A record number of unintentional overdose deaths in Western Australia have been reported and Mandurah is not immune.
Figures released in the Penington Institute's Australia's Annual Overdose Report 2020 revealed that 227 Western Australians died of unintentional overdoses in 2018 - an all-time high for the state.
In Mandurah, 66 people had died from an unintentional overdose in a five year period from 2014-18, 44 more than the previous five year period and 53 more than the five year period from 2004-2008.
The number of deaths is more than double the previous five year period and should be a warning that it has gone in the wrong direction, said Penington Institute deputy chief executive Dr Stephen McNally.
"Sixty-six people across five years is pretty devastating when you think of sixty-six lives and families that will now live with that forever," he said.
Consistent with findings in many other states and territories, residents in rural and regional WA die from overdoses at higher rates than residents of Greater Perth.
In 2018, the rates of unintentional drug-induced deaths were 8.7 deaths per 100,000 population in Perth, compared with 9.3 deaths per 100,000 population in regional and rural WA.
The rate of unintentional overdose deaths in the state increased from an already unacceptably high 6.4 per 100,000 people in 2012 to a staggering 8.8 per 100,000 in 2018.
The figure is close to double the mortality rate for melanoma across all of Australia in the same year (which was 4.7 deaths per 100,000).
Deaths where four or more substances were detected increased 123 per cent over the last five years.- Dr Stephen McNally
WA's overdose crisis is not only driven by illicit drugs. Legal drugs, which could be misused or used in combination with other drugs, also caused deaths in their hundreds.
WA led the way in 2018 when it came to overdose deaths from multiple different types of drugs, including stimulants, prescription opioids, heroin, benzodiazepines, and anti-depressants - suggesting a crisis on multiple fronts.
Since 2013, no state experienced as large an increase in unintentional deaths involving benzodiazepines as WA.
In just six years, unintentional overdose deaths involving these drugs, which Penington Institute has previously labelled "Australia's silent killer", increased by almost four times from a rate of 1.1 per 100,000 to 4.1 per 100,000 in 2018.
"What we are finding is that more and more people are dying when there are four or more substances, that is really concerning," Dr McNally said.
"In the past we have not seen it to that extent.
"Deaths where four or more substances were detected increased 123 per cent over the last five years.
"It went from 261 deaths in 2014 and it is up to 582 deaths in 2018."
Dr McNally said when they looked at the combination of drugs it showed a mix of pharmaceutical drugs such as opioids, benzodiazepines (commonly used for anxiety or sleeping) alcohol and other medications.
"It is actually becoming more and more common for people to be taking a number of different drugs," he said.
"People do not realise the strength and they do not realise the what interaction of putting one drug on top of another drug could do to them.
"This is not a story that is solely happening in WA it is happening across the country."
Dr McNally said it was crucial to get critical messages out to the community so people were aware what the risks of taking different drugs or a combination of drugs were.
"This is were a lot of people get themselves into trouble," he said.
"It is absolutely an area where governments need to improve, without a doubt, and it is with all governments, it is not something that is just federal or state it is local as well.
"We have a lot of strategies and interventions out there it is just that more needs to be invested in these strategies, we need a national overdose strategy, we need that on the agenda.
'There needs to be more campaigns out there to spread the information about what is going on and who is at risk."
The state government have a range of strategies in place to prevent drug and alcohol harm, including overdose.
A state government spokesman said any overdose death was a terrible tragedy, for the individual, their family and friends, and the community.
"The McGowan Government is providing nearly a billion dollars to Mental Health Alcohol and Other Drug Services in 2019-20 - more than a 9 per cent increase since 2016-17," the spokesperson said.
"This includes more than $86 million for alcohol and other drug prevention, treatment and support across Western Australia.
"Since 2017 the Government has also allocated $245 million to implement the Meth Action Plan across a wide range of areas.
"WA's long-running Drug Aware prevention campaign was the first comprehensive ongoing program on illicit drug education undertaken in Australia.
"WA is also taking part in the Take Home Naloxone Pilot with over 180 sites across the state supplying naloxone free of charge to people at risk or likely to witness an opioid overdose. This program has saved lives."
The Naloxone pilot is part of a $10 million investment by the Australian Government's which is being overseen by the Department of Health with state government's which also included NSW and SA.
Under the pilot, naloxone is available free to people in those states who may either experience, or witness, an opioid overdose. No prescription is required.
A Department of Health spokesperson said the Australian Government's approach to preventing and reducing the harms associated with illicit drugs was set out in the overarching framework of the National Drug Strategy 2017-2026..
"The strategy recognises Australia's long-standing and ongoing commitment to a balanced approach between health and law enforcement. The Strategy works on the principle of harm minimisation through the three pillars of supply, demand and harm reduction."
The spokesperson said the Australian Government also provided a wide range of Alcohol and Other Drug education services, including drug help, information and positive choices websites.
The government has also ran the "Cracks in the Ice" campaign along with funding Local Drug Action Teams to deliver a number of programs designed to prevent or minimise harm.
"The Australian Government has set aside approximately $7 million for a National Drugs Campaign this year," the spokesperson said.
"The Commonwealth is also working with states and territories to implement the national Real Time Prescription Monitoring (RTPM) system.
"The RTPM system will assist doctors and pharmacists to identify patients who are at risk of harm due to dependency, misuse of high-risk medicines, and patients who are diverting these medicines."
People aged in their 30's to 50's have highest number of overdose deaths
The report showed that it was not just young people who were dying from overdoses it was mostly people aged in their 30's, 40's and 50's.
"It is something we have seen for some time and it is not changing, we are still seeing that across Australia the people who died aged under 30 years is lower than 10 per cent," Dr McNally said.
"The people aged 30 to 39 years we are looking at nearly 23 per cent, the next 10 year bracket is around 27 per cent, those two decades is a big chunk of the community who fall into that."
Dr McNally said the message needed to get across that it affects people from different socioeconomic areas and different ages.
"What we are seeing across Australia is the high number of men that are dying from accidental overdoses, it is up around 70 per cent," he said.
"It is three times more likely that an Aboriginal or Torres Strait Islander person to die from an overdose than what it is for a non-Aboriginal person, it is really skewed."
Dr McNally said accidental drug overdoses was a silent health crisis because it wasn't often talked about because of the discrimination, shame and stigma around the issue.
The Australia's Annual Overdose Report was released on International Overdose Awareness Day to raise awareness around overdoses.
Australia's Annual Overdose Report 2020 revealed that, for the first time on record, WA had the highest rate of heroin-induced overdose deaths per capita, overtaking Victoria.
Penington Institute chief executive John Ryan said the findings should ring alarm bells in the city and throughout rural and regional Western Australia.
"West Australia continues to struggle with how to reduce the harms from stimulants such as ice while now also facing risks from a range of new drugs," he said.