Overdose statistics: polydrug use harms and prescription medications

Research into overdose statistics

This is blog 2 of 10 blogs on the topic of overdose statistics, drug overdose awareness and overdose prevention.

International Drug Overdose Awareness Day is held annually on 31 August 2021.

Led by the Penington Institute, this initiative provides an opportunity to increase community awareness of the increase in overdose-related fatalities according to the latest overdose statistics.

Australia (AU) overdose statistics – preventable deaths

In terms of overdose deaths in Australia (2020 overdose fatalities), over 2,000 individuals lost their lives — and friends and families lost their loved ones, in a single year according to the 2020 Annual Australian Overdose Report by the Penington Institute.

Read the blog on 2020-2021 overdose statistics 

Download the latest Australian overdose statistics revealed in the Penington Institute’s 2021 Australian Overdose Report (released 31 August 2021.*

Watch a video summary of the latest overdose statistics.

This number is expected to rise as the full impacts of the Covid-19 pandemic continue to emerge over the next few years and decades.

  • Most of these deaths were accidental (unintended) overdose scenarios that could have been prevented.
  • The most common substances in overdose deaths were opioids/synthetic opioids and benzodiazepines.
  • Polysubstance use (polydrug use) was a contributing factor to the majority of overdose fatalities.

We should all learn about the risks of polysubstance use, illicit pharmaceutical supply chains, and what to do (and NOT do) if we suspect someone is experiencing an overdose reaction.

Penington Institute’s CEO, John Ryan, discusses what’s needed to prevent these deaths in an interview with our team regarding the latest overdose statistics. 

Click here for the Interview.


The increase in overdose harms is being impacted by the following factors:

  • polydrug use (substance mixing)
  • non-medical use (NMU) of prescription medications
  • stolen APIs being used in criminal drug supply chains
  • dosing errors
  • impact of the Covid-19 pandemic
  • higher potency levels of illicit opioid products

Overdose awareness day provides healthcare professionals with the opportunity to share life-saving information with the community.

Overdose Awareness Day is an opportunity to increase our preparedness, as individuals, for assisting individuals in our community who may be experiencing an overdose, including family members who may have inadvertently consumed a dangerous combination of drugs (or alcohol and drugs).

Whether due to an illicit substance or to a prescription medication — we all need to do more to prevent overdose deaths.

Most of these deaths are preventable.

We are all likely to be a ‘first responder’ to an overdose event at some stage in our lifetime. This could involve a spouse or romantic partner, a child, a close friend, a loved one, a colleague, employee or neighbour  — so we need to know what to do (and what NOT to do) when we are facing an overdose toxicity scenario.

Time is of the essence during an overdose situation.

Be sure to call 000 — or your local ambulance/emergency services number (such as 911 in the United States) if you or someone you know is experiencing (or suspected as experiencing) a drug-related overdose.


How individuals can help prevent overdose fatalities

Most overdoses (73%) take place in private places. This means partners, friends, neighbours, and other community members may end up being ‘first responders’ — and should learn what to look for — and what to do (and not do).

When an overdose happens

It may not be obvious which substance — or how much of that substance — a person has consumed.

Nor what the impact will be over time. But it’s very important that you act fast to bring urgent medical attention to any suspected overdose scenario. Toxicity in the blood can reach fatal levels very quickly. Don’t wait to see what happens. Call 000 (Australia) or 911 (USA) or the relevant emergency services number for your region.

Also, learn what Naxolone can do in the event the overdose relates to opioid medications.

Continue reading for an overview of factors contributing to the increase in overdose fatalities and other drug-related harms (including polydrug use/prescription drug overdose fatalities).

You’ll also find links to Emergency Care Instructions for assisting someone suspected of having an overdose incident.

What factors are contributing to the increase in overdoses?

  • Many factors impact drug-related harms and drug-induced fatalities.
  • In terms of the increase in numbers of drug-induced deaths (drug overdoses) according to the latest overdose statistics, there are numerous interactive factors that should be explored.

Factors contributing to the increase in drug-induced deaths in recent decades include the following.

1. Non-medical use of medical prescriptions (NMU) and stolen medications

  • opioid medications prescribed for acute pain or chronic pain conditions, taken in increased amounts (e.g. above safe-use recommendations) when ‘drug tolerance’ occurs AND/OR
  • stolen opioid medications, such as prescription opioids diverted for non-medical use by family members, disability care assistants, healthcare professionals, etc.
  • mixing of prescription medications with other substances (alcohol, opioids) intentionally or accidentally
  • other actions leading to dangerous drug-drug interactions or harmful blood toxicity levels, which can lead to respiratory distress, organ failure, other harms, and drug-induced fatalities (overdose deaths)
  • potent pharmaceutical ingredients being diverted from regulated, batch-traced medical supply chains into unregulated criminal supply chains, where they are mixed with highly toxic chemicals
  • prescription medicines that lose purity controls and strength predictability when diverted and distributed through unregulated supply chains (illegal distribution channels lacking monitoring and drug-product safety testing requirements)
  • API strength variabilities (unequal dosing) caused by prescription medicines and/or raw API source materials being diverted into the hands of criminal drug supply chains
  • drug products and APIs being distributed by unscrupulous, unregulated, profit-focused sellers who face zero repercussions for drug-purchaser harms/fatalities due to the illicit nature of the supply chain; e.g.
    • criminal diversions of active pharmaceutical ingredients (APIs) and stolen prescription medicines typically become diluted and combined with various toxic fillers/contaminants (in ‘dirty labs’) with no regard for end-user safety
    • crushing and/or combing an API or prescription medication with rat poisons, other chemicals and other drugs, can reduce product purity by 90% or higher

2. Poly-substance use: higher toxicity levels from mixing prescribed medications with alcohol and other drugs

  • unsafe ‘street drug’ products are used in combination with prescription medicines and/or alcohol, which increases toxicity effects
  • route of administration (drug intake) or dosing is not per recommended methods/dosing, e.g. crushing and injecting or smoking/inhaling a pill-based prescription product
  • drug-induced deaths (overdose deaths) occurring in relation to widely-varying strengths in unregulated products, particularly ‘counterfeit pain medications’ and ‘fake medicines’ sold through illicit online pharmacies (i.e. unregulated suppliers/illegal distribution chains and untested products)
  • individuals taking larger than recommended doses of alcohol, pharmaceutical products, and/or street drugs, including ‘new’ drug takers with little or no internal tolerance to toxic substances
  • polydrug use (substance mixing) resulting in drug-drug interactions/deadly levels of toxicity
  • dosing errors (taking too much of prescribed medications by mistake)
  • patients mixing two or more pharmaceuticals without checking with their pharmacist and medical team/GP as to which medications are safe vs unsafe to intake concurrently and/or with substances such as alcohol
  • patients mixing potent herbal substances and ‘natural’ products, illicit protein powders, steroids, etc. with other medications/pharmaceutical products
  • using illicit substances and/or drugs with compromised purity, e.g.
    • amphetamine-type stimulants such as MDMA/ecstasy
    • synthetic opioids/other products containing deadly ingredients (poisons)
    • drugs from criminal supply networks or illicit online pharmacies (lacking quality/safety testing, and typically heavily contaminated with dangerous bacterias/moulds, metals, other poisons, etc)

3. Intentional self-harm and/or ‘self-medication’ attempts

Emergency care related to overdoses

Why is it important for all community members to learn how to identify overdose toxicity (drug-overdose reactions) and how to properly respond?

Based on emergency room visits statistics for drug-and-alcohol poisonings and drug-induced deaths, overdoses are steadily increasing over recent decades.

Hear from John Ryan about overdose statistic changes including research into overdose death [cohorts].

The fact remains that we are ALL likely to be faced, at some point – possibly more than once — with a friend, loved one, family member, colleague, or other community member experiencing overdose toxicity effects and respiratory distress.

What should we all learn to do – that might help someone survive when a person is experiencing overdose toxicity?

We should ALL take time to learn basic emergency responses that could help save our loved ones, family members, neighbours, colleagues, and other community members who could end up experiencing an overdose reaction.

This is an especially important endeavour, particularly since overdose harms are on the rise.

Responding to a suspected drug overdose/toxicity experience

From St Johns Ambulance Services (Victoria, Australia):

  • Whether accidental or deliberate, legal or illicit, a drug overdose is a serious situation for a First Aider to encounter.
  • Medical intervention is usually required to reverse the effects of the drug and reduce damage to critical organs like the heart, lungs, brain and liver.
  • Time is a critical factor in the survival of an overdose patient.


Overdose reduction: awareness and prevention

How we can all help reduce overdose risks in our communities.

The brief answer is that we can all help prevent overdose deaths by supporting and sharing overdose awareness information; by reducing stigmas; and by learning how to help someone suspected of an overdose.

Remember, time is critical to prevent organ damage and death after an accidental or intentional overdose. Always calls your local emergency services number for urgent assistance in the event of a suspected drug overdose and follow their instructions.

Source: St John’s Ambulance Services, Victoria, Australia

Naxolone as a potential overdose treatment

You may also want to familiarise yourself with basic overdose first aid including the potential use of naloxone in treating opioid-related overdoses. Source: Alcohol and Drug Foundation (ADF)

GMP and GDP compliance may help reduce overdose risks through effective pharmacovigilance systems, community education, batch tracing (serialisation technologies), and other diversion prevention measures.


Get involved with ‘drug overdose awareness day’ by contacting the Penington Institute.

  • International Drug Overdose Awareness Day is scheduled for Tuesday, August 31, 2021 (31 August 2021).
  • Led by the Penington Institute, Overdose Awareness Day helps increase community awareness of the potential risks of polydrug use, non-medical use of prescription medications, and other risks linked with drug-induced deaths/overdose toxicity levels from non-medical use of prescriptions, illicit drugs, alcohol and illicit medications.

Please click here to donate to the Penington Institute and click here to organise an overdose awareness campaign or fundraising event.

Pharmaceutical industry support of international overdose awareness and overdose prevention efforts

International Drug Overdose Awareness Day

  • As an industry, we can also do our part to help reduce overdoses by ensuring GMP compliance across the globe.
  • One of the articles in this 10-part blog series discusses how GMP compliance can prevent product diversions and the importance of packaging and labelling warnings and pharmacist involvement in overdose prevention efforts.

Compliance with Good Distribution Practice (GDP) and Good Documentation Practice are important ways we can help reduce pharmaceutical product diversions (theft), API diversions, and unsafe supply chains.

Regulators and internet companies can work together to prevent illicit drug distribution through unapproved, illegal ‘online pharmacies’ (read the article on counterfeit products in Australia and around the globe).

As an industry, we can also help by increasing community awareness of the dangers of non-medical use (NMU) of pharmaceutical products – and the dangers of mixing drugs (polysubstance use) such as mixing alcohol, opioid medications and certain types of prescriptions – as part of International Drug Overdose Awareness Day on the 31st of August 2021.

For additional information, read this entire series of blogs being published from 22 August 2021 through 31 August 2021 in support of polydrug-use overdose awareness and Drug Overdose Awareness Day (31 August 2021).

Please support the Penington Institute.

Click here for Blog 3 of the 10 blogs in this series.

Blog 3 discusses the impact of the Covid-19 pandemic on substance use and overdose rates.

Topics covered in this series: