Experiences of alcohol and other drugs among people who inject drugs

Introduction

People who inject drugs are at increased risk of experiencing harms such as stigma and discrimination, homelessness, mental health conditions, contact with the criminal justice system, fatal and non-fatal overdose, and blood-borne viruses such as human immunodeficiency virus (HIV) and hepatitis C virus (HCV). Of the estimated 14.0 million people who injected drugs globally in 2023, nearly half (6.9 million) were living with HCV and almost 1 in 8 (1.7 million) were living with HIV (UNODC 2025). 

This page focuses on alcohol and other drug use, harms and treatment among people who inject drugs living in Australia. The reporting uses data from a range of sources, mostly national administrative and survey data. For related content on harm reduction initiatives such as needle and syringe programs, see Harm reduction measures related to alcohol and other drugs.

What data sources are available?

There are a limited number of data sources that contain information about alcohol and other drug use, harms and treatment among people who inject drugs. These include self-report surveys and health administrative data sets. People who inject drugs are likely to be underrepresented in general population surveys. For this reason, the information on this page is largely drawn from sources that are specifically targeted at people who inject drugs. Each data set uses a different methodology.

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

How many people report injecting drug use in Australia?

In Australia, a low proportion of the general population report injecting drugs. The National Drug Strategy Household Survey (NDSHS) found that in 2022–2023, 1.4% of the population aged 14 and over had injected drugs in their lifetime and 0.2% had done so in the past year (stable from 2019) (AIHW 2024b, tables 5.2 and 5.6; Figure 1). Both recent and lifetime injecting drug use have declined over the past two decades.

What do we know about alcohol and other drug use among people who inject drugs?

Injecting drug use

Injecting drug use can be measured in different ways, including by asking people which drug they prefer to inject (‘drug of choice’), which drug they inject most often (‘drug most often injected’), and which drug they last injected (‘last drug injected’). People may provide different answers to these questions based on a range of factors including personal preference and availability of their preferred drug.

Heroin and methamphetamine are often cited as drugs of choice among people who inject drugs (Sutherland et al. 2025). Estimates from the Illicit Drug Reporting System (IDRS) show that methamphetamine continues to be the most common drug of choice among people who inject drugs, after surpassing heroin in 2021 for the first time since monitoring began (Sutherland et al. 2025, Figure 1). 

Heroin and methamphetamine are also the most widely used drugs among people who inject drugs, including ‘drug most often injected’ and ‘drug last injected’. In 2025:

• over half (54%) of IDRS participants reported using heroin in the past 6 months and 82% had used methamphetamine (primarily crystal methamphetamine) 
• over half (57%) of participants reported methamphetamine as the drug injected most often in the past month, up from 23% in 2000
• nearly 2 in 5 (37%) participants reported heroin as the drug injected most often in the past month, down from 58% in 2000 (Sutherland et al. 2025, Figure 2).

Data from the Australian Needle Syringe Program Survey (ANSPS) showed that methamphetamine and heroin are also the two most common drugs reported as the ‘drug last injected’ (Heard et al. 2025, Table 1.1.3; Figure 2). 

Other drugs that are often reported as the last drug injected include: 

• performance and image enhancing drugs (PIEDs), with the proportion in 2024 (5%) being relatively similar to previous years over the past decade 
• pharmaceutical opioids (including morphine, oxycodone, and fentanyl) (3% in 2024, the lowest proportion since 1995 when it was also 3%).
• methadone (4% in 2024 and relatively stable over time) (Heard et al. 2025, Table 1.1.3).

Alcohol, tobacco and other drug use

People who inject drugs often report use of other drugs, including legal drugs such as alcohol and tobacco, non-prescribed use of pharmaceuticals such as benzodiazepines, and use of illicit substances such as cannabis and cocaine (Sutherland et al. 2025). 

The 2025 IDRS showed that, of participants who responded, in the previous 6 months:

• almost 9 in 10 (87%) had used tobacco, and 89% of these reported daily use
• 1 in 4 (25%) had used e-cigarettes that were not obtained from a pharmacy, and 42% of these reported daily use
• over half (53%) had used alcohol, and 16% of these reported daily use 
• around 2 in 3 (65%) had used non-prescribed cannabis and/or cannabinoid-related products, and 50% of these reported daily use 
• nearly 1 in 4 (23%) had used non-prescribed benzodiazepines
• Around 1 in 5 (19%) had used cocaine 
• 1 in 10 had used non-prescribed morphine or oxycodone (9% and 10%, respectively), with lower rates of use for other pharmaceutical opioids (Sutherland et al. 2025).

Polydrug use is also common, with almost two-thirds (66%) of participants reporting using two or more drugs on the day prior to their interview in 2025 (excluding tobacco and e-cigarettes) (Sutherland et al. 2025).

What do we know about health and harms for people who inject drugs?

Burden of disease

The Australian Burden of Disease Study found that unsafe injecting practices were responsible for 0.6% of the total burden of disease and injuries in Australia in 2024 (AIHW 2024a). Unsafe injecting practices are linked to hepatitis B, HCV, HIV/AIDS, liver cancer and chronic liver disease. Liver cancer and chronic liver disease are the long-term consequences of contracting hepatitis B and HCV infection. In 2024, unsafe injecting practices were responsible for:

• 67% of the total burden of acute hepatitis C
• 32% of the total burden of liver cancer
• 31% of the total burden of chronic liver disease
• 24% of the total burden of acute hepatitis B
• 6.6% of the total burden of HIV/AIDS (AIHW 2024a, Table S5).
  
  

Injecting-related risk behaviours and health problems

Injecting drug use is a major risk factor for transmitting blood-borne viruses, including HIV, hepatitis B and HCV. Needle and syringe sharing among people who inject drugs is partly responsible for transmitting infection, although unsafe sexual behaviours also play a role (AIHW 2012).

Data from the ANSPS provides some evidence of the prevalence of risky behaviours related to injecting drug use in people 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) was stable over the past 5 years (from 23% in 2020 to 25% in 2024).
• The proportion of respondents reporting receptive sharing of needles and syringes in the last month remained stable from 16% in 2020 to 19% in 2024 (Heard et al. 2025).

Data from the 2025 IDRS provide additional evidence of risky behaviours, including:

• 8% of participants reported lending a needle to someone after they had used it, and 5% reported borrowing a needle after someone else had used it.
• 1 in 3 (31%) participants reporting re-using their own needle in the last month.
• 1 in 5 (19%) participants reporting sharing other injecting equipment (for example, spoons) in the last month, up from 15% in 2024 but down from a high of 51% in 2000 (Sutherland et al. 2025, Figure 38; Figure 3).

In 2025, 30% of IDRS participants reported experiencing an injection-related health problem in the last month, stable from 2024 (29%). Of those who responded, in the last month:

• 12% experienced nerve damage, stable from 2024 (12%).
• 9% reported that they had experienced a ‘dirty hit’ (that is, a hit that made them feel sick), stable from 2024 (7%).
• 14% experienced an infection or abscess, similar to 2024 (13%) (Sutherland et al. 2025, Table 23).
  
  

Blood-borne viruses

According to the ANSPS, biological testing indicates that exposure to HCV has been declining over time. Between 2015 and 2024:

• HCV antibody prevalence, indicating exposure to HCV, has fluctuated but remained lower than 50% since 2017. In 2024, two-fifths (39%) of respondents were HCV antibody positive, down from 45% in 2023.
• HCV ribonucleic acid (RNA) prevalence, indicating active infection, declined from 51% in 2015 to 8% in 2024, the lowest proportion since monitoring began.
• Lifetime HCV treatment among respondents eligible for treatment has increased from 11% in 2015 to 78% in 2024, following the introduction of DAAs in the Australian Government Pharmaceutical Benefits Scheme in 2016.
• The proportion of people with either no evidence of exposure to HCV or who had cleared infection both increased substantially (Heard et al. 2025). 
• In 2024, the prevalence of HCV antibodies continued to be higher among respondents reporting heroin (57%) or other opioids (48%) as the last drug injected, compared to respondents who last injected methamphetamine (32%) (Heard et al. 2025, Table 1.3.3).

National HIV antibody prevalence has remained below 2.5% over the 30 years to 2024. In 2024, the prevalence was 2.0% (Heard et al. 2025) (Figure 4). Additionally:

• Nationally, across all survey years, HIV antibody prevalence was consistently higher among male respondents than female respondents (Heard et al. 2025, Table 1.2.1; Figure 4). 
• HIV antibody prevalence has also been consistently higher among gay male respondents (29% in 2024) than among bisexual (5.6%) and heterosexual (0.5%) male respondents (Heard et al. 2025, Table 1.2.2).
• In 2024, HIV prevalence was highest among people who last injected methamphetamine (2.6%), followed by heroin (2.1%) and other opioids (1.3%) (Heard et al. 2025, Table 1.2.4).

Other harms

People who inject drugs are at increased risk of experiencing a range of harms, including mental health conditions and overdose. Drug overdose is a major cause of preventable death and is the leading cause of death among people who inject drugs worldwide (Degenhardt et al. 2019). Data from the IDRS show that in 2025, among people who regularly inject drugs:

• nearly 1 in 5 (19%) reported experiencing a non-fatal overdose in the last 12 months. Heroin was the most reported drug involved in recent overdoses, with 1 in 10 (10%) people experiencing a recent heroin overdose
• over half (55%) reported that they had experienced a mental health problem in the past 6 months, the highest proportion for the third year in a row since monitoring commenced. Half (49%) of these people had seen a mental health professional in the past 6 months, stable from 2024 (Sutherland et al. 2025).
  
  

How many people who inject drugs receive treatment for alcohol and other drug use?

Data from the 2025 IDRS showed that nearly 2 in 5 (38%) participants reported receiving treatment for substance use in 2025, similar to 2024 (37%). The most common treatment was methadone (20% of participants) (Sutherland et al. 2025, Table 24).

One in 10 (10%) participants reported difficulties accessing treatment in the last 6 months, stable relative to 2024 (10%). Methamphetamine (55%) and heroin (33%) were the main substances for which these participants had last sought treatment (Sutherland et al. 2025).

Where do I go for more information?

• Australian Needle Syringe Program Survey
• Illicit Drug Reporting System