One person dies every four hours from drug overdose in Australia, with the crisis gripping regional areas.
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The higher rate of unintended drug-induced deaths outside of greater capital cities is revealed in Australia's Annual Overdose Report 2023, released by the Penington Institute.
"It's no exaggeration to talk about an overdose crisis," Penington Institute chief executive John Ryan said.
"Overdose deaths in Australia have exceeded the road toll since 2014 and we see little to no action to demonstrably change this."
In 2021 there were 2231 drug-induced deaths reported nationwide, with 75 per cent unintentional.
The rate of accidental overdose deaths in rural and regional Australia has been on the rise since 2012 and has remained above the rate in greater capital cities.
Mr Ryan said factors for the higher regional rate were poorer access to healthcare in the country and the "tyranny of distance" in an emergency.
The use of pharmaceutical-related drugs after traumatic work and road accidents - more common in the country than city, is also a factor Mr Ryan said.
Stigma shrouds overdose crisis in Australia
Since 2001, Australia has lost more than 37,000 people to drug-induced deaths.
This represents one person overdosing every four hours.
"What we don't have is a plan to turn that around and try and drive towards zero," Mr Ryan said.
The Penington Institute is calling for urgent action from all levels of government, healthcare, researchers and community members working together to address the escalating crisis.
And it includes tackling stigma and misunderstanding in the community.
"I've been to so many funerals where the reason for the death is overdose but no one actually mentions it," Mr Ryan said.
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"It's a very taboo topic - I think that's a real shame because the more openness and honesty we have around these issues, the better off we'll be."
The report reveals overdose is a leading cause of death for those aged between 20 and 50 years and affects people of all economic backgrounds.
Australia needs to prepare for fentanyl crisis
Opioids were the most common drug type associated with unintentional drug-induced deaths in 2021, present in 45.7 per cent of such deaths according to the report.
Deaths involving fentanyl and similar substances have risen by 800 per cent since 2001.
The US has been ravaged by a deadly drug crisis fuelled by opioids with illicitly manufactured fentanyl a primary driver in the more than 105,000 drug overdose deaths estimated in the 12-months ending October 2021.
Mr Ryan said the tragedy in the US and Canada in relation to fentanyl was something he "dreads" for Australia.
But the chances of it happening were reasonable, he said.
"The global trafficking routes are now very integrated so it's reasonable to plan for the arrival of fentanyl and that means, for example, fixing the medication-assisted treatment system," Mr Ryan said.
"The methadone-buprenorphine system has been pretty stuck for a very long time - there's not enough prescribers, there's not enough nurses that are able to prescribe, there's not enough linkages into mental health care and very importantly not enough entry points into that system of care.
"We've got to do a lot more work to prevent the fentanyl problem coming to Australia."
Penington Institute released the report in the lead up to International Overdose Awareness Day on August 31.
"It's a real opportunity for community members to remember their family or friends lost to overdose, but also an opportunity to increase our prevention efforts," Mr Ryan said.
- For support from the Alcohol and Drug Foundation visit adf.org.au or call the DrugInfo line on 1300 85 85 84.