Opioid use is at an all-time high¹ with 3 million people using opioids across Australia and 1.9 million estimated to initiate opioids every year² – 50,000 of whom will cross the line from initiating opioids into persistent users in a single year.^2,3*

These are extraordinary figures and set to become even more so as the annual number of opioid prescriptions continues to increase (as of 2019).¹ In fact, Australia currently holds the title of the 8th highest opioid consumption internationally based on the number of defined daily doses of prescription opioids per million population.⁴ With that in mind, it’s hardly a surprise that as a healthcare practitioner you have likely had contact with an opioid-dependent patient – whether you realise it or not.⁵ 

All opioids – from codeine to heroin – can lead to dependence, and the consequences of leaving such dependence unchecked are dire. In Australia, people with opioid-use disorder have a crude all-cause mortality rate of 9.43/1000 patient-years and an overdose-specific mortality rate of 3.72/1000 patient-years.⁶ In a cohort study of people who had at least one prescription of an opioid agonist in NSW, the standardised mortality rate was alarmingly shown to be 6.06-fold higher than that observed in the general population of NSW.⁷ From a healthcare perspective, the Australian system sees nearly 150 hospitalisations, 14 emergency-department admissions and three deaths involving opioid harm on a daily basis.⁴ This amounts to a tremendous and increasing burden on the healthcare system as a whole with hospitalisations for opioid poisoning increasing by 25% over the last 10 years (2007–2008 vs 2016–2017), primarily driven by pharmaceutical-opioid hospitalisations, and the number of opioid deaths nearly doubling.⁴

The daily burden of opioid-use disorder⁴

Although 3 deaths a day might not sound like much compared with diseases like cancer (135 deaths/day) or coronary heart disease (48 deaths/day),^4,8,9 it translates to 882 unintentional and, frankly, unnecessary deaths a year.¹⁰ If you think these deaths are primarily associated with illegal opium or heroin use, you would be wrong – pharmaceutical opioids account for around 50% of those deaths, an astounding 429 people a year. Although the majority of deaths were in people aged 30–49 years, almost one in three unintentional drug-induced deaths involving pharmaceutical opioids were observed in people aged 50 and above, showing that addiction transcends the ages.¹⁰

What’s more, opioid-use disorder rarely presents as a standalone disease, with two thirds of people also suffering from a mental illness. Considering that such psychiatric comorbidities further increase morbidity and mortality as well as the risk of opioid misuse and overdose, these numbers are not inconsequential.¹¹ That’s why it is so important that opioid-use disorder is managed through an integrated model of care allowing the mental-health and substance-use issues to be addressed simultaneously. Psychosocial treatments are an essential component of all substance-use-disorder treatment programs and have a goal of helping people control the urge to use drugs and remain abstinent whilst also helping them cope with the emotional issues associated with addiction.¹² Given the significant implications of opioid-use disorder on both individual well-being and the healthcare system, the implementation of effective management strategies including psychosocial treatments is essential.¹³

If you would like to learn more about the risks of opioid dependence, visit the TurntoHelp website for healthcare professionals.

*Based on group-based trajectory modelling.

References:
1. Therapeutic Goods Administration. Addressing prescription opioid use and misuse in Australia. 2019. Available at www.tga.gov.au/publication/addressing-prescription-opioid-use-and-misuse-australia (accessed 23 February 2022).
2. Lalic S et al. Br J Clin Pharmacol. 2019;85:202–215.
3. Lalic S et al. Br J Clin Pharmacol. 2018;84:1267–1278.
4. Australian Institute of Health and Welfare 2018. Opioid harm in Australia and comparisons between Australia and Canada. Cat. no. HSE 210. Canberra: AIHW.
5. McDonough M. Aust Prescr. 2013;36:83–87.
6. Bahji A et al. J Addict Med. 2020;14(4):e118–e132.
7. Lewer D et al. J Psychiatr Res. 2020;130:435–440.
8. Australian Institute of Health and Welfare. Cancer in Australia 2021. Available at www.aihw.gov.au/reports/cancer/cancer-in-australia-2021/summary (accessed 23 February 2022).
9. Australian Institute of Health and Welfare. Coronary heart disease. 2020. Available at www.aihw.gov.au/reports/australias-health/coronary-heart-disease (accessed 23 February 2022).
10. Penington Institute (2021). Australia’s Annual Overdose Report 2021. Melbourne: Penington Institute.
11. Jones CM and McCance-Katz EF. Drug Alcohol Depend. 2019;197:78–82.
12. Dugosh K et al. J Addict Med. 2016;10(2):93–103.
13. Rice D et al. PLoS One. 2020;15(12):e0244401.