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  • Data source: Aboriginal & Torres Strait Islander health organisations: AOD treatment services 28 Jun 2017

    In relation to substance-use issues, Aboriginal and Torres Strait Islander primary health-care services provide:

    • health care, including extended care roles (for example, diagnosis and treatment of illness and disease, 24-hour emergency care, dental/hearing/optometry services)
    • preventive health care (for example, health screening for children and adults),
    • health-related community support (for example, school-based activities, transport to medical appointments), and
    • support.

    Information on the majority of Australian Government-funded Aboriginal and Torres Strait Islander substance use services are available from the Online Services Report (OSR) data collection. While the number of treatment episodes for Aboriginal and Torres Strait Islander people is reported through the Alcohol and Other Drug Treatment Services National Minimum Data Set (AODTS NMDS), it does not represent all alcohol and other drug treatments provided to Indigenous people in Australia. The OSR and AODTS NMDS have different collection purposes, scope and counting rules (see Box 1 for details).

    Key data from the 2015–16 OSR relevant to substance-use issues are provided below.

    Substance use issues

    The 5 most common substance-use issues reported by organisations providing substance-use services in 2015–16, in terms of staff time and organisational resources, were alcohol, cannabis or marijuana, amphetamines, multiple drug use and tobacco or nicotine (Table 1). In 2015–16, all of the 80 organisations reported alcohol as one of their 5 most common substance-use issues and almost all (94%) reported cannabis or marijuana. Organisations reporting amphetamines as a common substance-use issue increased from 45% in 2013–14 to 70% in 2014–15, and increased again to 79% in 2015–16. This pattern was consistent across remoteness areas.

    Table 1: Number of organisations reporting common substance-use issues, by remoteness area, 2015–16
    Substance use issu6 Major
    cities
    Inner regional Outer regional Remote Very
    remote
    Total
    Alcohol 16 14 19 16 15 80
    Cannabis/marijuana 13 13 18 16 15 75
    Amphetamines 15 13 17 10 8 63
    Multiple drug use 12 10 14 7 6 49
    Tobacco/nicotine 6 8 12 9 11 46

    Note: Organisations were asked to report on their 5 most important substance-use issues in terms of staff time and organisational resources.

    Source: Australian Institute of Health and Welfare (AIHW) 2017. Aboriginal and Torres Strait Islander health organisations: Online Services Report—key results 2015–16. Aboriginal and Torres Strait Islander health services report No. 8. Cat. no. IHW 180. Canberra: AIHW.

    Substance-use services

    In 2015–16, OSR substance-use services provided:

    • around 170,370 episodes
    • to around 32,740 clients
    • by 80 organisations (Table 2).
    Table 2: Number of substance-use organisations, clients and episodes, by remoteness area, 2015–16
      Organisations
    No.
    Organisations
    %
    Clients
    No.
    Clients
    %
    Episodes
    No.
    Episodes
    %
    Major cities 16 20.0 11,297 34.5 46,360 27.2
    Inner regional 14 17.5 2,149 6.6 13,727 8.1
    Outer regional 19 23.8 5,217 15.9 30,698 18.0
    Remote 16 20.0 9,248 28.2 25,091 14.7
    Very remote 15 18.8 4,829 14.7 54,494 32.0
    Total 80 100.0 32,740 100.0 170,370 100.0

    Notes

    1. Client numbers for 2012–13 and 2013–14 have been revised down due to data quality issues discovered in this year’s collection that were also occurring in these years. Errors in the data extracted from the PIRS of a few primary health-care organisations were found.
    2. In 2014–15, the reporting period was 1 June 2014 to 31 May 2015. Before 2014–15, it was the financial year from 1 July to 30 June.

    Source: Australian Institute of Health and Welfare (AIHW) 2017. Aboriginal and Torres Strait Islander health organisations: Online Services Report—key results 2015–16. Aboriginal and Torres Strait Islander health services report No. 8. Cat. no. IHW 180. Canberra: AIHW.

    By remoteness area:

    • Nearly one-quarter (24%) of organisations were located in Outer regional areas, while one-fifth were in both Remote areas (20%)and Major cities (20%).
    • Organisations in Outer regional areas provided services to around 5,200 (16%) clients, while organisations in Very remote areas provided services to around 4,800 (15%) clients.

    Substance use treatment

    Substance-use organisations provide treatment and assistance through residential treatment programs, sobering-up services and non-residential programs. In 2015–16:

    • just over half of clients (54%) receiving treatment were male
    • most episodes of care (87%) were for non-residential services (e.g. counselling), and male and female clients were equally likely to seek this type of treatment (a change from previous years, when female clients were slightly more likely to seek this type of treatment)
    • around 18,400 episodes of care (11%) were provided to clients accessing sobering-up services (overnight residential care, with no formal rehabilitation)
    • 8% of clients received treatment in a residential service (temporary live-in accommodation for formal substance-use treatment and rehabilitation) (Table 3).
    Table 3: Estimated number of clients and episodes of care, by sex and treatment type, 2015–16
    Treatment type Male
    No.
    Male
    %
    Female
    No.
    Female
    %
    Unknown
    No.
    Unknown
    %
    Total
    No.
    Total
    %
    Clients                
    Residential 1,984 9.9 782 4.7 78 11.0 2,844 7.6
    Sobering-up 3,983 19.9 4,095 24.6 2 0.3 8,080 21.6
    Non-residential 14,084 70.2 11,751 70.7 632 88.8 26,467 70.8
    Total 20,051 53.6 16,628 44.5 712 1.9 37,391 100.0
    Episodes                
    Residential 2,200 2.5 894 1.1 79 6.0 3,173 1.9
    Sobering-up 9,586 11.0 8,767 10.8 2 0.2 18,355 10.8
    Non-residential 75,725 86.5 71,888 88.2 1,229 93.8 148,842 87.4
    Total 87,511 51.4 81,549 47.9 1,310 0.8 170,370 100.0

    Note: Client numbers will differ to those presented in Table 2 as clients may be counted more than once if they attended multiple programs. In addition, data from some organisations have been excluded due to data quality issues.

    Source: Australian Institute of Health and Welfare (AIHW) 2017. Aboriginal and Torres Strait Islander health organisations: Online Services Report—key results 2015–16. Aboriginal and Torres Strait Islander health services report No. 8. Cat. no. IHW 180. Canberra: AIHW.

    Box 1: Comparison of treatment episode definitions in the OSR and AODTS NMDS

    The OSR definition of ‘episode of care’ starts at admission and ends at discharge (for residential treatment/rehabilitation and sobering-up/respite). ‘Other care’ refers to non-residential programs where the definition of ‘episode of care’ relates more to the number of visits or phone calls undertaken with clients. In contrast to the definition of ‘closed treatment episode’ used in the AODTS NMDS, the definition used in this collection does not require agencies to begin a new ‘episode of care’ when the main treatment type (‘treatment type’) or primary drug of concern (‘substance/drug’) changes. It is therefore likely that this concept of ‘episode of care’ produces smaller estimates of activity than the AODTS NMDS concept of ‘closed treatment episode’.

    The OSR collection, managed by the AIHW, records information about clients of any age, whereas the AODTS NMDS reports only about clients aged 10 and over.

    These differences mean that the two collections are not directly comparable.

  • Data source: Drug related hospitalisations 28 Jun 2017

    Information on hospitalisations is taken from the National Hospital Morbidity Database (NHMD). This database includes almost all public hospitals that provided data for the NHMD in 2015–16. The exception was an early parenting centre in the Australian Capital Territory. The great majority of private hospitals also provided data, the exceptions being the private free-standing day hospital facilities in the Australian Capital Territory. Further information can be found in Admitted patient care 2015–16: Australian hospital statistics.

    Number of drug-related separations

    Drugs described in this section include legal, accessible drugs such as alcohol and tobacco, drugs that are available by prescription or over the counter, such as analgesics and antidepressants, and drugs that are generally not obtained through legal means, such as heroin and ecstasy. Therefore, a proportion of the separations reported here may result from harm arising from the therapeutic use of drugs, and the inclusion of therapeutic use in these data may mean the burden on the hospital system appears larger than expected.

    In 2015–16:

    • there were about 10.6 million separations in Australia’s public and private hospitals
    • about 135,000 hospital separations with a drug-related principal diagnosis were reported in 2015–16 (Table 1), which represents 1% of all hospital separations, a similar proportion to previous years
    • sedatives and hypnotics continued to account for the highest proportion of hospital separations with a drug-related principal diagnosis (58% of all such separations), with alcohol making up 87% of separations for sedatives and hypnotics
    • on its own, alcohol accounted for 50% of all drug-related hospital separations
    • of all separations with a drug-related principal diagnosis, 13% were for analgesics, with opioids (heroin, opium, morphine and methadone) accounting for half of this group (6.6% of all drug-related separations)
    • stimulants and hallucinogens, including cannabis and cocaine, accounted for 17% of all separations where the principal diagnosis was drug-related
    • overnight separations continued to be more common for drug-related treatment than same-day separations, accounting for 59% of all drug-related separations.

    Definitions

    A hospital separation refers to a completed episode of admitted hospital care ending with discharge, death, transfer or a portion of a hospital stay beginning or ending in a change to another type of care (for example, from acute care to rehabilitation). The hospital separations data do not include episodes of non-admitted patient care provided in outpatient clinics or emergency departments. Patients in these settings may be admitted subsequently, with the care provided to them as admitted patients being included in the NHMD.

    Drug-related separations refer to hospital care with selected principal diagnoses (that is, the diagnosis established to be chiefly responsible for occasioning an episode of admitted patient care) of substance-use disorder or harm (all forms of harm, for example, accidental, intended or self-inflicted) due to selected substances (see Hospital separations data). Hospital separations where the diagnosis of drug-related harm or disorder is additional to the principal diagnosis such as problems related to certain chronic conditions caused by the use of drugs like tobacco and alcohol have been excluded.

    Separations can be either same-day (where the patient is admitted and separated on the same day) or overnight (where the patient is admitted to hospital and separates on a different date).

    Table 1: Hospital separations by drug-related principal diagnosis and duration, 2015–16
    Drug-related principal diagnosis Same day separations No. Same day separations % Overnight separations No. Overnight separations % Total separations No. Total separations %
    Analgesics            
    Opioids (includes opium, heroin and methadone) 3,430 6.3 5,474 6.8 8,904 6.6
    Non-opioid analgesics (includes paracetamol) 2,485 4.5 6,060 7.6 8,545 6.3
    Total analgesics 5,915 10.8 11,534 14.4 17,449 12.9
    Sedatives and hypnotics          
    Alcohol 31,737 57.9 36,502 45.5 68,239 50.5
    Other sedatives and hypnotics 3,492 6.4 6,365 7.9 9,857 7.3
    Total sedatives and hypnotics 35,229 64.2 42,867 53.5 78,096 57.8
    Stimulants and hallucinogens          
    Cannabinoids (includes cannabis) 2,029 3.7 3,991 5.0 6,020 4.5
    Hallucinogens (includes LSD) 129 0.2 134 0.2 263 0.2
    Cocaine 495 0.9 281 0.4 776 0.6
    Tobacco and nicotine 22 50 0.1 72 0.1
    Other stimulants (includes amphetamines) 5,037 9.2 11,360 14.2 16,397 12.1
    Total stimulants and hallucinogens 7,712 14.1 15,816 19.7 23,528 17.4
    Antidepressants and antipsychotics 2,711 4.9 6,393 8.0 9,104 6.7
    Volatile solvents 390 0.7 428 0.5 818 0.6
    Other and unspecified drugs of concern        
    Multiple drug use 2,827 5.2 2,822 3.5 5,649 4.2
    Unspecified drug use and other drugs not elsewhere classified 70 0.1 282 0.4 352 0.3
    Total other and unspecified drugs of concern 2,897 5.3 3,104 3.9 6,001 4.4
    Fetal and perinatal related conditions 2 3 5
    Total 54,856 100.0 80,145 100.0 135,001 100.0

    Note: Separations with a care type of ‘Newborn’ (without qualified days), and records for ‘Hospital boarders’ and ‘Posthumous organ procurement’ have been excluded.

    Source: AIHW analysis of the NHMD 2015–16.

    Trends in drug-related separations

    The total number of drug-related hospital separations has increased from 110,060 in 2011–12 to 135,001 in 2015–16. At the same time, total hospital separations have increased, with drug-related hospital separations consistently making up about 1% of all hospital separations across this 5-year period.

    Alcohol has consistently been the drug-related principal diagnosis with the highest number of hospital separations from 2011–12 to 2015–16, with the number of separations increasing from 61,913 to 68,239 in that time.

    Table 2: Hospital separations by drug-related principal diagnosis, 2011–12 to 2015–16
    Drug of concern diagnosis 2011–12 2012–13 2013–14 2014–15 2015-16
    Analgesics          
    Opioids 7,424 7,438 8,153 8,365 8,904
    Non-opioid analgesics 7,031 7,525 7,301 7,579 8,545
    Sedatives and hypnotics  
    Alcohol 61,913 62,359 64,248 65,701 68,239
    Other sedatives and hypnotics 9,896 8,919 8,717 9,173 9,857
    Stimulants and hallucinogens  
    Cannabinoids 4,053 4,314 4,991 5,550 6,020
    Hallucinogens 150 215 214 241 263
    Cocaine 284 444 523 827 776
    Tobacco and nicotine 59 60 84 77 72
    Other stimulants 5,814 7,001 8,548 12,190 16,397
    Antidepressants and antipsychotics 7,907 7,924 7,827 8,264 9,104
    Volatile solvents 842 805 884 901 818
    Other and unspecified drugs of concern  
    Multiple drug use 4,365 4,580 4,564 5,294 5,649
    Unspecified drug use and other drugs not elsewhere classified 297 299 256 295 352
    Fetal and perinatal conditions 25 27 27 26 5
    Total 110,060 111,910 116,337 124,483 135,001
    Rate of separation(a) (per 100,000 population) 489 488 499 527 562
    1. Crude rate is based on the Australian estimated resident population as at 31 December of the reference year.

    Note: Separations with a care type of ‘Newborn’ (without qualified days), and records for ‘Hospital boarders’ and ‘Posthumous organ procurement’ have been excluded.

    Source: AIHW analysis of the National Hospital Morbidity Database 2015–16.

    Hospital separations data

    The hospital separation data included in this report were extracted from the AIHW National Hospital Morbidity Database using a selection of codes from the International statistical classification of diseases and related health problems, 10th revision, Australian modification 8th edition (ICD-10-AM) (NCCC 2012) (see Table 3).

    Table 3: Relationship between the drug of concern and the ICD-10-AM codes
    Drug of concern identified in principal diagnosis ICD-10-AM codes
    Analgesics Opioids (includes heroin, opium, morphine and methadone) F11.0–11.9, T40.0–40.4
    Non-opioid analgesics (includes paracetamol) F55.2, T39.0, T39.1, T39.3, T39.4, T39.8, T39.9,
    Sedatives & hypnotics Alcohol (includes ethanol) E52, F10.0–10.9, G31.2, I42.6, K29.2, K70.0–70.9, K85.2, K86.0, T51.0–51.9, Z71.4
    Other sedatives and hypnotics (includes barbiturates and benzodiazepines; excludes ethanol) F13.0–13.9, T41.2, T42.3–42.8
    Stimulants and hallucinogens Cannabinoids (includes cannabis) F12.0–12.9, T40.7
    Hallucinogens (includes LSD) F16.0–16.9, T40.8, T40.9
    Cocaine F14.0–14.9, T40.5
    Tobacco and nicotine F17.0–17.9, T65.2, Z58.7, Z71.6
    Other stimulants (includes amphetamines and caffeine) F15.0–15.9, T40.6, T43.6, T46.0, T46.3
    Antidepressants and antipsychotics Antidepressants and antipsychotics F55.0, T43.0–43.5
    Volatile solvents Volatile solvents F18.0–18.9, T52.0–52.9, T53.0–9, T59.0, T59.8
    Other and unspecified drugs of concern Multiple drug use F19.0–19.9
    Unspecified drug use and other drugs not elsewhere classified (includes psychotropic drugs not elsewhere classified; diuretics; anabolic and androgenic steroids and opiate antagonists) F55.1, F55.3–6, F55.8, F55.9, N14.1–3, T38.7, T43.8–9, T50.1–3, T50.7, Z71.5
    Fetal and perinatal related conditions Fetal and perinatal related conditions (includes conditions caused by the mother’s alcohol, tobacco or other drug addiction) P04.2–4, Q86.0

    Note: Data for 2015–16 were reported to the NHMD using the ICD-10-AM.

    References

    1. NCCC (National Casemix and Classification Centre) 2012. International statistical classification of diseases and related health problems, 10th revision, Australian modification (ICD-10-AM) (ACCD 2014), incorporating the Australian Classification of Health Interventions (ACHI) (ACCD 2015) and Australian Coding Standards (ACS), 9th edition. Wollongong: NCCC.
  • Data source: Specialist Homelessness Services: drug and alcohol-related issues 28 Jun 2017

    The Specialist Homelessness Services Collection (SHSC) describes all clients who receive services from specialist homelessness agencies and the assistance they receive, including clients with an alcohol and other drug issue. A client is identified as having a current alcohol and other drug issue in the SHSC if they provide any of the following information:

    • Their formal referral source to the specialist homelessness agency was a 'drug and alcohol service'.
    • They reported 'problematic drug or substance use' or 'problematic alcohol use' as a reason for seeking assistance.
    • At some stage during their support period, a need was identified, a service provided or they were referred for 'drug/alcohol counselling'.
    • They reported they had been in a rehabilitation facility in the last 12 months or if in the week before presenting at a service, the client's residence or dwelling was 'rehabilitation'.

    In addition to supporting clients who are homeless, a key aim of specialist homelessness services is to prevent homelessness from occurring among those who find themselves at risk of becoming homeless. Services provided by Specialist Homelessness Services (SHS) agencies include accommodation and associated support services.

    Data notes

    Weighted SHSC data are presented from the 2014–15 reporting period onwards. This has changed from previous reports in this series, where SHSC data were unweighted. The weighted data presented here are not directly comparable to unweighted data that have been reported previously. Therefore, some trends using weighted data have been reported here to provide direct comparisons to previous years. Further information (including weighting methodology) on the SHSC and reports from the collection are available at Technical information and glossary.

    SHS clients

    In 2015–16, there were around 230,000 SHS clients aged 10 years or over, and of these 11% (26,505) were clients with a current alcohol and other drug issue. This proportion has remained relatively stable since the SHSC commenced in 2011–12 (Table SHSC 1).

    Table SHSC 1: SHS clients with a current drug and alcohol issue, 2011–12 to 2015–16
    Reporting year Number of clients with an AOD issue(a) Proportion of all clients(a)
    2015–16 26,505 11%
    2014–15 24,225 11%
    2013–14 23,253 11%
    2012–13 22,543 11%
    2011–12 23,016 12%

    Source: AIHW analyses of SHSC, 2015–16.

    1. Clients aged 10 years and over.

    Note: Data are weighted for all years for comparability.

    For clients with a current alcohol and other drug issue, in 2015–16:

    • just over half (53%) were aged 20–39 (Table SHSC 2)
    • just over half (55%) were male—much higher than for clients without a current alcohol and other drug issue (36%) (Table SHSC 2)
    • about one-quarter (27%) were Indigenous Australians, compared with 20% for clients without a current alcohol and other drug issue (Table SHSC 2)
    • the most common living arrangement was 'lone person' (55%)—much higher than for clients without a current alcohol and other drug issue (32%).
    • while one-third (33%) had no formal referral, the most frequently recorded source of formal referral to SHS agencies where specific information was provided was a specialist homelessness agency/outreach worker (15%), followed by referrals from drug and alcohol services (5%)
    • more than half (58%) reported an episode of homelessness in the 12 months before presenting, compared to 35% of those clients without a current alcohol and other drug issue.

    These results have remained relatively consistent over time, although there were increases in the proportion of clients reporting episodes of homelessness in the 12 months before presenting for service-for both clients with and without a current alcohol and other drug issue. The proportion of clients with a current alcohol and other drug issue reporting an episode of homelessness in the previous 12 months was stable from 2011–12 to 2013–14—between 50 and 51% of clients with a current alcohol and other drug issue—however, this increased to 58% in 2014–15 and 2015–16.

    Table SHSC 2: SHS clients with and without a current drug and alcohol issue, demographic characteristics, 2015–16
    Client demographics % with a current issue % without a current issue
    Age
    10–19 14.7 20.6
    20–29 25.7 23.7
    30–39 27.5 22.1
    40–49 21.4 18.0
    50–59 8.4 9.6
    60+ 2.4 6.0
    Sex
    Male 55.0 36.4
    Female 45.0 63.6
    Indigenous status
    Indigenous 26.7 19.5
    Non-Indigenous 69.6 63.6
    Not stated 3.7 10.3
    Total (number) 26,505 206,903

    Source: AIHW analyses of SHSC, 2015–16.

    Service use

    For clients with a current alcohol and other drug issue, in 2015–16:

    • about one-quarter (26%) recorded 'housing crisis' as their main reason for seeking assistance, followed by 'inadequate or inappropriate dwelling conditions' (11%) and 'domestic and family violence' (11%)—11% reported their alcohol or drug or substance use as their main reason for seeking assistance.
    • while 26% received services relating to drug and alcohol counselling (either provided directly by the agency, or where a referral was arranged), it accounted for only 2% of all services provided.
    • in total about 270,000 services were provided or a referral was arranged—just over 7 out of 10 (73%) of these services related to general support and assistance (e.g. advice and information not directly related to housing/accommodation services)
    • Clients with a current drug and alcohol issue required longer support periods on average, just over half (55%) received 90 days of support or fewer and just over 1 in 4 (26%) clients received over 180 days of support.
    • By comparison, clients without a current alcohol and other drug use had fewer days of support—59% of clients received 45 days or less of support and nearly 1 in 8 (13%) received over 180 days of support
    • Clients with a current drug and alcohol issue required more support periods, over three-quarters (77%) received between 1 and 3 support periods and 11% received 6 or more support periods. In contrast, the vast majority (94%) of clients without a current alcohol and other drug use received between 1 and 3 support periods, and only 2% received 6 or more support periods (Figure SHSC 1).

    Note, the number of clients reporting 'housing crisis' has changed substantially from 16% in 2013–14. This change was influenced by changes to client management systems in the collection for the 2014–15 reporting period.

    For clients with a current alcohol and other drug issue in the following housing situations at the beginning of support: 'no shelter or living in improvised dwellings', 'living in a house, townhouse or flat as a 'couch surfer' with no tenure':

    • around 2 in 5 (42%) were still in the same housing situation at the end of their closed support period
    • Just over one-fifth (22%) were housed in either public or community housing or private housing (10% and 12% respectively) and nearly one-fifth (19%) were housed in short-term accommodation at the end of their closed support period
    • 4% were in an institutional setting at the end of their closed support period.

    The picture was slightly different for those clients without a current alcohol and other drug issue who had no shelter or tenure at the beginning of their homelessness support period:

    • A larger proportion (49%) were still without shelter or tenure at the end of their support
    • A larger proportion (27%) were housed in either public or community housing or private housing (10% and 17% respectively) and 12% were housed in short-term accommodation at the end of their support
    • A smaller proportion (1%) were in an institutional setting (e.g. hospital, disability support, adult correctional facility, youth justice detention centre, immigration detention centre) at the end of their support period.

    Figure SHSC 1: SHS clients with and without a current drug and alcohol issue, number of support periods, 2015–16

    •11%25 of Specialist Homelessness Services (SHS) clients aged 10 years or over had a current alcohol and other drug issue

    Source: AIHW analyses of SHSC, 2015–16.

    For clients with a current alcohol and other drug issue in the following housing situations at the beginning of support: 'no shelter or living in improvised dwellings', 'living in a house, townhouse or flat as a 'couch surfer' with no tenure':

    • around 1 in 3 (35%) were still in the same housing situation at the end of their closed support period
    • nearly one-quarter (23%) were housed in either public or community housing or private housing (10% and 13% respectively) and nearly one-sixth (17%) were housed in short-term accommodation at the end of their closed support period
    • 4% were in an institutional setting at the end of their closed support period (e.g. hospital, disability support, adult correctional facility, youth justice detention centre, immigration detention centre).

    The picture was slightly different for those clients without a current alcohol and other drug issue who had no shelter or tenure at the beginning of their homelessness support period:

    • A larger proportion (46%) were still without shelter or tenure at the end of their support
    • A larger proportion (28%) were housed in either public or community housing or private housing (10% and 18% respectively) and 12% were housed in short-term accommodation at the end of their support
    • A smaller proportion (1%) were in an institutional setting at the end of their support period.