Cannabis
People in older age groups continue to be less likely to use cannabis than the general population aged 14 and over (AIHW 2020). However, the proportion of older people who have recently used cannabis has increased over time. Specifically, the 2019 NDSHS showed that:
- Recent use of cannabis has been increasing since 2001 among people in their 50s and those aged 60 and over, reaching its highest level in 18 years in 2019 (Figure OLDER2).
- Between 2016 and 2019, recent use of cannabis significantly increased among people in their 50s (from 7.2% to 9.2%) and those aged 60 and over (1.9% to 2.9%). This rise was driven by increased cannabis use among females, both in their 50s (up from 4.7% to 6.7%) and aged 60 and over (1.0% to 2.1%) (AIHW 2020, Table 4.43).
Data from the NDSHS suggest that older people are also more likely to use cannabis for medical purposes than people in younger age groups. In 2019, 43% of people who had recently used cannabis for medical purposes only were aged 50 and over, while 16% of people who used cannabis for non-medical reasons were aged 50 and over (AIHW 2020).
Pharmaceuticals
Prescription drug dispensing
Data from the Pharmaceutical Benefits Scheme (PBS) provide information on the number of prescriptions dispensed and the number of patients dispensed supplied at least one script under the PBS within a given financial year. The PBS database includes information medicines that may be used for non-medical purposes, including opioids, benzodiazepines and gabapentinoids. These numbers largely represent medicines being prescribed for and used for their intended purposes, but monitoring dispensing of these drugs is important in the context of harm reduction (see Box PHARMS1). Refer to the Technical notes and Box PHARMS2 for more information.
Data from the PBS indicate that rates of dispensing of opioids, benzodiazepines and gabapentinoids (such as pregabalin) increase with increasing age, and are highest for people in their 60s, 70s and 80 and over (Figure PHARMS2; tables PBS6, PBS8, PBS26, PBS28, PBS50 and PBS52). In 2020–21:
- People aged 80 and over had the highest rates of scripts dispensed and patients of any age group for opioids, benzodiazepines and gabapentinoids. This was followed by people aged 70–79, 60–69 and 50–59.
- Among people aged 80 and over, the rate of scripts dispensed for:
- Opioids (around 247,000 scripts per 100,000) was between 1.9 and 172 times higher than for people in other age groups (ranging from 1,400 scripts per 100,000 for people aged less than 18 to 127,000 for those aged 70–79).
- Benzodiazepines (81,500 scripts per 100,000) was between 1.8 and 208 times higher than for people in other age groups (ranging from 390 scripts per 100,000 for people aged less than 18 to 45,300 for those aged 70–79).
- Gabapentinoids (71,600 scripts per 100,000) was between 1.4 and 398 times higher than for people in other age groups (ranging from 180 scripts per 100,000 for people aged less than 18 to 51,200 for those aged 70–79).
- Females aged 80 and over had the highest dispensing rates of any group for opioids (around 299,000 scripts and 31,900 patients per 100,000 population), benzodiazepines (97,600 scripts and 19,000 patients per 100,000) and gabapentinoids (79,800 scripts and 10,000 patients per 100,000) (Figure PHARMS2; tables PBS6, PBS8, PBS26, PBS28, PBS50 and PBS52).
People in older age groups consistently had the highest rates of dispensing for opioids, benzodiazepines and gabapentinoids between 2012–13 and 2020–21. However, rates of dispensing of benzodiazepines and opioids declined over time for these age groups. Conversely, gabapentinoid dispensing rates increased across the period, but have stabilised since 2017–18 (Figure PHARMS2; tables PBS6, PBS8, PBS26, PBS28, PBS50 and PBS52).
Non-medical use of pharmaceuticals
Similar to cannabis, non-medical use of pharmaceutical drugs is generally lower among older age groups than the general population aged 14 and over. However, pharmaceuticals are the second most common drug used by older people.
- In 2019, 3.4% of people in their 50s and 3.7% of those aged 60 and over reported recent use of a pharmaceutical for non-medical purposes, compared with 4.2% of all people aged 14 and over.
- From 2016 to 2019, recent non-medical use of pharmaceutical drugs fell slightly for people in their 50s (from 4.1% to 3.4%) and significantly decreased for those aged 60 and over (from 4.5% to 3.7%) (AIHW 2020, Table 5.3).
Health and harms
For related content on health and harms, see also:
Drug-related hospitalisations
National Drug and Alcohol Research Centre (NDARC) analysis of the National Hospital Morbidity Database of drug-related hospitalisations (excluding alcohol) showed that, in 2020–21, people aged 20–29 and 30–39 had the highest rates of drug-related hospitalisations of any age group. However, this rate has been increasing among older age groups. From 1999–2000 to 2020–21:
- The rate of drug-related hospitalisations increased for people aged 50–59 (from 94.3 to 172.9 hospitalisations per 100,000 population), 60–69 (from 51.3 to 81.2 per 100,000) and people aged 70 and over (from 52.7 to 68.5 per 100,000).
- Males aged 40–49 had the greatest increase in the rate of hospitalisations of any group, increasing from 165 per 100,000 population in 1999–2000 to 357 per 100,000 population in 2020–2021 (Chrzanowska et al. 2022a).
Deaths due to harmful alcohol consumption
Alcohol-induced deaths are defined as those that can be directly attributable to alcohol use, as determined by toxicology and pathology reports (for example, chronic conditions such as alcoholic liver cirrhosis or acute conditions such as alcohol poisoning). Alcohol-related deaths include deaths directly attributable to alcohol use and deaths where alcohol was listed as an associated cause of death (for example, a motor vehicle accident where a person recorded a high blood alcohol concentration) (ABS 2018a).
In 2021, ABS Causes of Death data reported 1,559 alcohol-induced deaths and the majority (86%) of these deaths were in people aged 45 years and over (1,334 deaths) (ABS 2022, Table 13.12). Nine in 10 (91%) alcohol-induced deaths were due to the chronic affects of alcohol (1,413 deaths) and these deaths were predominantly in people aged 45 years and over (87%) (ABS 2022, Table 13.16). People aged 55–64 had the highest age-specific rate (15.5 deaths per 100,000 population), accounting for 3 in 10 alcohol-induced deaths (30% or 468). Additionally:
- The highest age-specific rates for males were for those aged 55–64 years (23.4 per 100,000 population), followed by those 65 and over (18.4 per 100,000 population).
- The highest age-specific rates for females were also those aged 55–64 years, (8.0 per 100,000 population), followed by those 45–54 years (6.5 per 100,000 population) (ABS 2022, Table 13.12).
- The median age at death was higher for males than females (58.9 and 57.6 years, respectively) (ABS 2022, Table 13.15).
Australian Institute of Health and Welfare (AIHW) analysis of the AIHW National Mortality Database showed that of the reported 1,559 alcohol-induced deaths in 2021, the highest age-specific rates for alcohol-induced deaths were for older people:
- 15.7 per 100,000 population for those aged 55–59
- 15.3 per 100,000 population for those 60–64
- 12.8 per 100,000 population for those aged 50–54 (Table S1.5).
In comparison, the lowest rates of alcohol-induced deaths were for young people aged 15–29—with rates equal to 0.4 per 100,000 population, or lower.
Higher rates of alcohol-related deaths were also recorded for the older age groups (ranging from 36.4 deaths per 100,000 population for those aged 60–64 to 33.6 per 100,000 population for those aged 50–54) (Table S1.5). This compares with the lowest rate of 3.7 per 100,000 population for people aged 15–19.
Drug-induced deaths
Drug-induced deaths are defined as those that can be directly attributable to drug use and include 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 2022).
In 2021, ABS Causes of Death data reported 1,704 drug-induced deaths. Of these deaths, 55% were in people aged 45 years and over (945 deaths). Overall, the highest rate was in the 45–54 year age group, with an age-specific rate of 13.5 deaths per 100,000 population; this age group was also the highest for both males and females (17.3 and 7.8 per 100,000 population, respectively). Additionally, for the older age groups:
- Males aged 55–64 reported an age-specific death rate of 10.2 per 100,000 population, (151 deaths), while males aged 65 and over reported a lower age-specific death rate of 6.1 per 100,000 population, (124 deaths).
- Females aged 55–64 reported an age-specific death rate of 7.3 per 100,000 population, (113 deaths), while females aged 65 and over reported a lower age-specific death rate of 5.1 per 100,000 population, (118 deaths).
- Almost half (48%, or 219 deaths) of intentional drug-induced deaths were for those aged 55 and over (ABS 2022).
AIHW analysis of the National Mortality database shows that in 2021, people aged 65 years and over were the only age group to not have personal history of self-harm as the most frequently occurring psychosocial risk factor. Personal history of self-harm was the second most frequently occurring risk factor, behind limitation of activities due to disability (14% of drug-induced deaths in this age group) (Table 2.7).
Data analysis on causes of death in Australia by the National Drug and Alcohol Research Centre (NDARC) show that the age profile of people with drug-induced deaths has changed over the last 2 decades:
- Between 1997 and 2005, the highest rate of drug-induced deaths was recorded for people aged 25–34 years. However, the rate decreased substantially from a peak of 22.0 per 100,000 population in 1999 to 7.1 per 100,000 in 2006. The rate has fluctuated since the beginning of the reporting in 1997, with 8.0 deaths per 100,000 population in 2020.
- Conversely, the rate for people aged 45–54 years increased from 5.6 deaths per 100,000 population in 1997 to 13.0 in 2020 – the equal highest rate recorded across all age groups for 2020.
- The rate for people aged 55–64 years also increased between 1997 (3.2 per 100,000 population) and 2020 (9.8 per 100,000 population) – the third highest rate recorded in 2020 (Chrzanowska et al. 2022).
Between 2019 and 2020, the rate of opioid-induced deaths continued to decrease for people aged 55-64 (5.9 per 100,000 population to 5.3), and people aged 75–84 (1.5 per 100,000 population to 1.4). There was an increase in opioid-induced deaths for people aged 65–74 (1.9 per 100,000 in 2019 to 2.3 in 2020) (Chrzanowska et al. 2022).
Treatment
The 2021–22 Alcohol and Other Drug Treatment Services Early Insights Report shows that 11% of clients receiving treatment were aged 50–59 and 5.2% were aged 60 and over (AIHW 2023a).
Data collected for the AODTS NMDS are released twice each year—a key findings report in April and a detailed report mid-year. Detailed information will be updated in June 2023.
Data collected for the AODTS NMDS are released twice each year—a key findings report in April and a detailed report mid-year. The Alcohol and Other Drug Treatment Services National Minimum Data Set (AODTS NMDS) provides information on treatment provided to clients by publicly funded AOD treatment services, including government and non-government organisations. Data from AIHW’s AODTS NMDS and National Opioid Pharmacotherapy Statistics Annual Data (NOPSAD) collections indicate that, in the last 11 years, an ageing cohort of Australians receiving drug and alcohol treatment has emerged.
NOPSAD data indicate that:
- On a snapshot day in 2022, 22% of clients who received opioid pharmacotherapy treatment were aged 50–59.
- The median age of clients who received opioid pharmacotherapy treatment has increased from 38 years in 2011 to 44 in 2022 (AIHW 2023b).
Data from the AODTS NMDS show that 16% of clients who received treatment for their own or someone else’s alcohol or other drug use in 2020–21 were aged 50 and over. This has increased from 13% in 2014–15 (AIHW 2022a).
In 2020–21, among clients who sought treatment for their own AOD use:
- The most common principal drug of concern among clients aged 50–59 was alcohol (59% of clients), followed by amphetamines (12%).
- Alcohol was also the most common principal drug of concern for those aged 60 and over (74% of clients), followed by cannabis (6%) (AIHW 2022a, Table SC.10).
- Counselling was the most common treatment type for clients aged 50–59 (43% of clients) and those aged 60 and over (40%), followed by assessment only (21% of clients aged 50–59 and 27% of those aged 60 and over) (AIHW 2022a, Table SC.19).
The AODTS data were matched with the Specialist Homelessness Services (SHS) collection to identify clients who use both services (matched clients) and compared characteristics between the groups (AIHW 2016). Older clients were identified as one of 4 vulnerable cohorts in the analysis (along with clients with a current mental health issue, clients who experienced family and domestic violence and young clients aged 15–24). The analysis found that matched clients aged 50 and over (when compared to the other vulnerable cohorts) were more likely to be:
- male (68%) and living alone (69%)
- receiving treatment for alcohol (68%)
- Indigenous (17%).
Older clients had similar patterns of alcohol and other drug treatment types, regardless of whether they were in the matched group or AODT-only group, with counselling being the most commonly provided treatment type for all older clients (AIHW 2016).
Smoking and alcohol cessation medicines
Data from the Pharmaceutical Benefits Scheme (PBS) provide information on the number of prescriptions dispensed and the number of patients supplied at least one script under the PBS within a given financial year. The PBS database includes information about medicines that are used to help people stop their smoking or alcohol consumption (smoking and alcohol cessation medicines).
Some smoking cessation medicines, such as Nicotine Replacement Therapies (NRT; for example, nicotine patches and gums), are available over-the-counter (OTC) as well as via a prescription. OTC NRT data are not captured in the PBS data as OTC medicines are not subsidised under the PBS. Refer to the Technical notes and Box PHARMS2 for more information.
Data from the PBS indicate that rates of dispensing of smoking and alcohol cessation medicines are consistently highest for people aged in their 40s, 50s and 60s (tables PBS66, PBS68, PBS82 and PBS84). In 2020–21:
- People aged 50–59 had the highest rates of smoking cessation medicine scripts dispensed and patient rates of any age group. This was followed by people aged 40–49 (scripts dispensed) or 60–69 (patient rate per 100,000 population).
- Males aged 50–59 had the highest rate of smoking cessation medicine scripts dispensed and patient rates of any group (around 4,500 scripts and 2,100 patients per 100,000 population).
- People aged 40–49 had the highest rates of alcohol cessation scripts dispensed and patient rates of any age group, followed by people aged 50–59.
- Males aged 40–49 had the highest rate of alcohol cessation medicine scripts dispensed and patient rates of any age group (around 970 scripts and 385 patients per 100,000 population) (tables PBS66, PBS68, PBS82 and PBS84).
Between 2012–13 and 2020–21, people in their 40s, 50s and 60s consistently had the highest dispensing rates for smoking and alcohol cessation medicines of any age group.
- Rates of smoking cessation medicine scripts dispensed fluctuated over time, but overall increased among people in their 50s and over. However, the rate of patients remained stable or declined for all age groups, apart from those in their 70s and those aged 80 and over where rates increased. This indicates that people in their 50s and 60s may be receiving an increasing number of scripts per patient across time.
- Rates of alcohol cessation medicine scripts dispensed and patients who received a supply of an alcohol cessation medicine increased across the period for people in their 40s and over (tables PBS66, PBS68, PBS82 and PBS84).