Health impacts

The health burden of alcohol and other drug use is considerable and includes hospitalisation from injury and other disease, mental illness, pregnancy complications, injection-related harms, overdose and mortality.

Drug-induced deaths

Drug-induced deaths are defined as those that can be directly attributable to drug use, as determined by toxicology and pathology reports. Data from the Australian Bureau of Statistics (ABS) showed:

  • There were 1,808 registered drug-induced deaths in 2016. This is the highest number of drug deaths in 20 years. Although the number of drug-induced deaths is the highest on record, the death rate per capita of 7.5 per 100,000 people is lower than that in 1999 (9.2 deaths per 100,000 people).
  • The most common drug class identified in drug-induced deaths data over the past decade was opioids (including the illegal use of heroin and licit and illicit use of opiate based analgesics—such as codeine, oxycodone and morphine—and synthetic opioid prescriptions—such as tramadol, fentanyl, and methadone).
  • By single drug type, the most common substance present in drug-induced in 2016 were benzodiazepines, identified in 663 deaths (36.7%) (benzodiazepines are included in the drug class ‘depressants’).
  • 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 [1] (Figure IMPACT1).

The National Drug and Alcohol Research Centre (NDARC) reported additional information on opioid-induced deaths, highlighting that in 2016 there were 1,045 opioid-induced deaths among Australian aged 15–64 years—a rate of 6.6 per 100,000 population. Close to 9 in every 10 (85%) of these deaths were considered accidental; a consistent trend in the data over the last decade [2].

Almost half (45%) of opioid-induced deaths among people aged 15–64 years in 2016 had recorded benzodiazepines as contributing to the death, continuing an increase since 2007 (35%). Other drugs commonly recorded as contributing to these opioid-induced deaths included antidepressants (23%), alcohol (14%), antipsychotics (13.5%) and paracetamol (9.9%) [2].

Deaths due to harmful alcohol consumption

The harmful consumption of alcohol can contribute to mortality in a number of different ways, and deaths can be directly attributable or partially attributable to harmful alcohol consumption. In Australia, deaths which are certified as being directly attributable to alcohol are coded as the underlying cause of death (the condition which initiated the train of morbid events). Alcohol-induced deaths are defined as those that can be directly attributable to alcohol use, as determined by toxicology and pathology reports [3].

Alcohol may also play a substantial role in a person’s death, yet not be recognised as the underlying cause of death. In such cases, the alcohol use would be referred to as an associated cause of death. Alcohol-related deaths are defined as deaths directly attributable to alcohol and together with deaths where alcohol were listed as an associated cause of death [3].

Data from the ABS showed:

  • There were 1,366 registered alcohol-induced deaths in 2017; the highest in 2 decades (1,156 deaths in 1997).
  • In 2017, the alcohol-induced death rate was 5.1 per 100,000 population and has remained stable since a low of 4.5 deaths per 100,000 in 2012.
  • The rate of alcohol-induced deaths for males has been on average 3.5 times higher than that of females over the past 2 decades.
  • There were an additional 2,820 deaths where alcohol was mentioned as a contributory cause of death in 2017. This highlights that people were twice as likely to have alcohol certified at death as a contributory factor than to have died from an alcohol-induced death [2].

The most common cause of alcohol-induced death was alcoholic liver disease; while mental and behavioural conditions due to alcohol use, including alcohol addiction, is the most common contributor to alcohol-related deaths. Mental and behavioural disorders due to alcohol abuse also made up about 20% of alcohol-induced deaths in 2017 [3].

Overall, the rate of alcohol-induced deaths has generally been higher than the most common drug classes over the past 2 decades (Figure IMPACT1).

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Box IMPACT1. National data sources on drug and alcohol deaths

A number of nationally representative data sources are available to analyse recent trends in drug and alcohol deaths. The ABS recently released data focussing on drug-induced causes of death, using data from the Registrar of Births, Deaths and Marriages in each state and territory, and the National Coronial Information System (NCIS) for those deaths certified by a coroner. The National Drug and Alcohol Research Centre (NDARC) and the Penington Institute use data provided by the ABS to report on drug deaths in Australia.

Each source provide different numbers of deaths, with differences in scope and terminology accounting for this variation. These differences include but are not limited to:

  • The ABS and NDARC use the terminology of drug-induced deaths to define those deaths that are directly attributable to drug use (i.e. where drug overdose is the underlying cause of death), while the Penington Institute uses the term drug-related deaths; despite defining these deaths as directly attributable to drug use.
  • NDARC only report on deaths due to a toxic effect of a drug/alcohol. Both the ABS and Penington Institute include data on deaths due to chronic misuse of a drug/alcohol (e.g. harmful long term methamphetamine use which has led to a cardiac issue).
  • The ABS and NDARC define drug-related deaths as deaths where a drug has played a contributory role (e.g. a traffic accident); the Penington Institute report does not report these deaths.
  • The ABS excludes deaths due solely to alcohol misuse, while the Penington Institute report includes these deaths.
  • NDARC present drug-induced deaths data for people aged 15–64 years, while the ABS and Penington Institute report for the whole of the population [1, 2, 3].

In addition, the ABS has recently released data on the harmful consumption of alcohol including alcohol-induced and alcohol-related deaths [3].

Burden of disease

Burden of disease analysis is used to compare the impact of different diseases, conditions or injuries on a population [2]. It combines the burden of living with ill health (non-fatal burden) with the burden of dying prematurely (fatal burden). This is measured through the calculation of disability-adjusted life years (DALY) – one DALY is one year of 'healthy life' lost due to illness and/or death.

Tobacco, alcohol and illicit drug use contribute to increased chronic disease, injury, accidental positioning and premature death [3] and are among the leading risk factors contributing to disease burden in Australia. Analysis of data from the Australian Burden of Disease Study 2011, including revised analysis of estimates for alcohol use and illicit drug use based on the latest evidence of linked diseases [3] indicated the following:

  • Tobacco use contributed to 9% of the total burden of disease in Australia in 2011. It was responsible for 36% of the burden of respiratory diseases, 22% of cancers, 12% of cardiovascular diseases and 3.5% of endocrine disorders (which includes diabetes) [2].
  • Alcohol use contributed to 4.6% of the total burden of disease in Australia in 2011 and was the leading contributor for people aged 25–44 [3]. Males experienced a greater proportion of disease burden attributable to alcohol use than females. Alcohol use was responsible for 100% of the burden due to alcohol dependence, and was responsible for about one-third of the burden of other land transport injuries (35%), road traffic injuries—motorcyclists (33%), other road traffic injuries (30%), and road traffic injuries—motor vehicle occupants (30%). It was also responsible for 40% of the burden of liver cancer and 37% of the burden of mouth and pharyngeal cancer (Table S2.63).  
  • Illicit drug use contributed to 2.3% of the total burden of disease in Australia in 2011, most of which was experienced by males and females aged 25–34 [3]. Males experienced a greater proportion of disease burden attributable to illicit drug use than females. Illicit drug use was responsible for 100% of illicit drug dependence burden and 65% of the accidental poisoning burden. It was also responsible for 83% of the Hepatitis C burden, 43% of the Hepatitis B burden, and 4.9% of the HIV/AIDS burden.
  • Opioid use accounted for the largest proportion (41%) of the illicit drug use burden, followed by amphetamine use (18%), cocaine (8%) and cannabis (7%). In addition, 18% of the burden was from diseases contracted through unsafe injecting practices (Table S2.69).
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Injury and hospitalisation

Recent consumers of alcohol (past 12 months)

  • According to the 2016 National Drug Strategy Household Survey (NDSHS),
    •  2.8% had been injured while under the influence of alcohol and required medical attention and 1.3% required admission to hospital for their injuries. 
    • 1% of required medical attention and/or hospitalisation because they were so intoxicated (Table S1.4).
  • People who consumed alcohol in risky quantities (lifetime or single occasion risk) were far more likely to require medical attention or admission to hospital due to injuries sustained while drinking or due to intoxication. This was even higher among people consuming 11 or more standard drinks at least monthly with 8.4% requiring medical attention for their injuries [4] (Table S1.5).

Recent users of illicit drugs (past 12 months):

  • Data from the 2016 NDSHS, that shows that 1.1% of recent illicit drugs users aged 14 years and over reported that they had injured themselves while under the influence of illicit drugs and required medical attention and 0.4% said their injury was serious enough to require hospitalisation (Table S1.6).
  • Less than 1% of recent illicit drug users reported that they had overdosed and required medical attention (0.5%) or hospitalisation (0.3%) but this was higher among people who had used meth/amphetamines in the previous 12 months (2.9% had overdosed and required medical attention or hospitalisation) (Table S1.7).
  • These data have a high relative standard error and should be interpreted with caution [4].

Information on drug-related hospitalisations can also be drawn from the National Hospital Morbidity Database (Figure IMPACT3):

  • In 2016–17, there were 11.0 million separations in Australia’s public and private hospitals, and drug-related principal diagnoses (considered to be responsible for an episode of admitted care to hospital) accounted for 1.2% (or 137,200) of those, a similar proportion to previous years.
  • Alcohol consistently had the highest number of hospital separations with a drug-related principal diagnosis between 2012–13 and 2016–17, accounting for about half of those separations.
  • Between 2012–13 and 2016–17, sedatives and hypnotics (excluding alcohol) continued to result in more drug-related hospital separations than opioids.
  • Over that period, the rate of drug-related hospital separations for sedatives and hypnotics (including the use of benzodiazepines) fell from 39.2 per 100,000 population in 2012–13, to a low rate of 37.7 per 100,000 in 2013–14, before rising again to 43.0 per 100,000 (or 8.1% of drug-related separations) in 2016–17.
  • In 2016–17, the rate of hospital separations where the drug-related principal diagnosis was for opioids (including heroin, opium, morphine, and methadone) was 35.6 per 100,000 population (or 6.8% of drug-related separations). This represents a rise from 32.7 separations per 100,000 population in 2012–13 [8].
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Mental illness

There is a strong association between illicit drug use and mental health issues. According to the 2016 NDSHS:

  • Between 2013 and 2016 there was an increase in the proportion of recent drug users experiencing high or very high levels of psychological distress (from 17.5% to 22.2%).
  • There was an increase in the proportion of recent drug users that had been diagnosed with or treated for a mental illness in the previous 12 months (from 20.7% to 26.5%) [4] (Table S1.9). 

Similar increases were reported by participants of the 2018 Ecstasy and Related Drugs Reporting System (EDRS), where the primary issue of concern reported among this population of regular psychostimulant users was anxiety (36%) and depression (30%) [9] (refer to Box HARM1 for more information).

Pregnancy complications

Tobacco smoking in pregnancy is the most common preventable risk factor for pregnancy complications, and is associated with poorer perinatal outcomes, including low birthweight, being small for gestational age, pre-term birth and perinatal death.

Data from the National Perinatal Data Collection showed, in 2016, that babies of mothers who smoked during pregnancy were more likely than babies of mothers who did not smoke to be:

  • low birthweight (12.4% compared with 5.8%)
  • small for gestational age (16.8% compared with 8.8%)
  • born pre-term (12.9% compared with 7.8%) [10].

Alcohol consumption during pregnancy is also associated with adverse impacts for development of the fetal brain. Fetal alcohol spectrum disorder (FASD) is the term used to describe the effects of prenatal alcohol exposure including fetal alcohol syndrome (FAS). There is currently no data available indicating prevalence rate of FASD in Australia, however there have been some jurisdictional based studies which reported birth prevalence rates of FAS of between 0.01 and 0.68 per 1000 live births. Higher rates of FAS are commonly found among Indigenous communities, likely reflecting socioeconomic factors and patterns of alcohol use [8].

The 2009 Australian Guidelines to reduce Health risks from Drinking Alcohol from the National Health and Medical Research Council state that for women who are pregnant or planning a pregnancy or breastfeeding, not drinking is the safest option [9].

The NSDHS showed that 56% of pregnant women abstained from drinking alcohol during their pregnancy, this is an increase from 40% in 2007 [4]. The remaining reported that they reduced their drinking during pregnancy (43%) compared with when they were not pregnant and 1% reported drinking the same. 

Injection-related harms

The NDSHS estimates that a very low proportion of the Australian general population aged 14 and over have injected drugs, either in their lifetime (1.6%) or in the past 12 months (0.3%) [4].

Analysis of 2011 burden of disease data shows that 0.4% of the total burden of disease and injuries were related to unsafe injecting practices [3]. This was specifically linked to chronic liver disease (around 65% of the burden of unsafe injecting practices) and liver cancer (32%).

Of those who do inject drugs, the sharing of injecting equipment remains a concern due to the risk of transmission of blood-borne viral infections (BBVI) such as human immunodeficiency virus (HIV) and hepatitis C virus (HCV), as well as other harms [10].

Data from the Australian NSP survey provides some evidence of the harms related to injecting drug use in persons who regularly inject drugs in Australia:

  • the proportion of respondents reporting reuse of needles and syringes (including the reuse of one’s own syringes) remained stable, between 23% in 2013 and 24% in 2017
  • the proportion of respondents reporting receptive sharing of needles and syringes increased, from 15% in 2013 to 17% in 2017
  • HIV antibody prevalence has remained low and stable nationally from 2013 to 2017 (between 1.4% to 2.1%), with some populations at greater risk than others [14].

Data from the Illicit Drug Reporting System (IDRS) provides additional evidence of harms, including [13]:

  • 11% of participants of the 2018 IDRS reporting lending a needle to someone after they had used it, and 9% reported borrowing a needle after someone else had used it. Re-use of their own needle was reported by 37% of IDRS participants (Table S3.65).
  • 73% of the IDRS sample experienced an injection-related health problem in the month preceding interview, a significant increase from the previous reporting period. The most prominent health problems were scarring/bruising (52%) and difficulty injecting (43%) (Table S3.66). 

Overdose

People who use illicit drugs or pharmaceutical drugs for non-medical purposes, can place themselves at high risk of fatal and non-fatal overdose.

National data on drug-related ambulance attendances are currently not available, but Victorian data show that the level of harm is considerable. In 2016–17, in Victoria, the rate of ambulance attendances involving any illicit drug was 179.6 per 100,000 population (11,097 attendances). The rate of ambulance attendances involving the licit or illicit use of pharmaceuticals was 170.2 per 100,000 (10,517 attendances) [15].

Data from the 2018 IDRS and EDRS shows rates of self-reported overdose:

  • Of participants of the 2018 IDRS, 42% reported a heroin overdose in their lifetime and 14% in the past 12 months [13].
  • Of regular ecstasy and other stimulant users who participated in the 2018 EDRS, 36% reported having ever experienced a non-fatal stimulant overdose and 25% in the past 12 months [9].

References

  1. Australian Bureau of Statistics (ABS) 2017. Causes of death, Australia, 2016. Cat. no. 3303.0. Canberra: ABS. Viewed 4 January 2018.
  2. Roxburgh A, Dobbins T, Degenhardt L & Peacock A 2018. Opioid, Amphetamine, and Cocaine-Induced Deaths in Australia: August 2018. Sydney, National Drug and Alcohol Research Centre, University of New South Wales.
  3. ABS 2018. Causes of death, Australia, 2017. Cat. no. 3303.0. Canberra: ABS. Viewed 12 October 2018.
  4. Penington Institute 2018. Australia’s annual overdose report 2018. Melbourne: Penington Institute.
  5. Australian Institute of Health and Welfare (AIHW) 2016. Australian burden of disease study: Impact and causes of illness and death in Australia 2011. Series no.3. BOD 4. Canberra: AIHW. Viewed 18 October 2017.
  6. AIHW 2018a. Impact of alcohol and illicit drug use on the burden of disease and injury in Australia: Australian Burden of Disease Study 2011. Australian Burden of Disease Study series no. 17. Cat. no. BOD 19. Canberra: AIHW.
  7. AIHW 2017a. National drug strategy household survey 2016: detailed findings. Drug statistics series no. 31. Cat. no. PHE 214. Canberra: AIHW. Viewed 14 December 2017.
  8. AIHW 2018b. Drug related hospitalisations. Canberra: AIHW. Viewed 30 November 2018.
  9. Peacock A, Gibbs D, Karlsson A, Uporova J, Sutherland R, Bruno R, Dietze P, Lenton S, Alati R, Degenhardt L & Farrell M 2018. Australian Drug Trends 2018. Key findings from the National Ecstasy and Related Drugs Reporting System (EDRS) Interviews. Sydney, National Drug and Alcohol Research Centre, UNSW Australia.
  10. AIHW 2018c. Australia’s mothers and babies 2016 – in brief. Perinatal statistics series no. 34. Cat. No. PER 97. Canberra: AIHW.
  11. Burns L, Breen C, Bower C, O’Leary C & Elliott E 2013. Counting fetal alcohol spectrum disorder in Australia: the evidence and the challenges. Drug and alcohol review. 32(5): 461-467.
  12. NHMRC (National Health and Medical Research Council) 2009. Australian guidelines to reduce health risks from drinking alcohol. Canberra: NHMRC. Viewed 12 October 2017.
  13. Peacock A, Gibbs D, Sutherland R, Uporova J, Karlsson A, Bruno R, Dietze P, Lenton S, Alati R, Degenhardt L & Farrell M 2018. Australian Drug Trends 2018: Key findings from the National Illicit Drug Reporting System Interviews. Sydney, National Drug and Alcohol Research Centre, UNSW Australia.
  14. Heard S, Iversen J, Geddes L & Maher L 2018. Australian Needle Syringe Program Survey National Data Report 2013-2017: Prevalence of HIV, HCV and injecting and sexual behaviour among NSP attendees. Sydney: Kirby Institute, UNSW.
  15. Turning point 2017. Ambo-AODstats. Melbourne: Victoria. Viewed 6 June 2018.