The shift in drug overdose trends and what GPs can do

It continues to be a leading cause of death in Australia, but who is now most at risk and from which substances?

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The demographic of drug-induced deaths has been steadily ageing over the past 20 years, the National Drug and Alcohol Research Centre (NDARC) has found.

A recently released, comprehensive report analysing the trends of drug-induced death in Australia from 2003-2022 showed a shift in the most at-risk age brackets and a change in which drugs were involved.

In the early 2000s, ages 25-34 and 35-44 accounted for the majority of deaths but as of 2022, 27% of drug-induced death were in those aged 45-54. There was a decrease over the years for those aged 35-44, but they were still the second largest group in 2022, accounting for 23% of drug-induced deaths.

Over this 20-year period, the percentage of deaths have increased in all age groups over 45, particularly in the 45-54 and 55-64 brackets, while decreasing in those age groups under 35.

There were 1819 drug-induced deaths in 2022. Drug-induced deaths increased on average by 4.1% per year from 2003, peaking in 2017 with 2003 deaths. By 2020, this had declined to 1967 and continued lowering in 2021 and 2022.

In 2022, 97% of these deaths were from overdose, 73% of which were classified as unintentional, which was consistent with previous years.  

Opioid-related deaths more than doubled from 2.3 to 5.8 deaths per 100,000 people between 2003 and 2017, increasing by an average of 6.9% per year. After the 2017 peak, the rate has gradually declined.

Figures from 2022 showed that heroin made up 43% of opioid overdose deaths, while natural and semi-synthetic opioids comprised the largest proportion of opioid overdose deaths in prior years, including 46% in 2021.

Amphetamine-type stimulants were involved in 28% of overdose deaths, increasing on average 16% per year from 2003 and peaking in 2020.

Cocaine made up less than 4% of overdose deaths, 91% of which were unintentional. While absolute numbers remained small, the rate has been increasing since 2003 an average of 11% per year.

Dr Rachel Sutherland, deputy program lead and one of the authors of the report, said: “Most drug-induced deaths were unintentional, occurred among males, and at home. There is increasing concern regarding the ageing demographic of people who use drugs, including those who inject drugs,” she said.

The Drug Trends team have found in previous research that despite health practitioners being considered a trusted source of information for older adults, conversations regarding substance use and associated harms are uncommon.

“While there are likely structural barriers to this (e.g., limited practitioner time), these represent potential missed opportunities, particularly since older adults are increasingly likely to present to health practitioners as they age,” Dr Sutherland told TMR.

“There is substantial scope to address the workforce development needs of key healthcare providers and to ensure that they are adequately skilled to appropriately identify and intervene where an older person’s substance use may constitute risk of harm.”

She explained that drug-induced deaths continue to be a leading cause of premature mortality in Australia, and many of these deaths are preventable. The drug deaths in 2022 were equivalent to five deaths per day and accounted for 1% of all registered deaths in Australia. Males accounted for 63% of these.

Most deaths involved multiple drugs, and 20 years of data shows that opioids and benzodiazepines have been consistently involved.

“When prescribing medications such as opioids and benzodiazepines, it is essential that GPs take the time to talk through the risks of overdose and other harms, particularly when mixing with other substances,” she said.

It has previously been suggested that naloxone be distributed along opioid prescriptions, especially for longer-term opioid use.

“For those using illicit opioids, it is also important that take-home naloxone is available, and that there is easy and equitable access to opioid agonist therapy,” she said.

Dr Sutherland says it’s important to acknowledge the role of suicide and self-harm in these deaths.

“One in four overdose deaths were intentional. At a minimum, one in ten had a history of self-harm. We know from studying drug-related hospitalisations that the rate of intentional poisoning is much higher than that of unintentional poisoning within that data. We need to consider the role of suicide prevention in addressing overdose as well,” she said.

She says that one of the most overlooked findings in the report is in relation to the social determinants of health, and their impact on mortality.

“One-third of drug induced deaths occur among people residing in the lowest socio-economic area and two-in-five had at least one psychosocial risk factor coded, mostly in relation to socioeconomic and psychosocial circumstances,” she said.

“While interventions to reduce the risk of fatal overdose or dependence (e.g., naloxone, opioid agonist therapy) are critical, we need to acknowledge the broader social, and structural determinants of mortality, and consider how they can be addressed in our response to prevent these deaths.”