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Australian Institute of Health and Welfare. (2021). Alcohol, tobacco & other drugs in Australia. Retrieved from https://www.aihw.gov.au/reports/alcohol/alcohol-tobacco-other-drugs-australia
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Australian Institute of Health and Welfare (AIHW) 2021, Alcohol, tobacco & other drugs in Australia, viewed 20 October 2021, https://www.aihw.gov.au/reports/alcohol/alcohol-tobacco-other-drugs-australia
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In Australia, pharmaceutical drugs are available via a prescription from a registered healthcare professional or over-the-counter (OTC) from a pharmacy, and are widely used to prevent, treat and cure injury and illness. When used appropriately, pharmaceutical drugs are associated with considerable reductions in morbidity and mortality and are an important pillar of public health. However, pharmaceutical drugs are subject to misuse.
Pharmaceutical non-medical use refers to the consumption of a prescription or over-the-counter drug for non-therapeutic purposes or other than directed by a registered healthcare professional (Larance et al. 2011). Common pharmaceuticals used for non-medical purposes in Australia include opioids and benzodiazepines (see Box PHARMS1 for more information). People may misuse pharmaceutical drugs for a range of reasons including to induce euphoria, to enhance the effects of alcohol and other drugs, to self-medicate illness or injury, to mitigate the symptoms of withdrawal from alcohol and other drugs, or to improve performance.
The non-medical use of pharmaceutical drugs is an ongoing concern internationally
The rate of prescription opioids dispensed increased from 2012–13 to 2015–16, before steadily declining to 2019–20
In 2019, nearly 1 in 25 (4.2%) Australians aged 14 and over reported the non-medical use of pharmaceuticals in the previous 12 months
Pharmaceutical pain-killers/pain-relievers and opioids (excluding over-the-counter) are the most common pharmaceuticals used for non-medical purposes
Between 2015–16 and 2019–20, the rate of hospitalisations for both benzodiazepines and opioids decreased
Between 1997 and 2019, the rate of deaths where benzodiazepines were present rose from 1.9 per 100,000 population to 3.3 per 100,000 population
View the Non-medical use of pharmaceutical drugs in Australia fact sheet >
In Australia, pharmaceutical drugs that are most often subject to non-medical use are opioids (painkillers/analgesics) and sedatives (sleeping/anti-anxiety medications).
Pharmaceutical opioids are used to treat pain and opioid (including heroin) dependence and examples include oxycodone, buprenorphine and codeine.
Sedatives are a group of drugs that cause calming and sedative effects due to their depressive activity on the central nervous system. Benzodiazepines comprise the largest group of drugs in this class and examples include diazepam, alprazolam and temazepam.
The non-medical use of pharmaceutical drugs is an ongoing concern internationally, with different pharmaceutical opioids being misused in different regions.
In Australia in 2019, past-year use of opioids (including the use of opiates and the use of pharmaceutical opioids for non-medical purposes), was 3.3% of the population aged 14 and over. This is higher than the global average (1.2% of the global population aged 15–64 years). In 2019, the majority of pharmaceutical misuse in Australia continued to be for codeine (UNODC 2021).
Dramatic increases in opioid-related deaths associated with rising use in the US have led to the problem being declared an 'epidemic' (CDC 2017; U.S. Department of Health & Human Services 2017). In the US in 2019, 3.6% of the population aged 12 and older had misused pharmaceutical opioids at least once in the past year (UNODC 2021).
Data from the Pharmaceutical Benefits Scheme (PBS) indicate that approximately 15.2 million opioid prescriptions were dispensed to 3.1 million patients in 2019–20 (Figure PHARMS1; Tables S2.7a and S2.8a). Oxycodone was the most commonly dispensed opioid (5.2 million prescriptions dispensed), but more patients were dispensed codeine (1.7 million patients) than oxycodone (1.2 million). This suggests that there was a higher number of PBS prescriptions dispensed per patient for oxycodone than codeine.
Between 2012–13 and 2015–16, there was an increase in the age-standardised rate of opioid prescriptions dispensed (from 53,801 per 100,000 to 58,485) and the rate of patients who received a PBS supply of an opioid (from 12,126 per 100,000 to 12,686). This trend then reversed, decreasing to 53,427 scripts dispensed per 100,000 and 11,480 patients per 100,000 in 2019–20.
Dispensing of prescription opioids may have been affected by recent policy changes. Please refer to the Policy context section for more information.
PBS data indicate that dispensing of prescription benzodiazepines is also common. In 2019–20, approximately 5.5 million benzodiazepine prescriptions were dispensed to 1.5 million patients (Figure PHARMS1; Tables S2.7a and S2.8a). Diazepam was the most common benzodiazepine dispensed in 2019–20 (2.5 million prescriptions dispensed), and there were also more patients who received a PBS supply of diazepam than for other benzodiazepines (787,000 patients).
Between 2012–13 and 2019–20, there was a steady decrease in the age-standardised rate of benzodiazepine prescriptions dispensed (from 26,496 per 100,000 in 2012–13 to 19,533 in 2019–20) and the rate of patients who were dispensed a benzodiazepine (from 6,480 per 100,000 in 2012–13 to 5,573 in 2019–20). However, dispensing varied across benzodiazepine drugs over time.
Dispensing of prescription benzodiazepines may have been affected by recent policy changes. Please refer to the Policy context section for more information.
This figure shows that the rate of opioid scripts dispensed increased from 53,801 per 100,000 population in 2012–13 to 58,485 per 100,000 in 2015–16, before declining to 53,427 per 100,000 in 2019–20. The rate of benzodiazepine scripts dispensed steadily decreased from 26,496 per 100,000 population in 2012–13 to 19,533 per 100,000 in 2019–20.
View data tables >
The Australian Criminal Intelligence Commission’s (ACIC) Illicit Drug Data Report includes data on prescription pharmaceutical detections at the Australian border (ACIC 2020). The importation of prescription pharmaceuticals is primarily undertaken by individuals for personal use and without criminal intent (ACIC 2020).
The number of pharmaceutical detections reported at the Australian border only reflect detections of benzodiazepines and opioids (including morphine, buprenorphine, methadone and oxycodone) (ACIC 2020). In 2018–19 there were a total of 1,156 pharmaceutical detections, an increase of 98% since 2009–10 (585 detections) (ACIC 2020). The majority (79%) of these detections were for benzodiazepines (912 in 2018–19). However, though they remain the minority of overall pharmaceutical detections, there has been an 8,033% increase in the number of pharmaceutical opioid detections over the past decade (3 in 2009-10, increasing to a record high of 244 in 2018–19) (ACIC 2020).
Data from the 2019 NDSHS showed that:
Between 2016 and 2019, there was a significant decrease in the use of pharmaceuticals for non-medical purposes (from 4.8% to 4.2%) (Table S2.32). This was driven by a decrease in the use of pain-killers/pain-relievers and opioids (excluding over-the-counter) (from 3.6% to 2.7%)—in particular, the proportion of people using codeine for non-medical reasons halved in this period (decreasing from 3.0% in 2016 to 1.5% in 2019) (AIHW 2020). This aligns with restrictions to codeine being introduced in 2018 (see Policy context: Restricting access to codeine).
The 2019 NDSHS showed that people who use pharmaceutical drugs for non-medical purposes were older than people who use illicit drugs (excluding pharmaceuticals) (median ages of 40.7 and 30.7 years, respectively). However, the recent non-medical use of pharmaceuticals was most common among those aged 20–29 (6.4%) (Figure PHARMS2; AIHW 2020).
In 2016, the way the NDSHS captured non-medical use of painkillers/analgesics and opioids changed to better reflect how these substances are used and understood in the community.
There were no changes to the tranquillisers/sleeping pills, steroids, or methadone/buprenorphine sections of the questionnaire.
These changes to the 2016 survey has resulted in a break in the time-series for painkillers and opiates and for the overall misuse of pharmaceuticals.
The figure shows the proportion of persons who reported recent use of tranquillisers/sleeping pills for non-medical purposes by age group in 2019. In 2019, recent non-medical use of tranquillisers/ sleeping pills in the last 12 months was common for people aged 40–49 (2.4%) and 20–29 (3%). It was least common for people aged 14–19 (1%).
Data from the 2019 NDSHS showed that a higher proportion of Australians aged 14 and over approved the regular adult non-medical use of prescription pain-killers/pain-relievers (12.4%) and tranquilisers/sleeping pills (9.3%) than all illicit drugs except for cannabis (19.6%). However, support for the non-medical use of pharmaceuticals was lower than approval for the use of tobacco (15.4%) and alcohol (45%) (AIHW 2020).
Findings from the 2019 NDSHS (AIHW 2020) showed:
The figure shows the proportion of recent non-medical use of pain-killers/pain relievers by people aged 14 and over and socioeconomic area in 2016 and 2019. In 2019, the proportion of people aged 14 and over living in the most disadvantaged socioeconomic areas who used pain-killers/pain relievers for non-medical purposes was higher than those from the most advantaged socioeconomic areas (3.0% compared 1.8%).
The National Wastewater Drug Monitoring Program (NWDMP) measures the presence of substances in sewerage treatment plants across Australia. This includes estimated population-weighted average consumption of fentanyl and oxycodone, although wastewater analysis cannot differentiate between prescribed and illicit use (ACIC 2021b). Data from the latest NWDMP reports indicate that nationally:
Despite the recent increase in oxycodone consumption, estimated average consumption of both fentanyl and oxycodone has declined overall since 2016. Consumption of fentanyl and oxycodone increased from August 2016 to August 2018, but has fallen each year since 2018. Consumption of both drugs was lower in August 2020 than in August 2016 in both capital city sites and regional areas (ACIC 2021a).
For state and territory data, see the National Wastewater Drug Monitoring Program reports.
Poly drug use is defined as the use of more than 1 illicit drug or licit drug in the previous 12 months. In 2019, the NDSHS showed that just over half (52%) of people who reported the non-medical use of pharmaceuticals in the last 12 months said they did not use any other illicit drug. The most common other drugs concurrently used were alcohol (50% exceeded the single occasion risk guideline at least monthly), cannabis (40%) and cocaine (27%) (Table S2.68).
Data on alcohol and other drug-related ambulance attendances are sourced from the National Ambulance Surveillance System for Alcohol and Other Drug Misuse and Overdose. Data for 2020 are currently available for New South Wales, Victoria, Queensland, Tasmania and the Australian Capital Territory. Data are presented for 4 snapshot months per year, specifically March, June, September and December. Please see the data quality statement for further information.
In 2020, multiple drugs were consumed in at least half of ambulance attendances related to benzodiazepines and opioid analgesics. For benzodiazepines, this ranged from 52% of attendances in New South Wales and Queensland to 67% of attendances in Tasmania; for opioid analgesics the range was from 50% in Tasmania to 62% in the Australian Capital Territory (Table S2.81).
For related content on non-medical use of pharmaceutical drugs impacts and harms, see also:
There are a range of short and long-term health, social and economic harms associated with the misuse of pharmaceutical drugs (Table PHARMS1). People who use opioids for chronic pain are more likely than the general population to use pharmaceutical drugs for non-medical purposes (Currow, Phillips & Clark 2016; Vowels et al. 2015). Iatrogenic dependence occurs when patients become dependent on medications that they were medically prescribed for legitimate purposes. Iatrogenic dependence is an increasing concern among people living with chronic non-cancer pain.
Source: Adapted from Currow, Phillips & Clark 2016; DCPC 2007; Nicholas, Lee & Roche 2011; NSW Ministry of Health 2017.
Data on alcohol and other drug-related ambulance attendances are sourced from the National Ambulance Surveillance System for Alcohol and Other Drug Misuse and Overdose.
In 2020, for benzodiazepine-related ambulance attendances:
Characteristics of benzodiazepine-related ambulance attendances varied by region in 2020:
In 2020, for opioid analgesic-related ambulance attendances:
Characteristics of opioid analgesic-related ambulance attendances varied by region in 2020:
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 (NHMD) showed that in 2019–20, of all drug-related hospitalisations:
There was a decrease in the number of hospitalisations related to benzodiazepines and opioids between 2015–16 and 2019–20.
In 2019–20, almost 3 in 4 hospitalisations for both benzodiazepines (72%) and opioids (73%) occurred in Major cities. In Australia, the rate of hospitalisations for benzodiazepines and opioids is typically higher in Major cities and Regional areas than in Remote and very remote areas (Man et al. 2021). In 2019–20:
Drug-induced deaths are defined as those that can be directly attributable to drug use, as determined by toxicology and pathology reports (ABS 2017). Drug-induced deaths are more likely to be due to pharmaceutical drugs than illegal drugs, with benzodiazepines being the most commonly-involved single drug type in drug-induced deaths (811 deaths in 2019). The rate of deaths where benzodiazepines were present rose from 1.9 per 100,000 population in 1997 to 3.3 deaths per population in 2019.
Over the past decade, there has been a rise in deaths with a prescription drug present. For synthetic opioids (including fentanyl and tramadol) in particular, the rate has increased from 0.3 per 100,000 (57 deaths) in 2010 to 0.9 per 100,000 (231 deaths) in 2019 (Figure PHARMS4; Table S1.1a).
This figure shows that drug-induced deaths increased for benzodiazepines, heroin, methadone, natural and semi-synthetic opioids and synthetic opioids from 2004 to 2017. Since 2017, deaths have been decreasing for benzodiazepines, natural and semi-synthetic opioids, synthetic opioids and methadone, but have continued to increase for heroin. In 2019, the most common substance present in drug-induced deaths was benzodiazepines (811 deaths), followed by heroin (474) and natural and semi-synthetic opioids (466).
The National Drug and Alcohol Research Centre (NDARC) reported that over half (56% or 632 deaths) of all opioid-induced deaths in 2019 were attributed to pharmaceutical opioids only. This is compared to 32% (356 deaths) for illicit opioids only (that is, heroin and opium) and a further 11% (118 deaths) that were attributed to both pharmaceutical and illicit opioids (Chrzanowska et al. 2021). This is consistent with findings from the ABS that indicated that pharmaceutical and prescription opioids were present in over 70% of opioid-induced deaths in 2018 (ABS 2019a). Pharmaceutical opioids were also the most common opioid present in intentional overdose deaths (suicide) (ABS 2019a).
Involvement of other drugs in pharmaceutical drug-induced deaths is common. For example, preliminary estimates from NDARC show that benzodiazepines were involved in 55% (614 deaths) of opioid-induced deaths in 2019 (Chrzanowska et al. 2021). In 2019, 97% of drug-induced deaths where benzodiazepines were present involved other drugs, including alcohol (AIHW unpublished).
The rate of drug-induced deaths involving benzodiazepines in 2019 was higher in Major cities (3.3 per 100,000 population) compared with Regional and remote areas (3.0 per 100,000 population). However, the rate of drug-induced deaths involving prescription opioids was slightly higher in Regional and remote areas than in Major cities for natural and semi-synthetic opioids (1.9 deaths per 100,000 population compared with 1.8 per 100,000 population) and synthetic opioids (1.2 deaths per 100,000 population compared with 0.8 deaths per 100,000 population) (Table 8).
The Alcohol and Other Drug Treatment Services National Minimum Data Set (AODTS NMDS) provides information on treatment provided to clients by publicly funded AOD treatment services, including government and non-government organisations. Data from the 2019–20 AODTS NMDS showed that pharmaceuticals were the principal drug of concern in 5% of closed treatment episodes for clients’ own drug use—a similar proportion to 2018–19 (Table S2.76; Figure PHARMS5).
The AODTS NMDS classification of ‘pharmaceuticals’ includes 10 drug types: codeine, morphine, buprenorphine, oxycodone, methadone, benzodiazepines, steroids, other opioids, other analgesics, and other sedatives and hypnotics. The most common drug types within this classification are benzodiazepines and opioids (AIHW 2021).
In 2019–20, where pharmaceuticals were the principal drug of concern:
Source: AIHW. Supplementary tables S2.76, S2.78 and S2.80.
For related content on at-risk groups, see:
The available evidence indicates that the misuse of pharmaceuticals among vulnerable populations is at substantially higher levels than in the general population.
In July 2017, the Australian Government announced $16 million in funding to implement a national real-time monitoring system of prescription drugs. The system will provide an instant alert to pharmacists and doctors if patients are receiving multiple supplies of prescription only medicines (also referred to as ‘doctor or pharmacy shopping’). The program will initially include the monitoring of controlled medicines that are particularly susceptible to misuse including morphine, oxycodone, dexamphetamine and alprazolam. The system aims to assist doctors and pharmacists to identify patients who are at risk of harm due to dependency, misuse or abuse of pharmaceutical drugs and patients that are diverting these medicines.
As of 1 February 2018, medicines containing codeine were reclassified to schedule 4 drugs, meaning they could no longer be sold over-the-counter in pharmacies and were available by prescription only. This decision was made by the Therapeutic Goods Administration (TGA) following substantial evidence of harm from the abuse and misuse of low dose codeine-containing medicines including analgesic preparations combined with other pain relief medicines such as aspirin, paracetamol and ibuprofen (TGA 2018).
Many over-the-counter combination medicines containing codeine were not listed on the PBS prior to February 2018 and are now only able to be obtained with a private prescription. As a result, these medicines are not represented in PBS claim data. However, the scheduling change may account for some of the reductions observed in the 2019 NDSHS in the non-medical use of pain-killers and opioids since 2016 (AIHW 2020).
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