Thousands have died in the past six years from prescription and illicit opioids. Credit:The Age/SMH

Dispensing rates of opioids have increased 15-fold and some people are becoming addicted via prescriptions then hitting the dark web for their fix. Still governments have been slow to act.

Normal text size Larger text size Very large text size Australia had almost 8500 opioid-related deaths in six years as pharmaceutical companies with links to the US drug crisis spent millions of dollars aggressively marketing powerful painkillers to doctors. New data from the National Coronial Information System and obtained by The Age and The Sydney Morning Herald shows that opioid-related deaths skyrocketed between 2010 to 2016 (the last year nationally consistent court records were available) fuelled by some of the strongest narcotics on the market. In 2016 opioids killed more people than the road toll. Loading Replay Replay video Play video Play video Of the 8421 fatalities over that period, 1881 involved oxycodone, an addictive painkiller trading under brand names like OxyContin or OxyNorm; while a further 757 involved fentanyl, a synthetic opioid up to 100 times more powerful than morphine. The rise of opioids in Australia has seen deaths double in a decade, opioid dispensing rates increase 15-fold since the 1990s and some people becoming addicted via prescriptions from GPs before "doctor shopping" for more. Some even turn to the dark web to find fentanyl or forge scripts for drugs such as OxyContin. Governments and regulators have reacted slowly to the crisis despite years of warnings from coroners, families and the medical profession.


“It’s obscene,” said Central Coast mother Deb Ware. Her son Sam developed a devastating addiction after he was given a packet of Panadeine Forte at 18, following a wisdom tooth extraction in 2015. The pills contain the opioid codeine. “Families are being torn apart. What’s it going to take for our leaders to step in - and step up?” Deb Ware, whose son Sam became addicted to opioids after having his wisdom teeth extracted as a teenager. Credit:Wolter Peeters Pharmaceutical opioids such as OxyContin, Endone and Tramadol are often prescribed by GPs to ease chronic pain, and people with severe conditions say they genuinely need them to get by. But they are also addictive, commonly misused, and potentially deadly. Australia now has the eighth-highest per-capita opioid consumption in the world. Out of 167 countries and territories it's ahead of New Zealand and the UK but still well behind the United States, where opioids have claimed an estimated 400,000 lives since 1999 and prompted serious political and legal backlash. However documents reveal that at the same time as opioid abuse was rising in Australia, drug companies were going to great lengths to promote their products using similar tactics as pharma giants in the US. One of those companies, Mundipharma Australia - an affiliate of US-based OxyContin maker Purdue Pharma - spent millions of dollars to fund and sponsor thousands of medical conferences, dinners and training seminars, according to transparency reports filed between 2011 and 2015.


Among them was a $66,000 conference in Italy for the International Association for the Study of Pain where Australian and New Zealand delegates were wined and dined in Milan; an $8200 “product launch meeting” for pharmacists over drinks and canapes in NSW; and an all expenses paid “pain master class” weekend for GPs at Brisbane’s Stamford Plaza, costing $128,000. Mundipharma says it "has always been firmly committed to strict compliance" with relevant codes, laws and federal regulations governing the way drug companies can promote their products in Australia. Documents also show that other producers of opioid-based drugs have also spent millions of dollars on educational and promotional activities over the same period, including Sanofi, Pfizer and Janssen Global Services. Responsibility now sits with the states and territories. A spokesman for Federal health minister Greg Hunt "Mundipharma is committed to providing the highest standard of accredited educational programs and quality resources for healthcare professionals, in response to their educational needs and in line with ensuring safe and appropriate prescribing of opioid-based treatments," a spokeswoman said. But the issue is sensitive because Purdue Pharma and its owners, the billionaire Sackler family, are now facing a string of lawsuits in the US by communities seeking to hold them to account for their role in the nation's opioid epidemic. Sam Ware Credit:AP Eleven members of the Sackler family sat on the inaugural board of Mundipharma Australia from 1998 - as Purdue was ramping up sales of OxyContin on the other side of the globe - until 2012. A company spokeswoman insisted, “they did not have an active day-to-day role in the management of Mundipharma’s business, which was led by a professional management team.” The board has since changed.


Concerns around the use and abuse of opioids have renewed pressure on the Morrison government to create a national monitoring system to stop people obtaining staggering amounts of painkillers from GPs. In theory, such a system would mean that any time a doctor or pharmacist is about to hand out opioids or other high-risk “Schedule 8” medicines, they would type their patient’s name into the software and receive a real-time alert about any other drugs the patient had already been given by other doctors. Court records show many people are currently falling through the cracks. One Victorian man was given 58 prescriptions for 1500 OxyContin tablets and a further 29 scripts for diazepam, a dangerous benzodiazepine used for anxiety, in the months before his death from an overdose. In another case, a 33-year-old security guard ended up overdosing after being prescribed oxycodone 22 times in 15 months, which he’d crush and inject for a quicker hit, along with pethidine, morphine, codeine and tramadol. Just last week, Daniel Eckersley was given a shortened sentence for murdering his wife and mother of his three children with a 120 millimetre kitchen knife during a drug-induced psychotic episode brought about by tramadol, which he had been prescribed by his doctor. The judge deemed Eckersley's drug use to be a mitigating factor that "significantly reduced" his "moral culpability". While legal painkillers are a large part of the problem, law enforcement agencies are also concerned about a rising illegal market supplied by “criminal entrepreneurs” obtaining pills through doctor-shopping, theft, or forging scripts. In the US, dealers have even started lacing heroin and counterfeit pills with fentanyl, resulting in an alarming new wave of overdoses by unsuspecting victims. “The response to the issue remains one of prevention, to ensure the illicit market does not develop as it has in North America,” a spokeswoman from the Australian Criminal Intelligence Commission said. Tom Ballantyne, the principal lawyer in the medical negligence department at plaintiff law firm Maurice Blackburn, said many of Australia’s opioid deaths could be prevented if the medical system didn’t “incentivise” quick consultations “where decisions aren’t properly reviewed and patients aren’t properly assessed.”


The issue is complex, because millions of people live with genuine chronic pain and rely on opioid based medication to cope. With an ageing population, the prevalence of painful conditions is likely to increase. But specialist services are limited, particularly in country towns. Pain medicine specialist Malcolm Hogg said GPs often lack appropriate training in pain management, which is why some drug companies provided educational programs to fill the void. “It’s easy to criticise the drug companies,” said Professor Hogg, who has been a guest speaker at Mundipharma-sponsored events, “but often they’re the ones stepping up.” Health Minister Greg Hunt said the Morrison government was “deeply committed to directly addressing the needless loss of life from the misuse of prescription medicines such as opioids.” However three years after pledging $16 million to roll out national prescription monitoring, the government still cannot say when the project will be delivered. Mr Hunt’s spokesman said that the program relies on the states and territories to integrate their different software systems. Some states are more advanced than others - for instance, Victoria has its own monitoring system in place, while NSW lags behind most of the country - so it is not known when the project will become a reality. “Responsibility now sits with the states and territories,” the spokesman said. “The Minister has written to State and Territory Health Ministers urging them to integrate their systems to the National Data Exchange as a matter of priority.”

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