies, structural barriers to treatment, and the enormous stigma associated with illicit drug use, still need to be overcome. We need more medically supervised injecting rooms, drug checking services throughout Australia, and we need to consider offering prescription heroin to the small proportion of people who are poor responders to traditional treatments.
The research base demonstrates the treatment and cost effectiveness of prescribed heroin, as well as its associated reduction in crime, but with illicit drug use still so highly stigmatised in Australia, unfortunately it seems this promising solution may still be a long way off for us.
Social determinants
Commitment to longer term strategies is also necessary. Addressing the root causes of opioid addiction is paramount. Socioeconomic factors, mental health issues, and social determinants of health strongly contribute to substance use disorders.
Australia should strive to create supportive environments that address these underlying factors. This includes providing accessible mental health services, reducing treatment barriers, promoting social inclusion, reducing stigma, and addressing poverty and inequality.
Australia’s opioid problem demands a comprehensive and evidence-based response. By learning from the experiences of other countries and adopting successful strategies, Australia can turn the tide on our opioid problem, saving lives and improving the well-being of individuals and communities across the country.
About the author
Associate Professor Jennifer Schumann is Head of the Drug Intelligence Unit at the Victorian Institute of Forensic Medicine and Department of Forensic Medicine, Monash University.
Schumann undertook a Churchill Fellowship to investigate successful public health policies for preventing opioid misuse in 2019.
See Croakey’s archive of articles on addiction.
