Australia's Drug Death Rate Is Now 10 Times Higher Than Portugal's

On Friday last week, news broke that Canberra music festival Spilt Milk wouldn't push ahead with playing host to Australia's first legal, professional pill testing service. For drug reform advocates, it came as a shock. Doctors and activists have been campaigning for years to get a pilot like this off the ground in Australia, with little luck—despite the fact similar services are common across Europe and even the US.

In 2017, harm minimisation is seemingly still too politically toxic in Australia. Forget safe injecting rooms or following Portugal's widely-cited example and decriminalising drugs, we can't even get pill testing over the line. And perhaps that's why the country's drug-induced death rate just hit its highest level since the heroin epidemic of the late 1990s.

Right now, Australia's drug death rate is sitting at 7.5 deaths per 100,000 people. By comparison, the death rate in Europe is 18 deaths for every million people. Portugal, where drugs were decriminalised in 2001, sees just 0.58 drug deaths per 100,000 people.That's a tenth of what we're currently seeing in Australia. So, what's going wrong here?

Well, one key thing to note is that what is driving Australian drug deaths has changed since 1999. Back then, the country was in the midst of a heroin glut and as harm minimisation campaigner Will Tregoning explains, a lot of people were using heroin in combination with benzodiazepines, such sleeping pills.

"It's a risky combination," Tregoning says. "And rates of overdose deaths were high." In essence, 1999 was an outlier. Instead the common theme that emerges when you look a little deeper at Australia's drug deaths, both in the 1990s and today, is benzodiazepines.

Today, while the heroin epidemic has abated, benzos remain present as ever in the drug-induced death data. In fact, benzos and other opioids—including oxycodone and codeine—were present in nearly 70 percent of drug-induced deaths in Australia in 2016.

"There were 1,808 drug induced deaths in 2016, with those deaths most commonly associated with benzodiazepines and oxycodone," says James Eynstone-Hinkins, Director of Health and Vital Statistics at the Australian Bureau of Statistics (ABS). "These are both prescription drugs which are used to manage anxiety and pain, respectively."

Australians can look at the US—in the grips of the opioid crisis—and recognise how dangerous pharmaceutical abuse can be. But we're largely ambivalent about the fact the same problems are emerging here. And that the deadly trend shows no sign of slowing.

"By a country mile, I do not think this is the peak. I think we are on the road to something rather bad," says Dr David Caldicott, an emergency room doctor at Canberra's Calvary Hospital. "Trends in drug-related deaths tend to be much like supertankers: They take a while to get going, and they take a while to stop."

If the tanker was going full steam ahead in 1999, it took until 2007 to get it under control. And then, something happened. What precisely shifted in 2007 is the subject of a lot of debate between researchers, activists, and policymakers.

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Eleven years ago Four Corners released a report on meth titled "The Ice Age" and this was when Australia's media really became obsessed with the so-called ice epidemic. By the end of 2006, politicians were holding a National Leadership Summit on Ice in Sydney.

During the 2007 (Kevin '07) election campaign, the Coalition run a "tough on drugs" platform amidst a media frenzy around Ben Cousins' drug struggles and the death of AFL player Chris Mainwaring. But while we were all so focused on ice, drug deaths in Australia from almost every commonly used substance have trended up—for at least the past decade. Both legal and illegal.

Over the same time, Australia has seen the number of people incarcerated in its prisons for drug offences jump by 64 percent. Male drug offenders still make up most of the prison population. But the past decade has also seen women behind bars for drugs jump a whopping 92 percent. With both drug death and incarceration rates rising, something clearly needs to change.

Nearly two decades ago, when Portugal was facing these kinds of numbers, its lawmakers decided to go down the path of decriminalisation—a move many saw as drastic. But in the years since, Portugal's declining drug deaths, incarceration, and HIV rates have earned the country scores of praise and thinkpieces. Yet in Australia, even low level harm minimisation steps—such as pill testing—remain politically toxic.

But looking at the numbers, the question does arise: If abuse of legal drugs is what's driving deaths in Australia, can steps like pill testing at music festivals really make any difference? Well, it's important to note that on their own, benzodiazepines pose very little risk of overdose. The danger arises when they are mixed with alcohol or other drugs.

Then there's the fact that psychostimulants—including meth, MDMA, speed etc—were still present in around a fifth of drug deaths in Australia last year. They pose a huge risk, especially to younger users. Even as the average age of drug users in Australia is on the rise, MDMA in particular remains a "young person's drug." But the window of risk is small. The average age people first try ecstasy in Australia is 21.7 years old, the age they're at the highest risk of dying from it is in their early 30s.

Compare this to benzos, where abuse starts early but the death rate peaks around middle age. In light of these numbers, perhaps Australia needs to shift the way we talk about pill testing. At least to get politicians on board. Instead of framing it as a policy shift that will inevitably lead us down the path to decriminalisation forged by Portugal, we should view it as an acute intervention. The best step the country can take, right now, to stop young people from dying while they are first experimenting with drugs.

Of course, broader drug reform will be needed to address the overall death rates, and incarceration rates—and maybe the Portuguese model really is the only way to do it. But if we can't even get pill testing off the ground, that's never going to happen.

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