Opioid crisis goes global as deaths surge in Australia
▻https://www.apnews.com/cfc86f47e03843849a89ab3fce44c73c
Half a world away, Australia has failed to heed the lessons of the United States, and is now facing skyrocketing rates of opioid prescriptions and related deaths. Drug companies facing scrutiny for their aggressive marketing of opioids in America have turned their focus abroad, working around marketing regulations to push the painkillers in other countries. And as with the U.S., Australia’s government has also been slow to respond to years of warnings from worried health experts.
In dozens of interviews, doctors, researchers and Australians whose lives have been upended by opioids described a plight that now stretches from coast to coast. Australia’s death rate from opioids has more than doubled in just over a decade. And health experts worry that without urgent action, Australia is on track for an even steeper spike in deaths like those seen in America, where the epidemic has left 400,000 dead.
“If only Australia could understand how quickly this can get out of hand. We’re not immune to it,” says Jasmin Raggam, whose brother Jon died in 2014 of an opioid overdose and whose brother-in-law is now addicted to the opioid OxyContin. “I was screaming from the mountaintops after Jon died and I’d started doing my research. And it was like I’m screaming and nobody wants to hear me.”
Opioids were once reserved for treating pain that was short-term, terminal or related to cancer. But in the 1990s, pharmaceutical companies began aggressively marketing them for chronic pain.
Starting in 2000, Australia began approving and subsidizing certain opioids for use in chronic, non-cancer pain. Those approvals coincided with a spike in opioid consumption, which nearly quadrupled between 1990 and 2014, says Sydney University researcher Emily Karanges.
A few years ago, a pharmacist at the hospital told her they needed to hire an extra person just to handle all the prescriptions they were handing out for Endone, a brand of oxycodone. Stevens discovered that the hospital’s Endone prescriptions had increased 500 percent in 8 years, with no decrease in other opioids dispensed. Further study revealed that 10 percent of patients were still taking opioids three months after surgery, even though the drugs are generally only recommended for short-term use.
“We were just pumping this stuff out into our local community, thinking that that had no consequences,” says Stevens, a vocal advocate for changing opioid prescribing practices. “And now, of course, we realize that it does have huge consequences.”
Just like in the U.S., as opioid prescriptions rose, so did fatal overdoses. Opioid-related deaths jumped from 439 in 2006 to 1,119 in 2016 — a rise of 2.2 to 4.7 deaths per 100,000 people, according to the Australian Institute of Health and Welfare. Most of those deaths were related to prescription opioids, rather than illegal opioids such as heroin.
More than 3 million Australians - an eighth of the country’s population - are getting at least one opioid prescription a year, according to the latest data.
In Australia, pharmaceutical companies by law cannot directly advertise to consumers, but are free to market the drugs to medical professionals. And they have done so, aggressively and effectively, by sponsoring swanky conferences, running doctors’ training seminars, funding research papers, giving money to pain advocacy groups and meeting with doctors to push the drugs for chronic pain.
“If the relevant governing bodies had ensured that the way the product was being marketed to doctors especially was different, I don’t necessarily think we would see what we’re seeing now,” says Bee Mohamed, who until recently was the CEO of ScriptWise, a group devoted to reducing prescription drug deaths in Australia. “We’re trying to undo ten years of what marketing has unfortunately done.”
Mundipharma, the international arm of Purdue, has received particular criticism for its marketing tactics in Australia. In 2018, addiction specialist Dr. Simon Holliday filed a complaint against the company over a marketing pamphlet for its drug Targin, a painkiller designed to prevent the constipation that is common with other opioids.
The campaign, which encouraged people suffering painkiller-induced constipation to talk to their doctors, never mentions Targin by name, because it legally can’t. But the advertising agency Mundipharma hired described on its website how they worked around that regulation, by using print, radio and online ads to target regions where pain medication use was high. Google search data showed that people looking for information on constipation from painkillers used terms like “blocked up,” so the agency used the phrase “blocked pipes.”
In a statement, Mundipharma said the campaign was a “disease awareness initiative” that did not violate the spirit of any law and did not market any medication.
Stevens, the Sydney pain specialist, has pushed back against several drug companies over their marketing tactics. A couple years ago, she says, Mundipharma was marketing Targin to surgeons at her hospital, reassuring them that they could prescribe higher doses. Unlike pain specialists, surgeons are generally not well-educated on the intricacies of opioids, she says.
In a statement, Mundipharma said it strictly adheres to the Medicines Australia code of conduct and has always been transparent about the risks associated with opioids. Still, in a submission last year to the TGA as it considered tougher restrictions on opioids, Mundipharma appeared to minimize the severity of Australia’s problem.
“We acknowledge that there is an issue associated with opioid misuse,” the company wrote. “However to describe the Australian situation as a ‘crisis’ is alarmist and risks stigmatizing patients who have a legitimate need for opioid analgesics to manage their pain.”
This is Australia’s poorest state, and like Appalachia, it is the country’s epicenter for opioids. Tasmania has the nation’s highest rate of opioid packs sold per person — 2.7 each. One region has the highest number of government-subsidized opioid prescriptions in Australia: more than 110,000 for every 100,000 people.
Ten years ago, while working as a dairy farmer, Casey jumped off a truck and felt her knees give way. An operation provided temporary relief, but the pain came back. She was told she had osteoarthritis.
A doctor prescribed her opioids to ease her pain. When she stuck the first patch on her skin, it felt like heaven.
But the agony eventually returned, so the doctor upped the dosage. The side effects were hell — depression, anxiety, panic attacks. And her pain got worse.