Overdose awareness Day!
Heath Ledger, Prescription drugs and overdose.
‘It was  years ago … but to me it’s like it was yesterday.’
These are the words of Kim Ledger as he recalled the loss of his son Heath to an opioid overdose in January 2008.
The 28-year-old actor had been caught up in a punishing production schedule, flying between three different countries and filming scenes at night in the bitter cold. He contracted a chest infection that developed into pneumonia, and experienced insomnia.
Heath visited a variety of doctors on his travels to help deal with these problems, collecting a veritable cornucopia of prescription medications, including opioids and sleeping pills.
In combination, the opioids, sleeping pills and the chest infection itself had a depressing effect on Heath’s respiratory system, causing it to shut down. This made him a high-profile casualty of what was emerging as a prescription opioid epidemic, which includes the use of legal drugs such as codeine, fentanyl and oxycodone.
This phenomenon has claimed thousands of lives in Australia and around the world.
While Heath’s death was the result of a medication mix he didn’t realise would exact such a heavy toll, other opioid users have a more long-term relationship with these types of drugs, often becoming unexpectedly addicted after using them as a treatment for chronic non-malignant pain.
‘The accidental addict. In a very short space of time, people can become addicted to oxycodone and products like that,’ Kim said.
Such was the case of 30-year-old nurse and mother of two, Katie Howman, found dead following a fentanyl overdose in her Toowoomba home just before Christmas in 2013. Investigations revealed she had visited 20 different doctors and 15 different pharmacies over the previous 13 months in her search for opioids.
Opioids – a category that includes pharmaceuticals such as oxycodone and fentanyl, as well as illicit versions such as heroin – remain the main cause of accidental overdose death in Australia. Opioid-related deaths hovered at around 450 per year at the turn of the century, but these numbers have risen sharply since 2006 to hit over 1100 per year since 2014.
What has led us to this epidemic, and what can GPs do to help curb it?
Too good to be true
In the late 1990s, prescription opioids seemed like an ideal answer to the often-difficult problem of chronic, non-malignant pain.
‘There was an increased demand to treat chronic pain. There were very few options and very little research that had been done on this problem,’ Dr Evan Ackermann, a GP with a special interest in opioids, told the RACGP.
‘This was mixed with a situation of some fairly aggressive drug company marketing of opioids and a change of clinical attitude towards pain. Normally, pain would be part of the healing process, but people started to say we should be looking at pain as the “fifth sign” and treating it aggressively.
‘It was a cultural shift across the healthcare sector, across the board, from pharmacy right through to general practice, specialists and hospitals.’…………….
‘There is a sense out there sometimes that it’s just people choosing to do this, that there’s a dichotomy between the genuine-pain patient and the bad drug user,’ she said. ‘My experience is that they’re the same group of people.
‘Opioids interact with us as a species in a particular way; all of us are at risk of side-effects and one of those major side-effects is dependency and addiction.’