Australia

"There was no change in recent use of most illicit drugs in 2013, and use of any illicit drug remained stable between 2010 and 2013. However, there was a significant change for a few specific drugs. The proportion of people who had misused a pharmaceutical rose from 4.2% in 2010 to 4.7% in 2013, whereas there were falls in the use of ecstasy (from 3.0% to 2.5%), heroin (from 0.2% to 0.1%) and gamma hydroxybutyrate (GHB).
"While there was no significant rise in meth/amphetamine use in 2013 (stable at around 2.1%), there was a change in the main form of the drug used. Among meth/amphetamine users, use of powder fell, from 51% to 29%, while the use of ice (or crystal methamphetamine) more than doubled, from 22% in 2010 to 50% in 2013.
"Questions on the use of synthetic cannabis and other psychoactive substances were included in the NDSHS for the first time in 2013 and results showed that 1.2% of the population (or about 230,000 people) had used synthetic cannabinoids in the last 12 months, and 0.4% (or about 80,000 people) had used another psychoactive substance such as mephedrone. While people in their 20s are normally the most likely to use illicit drugs, it was young people aged 14–19 who were slightly more likely to use synthetic cannabinoids (2.7% compared with 2.5%).
"In 2013, 8.3% of the population had been a victim of an illicit drug-related incident. While this was similar to the 8.5% in 2010, the proportion experiencing physical abuse by someone under the influence of illicit drugs rose from 2.2% in 2010 to 3.1% in 2013. Verbal abuse remained the most frequently reported incident overall.
"Community tolerance has increased for cannabis use, with higher proportions of people supporting legalisation and a lower proportion supporting penalties for sale and supply. People in Australia now consider meth/amphetamines to be more of a concern to the general community than any other illicit drug and the proportion who nominated it as a drug problem or as a drug that caused the most deaths also increased in 2013."

"• In 2013, 4.7% of Australians aged 14 or older had misused a pharmaceutical in the previous 12 months, which was a significant rise from 4.2% in 2010. This increase was only significant for males (from 4.1% in 2010 to 5.1% in 2013 and from 4.2% to 4.4% for females).
"• The rise in pharmaceutical misuse was mainly due to an increase in males in their 30s (4.5% in 2010 to 6.9% in 2013) and females in their 40s (3.1% in 2010 to 4.5% in 2013) misusing these drugs.
"• People aged 20–29 (5.8%) and 30–39 (5.3%) were most likely to have misused pharmaceuticals in the previous 12 months.
"• Pain-killers/analgesics (3.3%) were the most commonly misused pharmaceutical drug type and over–the-counter pain-killers (78%) were more commonly misused than prescription pain-killers (51%).
"• The proportion of people who had ever misused a pharmaceutical drug rose to 11.4% in 2013, up from 7.4% in 2010, the first increase in lifetime use since 2001."

"In 2016, the non‑medical use of pain‑killers/pain‑relievers and opioids (referred to as pain‑killers and opioids) were the second most common illicitly used drug in the previous 12 months, behind cannabis. However, in 2019, they were the fourth most common, after cannabis, cocaine and ecstasy (Table 4.6).

"From 2016 to 2019, the proportion of people using pain‑killers and opioids non‑medically in the previous week, month, 12 months and in their lifetime declined (Figure 5.1).

"Use remained stable or declined across all age groups between 2016 and 2019. The decline was most pronounced among young people aged 14–19, who in 2019 were half as likely to have used pain‑killers and opioids non‑medically in their lifetime as 14–19 year olds in 2016, and only a third as likely to have done so in the previous 12 months (tables 5.4 and 5.5)."

"Analgesics: Analgesics were the most commonly used substance (licit or illicit) with 95% of students aged 12 to 17 years having used an analgesic at some time in their lives. Females were more likely than males to use analgesics in all recency periods with for example 48% of females using analgesics in the week prior to the survey compared to 34% of males. The main reason for analgesic use was to help ease the pain associated with a headache/migraine (52%). For the majority of students (90%) parents were the main source of analgesics.
"The proportion of students using analgesics in 2014 in their lifetime was lower than the proportion found in 2011, but not 2008. There was no change in the proportion using these substances in the month and week before the survey between 2008 and 2014 or between 2011 and 2014.
"Tranquilisers: Of all students, 18% had used tranquilisers other than for medical reasons at some time in their lives. The proportion of students ever using tranquilisers increased with age. However, only three per cent of all students reported use in the past week. While the proportion of all students using tranquilisers in their lifetime had not changed between 2008 and 2014, the proportion reporting use in the past week in 2014 (3%) was significantly greater than in 2008 (2%) and 2011 (2%).
"Cannabis: Cannabis was the most commonly used illicit substance with 16% of students aged between 12 and 17 years ever using cannabis and seven per cent using it in the month before the survey. The proportion of students using cannabis increased with age. The most common method of using cannabis was smoking it as a bong with 62% of males and 54% of females who had used cannabis in the past year reporting this method of use. There were no significant differences in the proportion of students using cannabis in the past week, past month or lifetime between 2008 and 2014 or between 2011 and 2014.
"Inhalants: Use of inhalants was negatively associated with age, with lifetime use decreasing from 19% of 12-year-olds to 10% of 17-year-olds. Six per cent of all students had used inhalants in the month before the survey. Lifetime use of inhalants among younger and older students decreased between 2008 and 2014), but not between 2011 and 2014. While past month use decreased significant between 2008 and 2014 in the younger age group, this trend was not found in the older age group."

"The reported use of painkillers/analgesics such as ‘Disprin’, ‘Panadol’ or ‘Nurofen’ was extremely high among 12- to 17-year-old students. Among the entire sample, only five per cent of students had never used analgesics.
"Over two-thirds of all students had used these medications in the past month.
"The proportion of students using analgesics in the past week increased from 35% of 12-year-olds to 45% of 16-year-olds and 44% of 17-year-olds. The age increase was more evident for females than males.
"At all ages, females were significantly more likely than males to have used analgesics in their lifetime, in the past year, past month and the past week (p<0.01).
"Regularity of use: Of students who had used analgesics in the past year, 54% of females and 43% of males had used analgesics 10 or more times in the previous year. Sixteen per cent of males and 10% of females reported use of analgesics only once or twice in the past year.
"Of the male students who had used analgesics in the past week, 71% had used them only once or twice, while 20% had used them 3-5 times. Of the female students who had used analgesics in the past week, 68% had used them once or twice and 22% had used them 3-5 times."

"Around 18% of all students reported use of tranquilisers other than for medical reasons at least once in their lifetime. The proportion of students ever using tranquilisers increased with age from 14% of 12-year-olds to 21% of 16-year-olds and 20% of 17-year-olds (p<0.01).
"Use in the past month was low across all ages with around five per cent of students reporting to have used tranquilisers in this time period.
"Around three per cent of 12- to 17-year-old students used tranquilisers other than for medical reasons in the week before the survey.
"There were few differences in male and female students’ use of tranquilisers. However, among 14-year-olds, lifetime use, use in the past 12 months and use in the past month was higher for female compared to male students (p<0.01). Among 15-year-olds significantly more females than males had used tranquilisers in their lifetime and in the past year (p<0.01).
"Regularity of use: Of the 12% of students who had used tranquilisers in the past year, around 49% of males and 47% of females had used them only once or twice, while 19% of males and 22% of females had used them 3-5 times."

"Cannabis was the illicit substance most commonly used by secondary school students and prevalence was highest in the older age groups. Sixteen per cent of secondary students surveyed indicated they had used cannabis at some time in their lives with seven per cent using it in the past month and four per cent using it in the past week.
"In all recency periods the proportion of students using cannabis increased significantly with age (p<0.01).
"For all 12- to 17-year-olds, a greater proportion of males than females used cannabis in all recency periods (p<0.01). For 17-year-olds, males were more likely than females to use cannabis in their lifetime, in the past year, past month use and past week. For 16-year-olds, significantly more males than females reported lifetime use, past month use and past week use of cannabis. Among 15-year-olds, past-month and past week use was higher for males than females.
"Type of cannabis used, who it was used with and location of use: Students were asked to indicate whether they usually smoked cannabis as a joint, used it in a bong or ate it. Of the 14% of students who had used cannabis in the past year, the most common method for using cannabis was through a bong (62% of males and 54% of females). Joints were the next most usual method of using cannabis (38% of students who had used cannabis in the past year). The majority of students using cannabis in the past year generally used it with others (81% of males and 85% of females). The most common places for using cannabis were: at a friend’s home (40%), at a party (21%), at home (14%) and in a park (10%).
"Regularity of use: Of the 14% of students who reported using cannabis in the past year, 32% of males and 40% of females reported using cannabis only once or twice, while 39% of males and 26% of females had used it on 10 or more occasions."

"Involvement with smoking became more common as adolescents progress through secondary school.
"In 2014, 81% of all secondary students in Australia had no experience with smoking. While the proportion of students who had never smoked decreased with age, 61% of 17-year-olds had still never smoked.
"Around three per cent of all students had smoked more than 100 cigarettes in their lifetime, which peaked at eight per cent for 17-year-olds.
"The proportion of students smoking in the previous four weeks (past-month smokers) increased from one per cent of 12-year-olds to 17% of 17-year-olds.
"The proportion of students who were current smokers in 2014 increased from one per cent of 12-year-olds to 12% of 17-year-olds.
"Only around three per cent of all students had smoked on three or more of the past seven days (committed smokers), with this peaking at seven per cent of 17-year-olds.
"While in general the prevalence of smoking among male and female students was fairly similar, there were some differences with most of these found for the older students. For 16- and 17-year-olds, while more males than females had smoked 100 cigarettes in their lifetime (p<0.01), more females than males in these two ages had smoked in the past year (p<0.01). Smoking in the past seven days was more common for males than females aged 16 (p<0.01). Committed smoking was more common among males than females aged 16 and 17 years (p<0.01). Differences at the other ages were: 14-year-olds, more females than males smoked in the past month (p<0.01); 12-year-olds, more males than females smoked on three or more of the past seven days (p<0.01).
"Extrapolating the sample results to the Australian student population, it is estimated that just under 81,000 12- to 17-year-olds students in Australia had smoked at least one cigarette in the seven days preceding the survey (current smokers)."

"Alcohol use becomes more common with increasing age with 76% of 17-year-olds having consumed alcohol in the year preceding the survey, compared to 19% of 12-year-olds.
"Only 32% of all students reported never consuming alcohol.
"Students who drank alcohol in the preceding week were classified as ‘current drinkers’. The proportion of current drinkers increased with age (p<0.01) and peaked among 17-year-olds at 35% for males and 37% for females.
"Sex differences in the prevalence of alcohol consumption in the past year were evident in the 12-, 13- and 15-year-olds. Among 15-year-olds, females were more likely than males to have consumed alcohol in the past year (p<0.01). Twelve and 13-year-old males were more likely than same aged females to have consumed alcohol in the past year (p<0.01).
"The percentage of all students who consumed five or more drinks on one occasion in the past week increased from two per cent of 14-year-olds to 17% of 17-year-olds. More males than females drank at risky levels at age 12, 15, 16 and 17 (p<0.01)."

"In 2013, it was estimated that about 6.6 million (or 35%) people aged 14 or older had used cannabis in their lifetime and about 1.9 million (or 10.2%) had used cannabis in the previous 12 months (Online Table 5.4). Around 1 in 5 (21%) people aged 14 or older had been offered or had the opportunity to use cannabis in the previous 12 months (Online Table 5.12), and 1 in 10 (10.2%) reported that they did use cannabis in that time (Online Table 5.7). About 1 in 20 Australians (5.3%) had used in the month prior to the survey and 3.5% had used in the previous week. More specifically:
"• males were more likely to use cannabis at any frequency, than females (Online Table 5.5)
"• among people aged 14–24, the age at which they first tried cannabis increased from 16.2 to 16.7 between 2010 and 2013 (Online Table 5.10)
"• cannabis users were more likely to try cannabis in their teens and age of first use was younger compared to other illicit drugs (Online Table 5.10)
"• recent cannabis users (median age of 30 in 2013) were generally older than users of ecstasy (age 25), meth/amphetamines (age 28) and hallucinogens (age 24) (Online Table 5.16)
"• one-third (32%) of recent cannabis users used the drug as often as weekly (Online Table 5.11) and older people (50 or older) were more likely than younger people to use cannabis regularly, with at least 4 in 10 recent users in these age groups using it as often as once a week or more (Online Table 5.13)
"• one-fifth (19.8%) of recent cannabis users stated that all or most of their friends currently used cannabis, in contrast to only 0.8% of those who had never used the drug (Online Table 5.14)."

"In 2010, for people aged 14 years or older who had used cannabis in the previous 12 months, only 7.2% had not used any other listed drugs while using cannabis (Table 6.10). Males were more likely than females to use any drug in combination with cannabis except for over-the-counter pain-killers, which had the same proportion for both sexes (2.9%). The most common drugs that were mixed with cannabis were alcohol (85.2%) and tobacco (68.8%). Ecstasy was the most common illicit drug to be used at the same time as cannabis (23.9%)."

"There was a significant increase in the proportion of people who were offered or had the opportunity to use cocaine in 2013 (from 4.4% in 2010 to 5.2%). However, there was no change in the proportion using cocaine in the previous 12 months (2.1%) (online tables 5.3 and 5.12). Recent users also used cocaine less often in 2013, with a lower proportion using it every few months (from 26% to 18.0%) and a higher proportion using it once or twice a year from 61% to 71% (Online Table 5.11).
"Of people aged 14 or older, 8.1% (or 1.5 million) had used cocaine in their lifetime, and 2.1% (or about 400,000 people) had used it in the previous 12 months (Online Table 5.5). Cocaine use was highest among:
"• males, who were twice as likely as females to have used cocaine in the preceding 12 months (2.9% and 1.4%, respectively for those aged 14 or older)
"• those aged 30–39, who were most likely to have ever used cocaine (16.2%), particularly males (19.6%) (online tables 5.7 and S5.20)
"• people aged 20–29, both males (7.3%) and females (4.6%), were most likely to have used cocaine in the previous 12 months."

"The majority of drug deaths in an Australian study, conducted by the National Alcohol and Drug Research Centre, involved heroin in combination with either alcohol (40 percent) or tranquilizers (30 percent)."

"In 2013, about 1.3 million (7.0%) people had used meth/amphetamines in their lifetime and 400,000 (2.1%) had done so in the last 12 months (Online Table 5.5). Males were more likely than females to have used meth/amphetamines in their lifetime (8.6% and 5.3%, respectively) or in the last 12 months (2.7% and 1.5% respectively). In addition:
"• people aged 30–39 were slightly more likely than those in other age groups to have ever used meth/amphetamines (14.7%), while people aged 20–29 were more likely to have recently used meth/amphetamines (5.8%) (Online Table 5.7)
"• meth/amphetamine users are getting older; the average age of users was 24 in 2001, compared with 28 in 2013 (Online Table 5.16) and age of first use was also older, increasing from 17.9 in 2010 to 18.6 in 2013 among young people aged 14–24 (Online Table 5.10)
"• most people who were offered or had the opportunity to use meth/amphetamines didn’t use it—5.8% of people aged 14 or older were offered meth/amphetamines and 2.1% had used it (online tables 5.4 and 5.12)
"• among people aged 20–29, 14.1% had been offered or had the opportunity to use the drug, and 5.8% had used it (online tables 5.18 and S5.28)."

"The opportunity to use ecstasy was less common than cannabis with 7.2% of Australians stating they had been offered or had the opportunity to use the drug in the last 12 months (Online Table 5.12). Ecstasy was the second most commonly used illicit drug in a person’s lifetime, with 2.1 million (10.9%) people aged 14 or older reporting having ever used the drug and 500,000 had done so in the past 12 months, representing 2.5% of the population (Online Table 5.4). In addition:
"• the majority of recent ecstasy users only took ecstasy once or twice a year (54%) (Online Table 5.11)
"• the median age of recent ecstasy users was 25 (Online Table 5.16) and most people tried ecstasy as adults as the average age of initiation was 18.2 among people aged 14–24 (Online Table 5.10)
"• most ecstasy users claimed that at least some of their friends also used the drug; three-quarters said that about half or fewer of their friends currently used and one-quarter said all or most (Online Table 5.14)."

"Between 1993 and 2007, the daily drinking rate for people aged 14 or older remained largely unchanged, at around 8% (Figure 4.1). However, in 2010, there was a significant fall compared to 2007, and in 2013, the proportion drinking daily again declined from 7.2% to 6.5%. In addition:
"• in the previous 12 months, around three-quarters (78%) of the population aged 14 or older had consumed a full serve of alcohol, and 22% had not consumed alcohol
"• the proportion of people aged 14 or older who had never had a full serve of alcohol has risen since 2004, with an increase between 2010 and 2013 (from 12.1% to 13.8%)."

"About 1 in 5 people in Australia aged 14 years or older consumed alcohol at a level that puts them at risk of harm from alcohol-related disease or injury over their lifetime (Table 4.4). Results from the 2010 survey showed that:
"• there was little change in the proportion of risky drinkers from 2007 (20.3%) to 2010 (20.1%)
"• more than 3.7 million people in Australia aged 14 years or older were at risk of an alcohol-related disease or injury over their lifetime based on their pattern of drinking in 2010 (up from 3.5 million in 2007)
"• people aged 18–29 years were more likely than any other age group to drink alcohol in a way that put them at risk of alcohol-related harm over their lifetime (31.7% for those aged 18–19 years and 26.9% for those aged 20–29 years)
"• males were twice as likely as females to drink alcohol in quantities that put them at risk of incurring an alcohol-related chronic disease or injury over their lifetime (29.0% and 11.3%, respectively)
"• according to guideline 3 of the 2009 guidelines, for those aged under 18 years, not drinking is the safest option, and this is especially important for children aged under 15 years. Positively, the proportion of people aged 12–15 years and 16–17 years abstaining from alcohol increased in 2010 (from 69.9% to 77.2% and from 24.4% to 31.6%, respectively)."

"In 2010, 15.1% of people in Australia aged 14 years or older were daily smokers, declining from 16.6% in 2007. Between 1991 and 2010, the proportion of daily smokers declined by almost 40% to the lowest levels seen over the 19-year period (Table 3.1). The proportion of people who had never smoked increased. Also:
"• the number of people smoking daily in 2010 decreased by approximately 100,000 people (2.9 million in 2007 down to 2.8 million in 2010)
"• just under one-quarter of the population (24.1%) were estimated to be ex-smokers and more than half (57.8%) had never smoked in their life in 2010
"In 2010, those people who had never smoked (10.6 million) and those who were ex-smokers (4.4 million) far exceeded the number of smokers (3.3 million) aged 14 years or older."

"Australia’s consumption of opioid analgesics is ranked 10th internationally; North America ranks first. Per capita consumption of oxycodone and morphine preparations in Australia is relatively high (ranked third and fifth respectively, internationally); Canada ranks first for oxycodone and Austria first for morphine.¹ Consumption levels in Australia are still well below the top-ranking countries. Previous research in Australia has documented increases in the number of prescriptions for morphine in the late 1990s^2,3 and, more recently, increases in consumption of oxycodone.⁴"

"Morphine prescriptions declined from 38.3 to 30.7 per 1000 population between 2002–03 and 2007–08, representing a decrease of about 20%. Box 1A shows trends in morphine prescriptions by 10-year age group. Prescriptions were most common among older people (aged 70–79 and 80+ years), and much less common among younger people (aged 20–29 and 30–39 years). Significant linear declines over time were apparent in all age groups except the 50–59-year group."

"• In 2009–10, cannabis accounted for the highest number of drug-related arrests. There were 57,170 arrests involving cannabis in 2009–10, an increase of three percent from 2008–09, but an overall decrease of 17 percent from the number of arrests recorded in 1996–97.
"• The number of arrests for heroin peaked in 1998–99 with 14,341 arrests. This number fell considerably between 1999–2000 and 2001–02 before declining fairly consistently over the next 10 year period. In 2009–10, 2,767 arrests were made that involved heroin—an 81 percent decrease in arrests over that time.
"• In 1996–97, the number of arrests involving amphetamines was slightly below that of arrests involving ‘other’ drugs. Since then, however, arrests involving amphetamines have generally increased more than those involving other drugs, although this difference diminished in 2010, with only 3,893 more amphetamine arrests than arrests for other drugs. Overall, however, there has been a 258 percent increase in the number of amphetamine-related arrests since 1996–97.
"• In 2009–10, the number of cocaine arrests increased by 47 percent, rising from 848 in 2008–09 to 1,244. Despite this, the overall number of cocaine arrests remained lower than for any other drug type throughout the period.
"• Drug arrests involving a consumer were far more common across all drug types than those involving a provider. The highest proportion of those arrested (both consumers and providers) were for crimes involving cannabis (86%).
"• Providers accounted for 32 percent of cocaine-related arrests, 31 percent of heroin-related arrests and 28 and 24 percent of amphetamine and other drug-related offences, respectively."

"Australia’s prisoner population is growing at a rate well in excess of natural population growth. There were 29 700 adults in full-time custody at 30 June 2010, representing a 15% increase in the incarceration rate from 2000 to 2010. Women comprise 8% of adult prisoners but this proportion is increasing annually. Indigenous Australians2 are over-represented by a factor of 14, and the gap between Indigenous and non-Indigenous incarceration rates continues to widen.¹"

"It has been estimated that a very low proportion of the Australian general population aged 14 years and over have ever injected or recently injected drugs. In 2010, 1.8% of the population had injected a drug in their lifetime, with 0.4% having injected a drug in the past year. More than one-quarter (27.1%) of recent users injected daily and the majority obtained their needles and syringes from a chemist (64.5%). Males were more likely to have recently injected drugs in the past year than females (0.6% versus 0.3%). Those in the 20-29 and 30-39 year age groups had a higher proportion of past-year injecting drug use (0.9% for each) than those in other age groups (Australian Institute of Health and Welfare, 2011).
"Another recent prevalence estimate of injecting in Australia in 15-64 year olds is 1.09% (range = 0.65%-1.50%) which equates to approximately 149,591 persons (range = 89,253-204,564) (Mathers, Degenhardt, Phillips et al., 2008)."

(Prevalence of HIV Among Injection Drug Users in Australia) "The prevalence of HIV among people who inject drugs in Australia has remained low at 2.1% or less since 1995. The prevalence of HIV in 2011 was 1.2% (Figure 46). HCV prevalence among this group was much higher at 61% to 62% from 2005 to 2008, however this figure was lower at 53% 2011 (Figure 46) (Iversen and Maher, 2012)."

"In Australia it is estimated that about 13 per cent of people with HIV also have HCV. HIV shares major routes of transmission with both HCV and HBV. People who inject drugs are at particularly high risk for HCV and HIV co-infection.
"While HIV was not established in the Australian IDU population when NSPs were introduced, the prevalence of HCV was already high. HCV is a more robust virus than HIV and is transmitted more efficiently though blood-to-blood contact. Approximately 80 per cent of current HCV infections and 90 per cent of new infections are attributable to unsafe injecting practices (Commonwealth of Australia, 2005b). This explains IDUs being identified as a priority population within The Third National Hepatitis C Strategy."

"In 2012, IDRS participants were asked questions about BBVI [Blood-Borne Viral Infection] testing and vaccinations. Of those who commented, 93% reported testing for HBV in their lifetime compared to 96% for HCV and 94% for HIV.
"Of those who were tested for HBV, two-thirds (62%) had a test within the past year and one-third (30%) within the last three months. Six percent reported a positive result and 4% had been treated for HBV (anti-viral therapy only). Two-thirds (61%) had been vaccinated again HBV, with 87% having completed the course. The main reason for HBV vaccination was due to a history of injecting drug use (38%) (Table 81).
"Among those tested for HCV, two-thirds (65%) had a test within the past year and one-third (31%) within the last three months. Nearly half reported a positive result. Ten percent of those who commented had been treated for HCV (anti-viral therapy only), with 22% receiving HCV treatment (currently or in the last 12 months). The main reason for HCV testing on the last occasion was a ‘matter of routine’ (38%) and ‘it was a responsible thing to do’ (14%; Table 82)."

"Approximately 83 per cent of HCV infections have resulted from unsafe injecting drug use practices. In Australia in 2006 it was estimated that approximately 264,000 people had been exposed to HCV and had HCV antibodies with around 197,000 living with chronic hepatitis C. The estimated number of new cases of HCV infection has declined from 16,000 per annum in 2001 to 10,000 in 2005. The majority (65 per cent) of people with HCV are aged between 20 and 39 years and 35 per cent of national notifications of HCV are in women.
"While 25 per cent of HCV infections clear spontaneously within two to six months 75 per cent develop into chronic infections. Chronically infected persons will continue to be able to transmit the virus including those who experience no noticeable illness or symptoms. After 20 years, between 5 and 10 per cent of infections will have resulted in cirrhosis of the liver, with 2 to 5 per cent progressing to liver failure or a form of liver cancer known as hepatocellular carcinoma."

"In 2010, there appeared to be a relationship between a person’s cocaine use and his or her mental health, psychological distress (see Glossary for definition of the Kessler Psychological Distress Scale) and body mass index (Table 9.7). In addition:
"• people who recently used cocaine were more likely to have been diagnosed with or treated for a mental illness (17.4% for recent users compared with 11.9%), and have high or very high levels of psychological distress (17.5% for recent users compared with 9.7%) than those who had not used cocaine in the previous 12 months
"• recent cocaine users were more likely to be underweight (5.0% for recent users compared with 2.3%), and considerably less likely to be obese (8.2% for recent users compared with 22.0%) than those who had not used cocaine in the previous 12 months."

(Methamphetamine Use and Health) "This section compares meth/amphetamines use patterns with general health, selected health conditions, psychological distress (see Glossary for definition of the Kessler Psychological Distress Scale) and body mass index in people aged 18 years or older. The data are based on self-reported assessments and are not empirically verified. Table 8.7 shows there was a relationship between recent use of meth/amphetamines and a person’s mental health and body mass index. In addition:
"• recent users were twice as likely to report high or very high levels of psychological distress as those who had not used meth/amphetamines in the last 12 months (20.8% compared with 9.6%)
"• recent users were also twice as likely as non-recent users to report being diagnosed or treated for a mental illness in the previous 12 months (25.6% compared with 11.7%)
"• recent users of meth/amphetamines were less likely to be obese than non-users (14.6% and 21.8%, respectively)."

"There were 465 oxycodone-related deaths identified between 2001 and 2009. Box 3 shows deaths by year from 2002 to 2008, with the largest number occurring in 2007. Deaths adjusted for quantity of oxycodone prescribed each year fluctuated between 3.8 and 8 deaths per million defined daily doses (Box 3). Only 10% of these deaths were due to oxycodone toxicity alone. Multiple drug toxicity was more predominant (82% of deaths), with benzodiazepines and alcohol commonly implicated in these deaths. The remaining 8% were from other causes (eg, pneumonia or cardiac failure), with drug toxicity (including oxycodone toxicity) being a contributory cause (data not shown)."

"A striking finding from the toxicological data was the relatively small number of subjects in whom morphine only was detected. Most died with more drugs than heroin alone 'on board', with alcohol detected in 45% of subjects and benzodiazepines in just over a quarter. Both of these drugs act as central nervous system depressants and can enhance and prolong the depressant effects of heroin."

"The disadvantage of continuing to describe heroin-related fatalities as 'overdoses' is that it attributes the cause of death solely to heroin and detracts attention from the contribution of other drugs to the cause of death. Heroin users need to be educated about the potentially dangerous practice of concurrent polydrug and heroin use."

"Treatment episodes for problematic morphine use remained relatively stable during 2002–03 to 2007–08 (0.07 per 1000 population in 2007–08). Episodes for problematic oxycodone use doubled, from 0.01 per 1000 population in 2002–03 to 0.02 per 1000 population in 2007–08 (Box 2B)."

"• The number of needles and syringes distributed in Australia increased during the past decade (from ~27 million to ~31 million).
"• Expenditure on NSPs increased by 36% (adjusted for inflation) over this time period, mostly associated with personnel and not principally for equipment (Table a); a significant portion of the increased investment has been the Illicit Diversion Supporting Measures for NSPs to increase referrals to drug treatment and other services.
"Over the last decade there has been
"• Increases in funding for primary sites.
"• Increases in the number of secondary sites.
"• Increases (by 15%) in the numbers of units of equipment provided.
"• Stable spending on sterile injection equipment.
"• At the time of writing there were 85 primary sites, 737 secondary sites, 20 enhanced secondary sites, and 118 vending machines."

"Needle and syringe programs (NSP) were by far the most common source of needles and syringes in the preceding six months (95%), followed by chemists (16%). NSP vending machines were used by 33% of participants in TAS and 29% in NSW. Proportions reporting a friend, partner and/or dealer varied by jurisdiction. Hospitals and outreach/peer workers were also accessed (Table 75).

"In comparison, data from the 2010 National Drug Strategy Household survey reported that around 65% of recent injectors (used in the previous 12 months) obtained needles and syringes from a chemist, followed by 37% at NSP (Australian Institute of Health and Welfare, 2011)."

"It was estimated that: "

• For every one dollar invested in NSPs, more than four dollars were returned (additional to the investment) in healthcare cost-savings in the short-term (ten years) if only direct costs are included; greater returns are expected over longer time horizons. "

• NSPs were found to be cost-saving over 2000-2009 in seven of eight jurisdictions and cost-effective in the other jurisdiction. Over the longer term, NSPs are highly cost saving in all jurisdictions. "

• The majority of the cost savings were found to be associated with HCV-related outcomes. However, when only HIV-related outcomes were considered in the analysis, it cost $4,500 per DALY gained associated with HIV infection. "

• If patient/client costs and productivity gains and losses are included in the analysis, then the net present value of NSPs is $5.85bn; that is, for every one dollar invested in NSPs (2000-2009), $27 is returned in cost savings. This return increases considerably over a longer time horizon. "

• NSPs are very cost-effective compared to other common public health interventions, such as vaccinations (median cost per QALY of $58,000), allied health, lifestyle, and in-patient interventions (median cost of $9,000 per DALY gained), and interventions addressing diabetes and impaired glucose tolerance or alcohol and drug dependence (median cost of $3,700 per DALY gained)[2]."

"Investment in NSPs (2000-2009) has resulted in: " 

• An estimated 32,050 HIV infections and 96,667 HCV infections averted; " 

• Substantial healthcare cost savings to government related to HCV and HIV; " 

• Substantial gains in Disability Adjusted Life years. "For every dollar currently spent on the activities of NSP, more than four dollars will be returned (in addition to the investment; i.e., five times the investment) and approximately 0.2 days of disability-adjusted life gained. Over a longer time horizon there is even greater return."

"Nuns who run one of Australia's best known hospitals are to operate the country's first legal and medically supervised heroin injecting room after a radical overhaul of the drug laws in New South Wales. The 18 month trial will be administered by the Sisters of Charity, who also run Sydney's inner city St Vincent's Hospital.
"An estimated 50 000 visits a year by drug users are expected at the centre, which will be staffed by a medical supervisor, a registered nurse, and security staff. The controversial plan will include the provision of clean needles and syringes; users must supply their own drugs."

"In Australia the [Needle and Syringe] Program is the single most important and cost-effective strategy in reducing drug-related harms among IDUs. Australian Governments invested $130 million in NSPs between 1991 and 2000 resulting in the prevention of an estimated 25,000 HIV infections and 21,000 HCV infections, with savings from avoided treatment costs of up to $7.8 billion (Health Outcomes International et al., 2002). In the decade 2000-2009, the gross funding for NSPs was $243 million. This investment yielded healthcare cost savings of $1.28 billion; a gain of approximately 140,000 Disability-Adjusted Life Years (DALYs); and a net cost saving of $1.03 billion. During this time, NSPs have averted 32,061 new HIV infections and 96,918 new HCV infections (NCHECR, 2009)."

"In summary, the evidence available from this Evaluation indicates that:

"• operation of the MSIC in the King Cross area is feasible;

"• the MSIC made service contact with its target population, including many who had no prior treatment for drug dependence;

"• there was no detectable change in heroin overdoses at the community level;

"• a small number of opioid overdoses managed at the MSIC may have been fatal had they occurred elsewhere;

"• the MSIC made referrals for drug treatment, especially among frequent attenders;

"• there was no increase in risk of blod borne virus transmission;

"• there was no overall loss of public amenity;

"• there was no increase of crime;

"• the majority of the community accepted the MSIC initiative;

"• the MSIC has afforded an opportunity to improve knowledge that can guide public health responses to drug injecting and its harms."

"Of the total social cost of drug abuse in 2004/05 of $55.2 billion, alcohol accounted for $15.3 billion (27.3 per cent of the unadjusted total), tobacco for $31.5 billion (56.2 per cent), and illicit drugs $8.2 billion (14.6 per cent). Alcohol and illicit drugs acting together accounted for another $1.1 billion (1.9 per cent)."

"Of the total net production costs of $13.2 billion, tobacco accounted for by far the largest share (60.7 per cent or $8.0 billion). Alcohol represented 26.8 per cent ($3.5 billion) and illicit drugs 12.5 per cent ($1.6 billion). Of the gross production costs of $22.9 billion, workforce losses represented 47.9 per cent ($11.0 billion) and household losses 52.1 per cent ($11.9 billion)."

"The public health burden of cannabis use is probably modest compared with that of alcohol, tobacco, and other illicit drugs. A recent Australian study⁹⁶ estimated that cannabis use caused 0·2% of total disease burden in Australia—a country with one of the highest reported rates of cannabis use. Cannabis accounted for 10% of the burden attributable to all illicit drugs (including heroin, cocaine, and amphetamines). It also accounted for around 10% of the proportion of disease burden attributed to alcohol (2·3%), but only 2·5% of that attributable to tobacco (7·8%)."

"The harms to individuals, families, communities and Australian society as a whole from alcohol, tobacco and other drugs are well known. For example, the cost to Australian society of alcohol, tobacco and other drug misuse1 in the financial year 2004–05 was estimated at $56.1 billion, including costs to the health and hospitals system, lost workplace productivity, road accidents and crime." 

"The overarching approach of harm minimisation, which has guided the National Drug Strategy since its inception in 1985, will continue through 2010–2015. This encompasses the three pillars of: "

• demand reduction to prevent the uptake and/or delay the onset of use of alcohol, tobacco and other drugs; reduce the misuse of alcohol and the use of tobacco and other drugs in the community; and support people to recover from dependence and reintegrate with the community "

• supply reduction to prevent, stop, disrupt or otherwise reduce the production and supply of illegal drugs; and control, manage and/or regulate the availability of legal drugs "

• harm reduction to reduce the adverse health, social and economic consequences of the use of alcohol, tobacco and other drugs.

 "The three pillars apply across all drug types but in different ways, for example, depending on whether the drugs being used are legal or illegal. The approaches in the three pillars will be applied with sensitivity to age and stage of life, disadvantaged populations, and settings of use and intervention."

"Since the inception of the National Campaign Against Drug Abuse in 1985, Australia has had major successes in reducing the prevalence of, and harms from, drug use.
"&#149 Far fewer Australians are smoking and being exposed to second-hand smoke as a result of comprehensive public health approaches, including bans on advertising, bans on smoking in enclosed public spaces and significant investments in public education and media campaigns. The daily smoking rate among Australians aged 14 years and over has fallen from 30.5 per cent in 1988 to 16.6 per cent in 2007.
"• Far fewer people are using illegal drugs. The 2007 National Drug Strategy Household Survey shows the proportion of people reporting recent use of illegal drugs fell from 22 per cent in 1998 to 13.4 per cent in 2007. The recent use of cannabis—the most commonly used illegal drug—fell from 17.9 per cent in 1998 to 9.1 per cent in 2007.
"• Law enforcement agencies have continued to be effective in detecting and seizing illegal drugs to disrupt supply. The number of illegal drug seizures increased by almost 70 per cent between 1999–2000 and 2008–09, and the collective weight of seizures increased by about 116 per cent.
"• The heroin shortage that began in 2000 has been sustained, with heroin use remaining at low levels since then.
• Harms associated with injecting drug use have also been reduced. It is estimated that from 2000–2009 needle and syringe programs, which ensure the safe supply and disposal of syringes to injecting drug users, have directly averted over 32 000 new HIV infections and nearly 97 000 hepatitis C infections."

"Australia’s first NSP was trialled in New South Wales in 1986 with the provision of NSP services becoming New South Wales Government policy in early 1987 and the remaining states and territories implementing NSPs soon after via primary, secondary and pharmacy outlets (Dolan et al., 2005). This occurred following the discovery of HIV and the potential threat that this virus posed to the Australian community. The establishment of NSPs throughout Australia would not have been possible without bipartisan political support which continues to be an important element in the continuing existence and operation of NSPs."

"Commitment to evidence
"An important aspect of Australia’s approach to drug use has been the commitment to a comprehensive evidence base. Under the National Drug Strategy 2010–2015 there is a continued commitment to evidence-based and evidence-informed practice. Evidence-based practice means using approaches which have proven to be effective. For example, the continuing provision of detoxification, pharmacological therapies including opioid substitution therapies and cognitive behavioural therapies for alcohol, tobacco and other drug treatment is based on an extensive body of evidence in Australia and internationally.
"Evidence-informed practice involves integrating existing evidence with professional expertise to develop optimal approaches, including new or innovative approaches in a given situation. The National Drug Strategy 2010–2015 includes a commitment to innovation and trialling new approaches. For example, the introduction of the Illicit Drug Diversion Initiative (IDDI) supported police-based diversion in early intervention and prevention programs before there was comprehensive evidence supporting this approach. The success of IDDI was a catalyst for its expansion into court-based diversion and treatment at correctional centres. IDDI demonstrates that where there is little evidence, leadership is needed to support innovation. Allowing room for the development of such creative approaches to be developed in the future will require new evidence to be collected so that the impact and quality of new interventions is well-understood."

"• There is strong evidence of an association between social determinants—such as unemployment, homelessness, poverty, and family breakdown—and drug use. Socio-economic status has been associated with drug-related harms such as foetal alcohol syndrome, alcohol and other drug disorders, hospital admissions due to diagnoses related to alcoholism, lung cancer, drug overdoses and alcohol-related assault. In the 2007 National Drug Strategy Household Survey the highest prevalence of recent illegal drug use was reported by unemployed people—23.3 per cent compared with 13.4 per cent of the general population. Alcohol, tobacco and other drug use among homeless people is common. One study estimated the overall 12-month prevalence of harmful alcohol use for homeless people in Sydney at 41 per cent and the prevalence of drug use at 36 per cent. Family factors—including poor parent–child relationships, family disorganisation, chaos and stress and family conflict and marital discord with verbal, physical or sexual abuse—also have a strong association with drug use. There are a number of strong protective factors that guard against problematic alcohol and other drug use. These include having a job, a stable family life and stable housing. These factors can be important in preventing or overcoming drug-related problems."

"The only comprehensive evaluation of a medically supervised injecting centre was conducted during the 18 month trial of the Sydney centre. Staff intervened in 329 overdoses over one year with an estimate of at least four lives saved a year. There was no increase in reported hepatitis B or C infections in the area that the medically supervised injecting centre served despite an increase elsewhere in Sydney.

"The report described a decreased frequency of injecting related problems among clients. Half the centre's clients reported that their injecting practices had become less risky since using the centre. Furthermore, clients were more likely than other injectors to report that they had started treatment for their drug use; 11% of clients were referred to treatment for drug dependence. An economic evaluation of deaths averted by intervention of the medically supervised injecting centre showed that costs were comparable to those of other widely accepted public health measures.

"The centre also had benefits for the local community. Residents and business respondents reported fewer sightings of public injection and syringes discarded in public places, and syringe counts in the vicinity of the centre were lower after it opened than before. In addition, there was no evidence of an increased number of theft and robbery incidents in the area. Acceptance of the medically supervised injecting centre increased among both businesses and residents over the study period."

"Overall, results indicate that heroin prescription is a very promising approach in reducing any type of drug related crime across all relevant groups analyzed. It affects property crime as well as drug dealing and even use/possession of drugs other than heroin. These results suggest that heroin maintenance does not only have an impact by reducing the acquisitive pressure of treated patients, but also seems to have a broader effect on their entire life-style by stabilizing their daily routine through the commitment to attend the prescription center twice or three times a day, by giving them the opportunity for psychosocial support, and by keeping them away from open drug scenes."

"Prescribing injectable opiates is one of many options in a range of treatments for opiate-dependent drug users. In showing that it attracts and retains long term resistant opiate-dependent drug users in treatment and that it is associated with significant and sustained reductions in drug use and improvements in health and social status, our findings endorse the view that it is a feasible option."

"The results of this study are important for the child protection field. They show that, rather than severity of substance use being associated with mothers’ involvement with the child protection system, other factors are of greater importance. Of particular interest was the finding that having greater social support, particularly from parents, significantly reduced the likelihood of being involved with the child protection system."

"These pilot study findings showed that opiate-dependent injecting drug users with long injecting careers (most started between 1970 and 1982) and for whom opiate treatment had failed multiple times previously were attracted into and retained by therapy with injectable opiates."