Alcohol, tobacco & other drugs in Australia

Key findings

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The 2 most common subspecies within the cannabis genus from which cannabis is harvested are Cannabis sativa and Cannabis indica. Cannabis comes in 3 main forms:

• Herbal cannabis (also referred to as marijuana) – the dried leaves and flowers of the cannabis plant (the weakest form)
• Cannabis resin (hashish) – the dried resin from the cannabis plant
• Cannabis oil (hashish oil) – the oil extracted from the resin (the strongest form) (ACIC 2021a; NSW Ministry of Health 2017).

Cannabis is most commonly smoked in a rolled cigarette (joint) or water pipe, often in combination with tobacco, but it may also be added to food and eaten. Cannabis oil is generally applied to cannabis herb or tobacco and smoked, or heated and the vapours inhaled (ACIC 2021a).

The main psychoactive component of the cannabis plant is delta-9-tetrahydrocannabinol (THC). THC is highest in the flowering tops and leaves of the plant. Other than THC, cannabis has more than 70 unique chemicals that are collectively referred to as cannabinoids (ACIC 2018). Cannabis is a central nervous system depressant, but also alters sensory perceptions and may produce hallucinogenic effects when large quantities are used (ACIC 2018; NSW Ministry of Health 2017). The use of cannabis for medicinal purposes was legislated by the Australian parliament in 2016.

Synthetic cannabinoids are a new psychoactive substance that was originally designed to mimic or produce similar effects to cannabis (Alcohol & Drug Foundation 2017). The availability, consumption and harms associated with synthetic cannabis are discussed further in the section on new (and emerging) psychoactive substances (NPS).

Availability

Cannabis is relatively easy to obtain in Australia. Most participants in the Illicit Drug Reporting System (IDRS) and the Ecstasy and Related Drugs Reporting System (EDRS) report that cannabis is perceived as ‘easy’ or ‘very easy’ to obtain. This has remained relatively stable over time, as has perceived purity and pricing (Sutherland et al. 2022b; Sutherland et al. 2022a).

Perceived availability was the highest for hydroponic cannabis (92% of 2022 IDRS participants and 93% of 2022 EDRS participants rated it ‘easy’ or ‘very easy’ to obtain), followed by bush cannabis (81% of 2022 IDRS participants and 85% of 2022 EDRS participants perceived it ‘easy’ or ‘very easy’ to obtain) (Sutherland et al. 2022b; Sutherland et al. 2022a).

Data collection for 2022 took place from April–July for the EDRS and May–July for the IDRS. Due to COVID-19 restrictions being imposed in various jurisdictions during data collection periods for both the IDRS and the EDRS, interviews in 2020, 2021 and 2022 were delivered face-to-face as well as via telephone. This change in methodology should be considered when comparing data from the 2020, 2021 and 2022 samples relative to previous years.

The primary source of cannabis reported by people aged 14 years and over who had recently used cannabis was friends (65%), followed by dealers (17.9%) in 2019 (AIHW 2020, Table 4.101).

The Australian Criminal Intelligence Commission (ACIC) collects national illicit drug seizure data annually from federal, state and territory police services, including the number and weight of seizures to inform the Illicit Drug Data Report (IDDR).

According to the latest IDDR, in 2019–20, half (51%) of all national illicit drug seizures were for cannabis. However, cannabis only accounted for around a quarter (28%) of the weight of illicit drugs seized nationally. The number and weight of national cannabis seizures has increased over the last decade—the number of seizures increased from 50,073 in 2010–11 to a record 62,454 in 2019–20 and the weight seized increased from 5,452 kilograms in 2010–11 to a record 10,662 kilograms in 2019–20 (ACIC 2021a; tables S1.18 and S1.19).

The number of detections of cannabis at the Australian border increased between 2018–19 and 2019–20 by 15% (11,133 and 12,846, respectively). The number of detections has increased by 501% since 2010–11 (2,137).

The weight of cannabis detected at the Australian border increased from 69 kilograms in 2010-11 to 1,811 kilograms in 2018–19 before decreasing to 648 kilograms in 2019–20.

Consumption

Cannabis continues to be the world’s most widely used illicit drug; 4% of the global population aged 15–64 years (or approximately 200 million people) reported using cannabis at least once in 2019. ­The reported consumption of cannabis in the past year in Australia and New Zealand by the adult population in 2020 (12.1%) was higher than the global average of more than 4.0% (UNODC 2022).

The 2019 National Drug Strategy Household Survey (NDSHS) showed that cannabis continues to have the highest reported prevalence of lifetime and recent consumption among the general population, compared with other illicit drugs (AIHW 2020, tables 4.2 & 4.6). Note: for the first time in 2019, people who had used cannabis only for medicinal purposes and always had it prescribed by a doctor were identified and excluded from data relating to the recent use of cannabis, which focuses on illicit use (AIHW 2020). Data relating to the medicinal use of cannabis are reported separately (see Medicinal cannabis).

• For people aged 14 and over in Australia in 2019, 36% had used cannabis in their lifetime and 11.6% had used cannabis in the prior 12 months (Figure CANNABIS1).
• The lifetime use of cannabis has increased from 33% in 2001 while recent use of cannabis has decreased from 12.9%.
• Lifetime and recent use of cannabis increased significantly between 2016 and 2019 (up from 35% and 10.4% in 2016, respectively) (AIHW 2020, tables 4.41 and 4.43).

Figure CANNABIS1: Lifetimeᵃ or recentᵇ use of cannabis, people aged 14 and over, by age and sex, 2001 to 2019 (per cent)

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Cannabis use by age and sex

Since 2001, recent cannabis use has generally declined among the younger age groups (those aged 14–39), but has increased for the older age groups (40 or over).

• Compared with those in other age groups, people aged 20–29 continue to be the most likely to use cannabis but this declined from 29% in 2001 to 24% in 2019.
• Males aged 14 and over were more likely to have recently used cannabis (14.7%) than females (8.6%) (AIHW 2020, Table 4.43).

Between 2016 and 2019 there were significant increases in the use of cannabis among people aged 50–59 (from 7.2% to 9.2%) and 60 and over (from 1.9% to 2.9%) (Figure CANNABIS1; AIHW 2020, Table 4.43).

In 2001, the average age of cannabis users was 29 and this increased to 35 in 2019 (AIHW 2020). These results suggest there may be an ageing cohort of cannabis users.

Cannabis is used more frequently than other drugs such as ecstasy and cocaine. Specifically, 37% of people who used cannabis did so as often as weekly or more, compared with only 6.7% and 4.5% of ecstasy and cocaine users respectively. Males were more likely than females to use cannabis weekly (41% compared with 31%) (AIHW 2020).

Geographic trends

There was little change in the proportion of recent cannabis use between 2016 and 2019 for all states and territories, except New South Wales where it increased significantly from 9.3% to 11.0% (AIHW 2020, Table 7.14).

There was a significant increase in recent use of cannabis for people living in Major cities (from 10.4% in 2016 to 11.7% in 2019) (AIHW 2020, Table 7.15). However, after adjusting for differences in age, Australians living in Inner regional, Outer regional and Remote and very remote areas were more likely than those living in Major cities to have used cannabis in the previous 12 months (AIHW 2020).

For people living in areas of highest socioeconomic advantage, there was a significant increase in recent use of cannabis (from 9.4% in 2016 to 12.4% in 2019). Across other socioeconomic areas, at least 1 in 10 people had recently used cannabis (Figure CANNABIS2; AIHW 2020, Table 7.18).

Figure CANNABIS2: Recentᵃ use of cannabis, by remoteness area or socioeconomic area, people aged 14 and over, 2010 to 2019 (per cent)

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The National Wastewater Drug Monitoring Program (NWDMP) measures the presence of substances in sewerage treatment plants across Australia. Report 19 of the NWDMP expressed cannabis for the first time as daily doses per 1,000 people, this will allow cannabis consumption to be compared to other substances in the report with available dose data. Data on cannabis consumption has been recalculated back to August 2018. It should be noted that wastewater analysis cannot differentiate between prescribed and illicit use. For further information, see Box HARM2 and Data quality for the National Wastewater Drug Monitoring Program.

Data from report 19 of the NWDMP indicate:

• cannabis was the most consumed illicit drug in Australia, followed by methylamphetamine
• that the estimated population-weighted average consumption of cannabis in regional areas was twice as high as that in capital cities in December 2022 (ACIC 2023).

For state and territory data, see the National Wastewater Drug Monitoring Program reports.

Medicinal cannabis

In 2019, the NDSHS included 2 new questions regarding medical use of cannabis – if respondents had recently used cannabis for medical purposes, and whether the cannabis was prescribed by a doctor (AIHW 2020).

• Of people aged 14 and over who had used cannabis in the previous 12 months in 2019, 6.8% always used it for medical purposes and 16.3% used it for both medical and non-medical reasons.
• Of those who had recently used cannabis for medical purposes, 1.8% always obtained cannabis with a prescription and 2.1% sometimes did.
• When asked about their usual source, around half (51%) of people who had recently used cannabis medically said they normally obtained it from a friend, and 22% purchased it from a dealer (AIHW 2020).

Compared with people who did not use cannabis for medical purposes, people who had recently used cannabis for medical purposes only were:

• Typically older (43% aged 50 and over) than people who used cannabis non-medically (16%).
• More likely to live in the lowest socioeconomic areas (32% compared with 20%) and Inner regional areas (28% compared with 17.0%).
• More likely to experience chronic pain (53% compared with 6.9%), very high levels of psychological distress (27% compared with 9.7%) and poor or fair health (33% compared with 10.4%).
• Less likely to have recently used another illicit substance (20% compared with 44%) but more likely to smoke tobacco (51% compared with 39%).
• More likely to use cannabis daily or weekly (56% compared with 29%).
• More likely to use cannabis oil (23% compared with 4.5%), and less likely to use leaf (27% compared with 51%) (AIHW 2020).

Poly drug use

Poly drug use is defined as the use of mixing or taking another illicit or licit drug whilst under the influence of another drug. Cannabis use is also highly correlated with the use of tobacco, alcohol and other drugs. This makes measuring the effects of cannabis alone difficult and potentially increases risks for users.

The 2019 NDSHS showed that alcohol was the most common substance used concurrently with cannabis. Of those recent cannabis users who also consumed alcohol, 62% exceeded the single occasion risk guidelines at least monthly and 39% exceeded the lifetime risk guidelines (AIHW 2020, Table 1.3).

The most common other drugs concurrently used by recent cannabis users were:

• Tobacco (29%)
• Cocaine (25%)
• Ecstasy (19.7%)
• The non-medical use of pharmaceuticals (14.1%) (AIHW 2020, Table 1.3).

Data on alcohol and other drug-related ambulance attendances are sourced from the National Ambulance Surveillance System (NASS). Monthly data for 2021 are currently available for New South Wales, Victoria, Queensland, Tasmania and the Australian Capital Territory. It should be noted that some data for Tasmania and the Australian Capital Territory have been suppressed due to low numbers. Please see the data quality statement for further information.

In 2021, the proportion of cannabis-related ambulance attendances where multiple drugs were involved (excluding alcohol) ranged from 42% of attendances in Tasmania to 49% of attendances in Victoria (Table S1.10).

For related content on multiple drug involvement see Impacts: Ambulance attendances.

Harms

The effects of cannabis (like all drugs) vary from one person to another including, but not limited to, the amount consumed, the mode of administration, the user’s previous experience, mood and body weight (NSW Ministry of Health 2017). The active drug in cannabis makes its way into the bloodstream more quickly when cannabis is smoked, compared to when it is orally ingested. Ongoing and regular use of cannabis is associated with a number of negative long-term effects. Regular users of cannabis can become dependent and commonly reported symptoms of withdrawal include anxiety, sleep difficulties, appetite disturbance and depression (Hall & Degenhardt 2009; Nielsen & Gisev 2017).

An overview of some of the short and long-term effects of cannabis are provided in Table CANNABIS1.

Source: Adapted from (Hall & Degenhardt 2009; Nielsen & Gisev 2017; NSW Ministry of Health 2017).

Burden of disease and injury

The Australian Burden of Disease Study 2018, found that cannabis use contributed to 0.3% of the total burden of disease and injuries in 2018 and 10.2% of the total burden due to illicit drugs (AIHW 2021b; Table S2.5). Drug use disorders (excluding alcohol) (11%) contributed most to the burden due to cannabis use, followed by poisoning (10%). Only a small proportion (3% or less) of the burden of schizophrenia, anxiety disorders, road traffic injuries and depressive disorders was attributable to cannabis use (AIHW 2021).

Ambulance attendances

Data on alcohol and other drug-related ambulance attendances are sourced from the National Ambulance Surveillance System (NASS). Monthly data are presented in 2021 for people aged 15 years and over for New South Wales, Victoria, Queensland, Tasmania and the Australian Capital Territory.

In 2021, for cannabis-related ambulance attendances in these jurisdictions:

• Rates of attendances ranged from 85.3 per 100,000 population in New South Wales to 134.1 per 100,000 population in Tasmania.
• 3 in 5 (60%) of total attendances were for males.
• Ambulance attendances for cannabis are typically a younger cohort of people, with the highest rates of attendances in people aged 15–24. Rates of attendance ranged from:
  • 214.8 per 100,00 population in New South Wales (2,102 attendances), to
  • 341.3 per 100,000 population in the Australian Capital Territory (187 attendances) (Table S1.9).

Figure CANNABIS3: Ambulance attendances for cannabis, by age, sex and selected states and territories, 2021

Hospitalisations

Drug-related hospitalisations are defined as hospitalisations with a principal diagnosis relating to a substance use disorder or direct harm relating to use of selected substances (AIHW 2018).

AIHW analysis of the National Hospital Morbidity Database showed that cannabinoids (including cannabis) accounted for around 1 in 20 drug-related hospitalisations in 2021–22 (5.1% or 6,900 hospitalisations). This represents a rate of 26.6 cannabinoid-related hospitalisations per 100,000 population (Table S1.12c). 

In 2021–22:

• Almost 2 in 3 cannabinoid-related hospitalisations involved an overnight stay (64% or 4,400 hospitalisations), while the remainder ended with a same-day discharge. 
• Males were more likely than females to be hospitalised; almost 2 in 3 cannabinoid-related hospitalisations (62% or 4,200 hospitalisations)
• Over 1 in 3 cannabinoid-related hospitalisations were people aged 15–24 years old (35% or 2,400 hospitalisations) (Table S1.12a–12c).
• Over 2 in 3 cannabinoid-related hospitalisations occurred in Major cities (69% or 4,700 hospitalisations).
• When accounting for differences in population size, the rate of hospitalisations was highest in Remote and very remote areas (69.7 hospitalisations per 100,000 population, compared with 25.6 per 100,000 in Major cities) (Table S1.14).

In the 7 years to 2021–22:

• The number of hospitalisations for cannabinoids increased between 2015–16 and 2021–22 (from 6,000 to 6,900 hospitalisations), peaking at 7,500 in 2020–21.
• Accounting for population growth, the rate of cannabinoid-related hospitalisations was relatively stable between 2016–17 and 2020–21 at about 24-27 hospitalisations per 100,000 people. The only deviation was in 2020–21 when it peaked at 29.2 per 100,000 population.
• The rate of cannabinoids-related hospitalisations was highest in Remote and Very remote areas and increased from 2015–16 (41.0 per 100,000) to 2021–22 (69.7 per 100,000), peaking in 2019–20 (76.1 per 100,000)  (Table S1.14; Figure IMPACT5). 

Population estimates used to calculate rates for 2020–21 may have been impacted by public health measures introduced during the COVID-19 pandemic. See the Technical notes for more information.

Deaths

Drug-induced deaths are determined by toxicology and pathology reports and are defined as those deaths that can be directly attributable to drug use. This includes deaths due to acute toxicity (for example, drug overdose) and chronic use (for example, drug-induced cardiac conditions) (ABS 2021).

Australian Institute of Health and Welfare (AIHW) analysis of the AIHW National Mortality Database showed that in 2021, cannabinoids were present in 4.5% (or 76) of all drug-induced deaths, a decrease from 5.9% (109 deaths) in 2020 (Table S1.1).

The short-term effects of cannabis can increase the risk of road traffic crashes, largely due to diminished driving performance in response to emergencies (Hall & Degenhardt 2009). In 2016, cannabis was the second most common drug identified on toxicology for transport accidents where a drug (excluding alcohol) contributed to death (ABS 2017).

Treatment

The AODTS NMDS provides information on treatment provided to clients by publicly funded AOD treatment services, including government and non-government organisations.

In 2021–22, where cannabis was the principal drug of concern:

• Over 3 in 5 (62%) of clients were male and 1 in 5 (20%) were Indigenous Australians (AIHW 2023, tables SC.9 and SC.11).
• Two-thirds (66%) of clients were aged 10–29 (AIHW 2023, Table SC.10).
• The most common source of referral was a health service and self/family (both 29% of treatment episodes), followed by diversion from the criminal justice system (20%) (AIHW 2023, Table Drg.28).
• Counselling was the most common main treatment type (47% of treatment episodes), followed by assessment only (16%) (AIHW 2023, Table Drg.27; Figure CANNABIS4).
• The median treatment duration for cannabis was 26 days (AIHW 2023, Table Drg.30).

Figure CANNABIS4: Treatment provided for own use of cannabis, 2021–22

Source: AIHW 2023, tables Drg.1, SC.11 and Drg.27.

Where the most common drug of concern was cannabis, the proportion of people living in Regional and remote areas who travelled 1 hour or longer to treatment services was higher than in Major cities (25% compared with 7%) (AIHW 2019).

At-risk groups

The use of cannabis can be disproportionately higher for specific population groups.

• Marijuana, hashish or cannabis resin is the most commonly reported illicit drug used by Aboriginal and Torres Strait Islander people.
• The highest recorded number of arrests were those relating to cannabis and high proportions of police detainees and prison entrants recently used cannabis.
• Cannabis is the most commonly used illicit substance among adolescents aged 12–17.
• Cannabis is the most frequently used illicit drug for people who inject drugs.

Policy context

Public perceptions and policy support

There have been changes over time in public perceptions of cannabis use in Australia. Data from the 2019 NDSHS showed:

• There was a significant decrease in the proportion of Australians reporting cannabis as the first drug they thought of when asked about a drug problem – 12.4% in 2019 compared with 14.6% in 2013.
• Only 2.2% thought that cannabis caused the most concern to the general community.
• Personal approval of cannabis use by an adult increased significantly from 14.5% in 2016 to 19.6% in 2019 (AIHW 2020).

There have also been some associated changes in public perceptions about cannabis-related policies. For example:

• The majority of Australians aged 14 years and over (78%) do not support the possession of cannabis being a criminal offence, which is significantly higher than the 74% reported in 2016 (AIHW 2020, Table 9.15)
• 2 in 5 (41%) support the legalisation of cannabis for personal use (AIHW 2020, Table 9.26)