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This chapter presents data on illicit use of drugs not including tobacco and alcohol. When referring to illicit use of any drug this includes:
The first part of the chapter focuses on combined illicit use of any drug (including pharmaceutical misuse) and the second part focuses on use of selected illegal drugs not including pharmaceuticals (see Chapter 6 for more detailed information on pharmaceutical misuse).
'Illicit use of a drug' or 'illicit drug use' (used interchangeably in this report) can encompass a number of broad categories including:
Illicit drug use has both short-term and long-term health effects, and health impacts can be severe, including poisoning, infective endocarditis (an infection that damages the heart valves), mental illness, self-harm, suicide and death. The use of inhalants may lead to brain damage, disability and death. The use of some illicit drugs by injection can also allow the transmission of bloodborne viruses, including HIV/AIDS, hepatitis C and hepatitis B. The social impacts of illicit drug use include stressed family relationships, family breakdown, domestic violence, child abuse, assaults and crime (NRHA 2012).
For Australasia, it has been estimated that 2.6% of the burden of disease and 0.5% of deaths were attributable to illicit drug use in 2010 (IHME 2014). Overall, however, illicit drug use accounts for an increasing proportion of the global burden of disease (moving from the 18th to 15th ranking risk factor between 1990 and 2010) (IHME 2014). It is estimated that illicit drug use cost the Australian economy $8 billion annually through crime, productivity losses and health-care costs (NRHA 2012).
A limitation of the survey is that some people may not accurately or fully report information relating to illicit drug use and related behaviours, particularly where these activities may be illegal. This means that results relating to illicit drugs are likely to underestimate actual prevalence.
All data presented in this chapter are available through the online illicit drugs tables.
Illicit drug policy is shared across different levels of government and also different government agencies. Strategies to address illicit drugs are the responsibility of health, law enforcement, community services, education, and employment and training agencies, and require coordinated action between the Commonwealth and the state and territory governments.
Under the National Drug Strategy 2010–2015 (and its forerunners), Australian governments, non-government organisations, researchers and community groups continue to engage in a wide variety of activities to minimise the harm associated with illicit use of drugs. These include activities such as strategies focusing on specific drugs or populations at risk, legislation, treatment service programs and law enforcement activities.
School-based and general prevention initiatives are designed to delay the first use of illicit drugs and improve awareness of risks associated with illicit drug use. These programs provide factual information about drugs and their effects through targeted education and also mass media campaigns, such as the National Drugs Campaign.
Specialised drug treatment services for illicit drugs, like drug treatment services for other substances, are primarily provided by governments and non-government organisations with government funding. These services are complemented by private hospitals and also subsidised private services by general practitioners and allied specialists including mental health service providers.
The National Drug Strategy recognises illicit drug use as a health and social issue while acknowledging the role of law enforcement to detect and deter drug crime. Legislative and regulatory provisions relating to illicit drugs, precursor chemicals and proceeds of crime exist at the national level (for example border protection and compliance) and also within each jurisdiction.
In 2013 about 4 in 10 (42%) people in Australia had illicitly used a drug at some point in their lifetime (Online Table 5.1). This was a higher proportion than in 2010 (40%) but lower than the peak of 46% in 1998. Most of this rise in lifetime use was attributable to increases in the non-medical use of pharmaceuticals; lifetime illicit use of pharmaceuticals rose from 7.4% to 11.4% (Online Table 5.2). More specifically:
Ketamine was the only non-pharmaceutical illicit drug to show an increase in lifetime use and there was a small but significant decrease in the proportion of people having ever injected any drug.
Around 1 in 7 (15.0%) people aged 14 or older reported having used an illicit drug in the last 12 months and this level of use remained relatively stable between 2004 and 2013. Monthly or weekly use of illicit drugs was reported by fewer than 1 in 10 people—8.1% of the population had used an illicit drug in the last month, and a further 5.2% had done so in the last week (Figure 5.1). There was no change in recent use of most illicit drugs, but there was a change for the following drugs (Online Table 5.3):
Figure 5.1: Use of any illicit drug, people aged 14 or older, 2001 to 2013 (per cent)
Source: Online Table 5.1.
As discussed above, in 2013, 15.0% of Australians used an illicit drug (including use of pharmaceutical drugs for non-medical purposes) in the previous 12 months. Among illicit drug users, 4 in 5 used illegal drugs such as cannabis and cocaine, or other substances such as inhalants. In addition, 2.9% of people misused a pharmaceutical drug (and did not use any other illicit drug) in the previous 12 months. A further 1.8% of people had both misused a pharmaceutical and also used another illicit drug (Figure 5.2).
Figure 5.2: Relationship between recent illicit drug use and pharmaceutical use, people aged 14 or older, 2013 (per cent)
The most common illicit drug used was cannabis, with 10.2% of people aged 14 or older having used it in the previous 12 months and 35% having ever used it (Online Table 5.4). Ecstasy (10.9%) and hallucinogens (9.4%) were the second and third most common drugs for lifetime use, and pain-killers/analgesics (3.3%) and ecstasy (2.5%) were the second and third most common for recent use.
The use of any illicit drug in a lifetime or in the last 12 months varied with different age groups and for males and females (Online tables 5.5 and 5.7). Comparing lifetime use of illicit drugs showed that:
Similar to the patterns of lifetime use, the same differences in age and sex were apparent for use in the previous 12 months (Online Table 5.6).
Figure 5.3: Recent use(a) of illicit drugs, people aged 14 or older, selected illicit drugs, 2013 (per cent)
Source: Online tables 5.8, 5.22, 6.4 and S6.3.
Overall there were no changes in illicit use of drugs (includes pharmaceutical misuse) in 2013, but there were some significant changes among different age groups. People aged 50 and over generally have the lowest rates of illicit drug use; however, in recent years this age group has shown the largest rise in illicit use of drugs and were the only age groups to show a statistically significant increase in use (Figure 5.4). More specifically, compared with 2010:
Figure 5.4: Illicit use of any drug(a), people aged 14 or older, by age, 2001 to 2013 (per cent)
Source: Online Table 5.6.
It is often assumed that an observed increase in drug use in a particular age bracket is caused by more people in that age group taking up drug use. While this might seem an obvious interpretation of the data, trends in drug use can also result from generational differences in drug use and changes in the composition of the population over time, such as the ageing of a particular generation of people (McKetin et al. 2010).
There appears to be an ageing cohort of drug users in Australia. The median age of drug users has risen since 2001 for most illicit drugs (Figure 5.5). For example:
Figure 5.5: Median age of drug users, people aged 14 or older, 2001 to 2013
Source: Online Table 5.16.
Adolescence is often characterised by rapid physical and psychological transition, experimentation and risk-taking behaviour (ABS 2008). This may include illicit drug use and this behaviour can cause both short- and long-term health and other problems. Those who initiate drug use early are more likely to continue into future illicit and problematic drug use (Loxley et al. 2004).
The average age at which people aged 14 or older used their first illicit drug has fluctuated between 18.6 and 19.4 since 1995. However in 2013, the age at which people first tried an illicit drug was older, increasing (slightly but significantly) from 19.0 in 2010 to 19.4 in 2013 (Online Table 5.9). Users tended to be older when they first use pharmaceutical drugs than other illicit drugs, 24.3 for pharmaceuticals compared to 18.6 for other illicit drugs (excluding pharmaceuticals).
Among people aged 14–24, the age of initiation into illicit drug use increased from 16.0 in 2010 to 16.3 in 2013 (Online Table 5.9). More specifically, the age at which people first used cannabis and meth/amphetamines rose, with both these drugs showing an older age of first use in 2013.
The health risks of illicit drug use increase with the frequency and quantity of drugs used (Degenhardt et al. 2013). Cannabis and meth/amphetamine users were more likely to use the drug on a regular basis compared with other drugs (Online Table 5.10) with 45% and 32% (respectively) using it at least once a month while ecstasy and cocaine users were more likely to be infrequent users, only using the drug once or twice a year (54% and 71% respectively).
In 2013, there was no change in the frequency of cannabis or ecstasy use but there were some changes in use among cocaine and meth/amphetamine users. People who used cocaine also did so less often in 2013; a lower proportion used it every few months (from 26% to 18.0%) and a higher proportion only used once or twice a year (from 61% to 71%). While for meth/amphetamine users there was a rise in the proportion using it as often as daily or weekly (from 9.3% to 15.5%), particularly among ice users, one-quarter (25%) used it at least weekly (up from 12.4% in 2010) (Online Table 5.20).
This next section of the chapter focuses on illegal drugs (such as cannabis), emerging/novel psychoactive substances (such as synthetic cannabinoids), and other substances used inappropriately (such as inhalants). Refer to Chapter 6 for more information on misuse of pharmaceuticals.
There are a wide variety of strategies and services available to minimise the use and harm associated with cannabis use. In 2007, the National Cannabis Prevention and Information Centre was established to educate and train health professionals with the aim of increasing early intervention and reducing cannabis use (Hughes 2014).
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:
Recent use of cannabis has remained relatively stable over the past decade but there were some significant changes among different age groups (Online Table 5.15). Since 2001, recent cannabis use has generally dropped in the younger age groups (those aged 14–39), but either increased or remained stable for the older age groups (40 or older). Between 2010 and 2013, the proportion of people aged 50–59 and 60 or older using cannabis rose (from 5.5% to 7.3% and from 0.5% to 1.2% respectively) and is at the highest levels seen over the past decade among these age groups, which indicates that there appears to be an ageing cohort of cannabis users. In comparison to 2010, males aged 60 or older were twice as likely to use cannabis in 2013 (increasing from 0.8% to 1.8%) and females aged 50–59 were 1.6 times more likely to use cannabis (from 3.2% to 5.2%) but these proportions were still lower than younger age groups.
Figure: 5.6: Recent(a) use of cannabis, people aged 14 or older, by age, 2001 to 2013 (per cent)
Source: Online Table 5.15.
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:
Ecstasy use (reported as ecstasy/designer drugs prior to 2004) had been gradually increasing since 1995, before peaking in 2007. It then declined in 2010 and again in 2013 (Online Table 5.17). Although overall there was a decrease between 2010 and 2013, the fall was only significant for females (from 2.3% to 1.8%) and for people aged 30–39 (from 3.9% to 2.6%), particularly females in this age group (from 3.0% to 1.2%). There were no significant changes in use among any other age group.
Figure 5.7: Recent(a) use of ecstasy, people aged 14 or older, by age, 2001 to 2013 (per cent)
Source: Online Table 5.17.
Between 2004 and 2010, questions relating to meth/amphetamines use were refined to more accurately reflect substances used in Australia. More specifically in 2007 the term 'meth' was introduced and in 2010 clarification about non-medical use was added. Before 2004 the term 'meth' was not included.
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:
Meth/amphetamine use had been declining since it peaked at 3.7% in 1998 (Online Table 5.3) but remained stable at 2.1% between 2010 and 2013. There were no significant changes in the proportion of people using meth/amphetamines in last 12 months among different age groups or sexes (Figure 5.8). Patterns of meth/amphetamine use over time are:
Figure: 5.8: Recent(a) use of meth/amphetamines(b), people aged 14 or older, by age, 2001 to 2013 (per cent)
Source: Online Table 5.18.
Meth/amphetamines comes in many forms including powder/pills (speed), crystal methamphetamine (crystal meth or ice) and a sticky paste (base). Ice is usually the most pure form, followed by base then speed. The 'high' experienced from ice and base is much more intense, and with intense reactions come powerful responses including comedown, the potential for dependence (addiction) and chronic physical and mental problems (DoHA 2013).
In 2013 there was a change in the main form of meth/amphetamines used with ice replacing powder as the preferred form of the drug. Among recent users, powder decreased from 51% to 29% while the use of ice more than doubled, from 22% in 2010 to 50% in 2013 (Figure 5.9).
Figure 5.9: Main form of meth/amphetamine used, recent(a) users aged 14 or older, 2007 to 2013 (per cent)
Note: Base is recent users of Meth/amphetamines.
Source: Online Table 5.19.
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:
The proportion of males and females who had used cocaine in the previous 12 months has been increasing since 2004 and was highest in 2010 and 2013 (Figure 5.10). While use of drugs such as cannabis, ecstasy and meth/amphetamines has generally declined since 2004, the proportion of people using cocaine has been increasing since 2004. This is particularly so among those aged 20–29 and 30–39. Cocaine use in Australia is currently at the highest levels yet seen. More specific findings include:
Figure 5.10: Recent(a) use of cocaine, people aged 14 or older, by age, 2001 to 2013 (per cent)
Source: Online Table 5.21.
Novel, new or emerging psychoactive substances, or EPS, is a term used to describe drugs with mind-altering effects that are relatively new to the recreational drug market. EPS often mimic the effects of existing illicit psychoactive drugs such as cannabis, ecstasy (MDMA) and hallucinogens, or have chemical structures very similar to those substances. Other names given to this group of drugs include: research chemicals, analogues, legal highs, herbal highs, bath salts, party pills and synthetic drugs (NDARC 2013).
Psychoactive substances are emerging at an unprecedented rate as manufacturers use new chemicals to replace those that are banned (Bright 2013). By 2013, the emergence of 348 EPS had been reported to United Nations Office on Drugs and Crime (UNODC), the majority of which were identified between 2008 and 2013. However, this figure is likely to underestimate the number of these drugs, as the figure only reflects reports of official sources and does not take unofficial sources into account (UNODC 2014). There are 2 primary categories of product available in Australia: powders/pills and synthetic cannabis (Bright 2013).
A range of EPS with similar effects to more commonly known internationally controlled drugs such as cannabis and amphetamine-type substances (ATS) have already been identified as potential risks to public health and are controlled in Australia. Drugs in this category health have been scheduled as Prohibited Substances under the Commonwealth Poisons Standard (the Standard for the Uniform Scheduling of Medicines and Poisons or SUSMP), which is administered by the Therapeutic Goods Administration.
In 2013 there was a move towards greater alignment of Commonwealth and state and territory-level controls, and all jurisdictions have aligned their drugs and poisons legislation to cover those substances listed as prohibited under SUSMP. There is still variation in relation to approaches to enforcement.
At the Commonwealth level, changes have been made to the serious drug offences framework to better meet the emerging threat of EPS. Substances may now be listed quickly and permanently in the Criminal Code Regulations 2002 (Commonwealth) once the relevant criteria, which are harm and evidence based, have been met.
Similarly, states and territories have introduced controls on many EPS. Each state and territory has its own laws that determine what substances are subject to criminal controls.
Questions on the use of these drugs were included in the NDSHS for the first time in 2013 and results showed that 1.3% 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 (Figure 5.11). More specifically:
Figure 5.11: Recent(a) use of emerging psychoactive substances, people aged 14 or older, by age, 2013 (per cent)
Source: Online Table 5.22.
This section presents information on the use of other illicit drugs surveyed, including heroin, hallucinogens, ketamine, GHB and inhalants, as well as on drug-taking behaviour such as injecting drug use.
Injecting drug use is a major risk factor for transmitting bloodborne viruses, including HIV, hepatitis B and hepatitis C. Needle and syringe sharing among people who inject drugs is partly responsible for transmitting infection among drug users, although unsafe sexual behaviours also play a role (AIHW 2012).
Overall, the proportion of use of these drugs was small within Australia and generally stable between 2010 and 2013. In 2013:
The proportion of the population aged 14 or older who had used heroin (a drug that is commonly injected) or injected illicit drugs in the previous 12 months was low over the period 2001 to 2013 (less than 1% of the population; Figure 5.12). Positively in 2013, the number of people using heroin halved, from 40,000 to 20,000 (or from 0.2% to 0.1%) and the number of people who injected a drug declined from 80,000 to 60,000 (or from 0.4% to 0.3%).
Figure 5.12: Recent(a) use of other illicit drugs and other drug-taking behaviours, people aged 14 or older, 2001 to 2013 (per cent)
Source: Online Table 5.23.
Most people sourced cannabis (61%), ecstasy (63%), meth/amphetamines (57%) and cocaine (74%) from a friend (Online Table 5.25). Meth/amphetamine and ecstasy users were more likely than other drug users to source it from a dealer (31% and 30% respectively).
Ecstasy users were more likely to use the drug in a public venue (for example raves, pubs or clubs), while cannabis (87%), meth/amphetamine (76%) and cocaine (60%) users were more likely to use the drug in a private home (Online Table 5.26). Meth/amphetamine users were also less likely to use the drug in a public venue in 2013 (use at raves/dance parties and public establishments both declined significantly) which is likely to be related to the change in the main form of meth/amphetamine used.
The decision to use drugs for the first time and to continue using them is influenced by a number of factors. Most people use drugs because they want to feel better or different. There are different categories of drug use including experimental use (try it once or twice out of curiosity), recreational use (for enjoyment, to enhance a mood or social occasion), situational use (cope with the demands of a situation) and dependent use (need it consistently to feel normal or avoid withdrawals) (ADF 2013). People may not be aware of the underlying reasons they take drugs or may answer in a way they deem to be more socially acceptable.
In 2013, of people aged 14 or older, the most common reason that an illicit substance was first used was curiosity (66%), followed by wanting to do something exciting (19.2%) and wanting to enhance an experience (13.3%) (Online Table 5.27). The majority of lifetime drug users said they no longer used illicit drugs (44%) or that they only tried illicit drugs once (30%) (Online Table 5.28). Among those who continued to use the drug, the most common reason for continuing drug use was because they wanted to enhance experiences (30%) or do something exciting (17.5%) (Online Table 5.29). About 1 in 10 said they were influenced by their friends or family (10.7%) or they took drugs to improve their mood or stop feeling unhappy (10.2%). Ex-users of illicit drugs were more likely to admit to being influenced by their friends and family than recent users (19.7% compared with 9.4%).
The objectives of the National Drug Strategy 2010–2015 include reducing harm to community safety and reducing the harm to individuals from drug use (MCDS 2011). The NDSHS contributes to this by reporting on the experiences of illicit drug-related incidents and harm by people living in Australia. Online tables 5.30 and 5.31 present information about people aged 14 or older who were victims of an incident related to illicit drugs in the previous 12 months. These showed that in 2013: