Pharmaceuticals: client demographics and treatment
In 2019–20, pharmaceutical drugs were reported in 12% of all closed treatment episodes, either as a principal or additional drug of concern:
- 5% (9,904 episodes) of treatment episodes were for pharmaceutical drugs as a principal drug of concern
- pharmaceutical drugs were more likely to be reported as an additional drug of concern (7% of episodes)
- the most common additional drugs of concern reported with pharmaceuticals include amphetamines (19%), cannabis (18%) or alcohol (14%), but these drugs are not necessarily the subject of any treatment within the episode (FIGURE DRUGS1; tables SD.6–8).
Pharmaceutical use
Pharmaceuticals are drugs that are available from a pharmacy—over the counter or by prescription—which may be subject to misuse (MCDS 2011). Results from the National Drug Strategy Household Survey showed that, in 2019, 4.2% of Australians aged 14 and over reported non-medical, or extra-medical use of a pharmaceutical in the last 12 months (including pain killers/pain-relievers and opioids, tranquillisers/sleeping pills, steroids, or methadone/buprenorphine). This represents a decline in recent use, down from 4.8% in 2016 (AIHW 2020). This decline may in part be due to the rescheduling of codeine to a schedule 4 drug in February 2018, meaning that codeine could no longer be purchased from a pharmacy or chemist without a prescription. Between 2016 and 2019, codeine use halved (from 3.0% to 1.5%).
Pharmaceuticals are not listed as a broad drug group in the Australian Standard Classification of Drugs of Concern (ASCDC) classification. In the Alcohol and Other Drug Treatment Services National Minimum Dataset report, 10 drug types were identified as making up the group ‘pharmaceuticals’ for the purposes of this analysis: codeine, morphine, buprenorphine, oxycodone, methadone, benzodiazepines, steroids, other opioids, other analgesics, and other sedatives and hypnotics. Further information corresponding to the ASCDC codes and classifications is in Technical notes. Of these drugs, the most common classes are benzodiazepines and opioids (e.g., codeine).
Opioids
Opioids are a class of depressant drugs originally derived from the opium poppy, including both heroin and medicinal (pharmaceutical) opioids such as morphine and oxycodone. Pharmaceutical opioids are commonly prescribed for pain relief as they have strong analgesic effects; however, these drugs also produce effects including sedation and euphoria, and can be associated with negative health outcomes such as dependence and overdose (ADF 2020). Some people may purchase opioids illegally, or use their own medicine to become intoxicated; for example, by taking a higher dose than recommended.
Benzodiazepines
Benzodiazepines are depressant drugs: they slow down the activity of the central nervous system and the speed of messages going between the brain and the body. Formerly known as ‘minor tranquillisers’, benzodiazepines are most commonly prescribed by doctors to relieve stress and anxiety, and to aid sleep. They are a drug of dependence, and are associated with fatal and non-fatal overdose among people who use opioids. Some people use benzodiazepines illegally to become intoxicated or to come down from the effects of stimulants, such as amphetamines or cocaine (ADF 2013).
Over the 10-year period, the proportion of treatment episodes with a pharmaceutical drug as the principal drug of concern decreased from 7% (10,231 of episodes) in 2010–11 to 5% (9,904 episodes) in 2019–20 (Figure PHARMS1).
In 2019–20, among treatment episodes with a pharmaceutical as the principal drug of concern:
- the most common single drug type was benzodiazepines (2,736 episodes) and the most common drug class was opioids (4,942 episodes) (codeine, morphine, buprenorphine, methadone, oxycodone, and other opioids)
- opioids were the principal drug of concern in 3% (or 4,942) of all treatment episodes and an additional drug of concern in 3% of episodes (5,752)
- benzodiazepines were a principal drug of concern in 1% (2,736) of all treatment episodes and an additional drug of concern in 3% (7,158) of episodes (Table SD.9)
- the most common principal drugs of concern in combination with benzodiazepines as an additional drug of concern were cannabis (23%), alcohol (19%) or amphetamines (15%) (Table SD.7)
- opioids accounted for half (50%) of all pharmaceutical treatment episodes
- among treatment episodes with a pharmaceutical as the principal drug of concern, over one-quarter (28%) of episodes were for benzodiazepines and 11% were for both methadone and buprenorphine (Figure PHARMS2; Table SD.146).