Alcohol, tobacco & other drugs in Australia

Introduction

Around 7 million people live in rural and remote areas of Australia, accounting for 28% of the total population (AIHW 2024b). People living in the most remote areas generally have poorer health outcomes than those living in more urban areas, including higher rates of hospitalisation, death and injury. Those in remote areas also have poorer access to primary health care services (AIHW 2024b).

This page focuses on alcohol and other drug use and harms across remoteness areas in Australia. The reporting uses data from a range of sources, mostly national administrative and survey data.

What data sources are available?

There are a range of data sources that contain information about alcohol and other drug use across remoteness areas. These include self-report surveys that ask people about their use of alcohol and other drugs, wastewater analysis and health administrative data sets (such as administrative data routinely collected by hospitals). Each data set uses a different methodology, and the language used to describe alcohol and other drugs or remoteness areas may also differ across sources.

For more information about each data source, see Technical notes.

How does alcohol and other drug use vary across remoteness areas?

Tobacco smoking

Data from both the National Drug Strategy Household Survey (NDSHS) and the National Health Survey (NHS) show that people in more remote areas of Australia are more likely to smoke than those in major cities.

Results from the 2022 NHS found that people aged 18 and over living in Outer regional and remote areas were around 1.5 times as likely to smoke daily as those in Major cities (16.7% compared with 9.4%) (ABS 2023a, Table 6.3).

The proportion of people aged 14 and over who smoke daily has decreased over time in most remoteness areas, except for Remote and very remote areas where daily smoking rates have remained stable since 2016 (AIHW 2024a; Figure 1). In 2022–2023, the proportion of people who smoked daily in:

• Major cities decreased (from 9.7% in 2019 to 7.0% in 2022–2023)
• Inner regional areas decreased (13.4% to 10.5% in 2022–2023)
• Remote and very remote areas (20%) was higher than the proportion in Major cities (7%) (AIHW 2024a, Table 9a.12; Figure 1).

Vaping and e-cigarette use

In 2022–2023, people living in Major cities (3.9%) and Remote and very remote areas (*3.7%) were more likely than people living in Inner regional (2.2%) and Outer regional (2.5%) areas to use e-cigarettes/vapes daily (AIHW 2024a). Between 2019 and 2022–2023, daily use of e-cigarettes increased in all remoteness areas except for Remote and very remote areas where it remained stable (AIHW 2024a, Table 3.11).

* Estimate has a relative standard error of 25% to 50% and should be used with caution.

Risky drinking

In general, people living in more remote areas of Australia are more likely than people in Major cities to exceed the alcohol risk guidelines.

• The 2022–2023 NDSHS showed that people aged 14 and over living in Remote and very remote (40%) and Outer regional areas (39%) were about 1.4 times as likely as those living in Major cities (29%) to consume alcohol at risky levels (AIHW 2024a, Table 4.34; Figure 1).
• Similarly, the 2022 NHS showed that adults (aged 18 and over) in Outer regional and remote areas (30.9%) were more likely to drink at risky levels than those in Major cities (25.6%) (ABS 2023a, Table 6.3).

Illicit drug use

Data from the 2022–2023 NDSHS showed that people living in Remote and very remote areas (21%) were more likely to have recently used any illicit drug than those living in Major cities (18.4%), Inner regional (15.2%) and Outer regional (18.7%) areas (AIHW 2024a, Table 9a.12). This varied by drug type:

• People living in Remote and very remote areas were more likely than those living in Major cities to have used cannabis in the previous 12 months (13.2% and 11.7% respectively).
• Similar proportions of people living in Major cities, Inner regional and Outer regional areas recently used methamphetamine and amphetamine (1.1%, 0.9% and *0.7%, respectively). A higher proportion (*2.1%) of people living in Remote and very remote areas reported recent use of methamphetamine and amphetamine.
• People living in Remote and very remote areas were about 1.2 times as likely as those from Major cities to have recently used pain-killers/pain-relievers and opioids for non-medical purposes in 2022–2023 (*2.7% compared with 2.2%). This is a reduction from 2019 when they were 1.5 times as likely to have done so.
• Cocaine and ecstasy use were higher among those who lived in Major cities (AIHW 2024a, Table 9a.12; Figure 1).

* Estimate has a relative standard error of 25% to 50% and should be used with caution.

Between 2019 and 2022–2023:

• Recent use of cannabis decreased remained largely stable across all remoteness areas.
• Use of pain-killers/pain-relievers and opioids for non-medical purposes in remained stable across all remoteness areas except Outer regional areas, where it significantly decreased (from 3.5% to 2.2%) (AIHW 2024a, Table 9a.12; Figure 1).

Polydrug use

Analysis of NDSHS data indicated that polydrug use varied across remoteness areas. People in Remote and very remote areas were the most likely to use alcohol (79%) or tobacco (51%) at the same time as cannabis, while those in Major cities were the most likely to report using illicit drugs (24%) or not using other drugs (20%) with cannabis (AIHW 2024a).

What does wastewater drug monitoring tell us about alcohol and other drug use across capital cities and regional areas?

The National Wastewater Drug Monitoring Program (NWDMP) monitors selected substances of concern in most populated regions of Australia (ACIC 2025). The most recent wastewater report covers the period from April to August 2024 for both capital cities and regional sites, with additional information up to October 2024 for capital cities (ACIC 2025). 

Data from the NWDMP show that consumption of nicotine, alcohol, cannabis and methylamphetamine is generally higher in regional areas, while consumption of other drugs varies between capital cities and regional areas (Table 1).

Note: The amount of ketamine consumed cannot be determined based on excreted concentrations in wastewater, therefore ketamine is reported as the amount excreted (in milligrams) into the sewer network per 1,000 people per day.

This report showed that:

• In capital cities, average consumption of methylamphetamine reached record high levels in August 2024, while consumption of MDMA and excretion of ketamine reached record highs in October 2024.
• In regional areas, average heroin consumption reached a record high in August 2024 and methylamphetamine reached its highest level since April 2020 (ACIC 2025).

More information on wastewater drug monitoring is available in the National Wastewater Drug Monitoring Program reports.

How does prescription drug dispensing vary across remoteness areas?

Data on prescription medicine dispensing in this report are sourced from the Pharmaceutical Benefits Scheme (PBS). Data from the PBS provide information on the number of prescriptions dispensed and the number of patients supplied at least one script within a given financial year. The PBS database includes information on medicines that may be used for non-medical purposes (including opioids, benzodiazepines and gabapentinoids) and medicines that are used to help people stop their smoking or alcohol consumption (smoking and alcohol cessation medicines).

AIHW analysis of the PBS showed that in 2024–25:

• The highest crude rates of patients who were dispensed opioids were in Outer regional (around 13,600 per 100,000 population) and Inner regional (around 13,300 per 100,000 population) areas.
• The highest crude rate of patients who were dispensed benzodiazepines was in Inner regional areas (around 5,800 per 100,000 population).
• The highest crude rate of patients who were dispensed gabapentinoids was in Inner regional (around 3,100 per 100,000 population) and Outer regional (around 3,100 per 100,000 population) areas.
• The highest crude rate of patients who were dispensed smoking cessation medicines was in Outer regional areas (1,100 per 100,000 population).
• The highest crude rate of patients who were dispensed alcohol cessation medicines was in Inner regional areas (210 per 100,000 population) (tables PBS16, PBS36, PBS60, PBS76 and PBS92, Figure 2).

How do alcohol and other drug-related harms vary across remoteness areas?

Alcohol and other drug-related hospitalisations

Among all alcohol and other drug-related hospitalisations in 2023–24, most (72% or 104,716 hospitalisations) occurred in Major cities, but the highest rate of hospitalisations was in Remote and very remote areas (852.7 per 100,000 people, or 4,281 hospitalisations) (Table S1.14). Among alcohol-related hospitalisations in 2023–24, almost 3 in 4 (73% or 61,655) occurred in Major cities, but the rate of alcohol-related hospitalisations was highest in Remote and very remote areas (577.8 per 100,000 population, or 2,901 hospitalisations) (Table NHMD5, Figure 3).

Among other drug-related hospitalisations in 2023–24:

• Around 2 in 3 (67% or 4,599) cannabis-related hospitalisations occurred in Major cities, but the rate was highest in Remote and very remote areas (70.7 per 100,000 people, or 355 hospitalisations).
• Most hospitalisations for both amphetamines and other stimulants (68% or 12,264 hospitalisations) and cocaine (87% or 1,153) occurred in Major cities, but rates of hospitalisation for amphetamines and other stimulants were highest Remote and very remote areas (88.2 per 100,000 people or 443 hospitalisations, compared with 63.4 per 100,000 in Major cities).
• Most hospitalisations occurred in Major cities (65% or 3,973 for non-opioid analgesics, 74% or 4,733 for benzodiazepines and other sedative-hypnotics, 65% or 1,966 for antidepressants, and 66% or 1,996 for antipsychotics and neuroleptics.
• Although the number of pharmaceutical-related hospitalisations was higher in Major cities than Regional and remote areas, the rate was slightly higher in Regional and remote areas than Major cities across all pharmaceutical types except benzodiazepines and other sedative-hypnotics (Table NHMD5, Figure 3).

Drug-induced deaths (excluding alcohol)

AIHW analysis of preliminary data from the National Mortality Database showed that in Australia:

• In 2024, rates of drug-induced deaths were slightly higher in Major cities (age-standardised rate of 7.1 per 100,000 population; 1,424 deaths) than Regional and remote areas (6.7 per 100,000 population; 481 deaths).
• The rate of drug-induced deaths has fluctuated since 2009 in both Major cities and Regional and remote areas, reaching a peak of 8.2 per 100,000 people in 2017 in Major cities and 8.6 per 100,000 people in Regional and remote areas in 2016.
• Rates of drug-induced deaths have varied over time by drug type (Table NMD3, Figure 4).

Estimates for 2023 and 2024 are expected to rise following standard revision processes.

Recent NDARC analysis of preliminary revised data showed that the highest proportion of drug-induced deaths in 2023 occurred among people aged 45–54 for both Major cities (27% or 333 deaths) and Regional and remote areas (27% or 127 deaths) (Chrzanowska et al. 2025).

Where do I go for more information?

• National Drug and Alcohol Research Centre reports
• National Wastewater Drug Monitoring Program