Thread by @monicabarratt

This morning, @CoronersVic released their report "Victorian overdose deaths, 2011-2020".

The inclusion of 2020 data gives us some insights into how pandemic related drug market changes may have affected overdose deaths.

coronerscourt.vic.gov.au/victorian-over…

Thread below!

#1. The report includes deaths (in Victoria, AUS) where experts determined that acute toxic effects of drugs contributed to the death (excludes behavioural effects or chronic effects).

Drug types included pharmaceutical, alcohol and illegal drugs (inc. novel/new substances)

#2. Annual number of OD deaths peaked at 543 in 2018 to drop slightly to 516 (2019) and 526 (2020) (2% increase).

Over the decade, there is a gradual increase in the rate of OD per 100,000 population for males and females, across urban and rural populations.

#3. The proportion of overdoses that included multiple drugs has increased from 63% (2011) to 74% (2020).

In 2020, pharmaceuticals contributed to 76% of deaths, illegal drugs to 51% and alcohol to 29%. 2020 was similar to previous years.

#4. Benzodiazepines (mainly diazepam) contributed to 53% of all overdose deaths in 2020, with this rate remaining unchanged from previous years.

Prescription opioids (mainly methadone and oxycodone) contributed to 36% of deaths in 2020.

#5. Illegal drugs that contributed to the 526 deaths in 2020 inc. heroin (187), methamphetamine (111), NPS (33), cocaine (27), GHB (18), and MDMA (17).

Heroin-related deaths peaked in 2017 (220) and have since declined to 2020, while methamphetamine deaths peaked in 2016 (120).

#6. Heroin deaths in the City of Yarra, where the Richmond medically supervised injecting room is situated, decreased from 26 in 2018 (the injecting room opened in July 2018) to 9 in 2020.

All overdose deaths in Yarra also decreased from 32 (2018) to 25 (2019) to 17 (2020).

#7. Between 2019 & 2020, GHB overdoses doubled, while cocaine and MDMA also increased.

Causes of these changes are unclear, but could be related to disruptions in drug markets during the pandemic.

Small variances in GHB dose can result in overdose. See pubmed.ncbi.nlm.nih.gov/32068430/

#8. Increased deaths from cocaine and MDMA use seems to conflict with the strong signals from surveys in 2020 suggesting that many people had decreased or stopped their use due to a lack of access to club, festival and party settings. See globaldrugsurvey.com/gds-covid-19-s…

#9. Although the broader picture across Australia for cocaine is increased prevalence of use and increased harms, see work from @AmyKPeacock and @DrugTrendsAu crew onlinelibrary.wiley.com/doi/10.1111/da…

#10. Unlike in North America, fentanyl was only detected in 5 deaths in 2020 which is at its lowest across this decade.

Opioids in the NPS category, including butyl fentanyl and ocfentanil, were detected in only 2 deaths over the period.

#11. The anticonvulsant pregabalin featured in 69 deaths in 2020 and shows a consistent increasing trend across the 10 year period.

This trend matches with other Australian data including from NSW, see pubmed.ncbi.nlm.nih.gov/30098227/

#12. The pandemic led to increased 'unsupervised' doses of methadone in 2020, but this policy change did not lead to increased overdose deaths. Indeed, there was a reduction in overdose deaths involving diverted methadone.

Perhaps lockdowns reduced opportunities for diversion?

#13. New psychoactive substance (NPS) overdose deaths have shot up from 8 (2018) to 17 (2019) to 33 (2020).

This could be because toxicologists are better at finding them now. It is also likely that NPS were more prevalent in the illegal drug market during the pandemic.

#14. Novel benzos are the main driver of these trends - they were involved in 28 ODs in 2020, up from 10 in 2019 and 1 in 2018.

This category includes etizolam. Check out @DrSuziNielsen review of etizolam here: onlinelibrary.wiley.com/doi/abs/10.111…

#15. NPS empathogens appear in 2020 for the first time (n=5). These include ethylone and eutylone.

These drugs have been detected in substances sold as MDMA in NZ by their drug checking service @KnowYourStuffNZ - perhaps a similar substitution is also occurring here?

#16. There were 15 deaths associated with synthetic cannabinoid receptor agonists (SCRAs) over the decade, with most occurring in 2018-2019.

Drugs detected included: 5F-Cumyl-P7AICA, 5F- Cumyl-PINACA, 5F-MDMB-PICA, AB-CHMINACA, Cumyl-PeGACLONE, WIN55212-2.

#17. Victoria toughened its legislation on NPS in 2017. See justice.vic.gov.au/new-psychoacti…

The SCRA death trends here support the concern that while blanket ban legislation may reduce overall prevalence and harm rates, it may also result in more dangerous NPS appearing on the market.

#18. Without our own drug checking service in Victoria (AUS), we lack the capacity to rapidly warn the community about what new substances/combinations are emerging.

These data show that drug checking is needed more than ever, as drug markets are more unpredictable and complex.

#19. We look forward to being able to join our NZ neighbours to one day provide a service to the community that can identify adulterants and provide tailored substance-use counselling.

You can donate to @WeAreTheLoopAU to help bring this reality closer! theloop.org.au

#20. Finally, when reading these reports, they appear as numbers. But each overdose is the loss of someone's life. Each overdose is tragic. Each overdose can be prevented.

We should be considering all options to give as much information as possible to the community.

Some excellent coverage of this report by @SimoneFoxKoob of @theage

theage.com.au/national/victo…