About the opioid crisis in Australia and how you can make a difference

You may have heard about the opioid crisis but not looked into it, or maybe you know about it but haven't strategised how to avoid becoming part of it. Here is a run down so you can help someone else or maybe even help yourself.

Opioid drugs were traditionally derived from the red opium poppy but these days there are many drugs that act on the opioid receptors in the brain, spinal cord, gut and other parts of the body. When opioids bind to these receptors they depress central nervous system messages that in turn slows down the heart and breathing as well as stimulating the production of dopamine which leads to feeling of pain relief and or pleasure. From a lesser to a stronger scale there is codeine (also found in panadeine forte, nurofen plus, Panamax pro, Mersyndol and Codral cold & flu original), oxycodone (often brand named such as Oxycontin and Endone), tramadol, morphine, fentanyl (80-100 times stronger than morphine) and heroin.

So after surgery you might get prescribed an opioid or even if you have strong pain your doctor might prescribe you some but are you aware that 1 in 10 Australians prescribed opioids become addicted (according to the Penington Institute's Australia's Annual overdose Report 2017)? Compared to a decade earlier, opioid overdoses in Australia increased 60% to 3501 deaths between 2011-2015. This is linked to an increase of opioid prescriptions which saw 14 million prescriptions in Australia for 2017.

The Roger Nicholas' Review in 2019 found that between 1992 and 2012, opioid dispensing episodes increased from 500,000 to 7.5 million and the corresponding cost to the Australian government (paid by taxpayers) had a 31 fold increase from $8.5 million to $271 million. So the current cost to the government would be expected to reach around half a billion dollars. This is a huge expense of tax payers money that may not be necessary and these figures don't even take into account the cost of side effects from opioids.

The side effects laid out by Nicholas for long term opioid use can be:

• Respiratory symptoms can occur as opioids depress respiration and a 70% chance of sleep disordered breathing such as sleep apnoea
• Gastrointestinal symptoms such as constipation (about half of users) and nausea / vomiting (about a quarter of users)
• Cardiovascular effects such as bradycardia and hypotension
• Endocrine changes such as reduction in testosterone, oestrogen and adrenal androgens which can lead to infertility, hyogonadism, decreased sexual functionless of muscle mass, and anxiety and / or depression. Typical opioid endocrinopthy presents in men as decreased libido, erectile dysfunction, lethargy and depression while in women as sexual dysfunction, dysmenorrhea, reduced bone density and depression.
• Fractures in bones of opioid users as found by a 2015 study in Yunan, China were increased 88% and for hip fractures the increase was two fold.
• The central nervous system changes seem to show impaired cognitive function such as found with research on with 53 medications tested in seniors in West Virgina during driving where 15 drugs (including buprenorphine, codeine, dihydrocodeine, methadone and tramadol) gave significant interaction for collisions. Opioid use also seems to create changes to the brain that increases the risk of delirium.
• Depression
• Immune system interference to pathways for immune regulation and decreases in the effectiveness of acquired and natural immunity. Opioids such as codeine, morphine and fentanyl impair immune cell function (macrophages, T cells and natural killer cells) and weaken the gut barrier.
• Opioid induced hyperalgesia which increases sensitivity to certain stimuli which can be the same as the underlying pain. This could explain the loss of efficacy of opioids in some people which means the only way to improve pain levels is to reduce and cease opioid use.
• Opioid tolerance so increasing amounts of opioids are needed to get the same amount of pain reduction and hence increases the risk of higher doses.

In 2018, Opioids accounted for 3 deaths per day in Australia, and represented over two thirds of the total drug-induced fatalities. Of these deaths, pharmaceutical opioids were present in over 70% of cases. The Australian Bureau of Statistics in 2019 showed the majority of these opioid fatalities were unintentional overdoses in middle-aged males, involving the use of pharmaceutical opioids.

The most commonly misused opioid is OTC codeine medications (75% of recent painkiller misusers), followed by prescription codeine users (e.g. Panadeine Forte) which made up 40% of opioid misusers.

What can be done about all of this?

There are efforts to convert people from prescription opioids to over the counter (OTC) medications that have less serious effects as an immediate action to reduce the amount of opioid use and abuse. You can help yourself or the person you are concerned about to switch medication or even better is to seek natural solutions first / early as it's easier to prevent addiction and adverse effects by not using or limiting the use of opioids in the beginning.

Ultimately, prescribing habits by doctors need to be reviewed and the public needs to become more aware of how complementary and alternative medicine (CAM) can deal with pain so that opioid use isn't necessary. CAM includes acupuncture, pain support groups, counselling, nutritional support from a dietician / nutritionist, TENS machines, yoga / relaxation therapy, naturopathy, physical therapy, massage and chiropractic.

Patients using chiropractic for spinal pain had 64% lower odds to receive an opioid prescription and 83% of chiropractic patients rely less on medications to help manage low back pain. Straight away from these two findings it is easy to see there will be ways to reduce opioid use, they just need to be built into the system better.

The Foundation for Chiropractic Progress Report in 2016 well describes the situation and benefits of early medical referral to chiropractors. It reports on the American situation which will have relevance to Australia. If you want to reduce or cease using opioids or avoid starting opioids then ask more informed questions to your medical provider and try CAM where appropriate. These are the other centres in NSW that give free assistance too:

Sydney Drug Education & Counselling Centre

Provides free counselling and support for young people aged 14 -25 with problematic alcohol and other drugs (AOD) use and their families.

Phone: (02) 9977 0711

Alcohol and Drug Information Service (ADIS) NSW

ADIS provides 24 hour 7 day a week telephone counselling, support, referrals and information for those affected by alcohol or other drugs.

Each NSW Health local health district also has a local central intake telephone line to connect people with alcohol and other drug services in that region.

ADIS Central phone: 1800 250 015