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02 JULY 2020

This week, the Australian Criminal Intelligence Commission released the tenth National Wastewater Drug Monitoring Program Report.

Understanding drug consumption at a population level supports the effective allocation of resources to priority areas. It also allows monitoring of the progress of demand, supply and harm reduction strategies. This approach has served Australia in many important aspects, most recently being the detection of the COVID-19 virus in wastewater in a number of geographic locations.

Perhaps one of the most important aspects of this report is the number and diversity of regional data sites that facilitates analysis of drug trends outside of the capital cities and informs local responses to the different circumstances that apply in each location.

Unfortunately, the tenth report once again reiterates the great divide in health outcomes, support and options that millions of regional Australians live with. The fact that per capita consumption of strong opioids like oxycodone and fentanyl per capita is higher in regional sites than in the capital cities should not come as a surprise to anyone. But is this purely a drug use issue? Are we just going to look at this data through the same old lens once again?

Data released by Painaustralia shows that Australians in rural and remote areas tend to experience higher rates of medication prescription, including opioids, likely due to higher prevalence rates of pain conditions and decreased access to appropriate pain management interventions. Concerningly, GPs in more remote Medicare locations were less likely to refer Australians living with chronic pain to another health professional (largely because they are not available), making options for best practice management beyond medication limited.

Research has also shown us that proximity to pain management services in Australia is a real barrier for millions of consumers.  A report from the electronic Persistent Pain Outcomes Collaboration (ePPOC) released last year showed that the overwhelming majority of pain services (89%) are located in a major city. The majority of people live less than 25 kilometres from pain management services, while this distance is over 100 kilometres for 10% of people.

The evidence both from the latest wastewater report and the countless other reports on poor health outcomes among regional Australians, continue to highlight the major gap that currently exists within our nation.

It is indisputable that nearly all opioid prescribing has its origins in efforts to manage acute or chronic pain, yet the public discussion about how we could manage pain better and more safely is still focussed on drug addiction and dependency. We need to broaden our narrow focus and have a frank and honest discussion about the infrastructure that we need to build to support some of the most vulnerable and disenfranchised individuals in our communities. 

Carol Bennett
CEO