A hospital separation is a completed episode of admitted hospital care ending with discharge, death, transfer, or a portion of a hospital stay. The AIHW’s National Hospital Morbidity Database (NHMD) showed that, in 2018–19, of all separations with a drug-related principal diagnosis:
- benzodiazepines and other sedatives and hypnotics (including barbiturates; excluding ethanol) accounted for 6.8% of all drug-related separations.
- 11% were for analgesics, with opioids (heroin, opium, morphine and methadone) accounting for half of this group (6.2% of all drug-related separations) (Table S1.8a).
Between 2014–15 and 2018–19, benzodiazepines and other sedatives and hypnotics (excluding alcohol) continued to result in more drug-related hospital separations than opioids. However, hospital separations for benzodiazepines have decreased in the past two years, falling from 6,361 separations in 2016–17 to 5,204 separations in 2018–19 (Table S1.8b).
In 2018–19, hospital separation rates (per 100,000 population) for benzodiazepines and other sedatives and hypnotics were 1.5 and 2.1 times higher, respectively, for people living in Major cities compared with Remote and very remote areas. Hospital separation rates (per 100,000 population) for opioids were 1.6 times higher for people residing in Major cities compared with Remote and very remote areas in 2018–19.
The rate of drug-related hospital separations for non-opioid analgesics was 1.7 times higher for people usually residing in Remote and very remote areas compared with those in Major cities (45.3 per 100,000 population compared with 26.0 per 100,000 population). The rate decreased between 2017–18 and 2018–19 in all regions, with the exception of Remote and very remote areas where the rate increased from 36.8 separations per 100,000 population to 45.3 per 100,000 population (Table S1.8c; AIHW unpublished).
Ambulance attendances
Data on alcohol and other drug-related ambulance attendances are sourced from the National Surveillance System for Alcohol and Other Drug Misuse and Overdose report. Data for 2019 are available for New South Wales, Victoria, 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.
The rate of benzodiazepine-related attendances ranged from 14.2 per 100,000 population in Tasmania to 24.0 per 100,000 population in Victoria. The rates of attendances were higher for metropolitan areas (when compared to regional areas) for New South Wales, Victoria and Tasmania.
The majority of benzodiazepine-related attendances were for females, while the majority of opioid analgesic-related attendances in New South Wales and Tasmania were for males. The median age of benzodiazepine-attendances was similar across jurisdictions (35 to 38 years), however for opioid analgesic-related attendances, the median age ranged from 34 years in the Australian Capital Territory to 46 years in Tasmania.
Higher rates for benzodiazepine-related ambulance attendances were reported in metropolitan areas for New South Wales (17.4 per 100,000 population compared with 12.1 for regional areas), Victoria (24.3 per 100,000 population compared with 23.2 for regional areas) and Tasmania (Greater Hobart 19.8 per 100,000 population compared with 9.9 for regional areas).
Similar proportions of benzodiazepine-related attendances were transported to hospital in metropolitan and regional areas for New South Wales (90% and 91%, respectively), Victoria (90% and 92%, respectively) and Tasmania (~89% and ~83%, respectively) (Table S2.81) (Moayeri et al. 2020).
Of the 1,740 drug induced deaths in 2018, the most common substance present was a benzodiazepine (51%)—this is consistent with findings from previous years (Figure PHARMS4). Between 2009 and 2018, the number of deaths where benzodiazepines were present rose by 70% (from 518 to 883 deaths) (Table S1.1).
It is important to note that benzodiazepines may not have been recorded as the underlying cause of death, as they often occur in the context of polysubstance use. Analysis by the National Drug and Alcohol Research Centre (NDARC) found that in 693 deaths in which opioids were deemed to be the underlying cause of death, benzodiazepines were recorded as contributing to the death (Man et al. 2019). In 2018, in over 97% of drug-induced deaths where benzodiazepines were present, they were taken in conjunction with other drugs, including alcohol (AIHW unpublished).
Over the past decade, drug-induced deaths were more likely to be due to prescription drugs than illegal drugs, and there has been a substantial rise in the number of deaths with a prescription drug present. For synthetic opioids (including fentanyl and tramadol) in particular, the rate has increased from 0.1 per 100,000 (32 deaths) in 2009 to 1.0 per 100,000 (241 deaths) in 2018 (Table S1.1).
NDARC reported that in 2018, there were 655 (60%) deaths attributed to pharmaceutical opioids only, 322 (30%) to illicit opioids only (such as heroin and opium) and 108 (10%) deaths to both pharmaceutical opioids and illicit opioids (Man et al. 2019). This is consistent with the findings from the ABS that indicated that pharmaceutical opioids 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 suicide overdose (ABS 2019a).
The rate of drug-induced deaths involving benzodiazepines was similar in Major cities and Regional and remote areas in 2018 (Table S2.71). However, the rate of drug-induced deaths involving prescription opioids was higher in Regional and remote areas than in Major cities for natural and semi-synthetic opioids (2.3 deaths per 100,000 population compared with 1.8 per 100,000 population) and synthetic opioids (1.3 deaths per 100,000 population in Regional and remote areas, compared with 0.9 deaths per 100,000 population in Major cities) (Table S2.71).