An upward trend in drug-related deaths in Australia, which has persisted for two decades, culminated in the highest-ever number of overdose deaths in 2024, new data indicated. Addiction specialists are calling for a national strategy to address this issue.

“The number of deaths is shocking,” Nicholas Lintzeris, MBBS, PhD, conjoint professor of addiction medicine at The University of Sydney in Sydney, told Medscape News Australia. “We’re talking about five Australians dying every day from drug overdoses…and yet there’s been sadly little in the way of response.”

More than 2000 people died from drug effects in 2024, according to two independent reports by the Penington Institute, Carlton, and the National Drug and Alcohol Research Centre at the University of New South Wales, Kensington, both based on data from the Australian Bureau of Statistics.

In Australia, the rate of overdose deaths per 100,000 people has generally risen since 2006, with a slight decline after 2017, the reports concluded.

“The number of overdose deaths was comparable to [the number of] motor vehicle accident deaths around 15 years ago,” said Lintzeris. “Since then, the number of road accident deaths has stayed the same. The number of overdose-related deaths continues to rise.”

The last time Australia had a national overdose strategy was in 2002, and the country is overdue for a coordinated action plan across the state, territory, and federal governments, Lintzeris added.

Which Drugs Are Involved?

Many factors have contributed to the increase in drug-related deaths over the past 20 years. “There is no single pattern of drug use that is contributing to this,” said Lintzeris.

“Drug-induced deaths reflect a complex interaction between chronic health conditions, mental health problems, pain, social disadvantage, aging populations, and changes in both illicit and pharmaceutical drug markets,” Suzanne Nielsen, PhD, pharmacist and the deputy director of the Monash Addiction Research Centre at Monash University in Melbourne, told Medscape News Australia.

Drug-induced deaths were driven by a mix of prescription, over-the-counter, and illicit drugs, with polydrug use implicated in 73% of overdose deaths between 2020 and 2024. Three quarters of drug-induced deaths were unintentional. Opioids were involved in 56% of deaths in 2024 and were the drug class most likely to cause deaths.

Other substances involved in deaths were antiepileptic, sedative-hypnotic, and antiparkinson drugs (45% of cases); amphetamine-type stimulants (39%); antidepressants (24%); and antipsychotics (16%).

About 48% of opioid-related deaths in 2024 involved heroin use, 33% involved natural and semisynthetic opioids (such as morphine, codeine, and oxycodone), 24% involved illicit synthetic opioids (such as fentanyl, tramadol, and pethidine), and 16% involved methadone, a prescription drug used to treat opioid dependence.

Opioids cause fatal overdoses by suppressing breathing. They are dangerous when combined with other sedating drugs, such as benzodiazepines, which are used to treat anxiety and seizures, said Nielsen. Stimulants can cause fatal cardiovascular events and can be deadly when combined with opioids. But “focusing on one drug class in isolation risks missing the broader pattern of polysubstance use seen in many fatalities,” Nielsen added.

What Is Driving These Trends?

The waiting times for heroin dependence treatment with methadone are now 2-3 months long in many parts of Australia, which could be contributing to the increased death rate, said Lintzeris.

A system for real-time prescription monitoring has been introduced across all Australian jurisdictions to curtail drug-seeking behavior. But Victoria is the only state where it is mandatory to check the system before prescribing certain drugs, and clinicians often don’t have time to do so, said Lintzeris.

Australia has a take-home program for naloxone, a medication that can temporarily reverse the effects of an opioid overdose, but “we haven’t really rolled that out as well as we can or should have,” and only a handful of emergency departments routinely give naloxone to people who have overdosed or their carers, said Lintzeris.

Who Is Most Affected?

Two thirds of all drug-induced deaths in 2024 occurred in men. Around a quarter of deaths were in people aged 45-54 years, and 23% of deaths were in people aged 35-44 years.

Close to a third of deaths were in people who lived in areas with the most socioeconomic disadvantage. About 73% of overdose deaths occurred in major cities.

Patients who died of a drug overdose often had psychosocial risk factors. About 12% of those who died had a personal history of self-harm, and around 5% experienced a divorce or separation, legal issues, disappearance or death of a loved one, or problems with their spouse or partner.

What Can Clinicians Do?

Simply prescribing less isn’t the solution to reducing overdoses because it can push people toward illicit drugs, said Nielsen. “The challenge is to reduce harms without creating barriers to treatment.”

The Monash Addiction Research Centre recently developed an Opioid Safety Toolkit, which provides advice for clinicians and patients on how to reduce the risk for overdose, including recommending take-home naloxone.

Providing education about the risk for polydrug use and how to recognize the signs of overdose can also help keep patients safe, said Nielsen.

Lintzeris is a board member at the Penington Institute, an honorary, unpaid position. Nielsen reported no relevant financial relationships.

Felicity Nelson is a science and health journalist based in Sydney.