Is Australia ready for fentanyl?

McKeown, Hugh E.; Rook, Trevor J.; Pearson, James R.; Jones, Oliver A.H.

doi:10.1016/j.scijus.2018.04.004

Cited by 8 publications

(5 citation statements)

References 19 publications

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“…The observation that fentanyl has a higher CF relative to FTI indicates that it may be more toxic at the point of overdose rather than prescribing. Since around 2006, there have been increases in fentanyl prescribing and deaths in Australia, some of which may be accounted for by increasing diversion and illicit use . The relatively high toxicity of opioids is concerning, that given opioid dispensing in Australia increased 15‐fold (500,000–7,500,000) between 1992 and 2012 with proportionate increases in harms measured by deaths and hospitalizations …”

Section: Discussionmentioning

confidence: 99%

“…Since around 2006, there have been increases in fentanyl prescribing and deaths in Australia, some of which may be accounted for by increasing diversion and illicit use. 22,23 The relatively high toxicity of opioids is concerning, that given opioid dispensing in Australia increased 15-fold (500,000-7,500,000) between 1992 and 2012 with proportionate increases in harms measured by deaths and hospitalizations. 24 The finding that TCAs have the highest FTI and CF of all of the antidepressants is consistent with previously studies in which other antidepressants have >10-fold lower lethal toxicity.…”

Section: Discussionmentioning

confidence: 99%

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The relative lethal toxicity of pharmaceutical and illicit substances: A 16‐year study of the Greater Newcastle Hunter Area, Australia

Brett

Wylie

Raubenheimer

et al. 2019

Brit J Clinical Pharma

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Aims We aim to calculate 2 metrics of relative lethal toxicity; the fatal toxicity index (FTI; number of deaths per year of a daily dose) and the case fatality (CF; number of deaths per overdose) with a focus on opioids, antidepressants, antipsychotics, benzodiazepines and illicit drugs. Methods This descriptive cohort study used the Australian National Coronial Information System (NCIS) to identify a population of individuals with drug‐associated deaths in the Greater Newcastle Hunter Area between January 2002 and December 2016. This was combined with Australian medicine dispensing data and corresponding data from the Hunter Area Toxicology Service to calculate FTI and CF. Results There were 444 drug‐related deaths and 21,296 overdoses during the study period. FTI and CF were well correlated (Spearman's rho 0.64, P < .001). Of the classes of interest, opioids had the highest FTI (40.3 95% confidence interval [CI] 35.2–45.4 deaths per 100 years of use at the defined daily dose or deaths/DDD/100 years) and CF (12.4% 95%CI 11.0–13.9). Fentanyl, methadone and morphine had the highest relative fatal toxicity within this class. Tricyclic antidepressants had the highest relative fatal toxicity of all antidepressants (FTI 14.5 95%CI 9.7–19.3 deaths/DDD/100 years and CF 7.1% [95%CI 4.8–9.3]) and benzodiazepines appeared to be more associated with multiple agent deaths than single. Of the illicit drugs, heroin had the highest CF (26.4%, 95%CI 19.1–33.7). Conclusion Knowledge of relative lethal toxicity is useful to prescribers and medicines and public health policy makers in restricting access to more toxic drugs and may also assist coroners in determining cause of death.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The relative lethal toxicity of pharmaceutical and illicit substances: A 16‐year study of the Greater Newcastle Hunter Area, Australia

Brett

Wylie

Raubenheimer

et al. 2019

Brit J Clinical Pharma

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“…Overall overdose deaths and first-responder calls increased in a community-based sample in an impoverished neighborhood in Vancouver, Canada, in 2017, and fentanyl was detected in 52% of the subjects who were prescribed opioid agonist therapy 27 . At the same time, fentanyl-related deaths also increased in Australia 28,29 .…”

Section: Epidemic and Evolution Of Illicit Fentanyl Usementioning

confidence: 98%

The rising crisis of illicit fentanyl use, overdose, and potential therapeutic strategies

et al. 2019

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Fentanyl is a powerful opioid anesthetic and analgesic, the use of which has caused an increasing public health threat in the United States and elsewhere. Fentanyl was initially approved and used for the treatment of moderate to severe pain, especially cancer pain. However, recent years have seen a growing concern that fentanyl and its analogs are widely synthesized in laboratories and adulterated with illicit supplies of heroin, cocaine, methamphetamine, and counterfeit pills, contributing to the exponential growth in the number of drug-related overdose deaths. This review summarizes the recent epidemic and evolution of illicit fentanyl use, its pharmacological mechanisms and side effects, and the potential clinical management and prevention of fentanyl-related overdoses. Because social, economic, and health problems that are related to the use of fentanyl and its analogs are growing, there is an urgent need to implement large-scale safe and effective harm reduction strategies to prevent fentanyl-related overdoses.

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“…Similarly, other Anglo-Saxon countries with relatively lower PO consumption levels (e.g. Australia, New Zealand, United Kingdom) have not experienced the extreme spikes in opioid mortality that have been observed in the U.S. and Canada [70,[76][77][78][79]. Yet, there remains potentially inconsistent evidence that is difficult to reconcile with the perspectives presented.…”

Section: Main Textmentioning

confidence: 84%

The opioid mortality epidemic in North America: do we understand the supply side dynamics of this unprecedented crisis?

Fischer

Pang

Jones

2020

Subst Abuse Treat Prev Policy

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While there has been extensive attention to the 'demand side'or use and adverse consequences, including mortalityof the 'opioid crisis' presently unfolding across North America, few considerations have focused on the supply side. This paper examines the supply side dynamics of this unprecedented public health phenomenon. We provide evidence for several interrelated supply-side elements that have contributed to the present public health crisis. We observe that initially, persistently high levels of prescription opioid availability and use exposed large proportions of the North American population to opioids, resulting in correspondingly high levels of medical and non-medical use (e.g., involving diversion). While various intervention measures to control prescription opioid availability and use have been implemented in recent years, leading to eventual reductions in opioid dispensing levels, these occurred late in the crisis's evolution. Moreover, these supply reductions have not been met by corresponding reductions in opioid use or demand levels. These growing discrepancies between opioid demand and prescription-based sources have left major gaps in opioid supplies. In response to such supply gaps, highly potent and toxic illicit opioid products have rapidly proliferated across North America, and become a core driver of the dramatic spikes in opioid overdose fatality levels in recent years. These supply-related interrelations are corroborated by a corresponding increase in illicit opioid-related fatalities, which arose just as medical opioid supplies began to decrease in many jurisdictions. Improved analyses and understanding of the supplyside dynamics of the opioid crisis are urgently needed in order to inform future intervention and policy development. Meanwhile, the high mortality toll related to illicit, highly toxic opioid exposure requires sustained solutions, including supply-oriented measures (e.g., safer opioid distribution for at-risk users) towards improved public health protection.

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Is Australia ready for fentanyl?

Cited by 8 publications

References 19 publications

The relative lethal toxicity of pharmaceutical and illicit substances: A 16‐year study of the Greater Newcastle Hunter Area, Australia

The relative lethal toxicity of pharmaceutical and illicit substances: A 16‐year study of the Greater Newcastle Hunter Area, Australia

The rising crisis of illicit fentanyl use, overdose, and potential therapeutic strategies

The opioid mortality epidemic in North America: do we understand the supply side dynamics of this unprecedented crisis?

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