Recent trends in heroin and pharmaceutical opioid‐related harms in Victoria, Australia up to 2018

Abstract

Aims To characterize the trajectory in the years leading up to 2018 in pharmaceutical opioid and heroin morbidity in Victoria, Australia, and to assess the effect on that trajectory of reformulation of oxycodone to a form that could not be easily snorted or injected. Design Interrupted time-series analyses of population-level data before versus after reformulation of oxycodone, stratified by sex. Setting Victoria, Australia. Participants The population of Victoria aged 12+ years. Measurements Ambulance patient care and emergency department (ED) records were examined using both fixed-code and free-text fields, with each record manually cleaned and checked by trained coders. These were used to derive the output variables providing an index of harm: rates of opioid-related ambulance attendances and ED attendances for pharmaceutical opioids and heroin. The input variable was pre-versus post-oxycodone reformulation. Findings There were 30 045 opioid-related ambulance attendances from January 2012 to October 2018 (54% heroin-related), and 10 113 ED attendances from July 2008 to June 2018 (39% heroin-related). There was an increase in the rate (events per 100 000 people per year) of all opioid ED attendances from 2008 to 2018 [increase = 0.063; 95% confidence interval (CI) = 0.049, 0.078]. Pharmaceutical opioid ED attendances decreased from 2014 onwards (slope change = -0.083; 95% CI = -0.108, -0.059). Heroin-related ED attendances increased from 2014 to 2018; 11 324 heroin-related ambulance attendances and 1980 ED attendances were observed from April 2014 to June 2018, compared with the respective estimates of 8176, and 1661 had the pre-April 2014 trend continued (ambulance slope change = 0.296, 95% CI = 0.104, 0.489; ED slope change = 0.026, 95% CI = 0.005, 0.046). The inflection point of 2014 coincided with the re-formulation of oxycodone. Conclusion In Victoria, Australia, there appears to have been a trend starting around mid-2014 of increasing heroin-related harm, and a flattening of the increase or a decrease of harms relating to pharmaceutical opioids. These changes may, in part, reflect reformulation of oxycodone to reduce the extent to which it can be injected or snorted.

Illicit drug use and harms in Australia in the context of COVID‐19 and associated restrictions: Anticipated consequences and initial responses

“…With all major drug types likely to be impacted by changes in air transport , we should expect similar impacts on drug markets with COVID‐19 as were observed in the heroin drought, at least in the short term. The medium‐ and long‐term effects of the heroin drought were much less clear—the market recovered, but rates of use and harms did not immediately return to those observed in the late 1990s (although some recent work does suggest rising rates of heroin‐related harms in recent years) . However, in the current environment where supply chains are disrupted internationally, markets may rebound more, as would be expected by normal economic theory, and return to pre‐COVID‐19 levels as markets adapt in the context of the technology advances of recent years (e.g.…”

Supply-Side Drug Policy in the Presence of Substitutes: Evidence from the Introduction of Abuse-Deterrent Opioids

“…In this case, we would predict less substitution to heroin. 17 While some substate information is available (e.g., county-level mortality), substate data is not available for our primary measure of OxyContin misuse (our source of variation in exposure to the reformulation). Our empirical strategy requires that we have cross-sectional variation in misuse, and we will show that there is sufficient…”

Review article: Rapid review of the emergency department‐initiated buprenorphine for opioid use disorder

“…2 In Australia, between 2014 and 2019 there was a 40% increase in heroinrelated harms and a significant increase in heroin-related ED attendances. 3 It is critical for Australia to address the increasing incidence of opioid-related deaths to prevent mirroring the 'Opioid Epidemic' of North America. 4,5 Maintenance pharmacotherapy with opioid agonist treatment (OAT) has been shown to reduce withdrawal symptoms, cravings, non-medical opioid use, HIV infection rates and mortality.…”

“…10,14,15 Currently, these few prescribers cannot meet the needs of an increasing number of patients, and the current model for OAT is inadequate for those without a regular GP or a fixed address. 3,16 In 2019, long-acting injectable buprenorphine (LAIB) became available in Australia and may alleviate some of the difficulties of long-term treatment. 17,18 Injections given weekly or monthly, could reduce the demand on GPs and pharmacies and could improve quality of life by negating the need to attend a pharmacy frequently for supervised dosing of buprenorphine.…”