Alcohol, tobacco & other drugs in Australia

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 and includes both those due to acute toxicity (for example, drug overdose) and chronic use (for example, drug-induced cardiac conditions) as determined by toxicology and pathology reports (ABS 2021). See also the Technical notes.

Multiple drug types may have been reported on a single death record as associated causes of death. As a result, the sum of each drug type may be more than the total number of deaths.

Preliminary AIHW National Mortality Database data in 2020 showed that:

• There were 1,842 drug-induced deaths (age-standardised rate of 7.2 per 100,000 population).
• Although the number of drug-induced deaths in 2020 was higher than the peak recorded in 1999, after adjusting for population growth and ageing, the rate of drug-induced deaths in 2020 (7.2 deaths per 100,000 population) was 21% lower than in 1999 (9.1 deaths per 100,000 population) (Figure IMPACT1; Table S1.1).
• Benzodiazepines continued to be the largest contributor to drug-induced deaths. In 2020, there were 817 drug-induced deaths involving benzodiazepines (age-standardised rate of 3.2 per 100,000 population) (Figure IMPACT1; Table S1.1).

Preliminary Australian Bureau of Statistics data on Causes of Death show that in 2020:

• Of the 1,842 drug-induced deaths, 1,187 were males and 655 were females, fewer than in 2019 (1,874; 1,188 males and 686 females).
• The median age at death was higher for females than males (48.1 and 44.4 years respectively)
• Over two-thirds (67%) of drug-induced deaths were considered accidental (1,233 deaths) and 23% (428 deaths) were considered intentional. This compares to 1,244 accidental drug-induced deaths and 442 intentional drug-induced deaths in 2019 (66% and 24%, respectively) (ABS 2021).

Figure IMPACT1: Number or age-standardised rate (per 100,000 population) of drug-induced deathsᵃ, by drug type or drug class, 1997 to 2020

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In 2020, the highest rate of drug-induced deaths was for people aged 35–44 and 45–54 (both 14.0 per 100,000 population). This has changed since the late 1990s and early 2000s, when the rate of deaths were highest for people aged 25–34 (Chrzanowska et al. 2022).

Common drug classes and types identified in drug-induced deaths

Over the past 2 decades, benzodiazepines have remained the most commonly-identified single drug type in drug-induced deaths, and opioids the most common drug class (Figure IMPACT1; Table S1.1). AIHW analysis of the National Mortality Database showed that, in 2020:

• Opioids were the most commonly identified drug class, present in 3 in 5 (59% or 1,091) drug-induced deaths, an age-standardised rate of 4.3 per 100,000 population. Opioids include a number of drug types including heroin, opiate based analgesics (such as codeine and oxycodone) and synthetic opioid prescriptions (such as tramadol and fentanyl).
• Benzodiazepines were the most commonly identified single drug type, present in over 2 in 5 (44% or 817) deaths. It is important to note that benzodiazepines may not have been recorded as the underlying cause of death and are commonly reported as an associated cause in deaths due to other drug types.
• Other drugs commonly identified in drug-induced deaths included depressants excluding alcohol (54% or 986 deaths) and psychostimulants excluding cocaine (28% or 524 deaths).

Preliminary mortality data indicate that there has been a recent change in the main type of opioid identified in drug-induced deaths. Over the past decade, opioid-induced deaths were more likely to be due to prescription drugs than illegal drugs, and there has been a rise in the number of deaths with a prescription drug present. However, the proportion and rate of opioid-induced deaths relating to illegal opioids—opium and heroin—is increasing.

• Preliminary data from AIHW analysis of the National Mortality Database indicate that in 2020, there continues to be a slightly higher rate of drug-induced deaths involving heroin (1.9 per 100,000 population) than natural and semi-synthetic opioids (1.7 per 100,000) (Figure IMPACT1; Table S1.1).

Since 1997, the most common other drug involved in opioid-induced deaths was benzodiazepines (58% or 624 deaths in 2020). The majority (78%, 840 deaths) of opioid-induced deaths were accidental (Chrzanowska et al. 2022).

Poly drug use

In 2020, 5 or more drugs were present in 19.3% of all drug-induced deaths, and a further 17.9% reported 3 drugs present. Females were more likely than males to have 5 or more drugs present at toxicology (23.0% and 17.3%, respectively) (ABS 2021).

Geographic trends

AIHW analysis of the National Mortality Database showed that in 2020:

• The rate of drug-induced deaths was marginally higher in Major cities (age-standardisation rate of 7.2 per 100,000 population) compared with Regional and remote areas (6.8 per 100,000 population) (Table 8). The lowest rate of drug-induced deaths was recorded in Remote and very remote areas (5.6 per 100,000 population, compared with 7.2 for Major cities and 6.9 for Regional areas) (AIHW unpublished).
• The rate of drug-induced deaths has fluctuated since 2009 in both Major cities and Regional and remote areas. However, when comparing the rates for 2009 and 2020, in Regional and remote areas the rate increased by 12% while the rate in Major cities increased by 6% (Table 8).

Analysis by the National Drug and Alcohol Research Centre (NDARC), shows that in 2020, the highest proportion of drug-induced deaths in Major cities was among those aged 35–44 (26%, 352 deaths) and in Regional and remote areas was among those aged 45–54 (27%, 124 deaths) (Chrzanowska et al. 2022).

Psychosocial risk factors

Psychosocial risk factors, recorded for coroner-referred deaths in the National Mortality Database, are ‘social processes and social structures which can have an interaction with individual thought or behaviour and health outcomes’ (ABS 2019). Risk factors may not be mutually exclusive and therefore deaths with multiple psychosocial risk factors recorded will be counted in more than one category.

In 2020, at least one psychosocial risk factor was recorded in over one-third (37%) of drug-induced deaths. For intentional drug-induced deaths, this proportion was about 7 in 10 (69%) (Table S1.2).

Personal history of self-harm continued to be the most commonly identified risk factor (13%), followed by relationship issues including: disappearance and death of a person in the primary support group (4.7%); disruption of family by separation and divorce (3.7%); and problems in relationship with spouse or partner (3.7%) (Table S1.3).  However, there were some notable differences when they were examined by intent, age and sex:

• Release from prison was ranked the 6^th most common psychosocial risk factor for all drug-induced deaths, however, for accidental deaths, this was the second most common risk factor identified (Table S2.6).
• Limitation of activities due to disability was the most common risk factor for people aged 65 years and older, (Table S2.7).

• Disruption of family by separation and divorce was the second most common risk factor for males, while for females it was disappearance and death of a family member (Table S2.8).

There were also differences in the most commonly identified psychosocial risk factors across drug types:

• For cocaine, disruption of family by separation and divorce and personal history of self-harm were the most commonly identified risk factors.
• For heroin and synthetic opioids, release from prison was the second most common risk factor identified in drug-induced deaths.
• In drug-induced deaths involving benzodiazepines and natural and semi-synthetic opioids, disappearance and death of a family member was the second most common risk factor (Figure IMPACT2).

Figure IMPACT2: Leading psychosocial risk factors identified in drug-induced deaths, by drug class or drug type, 2020

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Associated causes of death

Associated causes of death refer to conditions other than the underlying cause of death and can include diseases that are part of the chain of events leading to death, risk factors and co-morbid conditions (ABS 2020). People with multiple associated causes of death recorded will be counted in more than one category.

AIHW analysis of the National Mortality Database showed that of drug-induced deaths in 2020 (Table S1.3):

• 1 in 2 (49%) had mental and behavioural disorders due to psychoactive substance use as an associated cause of death.
  • Of the 1,370 mentions of these disorders as an associated cause of death, most were mental and behavioural disorders due to the use of opioids or alcohol (Table S2.9).
• Over 1 in 3 (37%) had mood (affective) disorders as an associated cause of death.
  • Of the 615 mentions of mood (affective) disorders as an associated cause of death, the majority were for depressive episode (83%) and the remaining 17% were for bipolar affective disorder (Table S2.9).

Deaths due to harmful alcohol consumption

Alcohol-induced deaths are defined as those that can be directly attributable to alcohol use (i.e. where an alcohol-related condition is recorded as the underlying cause of death), as determined by toxicology and pathology reports. This may be the result of a chronic condition directly related to alcohol use (e.g. alcoholic liver cirrhosis) or from an acute condition directly related to harmful consumption (e.g. alcohol poisoning).

Alcohol-related deaths include deaths directly attributable to alcohol use (as defined above) and deaths where alcohol was listed as an associated cause of death (e.g. a motor vehicle accident where a person recorded a high blood alcohol concentration) (ABS 2018). See also the Technical notes.

Australian Institute of Health and Welfare (AIHW) analysis of the AIHW National Mortality Database (Table S1.4) showed that in 2020:

• The number alcohol-induced deaths continue to rise, with 1,452 deaths reported in 2020, an 8% increase from 1,344 alcohol-induced deaths in 2019. After adjusting for population growth and ageing, the rate of alcohol-induced deaths increased from 4.8 per 100,000 population in 2019 to 5.2 per 100,000 population in 2020.
• There were 4,516 alcohol-related deaths in 2020. This has increased from 2,746 alcohol-related deaths in 2011, an increase from 11.6 per 100,000 population to 16.4 per 100,000  (Table S1.4).

Australian Bureau of Statistics data on Causes of Death show that in 2020:

• The majority of the 1,452 alcohol-induced deaths (73% or 1,056 deaths) were recorded for males (396 deaths for females).
• After adjusting for population growth and ageing, Remainder of states had a higher rate of deaths than Capital cities (6.4 and 4.5 per 100,000 population, respectively). However, Remainder of states had a lower number of alcohol-induced deaths (630 deaths in Remainder of states and 749 deaths in Capital city areas) (ABS 2021).

Burden of disease

The Australian Burden of Disease Study 2018 shows that tobacco use (8.6%) and alcohol use (4.5%) collectively accounted for 13.1% of the total burden of disease in Australia in 2018. Declines were observed for most leading risk factors with the exception of illicit drug use for which the age-standardised DALY rate increased by 35% between 2003 and 2018 (AIHW 2021c).

Burden of disease analysis is used to compare the impact of different diseases, conditions or injuries on a population (AIHW 2021ca). 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, poisoning and premature death and are among the leading risk factors contributing to disease burden in Australia (AIHW 2021c) (Figure IMPACT3). Analysis of data from the Australian Burden of Disease Study 2018 for tobacco, alcohol and illicit drug use based on the latest evidence of linked diseases indicated the following:

• Tobacco, alcohol and illicit drug use collectively accounted for 16.1% of the total burden of disease in Australia in 2018.
• Tobacco use contributed to 8.6% of the total burden of disease in Australia in 2018. It was responsible for 39% of the burden of respiratory diseases, 22% of cancers, 10.7% of cardiovascular diseases, and 6.2% of infections (AIHW 2021b, Table 6.3).
• Alcohol use contributed to 4.5% of the total burden of disease in Australia in 2018 and was the leading risk factor for males aged 15–44 (12.3% compared to females 3.9%). 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 use disorders, 40% of liver cancer burden, 25% of road traffic injuries—motor vehicle occupant burden, 19% of chronic liver disease burden and 14% of suicide burden (Table S2.4) .  
• Illicit drug use contributed to 3.0% of the total burden of disease in Australia in 2018, most of which was experienced by people aged 15–44. Males aged 15–44 experienced a greater proportion of total disease burden attributable to illicit drug use than females in this age group (10.6% compared to 4.4%).
• Illicit drug use was responsible for 100% of the burden of drug use disorders (excluding alcohol) and 72% of the poisoning burden. It was also responsible for 74% of the acute Hepatitis C burden, 33% of the acute Hepatitis B burden, and 7.2% of the HIV/AIDS burden.
• Opioid use accounted for the largest proportion (31%) of the illicit drug use burden, followed by amphetamine use (24%), cocaine (10.9%) and cannabis (10.2%). In addition, 17.8% of the burden was from diseases contracted through unsafe injecting practices (Table S2.5) (AIHW 2021b).

The Australian Burden of Disease Study: Impact and causes of illness and death in Aboriginal and Torres Strait Islander people 2018 describes the impact of 219 diseases and injuries among Aboriginal and Torres Strait Islander people in terms of fatal and non-fatal burden. Some key findings from the Study show:

Tobacco use: Tobacco use was the highest risk factor, accounting for 12% of total disease burden, an increase from 10% in 2003.

• Over 800 deaths were attributed to tobacco use in 2018, 23% of all deaths among the Indigenous population.
• Tobacco use contributed to the highest portion of the total health gap between Indigenous and non-Indigenous Australians, accounting for 20% of the gap. Total health gap is measured by the difference in DALY (disability-adjusted life years) rates between Indigenous and non-Indigenous Australians (Table S3.7) (AIHW 2022a).

Alcohol use: Alcohol use was the second highest risk factor, accounting for 10% of total disease burden.

• 350 deaths were attributed to alcohol use in 2018, 9.7% of all deaths among the Indigenous population.
• Alcohol use contributed to 12% of the health gap between Indigenous and non-Indigenous Australians. Alcohol use accounted for a larger proportion of the health gap for males compared to females (18% and 7.7%, respectively) (Table S3.7).

Illicit drug use: Illicit drug use was the 4th highest risk factor, accounting for 6.9% of total disease burden.

• 224 deaths were attributed to illicit drug use in 2018, 6.2% of all deaths among the Indigenous population.
• Illicit drug use saw the highest increase in total attributable burden age-standardised rate (ASR) between 2003 and 2018 at 77% (13 attributable DALY ASR in 2003, 23 attributable DALY ASR in 2018) (AIHW 2022a).

Figure IMPACT3: Burden of disease due to alcohol or illicit drug use, by selected linked disease and sex, 2018

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Injury and hospitalisation

Recent consumers of alcohol (past 12 months)

• According to the 2019 National Drug Strategy Household Survey (NDSHS):
  • 1.2% of consumers aged 14 years or older had been injured while under the influence of alcohol and required medical attention and 0.4% required admission to hospital for their injuries. 
  • Less than 1% of consumers aged 14 years or older required medical attention (0.3%) or hospitalisation (0.2%) because they were so intoxicated (AIHW 2020, Table 3.43).
• 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 aged 14 years or older who consumed 11 or more standard drinks at least monthly with 4.9% requiring medical attention for their injuries (AIHW 2020, Table 3.44).

People who have recently used illicit drugs (past 12 months)

2019 NDSHS data on injury and hospitalisation for people who have recently used illicit drugs have a high relative standard error and should be interpreted with caution (AIHW 2020).

• Data from the 2019 NDSHS shows that 1.2% of people aged 14 and over who have recently used illicit drugs reported that they had injured themselves while under the influence of illicit drugs and required medical attention and 0.5% said their injury was serious enough to require hospitalisation (AIHW 2020, Table 4.32).
• Less than 1% of people who have recently used illicit drugs reported that they had overdosed and required medical attention (0.9%) or hospitalisation (0.4%) (AIHW 2020, Table 4.32). This was higher among people who had used meth/amphetamines in the previous 12 months (2.0% had overdosed and required medical attention and 0.8% required hospitalisation) (AIHW 2020, Table 4.31).

Hospitalisations

What is a drug-related hospitalisation?
A hospitalisation is an episode of admitted patient care ending with discharge, transfer or death, or a portion of a hospital stay beginning or ending in a change of type of care (AIHW 2022). Drug-related hospitalisations are hospitalisations where the principal diagnosis relates to a substance use disorder or direct harm due to selected substances (AIHW 2018). The principal diagnosis is considered to be responsible for an episode of admitted patient care to hospital. For more information, see Technical notes.

There were 11.8 million hospitalisations in Australia’s public and private hospitals in 2020–21, rising from 11.1 million in the previous year (AIHW 2022). Hospitalisations with a drug-related principal diagnosis accounted for 1.3% of all hospitalisations in 2020–21 (152,000 hospitalisations) (Table S1.12).

AIHW analysis of the National Hospital Morbidity Database (NHMD) showed that, for drug-related hospitalisations, overnight hospitalisations continued to be more common than same-day hospitalisations in 2020–21 (58% of all drug-related hospitalisations) (Table S1.12).

In the 6 years to 2020–21:

• The total number of drug-related hospitalisations increased by 12% (from 136,000 hospitalisations in 2015–16 to 152,000 in 2020–21). The largest increase occurred between 2019–20 and 2020–21, when there was a 7.9% rise from 141,000 hospitalisations in 2019–20.
• After accounting for population growth, the rate of drug-related hospitalisations remained relatively stable between 2015–16 and 2019–20 (565.1 and 550.5 hospitalisations per 100,000 population, respectively), then increased to 2020–21 (591.0 per 100,000).
• Increases in the number and rate of drug-related hospitalisations between 2019–20 and 2020–21 were primarily driven by a rise in alcohol-related hospitalisations (Table S1.13; Figure IMPACT4).

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.

Figure IMPACT4:  Hospitalisations with a drug-related principal diagnosis, by drug type, 2015–16 to 2020–21 (number or crude rate per 100,000 population)

View data tables >

Common drug types and classes identified in drug-related hospitalisations

In 2020–21, among drug-related hospitalisations:

• Alcohol accounted for nearly 3 in 5 hospitalisations (58% or 86,400 hospitalisations). Alcohol remained the most common drug type involved in drug-related hospitalisations in the 6 years to 2020–21 (Table S1.13; Figure IMPACT4).
• Amphetamines and other stimulants accounted for 10% of hospitalisations (15,100 hospitalisations). Most of these related to methamphetamine (82% or 12,400)
• Antiepileptic, sedative-hypnotic and antiparkinsonism drugs (excluding alcohol) accounted for 6.9% of hospitalisations (10,400 hospitalisations). Over 2 in 5 of these hospitalisations were related to benzodiazepines (45% or 4,700 hospitalisations).
• Other drugs included non-opioid analgesics (5.4% or 8,200 hospitalisations), cannabinoids (4.9% or 7,500) and opioids (4.4% or 6,700) (tables S1.12 and S1.13; Figure IMPACT4).

The most recent analysis of the NHMD by the National Drug and Alcohol Research Centre (NDARC) identified 62,800 drug-related hospitalisations in 2019–20 (Chrzanowska et al. 2021). This is lower than the number estimated by the AIHW for that period (141,000 hospitalisations; Table S1.13). The difference is primarily due to the exclusion of alcohol-related hospital hospitalisations from the NDARC analysis (see Box IMPACT2). According to the NDARC analysis:

• The most common drugs recorded in drug-related hospitalisations in 2019–20 were similar to those reported in the AIHW analysis for 2020–21 (excluding alcohol).
• The age-standardised rate of drug-related hospitalisations was higher in 2019–20 than in 1999–2000 but has remained stable since 2017–18 (Chrzanowska et al. 2021).

Overdose and misuse

Overdose and misuse of alcohol and other drugs (AOD) are public health concerns that affect the community on many levels. Surveillance and monitoring of AOD overdose and misuse can help to form an evidence base in relation to trends and emerging patterns of harms (Moayeri et al. 2020).

Data from the Illicit Drug Reporting System (IDRS) and the Ecstasy and Related Drugs Reporting System (EDRS) show rates of self-reported overdose among people who regularly use stimulant drugs (EDRS) and who regularly inject drugs (IDRS). In 2021:

• 1 in 10 (9%) IDRS participants reported experiencing a non-fatal heroin overdose in the last 12 months (Sutherland et al. 2021b).

• 16% of EDRS participants reported experiencing a non-fatal stimulant overdose in the last 12 months (Sutherland et al. 2021a).

Data collection for 2021 took place from April–August for the EDRS and June–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 and 2021 were delivered face-to-face as well as via telephone. This change in methodology should be considered when comparing data from the 2020 and 2021 samples relative to previous years.

Ambulance attendances

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.

For the 5 jurisdictions where data are available, in 2021:

• Across all jurisdictions, the highest number (and rate) of ambulance attendances were alcohol intoxication-related. Adjusting for population differences in jurisdictions, rates ranged from 456.8 per 100,000 population in New South Wales to 681.0 in the Australian Capital Territory.
• Ambulance attendance rates were considerably lower for all other drugs reported here, including amphetamines (any) (49.3 per 100,000 population in Tasmania to 85.2 per 100,000 population in Victoria).
• Ambulance attendances for any pharmaceutical drug were predominantly for females (6 in 10, or 60%), while most attendances for alcohol and illicit drugs were for males (Table S1.9).
• Ambulance attendances for antidepressants were predominantly for females aged 15–24 and 25–34 (29% and 13% of all antidepressant attendances respectively).
• Around 90% of benzodiazepine-related ambulance attendances resulted in transfer to hospital (ranging from 83% in the Australian Capital Territory to 92% of attendances in Queensland). Heroin had the lowest rates of transfer to hospital, ranging from 48% in the Australian Capital Territory to 86% of attendances in Queensland.
• The involvement of multiple drugs (excluding alcohol) was reported in less than half of attendances for alcohol and illicit drugs. However, in over half of all pharmaceutical attendances, multiple drugs were reported (Table S1.9).

Figure IMPACT5: All alcohol and other drug ambulance attendances, by month, sex and selected states and territories, 2021

Transport to hospital

In 2021 ambulance attendances requiring transport to hospital varied across jurisdictions, drug types, sex and age groups. Specifically, attendances requiring transport to hospital for:

• Any type of pharmaceutical drug required a higher rate of transport to hospital than other drugs, ranging from 86% of attendances in the Australian Capital Territory to 93% of attendances in Queensland.
• Alcohol-related attendances ranged from 71% of attendances requiring transport to hospital in the Australian Capital Territory to 84% of attendances in Queensland.
• Heroin attendances requiring transport to hospital ranged from 48% of attendances in the Australian Capital Territory to 86% of attendances in Queensland.

Figure IMPACT6: Ambulance attendances involving transport to hospital, by age, sex and selected states and territories, 2021

Police co-attendance

Police co-attendance also varied, particularly across drug types. In 2021:

• The highest proportion of ambulance attendances where police co-attended involved amphetamines (any), ranging from:
  • 3 in 10 (30%) in the Australian Capital Territory, to almost 1 in 2 (48%) of attendances in Victoria.
• Police co-attendance was generally less likely where a pharmaceutical drug was involved, ranging from 20% of attendances in Queensland to 31% of attendances in Victoria.

Figure IMPACT7: Ambulance attendances involving police co-attendance, by age, sex and selected states and territories, 2021

Multiple drug involvement

Ambulance attendances where multiple drugs were involved varied between drug types and across jurisdictions. In 2021:

• Around 1 in 5 (18%) alcohol-related attendances involved at least one other drug.
• Over half of any pharmaceutical-related attendances involved at least one other drug (excluding alcohol), ranging from 52% in New South Wales to 58% in Victoria (Table S1.10).

Figure IMPACT8: Ambulance attendances involving multiple drug use, by age, sex and selected states and territories, 2021

Mental health conditions

For related content on people with mental health conditions, see also:

> People with mental health conditions

According to the 2019 NDSHS:

• between 2016 and 2019 there was an increase in the proportion of people who had recently used an illicit drug (in the past 12 months) experiencing high or very high levels of psychological distress (from 22% to 26%)
• the proportion of people who recently used drugs who had been diagnosed with or treated for a mental health condition in the previous 12 months remained stable at around 26% (AIHW 2020, Table 4.14).

Over half (58%) of participants of the 2021 EDRS reported mental health issues in the preceding 6 months, an increase from 52% in 2020. The primary issue of concern reported among this population of people who regularly use ecstasy and other stimulants was anxiety (71%) and depression (62%) (Sutherland et al. 2021a) (refer to Box HARM1 for more information). 

Data collection for the EDRS for 2021 took place from April–August. Due to COVID-19 restrictions in various jurisdictions, interviews were delivered via face-to-face interview and by telephone. This change in methodology should be considered when comparing data from the 2020 and 2021 samples relative to previous years.

Pregnancy complications

Supporting the health and wellbeing of women throughout pregnancy helps to ensure healthy outcomes for mothers and their babies. Encouraging healthy behaviours during pregnancy can reduce the risk of adverse outcomes for mothers and their babies.

Tobacco smoking in pregnancy is the most common preventable risk factor for pregnancy complications. Smoking 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 that, in 2020 compared to babies of mothers who did not smoke, babies of mothers who smoked at any time during pregnancy were more likely to be:

• Low birthweight (13.1% compared with 5.8% of liveborn babies).
• Small for gestational age (16.2% compared with 8.6% of liveborn singleton babies).
• Born pre-term (13.6% compared with 7.7%) (AIHW 2022b).

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 are currently no data available indicating the prevalence of FASD in Australia, however there have been some jurisdictional based studies which reported birth prevalence of FAS of between 0.01 and 0.68 per 1000 live births. Higher prevalence of FAS is commonly found among Indigenous communities, likely reflecting socioeconomic factors and patterns of alcohol use (Burns et al. 2013).

New Australian guidelines to reduce health risks from drinking alcohol were released in December 2020. National Drug Strategy Household Survey data relating to the updated guidelines are available in the Measuring risky drinking according to the Australian alcohol guidelines report.

The latest Australian Guidelines to reduce Health risks from Drinking Alcohol advise that to prevent harm from alcohol to their unborn child, women who are pregnant or planning a pregnancy should not drink alcohol (NHMRC 2020).

The 2019 NDSHS showed that 65% of pregnant women (aged 14–49) abstained from drinking alcohol during their pregnancy; this is an increase from 40% in 2007 and 56% in 2016. The remaining women reported that they reduced their drinking during pregnancy (35%) compared with when they were not pregnant, and less than 1% reported drinking the same (AIHW 2020).

Questions on substance using during pregnancy were updated in the 2013 NDSHS to provide a more accurate picture of drinking during pregnancy—see 2019 NDSHS Technical notes for further information. Each question collects information about slightly different concepts. The measure about what women consumed before and after knowledge of pregnancy is likely to give the most accurate estimate on the amount of alcohol consumed during pregnancy but has only been collected since 2013.

Results from the 2019 NDSHS showed that among pregnant women aged 14–49 who were unaware of their pregnancy, about 1 in 2 (55%) consumed alcohol before they knew they were pregnant, and this declined to 14.5% once they knew they were pregnant. Among all pregnant women, regardless of whether they knew they were pregnant, 3 in 10 (30%) reported drinking alcohol during pregnancy and this has declined from 42% in 2013 (AIHW 2020).

Injection-related harms

For related content on injecting drug use, see also:

> People who inject drugs: Illicit drugs

The 2019 NDSHS estimates that a very low proportion of the Australian general population aged 14 and over have injected drugs, either in their lifetime (1.5%) or in the past 12 months (0.3%) (AIHW 2020, tables 4.2 & 4.6). People who inject drugs are at a higher risk of living with HIV and hepatitis C (UNODC 2022).

Mental health conditions

For related content on people with mental health conditions, see also:

> People with mental health conditions

According to the 2019 NDSHS:

• between 2016 and 2019 there was an increase in the proportion of people who had recently used an illicit drug (in the past 12 months) experiencing high or very high levels of psychological distress (from 22% to 26%)
• the proportion of people who recently used drugs who had been diagnosed with or treated for a mental health condition in the previous 12 months remained stable at around 26% (Table S1.9).

Over half (58%) of participants of the 2021 EDRS reported mental health issues in the preceding 6 months, an increase from 52% in 2020. The primary issue of concern reported among this population of people who regularly use ecstasy and other stimulants was anxiety (71%) and depression (62%) (Sutherland et al. 2021a) (refer to Box HARM1 for more information). 

Data collection for the EDRS for 2021 took place from April–August. Due to COVID-19 restrictions in various jurisdictions, interviews were delivered via face-to-face interview and by telephone. This change in methodology should be considered when comparing data from the 2020 and 2021 samples relative to previous years.

Pregnancy complications

Supporting the health and wellbeing of women throughout pregnancy helps to ensure healthy outcomes for mothers and their babies. Encouraging healthy behaviours during pregnancy can reduce the risk of adverse outcomes for mothers and their babies.

Tobacco smoking in pregnancy is the most common preventable risk factor for pregnancy complications. Smoking 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 that, in 2020 compared to babies of mothers who did not smoke, babies of mothers who smoked at any time during pregnancy were more likely to be:

• Low birthweight 13.1% compared with 5.8% of liveborn babies).
• Small for gestational age (16.2% compared with 8.6% of liveborn singleton babies).
• Born pre-term (13.6% compared with 7.7%) (AIHW 2022b).

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 are currently no data available indicating the prevalence of FASD in Australia, however there have been some jurisdictional based studies which reported birth prevalence of FAS of between 0.01 and 0.68 per 1000 live births. Higher prevalence of FAS is commonly found among Indigenous communities, likely reflecting socioeconomic factors and patterns of alcohol use (Burns et al. 2013).

New Australian guidelines to reduce health risks from drinking alcohol were released in December 2020. National Drug Strategy Household Survey data relating to the updated guidelines are available in the Measuring risky drinking according to the Australian alcohol guidelines report.

The latest Australian Guidelines to reduce Health risks from Drinking Alcohol advise that to prevent harm from alcohol to their unborn child, women who are pregnant or planning a pregnancy should not drink alcohol (NHMRC 2020).

The 2019 NDSHS showed that 65% of pregnant women (aged 14–49) abstained from drinking alcohol during their pregnancy; this is an increase from 40% in 2007 and 56% in 2016. The remaining women reported that they reduced their drinking during pregnancy (35%) compared with when they were not pregnant, and less than 1% reported drinking the same (AIHW 2020).

Questions on substance using during pregnancy were updated in the 2013 NDSHS to provide a more accurate picture of drinking during pregnancy—see 2019 NDSHS Technical notes for further information. Each question collects information about slightly different concepts. The measure about what women consumed before and after knowledge of pregnancy is likely to give the most accurate estimate on the amount of alcohol consumed during pregnancy but has only been collected since 2013.

Results from the 2019 NDSHS showed that among pregnant women aged 14–49 who were unaware of their pregnancy, about 1 in 2 (55%) consumed alcohol before they knew they were pregnant, and this declined to 14.5% once they knew they were pregnant. Among all pregnant women, regardless of whether they knew they were pregnant, 3 in 10 (30%) reported drinking alcohol during pregnancy and this has declined from 42% in 2013 (AIHW 2020).

Injection-related harms

For related content on injecting drug use, see also:

> People who inject drugs: Illicit drugs

The 2019 NDSHS estimates that a very low proportion of the Australian general population aged 14 and over have injected drugs, either in their lifetime (1.5%) or in the past 12 months (0.3%) (AIHW 2020) (tables S2.31 & S2.32). People who inject drugs are at a higher risk of living with HIV and hepatitis C (UNODC 2022).