Australia first in worldwide prescription opioid use

Matt Woodley

28/05/2019 3:39:03 PM

A global survey found half of Australian users also got ‘high’ from opioids at least once last year, but does this tell the whole story?

Blister pack of opioids
The Global Drug Survey found that 30.4% of Australian respondents reported prescription opioid use in the past 12 months.

Dr Hester Wilson, Chair of the RACGP Specific Interests Addiction Medicine network, told newsGP that while the results are helpful, the survey’s limitations mean it is not representative of the wider community.
The online nature of the Global Drug Survey (GDS) means it is biased towards respondents with easy access to the internet, who generally have higher levels of health literacy than the general population, Dr Wilson said.
According to its organisers, the mean age of respondents is around 25 years, while 85% are heterosexual, 90% are white and 60% have a university degree. Additionally, the ratio of male to female respondents is 2:1 and 70% have used an illicit drug in the past year.
‘You can’t base prevalence on this. This is a group of young, university-educated, men and women [who go clubbing] and are more likely to be employed – white, non-Indigenous, and not from a culturally diverse background,’ Dr Wilson said.
‘[However], it’s starting to get some data on what is actually happening out there … so it is useful.’
According to the survey, a world-leading 30.4% of Australian respondents reported prescription opioid use in the past 12 months, with the US close behind on 29.2% – both considerably higher than the global average of 16.5%.
Nearly 51% of global users admitted using prescription opioids to get ‘high’ in the past year, with Australia ranked fourth in this category (56.3%), behind the US (69.4%), Finland (65.7%) and England (57%).
Australia also reported the second highest rate of people using prescription opioids to get high 1–2 times per year (30%), but was below the global average for more than three times per year; only 22.2% of Australian users admitted to this amount of use, compared to 38.8% of US respondents and 24.9% globally.
Despite Australia’s relatively high ranking in the GDS, Dr Wilson believes it is too difficult to determine whether the use is harmful or if these respondents are at risk of becoming dependent. This is primarily due to a lack of clarity over what getting ‘high’ constitutes, the amount of opioids that have been used, and the backgrounds of individual users.
‘We have a group of people who will use a little bit of opioid … and they notice when they take it, it makes them feel good and they might try a little bit, but are they dependent?,’ Dr Wilson said.
‘My suspicion with this group of young people – white, privileged, highly-educated, computer literate, digital natives – is that they’re probably a group that is less likely to become dependent.
‘The real drug that you need to worry about in terms of experimenting is tobacco. Nicotine is highly, highly addictive, much more addictive than any other drug.
‘We know from the evidence around nicotine addiction that for a group of young people who start social smoking, and do it just once a month and are not addicted, the usual trajectory for them is that they use more and more, and [eventually] become daily users and become dependent.’
Aside from prescription opioid use, Australians ranked first in:

  • respondents who accessed emergency medical treatment due to alcohol use (4.1%)
  • median number of days of MDMA use (10)
  • median amount of MDMA pills per day of use (two).
Australian respondents also ranked in the top five for:
  • mean number of times respondents got drunk in the past year (47.4)
  • MDMA users who sought emergency treatment (2.3%)
  • median amount of cocaine used on a usual day of use (0.5 g).
Dr Wilson believes that while there is a portion of our society that will ‘just say no to drugs’, many more will not, making education more effective than prohibition when trying to minimise problematic drug use that causes harm.
‘The reality is that young people are using [drugs] … they do it to have fun, they do it to have an experience,’ she said.
‘The majority of those people will not come to harm, but some of them will. So it’s around understanding that it does happen and … for us as GPs, being open to that and giving evidence-based information rather than a moral response.
‘Treat them as participants in their behaviours and their health, rather than telling them what to do. There’s nothing worse than being told what to do, it doesn’t matter how old you are.’

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Hilary Fine   1/06/2019 4:52:01 PM

Just want to add a comment , a bit lateral but one of my codeine concerns . Over the counter codeine Linctus cough syrup products. In Fremantle and surrounds where I work, some pharmacists readily sell it to young adolescents knowing that they mix up a cocktail with sprite and antihistamines ( purple drank). Cheap. They sometimes use it in excessive quantities. The codeine addiction is falling under the radar and this may also a pathway to heroin use. . Despite my lobbying of our AMA WA GP representative, apparently when codeine over the counter was changed , this product was not deemed to be worth adding to the list. Keen to hear others views on this...