THE 1998 JAMES RANKIN ORATION: Reducing the toll of opioid overdose deaths in Australia

Opioid overdose mortality among young adults in Australia has increased consistently over the past several decades. Among Australian adults aged 15–44 years, the number of these deaths has increased from six in 1964 to 600 in 1997. The rate (per million adults in this age group) increased 55-fold, from 1.3 in 1964 to 71.5 in 1997. The proportion of all deaths in adults in this age group caused by opioid overdose increased from 0.1% in 1964 to 7.3% in 1997. The magnitude of the increase makes it unlikely to be an artefact of changes in diagnosis, especially as similar increases have also been observed in other countries. These trends are also consistent with historical information which indicates that illicit heroin use first came to police attention in Sydney and Melbourne in the late 1960s. There is an urgent need to implement and evaluate a variety of measures to reduce the unacceptable toll of opioid overdose deaths among young Australians. These include: peer education about the risks of polydrug use and overdose after resuming opioid use after periods of abstinence, and attracting more dependent users into opioid maintenance treatment. Measures are also needed to improve responses to overdose by encouraging witnesses to call ambulances, training drug users in CPR, and trialling distribution of the opiate antagonist naloxone to users at high risk of overdose.