The Penington Institute's Australia’s Annual Overdose Report 2020 comments
The number of Australians who die from unintentional drug overdose each year continues its long-term rise. This report examines drug-induced deaths, where the death is directly attributable to the drug use, with a focus on unintentional-drug induced deaths. This report presents key statistics about unintentional drug-induced deaths in Australia from 2001 to 2018 ....
Opioids continue to be the primary drug group associated with unintentional drug-induced deaths, though there have been substantial changes in the types of opioids since 2001. While deaths involving pharmaceutical opioids have constituted the majority of unintentional deaths due to opioids since 2004, there has been a dramatic rise in deaths involving heroin since 2012, resulting in heroin deaths overtaking those involving pharmaceutical opioids in 2018.
Benzodiazepines remain the second most common group of drugs identified in unintentional drug-induced deaths, behind opioids, though these are predominantly identified in poly-substance overdose deaths. Since 2013 there has been a substantial increase in unintentional drug-induced deaths involving benzodiazepines in both Western Australia and Victoria, and to a lesser extent, New South Wales.
There has been a sharp rise in deaths involving stimulants (including methamphetamine) in Australia since 2012, which is seen in both regional and urban areas. In contrast, the increase in deaths involving anti-depressants has been slower. Deaths involving other prescription medications – such as anti-convulsant medications and anti-psychotics – have increased markedly in the last few years, although they account for only a small proportion of all unintentional drug-induced deaths.
Drug-induced death is not confined to either illegal drugs or those taken as medicines; alcohol may also be involved in unintentional drug-induced deaths. When used in conjunction with other drugs, alcohol may contribute to a fatal overdose, or rarely, be the sole cause of an unintentional drug-induced death. Up until recently, alcohol was the third most common drug involved in unintentional drug-induced deaths, though it has recently been surpassed by both stimulants and anti-depressants.
While a single drug may be identified in an unintentional drug-induced death, it is rare for a death to be attributable to toxicity from a single drug; deaths involving multiple drugs are the norm rather than the exception. For example, the data show that poly-drug deaths involving four or more substances have increased significantly in recent years.
While drug use is commonly associated with younger people, this report shows that it is middle-aged Australians (30-59 years) who have the highest incidence of unintentional drug-induced mortality. Further, the gap between this middle-aged cohort and Australians under-30 or over-60 has expanded in the last fifteen years and continues to widen.
Unintentional drug-induced deaths overall are more prevalent among men, with the number of deaths for males increasing more rapidly than for women in recent years. Similarly, the rate of unintentional drug-induced death remains higher for Aboriginal Australians than for non-Aboriginal Australians, and this gap has been widening.
Finally, unintentional drug-induced deaths occur across all socio-economic areas, with small differences in prevalence observed between the most advantaged neighbourhoods and the most disadvantaged neighbourhoods.
Unintentional drug-induced deaths includes drug overdoses, wrong drugs given or taken in error, and accidental poisoning due to drugs. Drug-induced deaths deemed homicidal, suicidal or of undetermined intent are not included in unintentional drug-induced deaths.
Drugs and overdose also tend to be associated with urban areas; the data, however, reveal that the highest growth in unintentional drug-induced deaths has been occurring in regional settings, away from capital cities. This trend poses important challenges for addressing overdose in regional areas. It highlights the need to increase capacity in regional and rural areas through such approaches as enhanced provision of naloxone and greater resources for drug and alcohol treatment and support services.
The report's key findings, drawing on data provided by the Australian Bureau of Statistics, are -
There were 1,556 unintentional drug-induced deaths in Australia in 2018, accounting for more than three-quarters (75.2%) of all drug-induced deaths.
• This equates to more than four unintentional drug-induced deaths per day in 2018, or one death every 5.6 hours. It is anticipated that these numbers will rise as cases are finalised through the coronial system.
• Opioids were the drug group most commonly identified in unintentional drug-induced deaths in 2018 (involved in 900 deaths), followed by benzodiazepines (involved in 648 deaths), pharmaceutical opioids (involved in 457 deaths) and stimulants (involved in 442 deaths).
• Unintentional deaths were most common among the 40-49 age group, which accounted for 26.9% of all unintentional drug-induced deaths in 2018. Fewer than one in ten (9.6%) deaths recorded was among those aged under 30.
• Males were almost three times as likely as females to suffer an unintentional drug-induced death in 2018, accounting for 71.5% of deaths.
• Aboriginal people were almost three times as likely to die from an unintentional drug-induced death in 2018, with a rate of deaths of 17.3 per 100,000 population, compared with 6.0 deaths per 100,000 population for non-Aboriginal people.
The gap between unintentional drug-induced deaths and the road-toll continues to widen.
• Unintentional drug-induced deaths are increasing by 3.0% per year, based on trends from the 2001 to 2018 period. If nothing is done to alter this trend, it will equate to an additional 330 drug-induced deaths by 2023, of which 248 will likely be unintentional. In contrast, the road toll has decreased on average by 2.2% per year, equating to 128 fewer deaths by 2023.
• In 2018, 1,556 people died from unintentional drug-induced overdoses in Australia, compared with 1,220 people who died on our roads.
The number of unintentional drug-induced deaths has increased significantly over the past 15 years, from 981 in 2001 to 1,556 in 2018.
• From 2001 to 2018, the population of Australia increased by 29.9%. During the same period, the number of unintentional drug-induced deaths increased by 58.6%.
• Opioids continue to be the most commonly identified drug group in unintentional drug-induced deaths, and the number of unintentional drug-induced deaths involving opioids has nearly trebled in the last 12 years.
• There are significant increases in deaths involving benzodiazepines, stimulants, cannabinoids, anti- depressants, anti-convulsants (used to treat epilepsy, mood disorders and neuropathic pain) and anti- psychotics. In the last 15 years, unintentional drug-induced deaths involving stimulants have increased seven-fold, while those involving benzodiazepines have increased four-fold. Deaths involving both anti-psychotic and anti-convulsant medications have increased dramatically in the last five years, although the number of deaths remains lower than for other drug types.
• Poly-drug use underlies many of these deaths, and deaths where four or more substances were detected are increasing dramatically. The number of unintentional drug-induced deaths that involve four or more substances has almost quadrupled, from 163 in 2013 to 582 in 2018. In comparison, deaths involving the detection of a single drug, or the detection of alcohol on its own, have not significantly increased over time. Deaths involving the detection of two drugs have decreased slightly from a high of 277 in 2012, while those involving three drugs have slowly increased from 125 in 2008 to 207 in 2018.
The increase in unintentional drug-induced deaths is more pronounced among some groups within the community.
• Since 2001, the number of unintentional drug-induced deaths has increased significantly among people aged 30-59 (from 540 to 1,111 in 2018, an increase of 105.7%), but has decreased among those aged under 30 (from 248 to 150 in 2018, a decrease of 39.5%).
• Since 2012, the number of unintentional drug-induced deaths among males increased by 36.8%, while the number of deaths among females increased by 4.7%.
• The rate of unintentional drug-induced death among Aboriginal people is far higher than the rate among non-Aboriginal people for the entire period examined in this report (2001 to 2018), and has been increasing since 2009. In 2018, the rate of unintentional drug-induced death among Aboriginal people was 17.3 per 100,000 people; in 2009 the rate was 9.5 per 100,000 people.
• Since 2011, the rate of unintentional drug-induced deaths in regional parts of Australia has surpassed the rate seen in capital cities. From 2011 to 2018 the rate of unintentional drug-induced deaths in rural and regional Australia increased by 15.9%, while the rate in capital cities increased by only 3.6%.
The number of unintentional drug-induced deaths involving opioids has increased consistently since 2006.
• The number of unintentional drug-induced deaths involving opioids has nearly trebled in the last 12 years, increasing from 338 in 2006 to 900 in 2018.
• Sharp increases have been observed in the last five years in the number of unintentional deaths involving heroin and oxycodone / morphine / codeine. Since 2013, the number of deaths involving heroin has increased from 195 to 402 – an increase of 106.2% – while the number of deaths involving oxycodone / morphine / codeine has increased from 269 to 321– a 35.7% increase.
• While unintentional drug-induced deaths involving heroin are most common among 30-39 year-olds (568 deaths from 2014 to 2018), deaths involving pharmaceutical opioids are most common in the 40-49 age group (851 deaths from 2014 to 2018).
• Males had a higher proportion of unintentional drug-induced deaths involving heroin than females during the period from 2014 to 2018 (35.1% among males, compared with 21.2% among females), whereas females had a higher proportion of unintentional drug-induced deaths involving pharmaceutical opioids (47.5% among males, compared with 57.2% among females).
• In the capital cities, the number of unintentional drug-induced deaths involving heroin has increased dramatically since 2014 (from 156 to 312 in 2018) and in 2016 overtook the number of deaths involving oxycodone / morphine / codeine (186 in 2018). In contrast, unintentional drug-induced deaths involving opioids outside of capital cities continue to be dominated by oxycodone / morphine / codeine (135 deaths in 2018).
• The highest rates of unintentional drug-induced deaths involving heroin have predominantly occurred in Victoria, with a sharp increase from 2012 onwards, resulting in a rate of 2.4 deaths per 100,000 population in 2018. However, in 2018 Western Australia overtook Victoria to have the highest rate of heroin-related unintentional drug-induced deaths, with 2.8 per 100,000 population.
The number of unintentional drug-induced deaths involving benzodiazepines has continued to rise overall.
• Since 2013, the increase in the rate of unintentional drug-induced deaths involving benzodiazepines has been most evident in Western Australia (from 1.1 to 4.1 deaths per 100,000 population in 2018) and Victoria (from 1.8 to 2.8 deaths per 100,000 population).
• The number of unintentional drug-induced deaths involving benzodiazepines over the period 2014 to 2018 was highest among people aged 40-49 (accounting for 33.0% of deaths involving benzodiazepines), followed by those aged 30-39 (28.2% of deaths involving benzodiazepines).
• Males accounted for two-thirds (67.0%) of unintentional drug-induced deaths involving benzodiazepines in the period 2014 to 2018 (1,926 deaths) compared with 947 deaths among females.
The number of unintentional drug-induced deaths involving stimulants has increased sharply since 2012.
• There were 442 unintentional drug-induced deaths involving stimulants in 2018, up from 87 in 2008 – an increase of more than 400%.
• From 2014 to 2018, males accounted for three-quarters of unintentional drug-induced deaths involving stimulants (1,470 deaths, 75.8%), compared with 469 deaths among females.
• From 2011 to 2018, the rates of unintentional drug-induced deaths involving stimulants increased from 0.5 to 1.8 deaths per 100,000 population in capital cities, compared with 0.4 to 1.6 deaths per 100,000 population outside of the capital cities.
The rate of unintentional drug-induced deaths involving anti-depressants has increased steadily in most states and territories since 2001.
• Unintentional drug-induced deaths involving anti-depressants were relatively low compared to other substances, yet are increasing in all states and territories (except South Australia), particularly in Western Australia, which has quadrupled from 0.7 in 2013 to 2.8 in 2018.
• There is a slightly older age profile for unintentional drug-induced deaths involving anti-depressants than for those involving either benzodiazepines or stimulants, with the highest number of unintentional deaths during 2014 to 2018 among people aged 40-49 (accounting for 32.7% of deaths involving anti-depressants), followed by those aged 50-59 (24.5% of deaths) and those aged 30-39 (24.3% of deaths).
• More than one in ten (10.5%) unintentional deaths involving anti-depressants were among people aged 60 and over.
• There is a more even sex distribution for unintentional drug-induced deaths involving anti-depressants than for those involving other drug types, with 971 deaths among males (57.8% of deaths involving anti- depressants) and 709 deaths among females from 2014 to 2018. The rate of unintentional drug-induced deaths involving cannabinoids has increased steadily in all states and territories since 2013.
• The rates of unintentional drug-induced deaths involving cannabinoids were relatively low, yet are increasing in all states and territories, particularly in Western Australia, which increased from 0.5 deaths per 100,000 population in 2013 to 2.3 in 2018, and Victoria, which increased from 0.2 to 1.5 deaths per 100,000 population during the same period.
• From 2014 to 2018, males accounted for three-quarters of unintentional drug-induced deaths involving cannabinoids (880 deaths, 74.2%), compared with 306 deaths among females.
• After many years of almost identical rates of unintentional drug-induced deaths involving cannabinoids in both capital cities and rural and regional areas, preliminary data for 2018 show that rates outside of capital cities (1.5 deaths per 100,000 population in 2018) have diverged from those in the capital cities (1.2 deaths per 100,000 population).
The rate of unintentional drug-induced deaths involving anti-convulsants and anti-psychotics has increased markedly in recent years.
• While the overall number of unintentional drug-induced deaths involving anti-convulsants is low (128 deaths in 2018, representing 8.2% of all unintentional drug-induced deaths), the number has increased markedly since 2015, when there were only 11 deaths.
• Rates of unintentional drug-induced deaths involving anti-psychotics have increased markedly since 2013, (when there were 15 deaths involving anti-psychotics) to 223 such deaths in 2018, representing 14.3% of all unintentional drug-induced deaths.
