Content warning: this article mentions drug use and death. If this story raises any issues for you, please call DirectLine on 1800 888 236 or Lifeline on 13 11 14.

More lives are lost to accidental overdose than to the road toll each year in Victoria*. Contrary to common (mis)conceptions, the main contributor to accidental overdose are legal, prescription medication. Certain legal pharmaceuticals (Oxycodone, Morphine and Codeine instances combined) contributed to around 550 deaths in Australia while illegal opioids (Heroin, et. al.) contributed to around 370 in 2016. Deaths involving pharmaceutical opioids are most common in the 40-49 age group (851).

But behind the statistics are deeply personal stories – that every life lost to overdose is that of a friend, a parent, a neighbour, or a child.

International Overdose Awareness Day – a global event that had humble beginnings right here in Melbourne 20 years ago - reminds us that overdose does not discriminate, and every death deserves to be recognised and mourned.

On 31 August (International Overdose Awareness Day) we are encouraged pause, reflect and remember family and friends lost, reduce the stigma around drug related death, and advocate for systematic drug policy change to reduce the incidence of accidental overdose.

As a teenager, Riley** was prescribed pain relief in the form of codeine to manage post-operative procedures and chronic pain. This led to an opioid addiction that did not serve Riley well but was more common than they knew at the time.

“It was common in my circle of friends, but it was also not spoken about. We feared judgement from our doctors, leaders, and peers. There were arguments about whether or when to call an ambulance, people hiding their use in bathrooms – one person was found so late after an accidental overdose that they had to relearn how to walk.”

Now in their mid-twenties, Riley reflects on their decision to abstain from opioids, “my decision to abstain from opioids came after the first death of a friend to accidental overdose. A maddening, avoidable and heart wrenching loss that splintered our world. They were alone, assumed asleep, and paramedics were unable to ascertain what and when they had last taken. There was no naloxone in the house.”

Youth Projects has long been at the forefront of harm reduction and minimisation, launching our first Needle Syringe Program in 1990. The program was initially delivered as an in-house exchange coupled with mobile outreach across Broadmeadows, Brunswick and Coburg. The free, confidential service has since grown to deliver more than 130,000 annual contacts via fixed, mobile and street-based outreach services in more than 60 suburbs across inner, north and northwest Melbourne, and expanded into overdose response training and management, Peer Support and Pharmacotherapy programs, and harm minimisation and reduction services.

According to the 2019 National Drug Strategy Household Survey (NDSHS), an estimated 9.0 million (43%) people aged 14 and over in Australia had illicitly used a drug at some point in their lifetime (including the non-medical use of pharmaceuticals) and an estimated 3.4 million (16.4%) had used an illicit drug in the previous 12 months.

Given the high rates of overdose attributable to opioid overdose in Victoria, take-home naloxone (THN) training continues to be a key component of Youth Projects’ overdose response activities. Our THN training is based on Penington Institute’s COPE Framework and seeks to improve community capacity to respond to overdose by training participants on how to recognise the signs and symptoms of overdose, appropriately respond to overdose events and safely administer naloxone.

To ensure the ongoing and widespread availability of THN, the Proactive Response Overdose Initiative has continued to facilitate a network of partnering pharmacies through which individuals can directly access no-cost naloxone - removing financial barriers for vulnerable people and reducing the overall instance and harms associated with overdose events.

For Emily**, the absence of harm minimisation and take-home naloxone led to potentially avoidable situations in her teens and could have saved the life of people within her circle of friends.

“I have been a stimulant user on and off since my early teens. Stimulant use was also big within my friend groups. We had no education around how to use safely, we didn’t have the knowledge of what would constitute someone experiencing toxicity or an overdose from using – let alone what should be done if it actually happened. We feared the repercussions of calling ambo’s if there was a problem. Luckily, most of the time there wasn’t.”

“Except on one occasion. A friend (just 23 at the time) was a poly substance user (using more than one drug at any one time) and had been going hard for some time, until unfortunately she reached her limit. She had a cardiac arrest, ended up in ICU, and died later that week. It was an accident that I wish we’d been more aware of could actually happen – I could have potentially saved her life if I knew what to look out for.”

Emily has used her personal experience with substances and these life-changing events to pursue a career in harm minimisation to offer strength, hope and encouragement to others with similar experiences.

Since launching our Proactive Overdose Response Initiative in 2018, over 470 individuals have been trained in overdose prevention using naloxone which has resulted in over 40 lives directly saved through known overdose reversals. During the pandemic, training and brief interventions continued being facilitated via our unique and innovative Hotel Outreach Initiative.

This International Overdose Awareness Day we thank the Victorian Department of Health and Human Services for their ongoing funding of community naloxone, where the lifesaving antidote can be administered by peers when and where an overdose occurs.

Naloxone is used in the community to potentially save a life at least once a day in Melbourne alone.

For media enquiries, please contact Nic Horton by emailing [email protected].

   

* Unintentional drug-induced deaths are increasing by 3.0% per year, based on trends from the 2001 to 2018 period. If nothing is done to alter this trend, it will equate to an additional 330 drug-induced deaths by 2023, of which 248 will likely be unintentional. In contrast, the road toll has decreased on average by 2.2% per year, equating to 128 fewer deaths by 2023. In 2018, 1,556 people died from unintentional drug-induced overdoses in Australia, compared with 1,220 people who died on our roads.

**Personal experiences have been de-identified and names changed to respect the privacy and anonymity of the very real people sharing their stories.

Sources: Penington Annual Overdose Report 2020, Victorian Coroner's Report 2020, 2019 National Drug Strategy Household Survey and PORI (Proactive Overdose Response Initiative) Group Report Jan-Jun 2021