BLACK RIVER, Australia (AP) — The coroner’s sense of futility was clear, as he investigated the death of yet another Australian killed by prescription opioids.
Coroners nationwide have long urged officials to address Australia’s ballooning opioid addiction, and to create a tracking system to stop people from collecting multiple prescriptions from multiple doctors. Yet even as thousands died, the coroners’ pleas were met largely with silence.
“For what it is worth, I add my voice to the chorus pleading for urgency,” Western Australia coroner Barry King wrote in his report, delivered in May.
Half a world away, Australia has failed to heed the lessons of the United States, and is now facing skyrocketing rates of opioid prescriptions and related deaths. Drug companies facing scrutiny for their aggressive marketing of opioids in America have turned their focus abroad, working around marketing regulations to push the painkillers in other countries. And as with the U.S., Australia’s government has also been slow to respond to years of warnings from worried health experts.
In dozens of interviews, doctors, researchers and Australians whose lives have been upended by opioids described a plight that now stretches from coast to coast. Australia’s death rate from opioids has more than doubled in just over a decade. And health experts worry that without urgent action, Australia is on track for an even steeper spike in deaths like those seen in America, where the epidemic has left 400,000 dead.
“If only Australia could understand how quickly this can get out of hand. We’re not immune to it,” says Jasmin Raggam, whose brother Jon died in 2014 of an opioid overdose and whose brother-in-law is now addicted to the opioid OxyContin. “I was screaming from the mountaintops after Jon died and I’d started doing my research. And it was like I’m screaming and nobody wants to hear me.”
On an island off the coast of Tasmania, Dr. Bastian Seidel and his colleagues are immersed in what he calls a “nightmare scenario.” Two years ago, when he was president of the Royal Australian College of General Practitioners, Seidel dubbed Australia’s opioid problem a “national emergency.” Today, he wonders if anyone was listening.
“It’s depressing at times to see how we, as practitioners, literally messed up our communities,” he says. “It’s our signature on the scripts. ... But the pressure being put on by the drug companies, by certain health sectors — that’s the situation that we are facing now.”
Australia knows the extent of the problem, he says. The country knows addiction is devastating its communities. And yet, he says, nobody is doing anything.
“Unfortunately, in Australia, we’ve followed the bad example of the U.S.,” he says. “And now we have the same problem.”
AUSTRALIA’S OPIOID ADDICTION
Opioids were once reserved for treating pain that was short-term, terminal or related to cancer. But in the 1990s, pharmaceutical companies began aggressively marketing them for chronic pain.
Starting in 2000, Australia began approving and subsidizing certain opioids for use in chronic, non-cancer pain. Those approvals coincided with a spike in opioid consumption, which nearly quadrupled between 1990 and 2014, says Sydney University researcher Emily Karanges.
Dr. Jennifer Stevens, a pain specialist, saw the surge with startling clarity while working at St. Vincent’s Hospital in Sydney.
A few years ago, a pharmacist at the hospital told her they needed to hire an extra person just to handle all the prescriptions they were handing out for Endone, a brand of oxycodone. Stevens discovered that the hospital’s Endone prescriptions had increased 500 percent in 8 years, with no decrease in other opioids dispensed. Further study revealed that 10 percent of patients were still taking opioids three months after surgery, even though the drugs are generally only recommended for short-term use.
“We were just pumping this stuff out into our local community, thinking that that had no consequences,” says Stevens, a vocal advocate for changing opioid prescribing practices. “And now, of course, we realize that it does have huge consequences.”
Just like in the U.S., as opioid prescriptions rose, so did fatal overdoses. Opioid-related deaths jumped from 439 in 2006 to 1,119 in 2016 — a rise of 2.2 to 4.7 deaths per 100,000 people, according to the Australian Institute of Health and Welfare. Most of those deaths were related to prescription opioids, rather than illegal opioids such as heroin.
More than 3 million Australians — an eighth of the country’s population — are getting at least one opioid prescription a year, according to the latest data.
The numbers and the warnings may have been glossed over partly because of Australia’s piecemeal system of data collection and reporting, says Dr. Christian Rowan, an addiction specialist in the state of Queensland. Data is reported by various states, coroners and agencies, and often includes only prescriptions filled through the government-subsidized drug system and not private prescriptions.
“Because it’s fragmented, people haven’t had a line of sight as to what’s happening,” he says.
Australia’s government insists it is now taking the problem seriously. The opioid codeine, which used to be available over the counter, was restricted to prescription-only in 2018. And last month, the country’s drug regulator, the Therapeutic Goods Administration, announced tougher opioid regulations, including restricting the use of fentanyl patches to patients with cancer, in palliative care, or under “exceptional circumstances.”
“I can’t speak for the past,” says Greg Hunt, who became the federal Health Minister in 2017. “I can speak for my watch and my time where this has been one of my absolute priorities, which is why we’ve taken such strong steps. ... My focus has been to make sure that we don’t have an American-style crisis.”
But for Sue Fisher, whose 21-year-old son Matthew died in 2010 of an overdose, it’s too little, too late. The crisis is here, along with what she calls a “crisis of ignorance.”
“We’re living in a country that is oblivious to what’s going on,” she says. “Why aren’t we learning from America’s mistakes? Why don’t we learn?”