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 (ABS 2017). Multiple drug types may have been reported on a single death record. As a result, the sum of each drug type may be more than the total number of deaths. Analysis of the AIHW National Mortality database showed:

  • In 2017, 1,795 deaths were drug-induced (a rate of 7.4 per 100,000 population) (Tables S1.1 and S2.71). Although the number of drug-induced deaths in 2017 was the second highest on record, the rate is still lower than that of drug-induced deaths recorded in 1999 (9.1 deaths per 100,000 population).
  • Opioids were the most common drug class identified in drug-induced deaths data over the past two decades. This includes 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) (Figure IMPACT1).
  • By single drug type, the most common substance present in drug-induced deaths in 2017 were benzodiazepines, identified in 824 deaths (46%) (benzodiazepines are included in the drug class ‘depressants’) (AIHW 2019a).
  • The rate of drug-induced deaths has increased at a faster rate in Regional and remote areas, up 41% in the past decade (2008–2017), compared with a 16% increase in Major cities over the same period. However, in 2017 the rate of drug-induced deaths was slightly higher in Major cities (7.4 per 100,000 population), compared with Regional and remote areas (7.2 per 100,000 population) (AIHW 2019a).
  • 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 (AIHW 2017).

The National Drug and Alcohol Research Centre (NDARC) reported additional information on opioid-induced deaths, highlighting that in 2017 there were 1,084 opioid-induced deaths among Australian aged 15–64 years—a rate of 6.7 per 100,000 population (see Box IMPACT1) (Chrzanowska et al. 2019). About 8 in 10 (81%) of these deaths were considered accidental; a consistent trend in the data over the last decade (Chrzanowska et al. 2019).

Over half (56%) of opioid-induced deaths among people aged 15–64 years in 2017 had recorded benzodiazepines as contributing to the death, continuing an increase since 2007 (35%) (Chrzanowska et al. 2019). Other drugs commonly recorded as contributing to these opioid-induced deaths included antidepressants (32%), antipsychotics (18.8%), alcohol (16.2%), and paracetamol (14.9%) (Chrzanowska et al. 2019).

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), Australian Institute of Health and Welfare (AIHW) and the Penington Institute use data provided by the ABS to report on drug deaths in Australia.

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

  • The ABS, AIHW 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. The ABS, AIHW 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 and AIHW exclude drug-induced 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, AIHW and Penington Institute report for the whole of the population (ABS 2017; Chrzanowska et al. 2019; ABS 2018; AIHW 2019).

In addition, the ABS has recently released data on the harmful consumption of alcohol including alcohol-induced and alcohol-related deaths (ABS 2018).

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 (ABS 2018).

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 was listed as an associated cause of death (ABS 2018).

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 (ABS 2018).

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 (ABS 2018).

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

Burden of disease

Burden of disease analysis is used to compare the impact of different diseases, conditions or injuries on a population (AIHW 2019b). 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 (ABS 2019b) and are among the leading risk factors contributing to disease burden in Australia. Analysis of data from the Australian Burden of Disease Study 2015 including revised analysis of estimates for alcohol use and illicit drug use based on the latest evidence of linked diseases (AIHW 2019b) indicated the following:

  • Tobacco use contributed to 9.3% of the total burden of disease in Australia in 2015. It was responsible for 41% of the burden of respiratory diseases, 22% of cancers, 11.5% of cardiovascular diseases, and 6.8% of infections (AIHW 2019b).
  • Alcohol use contributed to 4.5% of the total burden of disease in Australia in 2015 and was the leading risk factor for males aged 25–44 (11.9% compared to females 3.4%) (AIHW 2019b). 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, 28% of chronic liver disease burden, 22% of road traffic injuries—motor vehicle occupant burden and 14% of suicide burden (Table S2.63) (AIHW 2019b).  
  • Illicit drug use contributed to 2.7% of the total burden of disease in Australia in 2015, most of which was experienced by males and females aged 25–44 (AIHW 2019b). Males aged 25–44 experienced a greater proportion of total disease burden attributable to illicit drug use than females (10% compared to 4.4%) (AIHW 2019b). Illicit drug use was responsible for 100% of the burden of drug use disorders (excluding alcohol) and 27% of the poisoning burden. It was also responsible for 75% of the acute Hepatitis C burden, 37% of the acute Hepatitis B burden, and 7.9% of the HIV/AIDS burden (AIHW 2019b).
  • Opioid use accounted for the largest proportion (37%) of the illicit drug use burden, followed by amphetamine use (21%), cocaine (11.4%) and cannabis (8.3%). In addition, 18.2% of the burden was from diseases contracted through unsafe injecting practices (Table S2.69) (AIHW 2019b).

Injury and hospitalisation

Recent consumers of alcohol (past 12 months)

  • According to the 2016 National Drug Strategy Household Survey (NDSHS),
    •  2.8% of consumers aged 12 years or older 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 consumers aged 12 years or older 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 aged 12 years or older consumed 11 or more standard drinks at least monthly with 8.4% requiring medical attention for their injuries (AIHW 2017a) (Table S1.5).

Recent users of illicit drugs (past 12 months):

2016 NDSHS data on injury and hospitalisation for recent users of illicit drugs have a high relative standard error and should be interpreted with caution (AIHW 2017a).

  • 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).

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 1.0% (or 137,000) 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 (51%).
  • In 2016–17, for people residing in Regional and very remote areas alcohol accounted for nearly three quarters (72%) of hospital separations with a drug-related principal diagnosis (AIHW 2019a). The rate of drug-related hospitalisations for alcohol was higher for people residing in Regional and very remote areas (1,624.9 per 100,000) compared with Major cities (286.7 per 100,000) (AIHW 2019a).
  • Between 2012–13 and 2016–17, sedatives and hypnotics (excluding alcohol) continued to result in more drug-related hospital separations than opioids.
  • In 2016–17, hospital separation rates (per 100,000 population) for other sedatives and hypnotics were 1.2 times higher for people living in Remote and very remote areas compared with Major cities (AIHW 2019a).
  • 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 (AIHW 2018).
  • Hospital separation rates (per 100,000 population) for opioids were 1.4 times higher for people residing in Remote and very remote areas compared with Major cities in 2016–17 (AIHW 2019a).
  • Hospital separation proportions (5.7%) and rates for cannabinoids were higher for people residing in Remote and very remote areas compared to other areas.

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 who had been diagnosed with or treated for a mental illness in the previous 12 months (from 20.7% to 26.5%) (AIHW 2017a) (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%) (Peacock et al. 2018) (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 2017, that babies of mothers who smoked during pregnancy were more likely than babies of mothers who did not smoke to be:

  • low birthweight (12.9% compared with 6.0%)
  • small for gestational age (16% compared with 9%)
  • born pre-term (13.6% compared with 8.1%) (AIHW 2019c).

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 (Burns et al. 2013).

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 (NHMRC 2009).

The NSDHS showed 56% of pregnant women abstained from drinking alcohol during their pregnancy, this is an increase from 40% in 2007 (AIHW 2017a). The remaining women 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%) (AIHW 2017a)

The Australian Burden of Disease Study 2015 showed that 0.5% of the total burden of disease and injuries were related to unsafe injecting practices (ABS 2019b). This was specifically linked to acute Hepatitis C (75% of the attributable burden), acute Hepatitis B (37%), chronic liver disease (24%), liver cancer (24%) and HIV/AIDs (8%).

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 (AIHW 2018).

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 recent reuse of needles and syringes (including the reuse of one’s own syringes) increased from 21% in 2014 to 26% in 2018.
  • the proportion of respondents reporting receptive sharing of needles and syringes in the last month increased from 16% in 2014 to 18% in 2018.
  • HIV antibody prevalence has remained low and stable nationally from 2014 to 2018 (between 1.4% and 2.1%), with some populations at greater risk than others (Heard et al. 2019).

Data from the Illicit Drug Reporting System (IDRS) provides additional evidence of risk of harms and actual experience of harms, including (Peacock et al. 2018):

  • 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 2017–18, in Victoria, the rate of ambulance attendances involving any illicit drug was 206.6 per 100,000 population (12,768 attendances). The rate of ambulance attendances involving the licit or illicit use of pharmaceuticals was 178.2 per 100,000 (11,013 attendances) (Turning Point 2018). 

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 (Peacock et al. 2018b).
  • 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 (Peacock et al. 2018a).

References

ABS (Australian Bureau of Statistics) 2017. Causes of death, Australia, 2016. ABS cat. no. 3303.0. Canberra: ABS. Viewed 4 January 2018.

ABS 2018. Causes of death, Australia, 2017. ABS cat. no. 3303.0. Canberra: ABS. Viewed 12 October 2018.

AIHW (Australian Institute of Health and Welfare) 2017a. National drug strategy household survey 2016: detailed findings. Drug statistics series no. 31. Cat. no. PHE 214. Canberra: AIHW. Viewed 14 December 2017.

AIHW 2018. Drug related hospitalisations. Canberra: AIHW. Viewed 30 November 2018.

AIHW 2019a. Alcohol and other drug use in regional and remote Australia: consumption, harms and access to treatment, 2016–17. Cat. no. HSE 212. Canberra: AIHW. Viewed 15 March 2019.

AIHW 2019b. Australian burden of disease study: Impact and causes of illness and death in Australia 2015. Series no.19. BOD 22. Canberra: AIHW. Viewed 13 June 2019.

AIHW 2019c. Australia’s mothers and babies 2017 – in brief. Perinatal statistics series no. 35. Cat. No. PER 100. Canberra: AIHW.

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.

Chrzanowska A, Dobbins T, Degenhardt L & Peacock A 2019. Trends in Drug-Induced Deaths in Australia, 1997–2017. Drug Trends. Sydney: National Drug and Alcohol Research Centre, UNSW Australia. Viewed 16 July 2019.

Heard S, Iversen J, Geddes L & Maher L 2019. Australian Needle Syringe Program Survey National Data Report 2014-2018: Prevalence of HIV, HCV and injecting and sexual behaviour among NSP attendees. Sydney: Kirby Institute, UNSW.

NHMRC (National Health and Medical Research Council) 2009. Australian guidelines to reduce health risks from drinking alcohol. Canberra: NHMRC. Viewed 12 October 2017.

Peacock A, Gibbs D, Karlsson A, Uporova J, Sutherland R, Bruno R, Dietze P, Lenton S, Alati R, Degenhardt L & Farrell M 2018a. 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.

Peacock A, Gibbs D, Sutherland R, Uporova J, Karlsson A, Bruno R, Dietze P, Lenton S, Alati R, Degenhardt L & Farrell M 2018b. Australian Drug Trends 2018: Key findings from the National Illicit Drug Reporting System Interviews. Sydney, National Drug and Alcohol Research Centre, UNSW Australia.

Penington Institute 2019. Australia’s annual overdose report 2019. Melbourne: Penington Institute.

Turning point 2017. Ambo-AODstats. Melbourne: Victoria. Viewed 6 June 2018.