Australian Institute of Health and Welfare (2022) Alcohol, tobacco & other drugs in Australia, AIHW, Australian Government, accessed 01 February 2023.
Australian Institute of Health and Welfare. (2022). Alcohol, tobacco & other drugs in Australia. Retrieved from https://www.aihw.gov.au/reports/alcohol/alcohol-tobacco-other-drugs-australia
Alcohol, tobacco & other drugs in Australia. Australian Institute of Health and Welfare, 14 December 2022, https://www.aihw.gov.au/reports/alcohol/alcohol-tobacco-other-drugs-australia
Australian Institute of Health and Welfare. Alcohol, tobacco & other drugs in Australia [Internet]. Canberra: Australian Institute of Health and Welfare, 2022 [cited 2023 Feb. 1]. Available from: https://www.aihw.gov.au/reports/alcohol/alcohol-tobacco-other-drugs-australia
Australian Institute of Health and Welfare (AIHW) 2022, Alcohol, tobacco & other drugs in Australia, viewed 1 February 2023, https://www.aihw.gov.au/reports/alcohol/alcohol-tobacco-other-drugs-australia
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People who inject drugs (PWID) are among the most marginalised and disadvantaged drug users. They experience multiple negative health consequences including higher risk of fatal overdoses and are disproportionately affected by blood-borne infectious diseases (such as HIV and hepatitis C). There were over 11 million people who inject drugs globally in 2019, of whom 1.4 million were living with HIV and 5.6 million with hepatitis C. Almost 1.2 million people live with both (UNODC 2021).
In 2019, 1.5% of the population aged 14 and over reported injecting a drug in their lifetime
Prevalence of drug injection
In 2019, 0.3% of the population aged 14 and over reported injecting a drug in the past year
In 2022, 54% of people who inject drugs (PWID) reported that methamphetamine was the drug they injected most often in the last month, and 35% said they most often injected heroin.
Drug most often injected
People who inject drugs experience considerably poorer health outcomes than others who use drugs
Health and harms
Globally in 2020, over 11 million people injected drugs, 1.4 million of these people were living with HIV and 5.5 million living with hepatitis C
In 2020, 39% of PWID were HCV antibody positive, a decline since 2016 when it was 51%
Injection-related health problems
View the People who inject drugs fact sheet >
In Australia, a low proportion of the general population report injecting drugs. Information on data sources referred to in this section are in Box PWID1. The National Drug Strategy Household Survey (NDSHS) found that in 2019, 1.5% of the population aged 14 and over had injected a drug in their lifetime (AIHW, Table 4.2), with 0.3% having injected a drug in the past year (both stable from 2016) (AIHW 2020, Table 4.6; Figure PWID1). Males who were aged 14 and over were more likely to have recently injected drugs (in the past year) than their female counterparts (2.2% compared to 0.9%) (AIHW 2020).
As PWID are likely to be underrepresented as respondents of the NDSHS, this section will largely draw upon data from other sources that are specifically targeted at PWID including the Illicit Drug Reporting System (IDRS) coordinated by the National Drug and Alcohol Research Centre (NDARC) and the Australian Needle and Syringe Program Survey (ANSPS) coordinated by the Kirby Institute.
The figure shows that both lifetime and recent injecting drug use were lower in 2019 than in 2001. Lifetime drug use decreased slightly from 1.8% of people aged 14 and over in 2001, to 1.5% in 2019. Similarly, recent drug use fell from 0.6% to 0.3%.
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Heroin and methamphetamine are the most commonly injected drugs in Australia and are often cited as preferred drugs among PWID (Heard et al. 2022; Sutherland et al. 2022).
Estimates from the Illicit Drug Reporting System (IDRS) show that methamphetamine continues to be the most common drug of choice among PWID, after surpassing heroin, in 2021, for the first time since monitoring began (Sutherland et al. 2022).
Estimates from the 2022 IDRS showed that, among PWID who responded:
Data collection for 2022 took place from May to July. Due to COVID-19 restrictions being imposed in various jurisdictions during data collection periods, interviews in 2020, 2021 and 2022 were delivered face-to-face as well as via telephone. This change in methodology should be considered when comparing data from the 2020, 2021 and 2022 samples relative to previous years.
Injecting drug use among PWID is often assessed by asking people to report the drug that they most recently injected (last drug injected). Data from the Australian Needle Syringe Program Survey 2017–2021 showed that methamphetamine and heroin are the most common last drugs injected (Figure PWID2).
Other drugs that are often reported as the last drug injected include performance and image enhancing drugs (PIEDs; such as steroids, peptides or hormones) (Heard et.al, 2022).
The figure shows that in 2021, methamphetamine was the most common drug that was last injected (51%), followed by heroin (20%) and pharmaceutical opioids (7%). In 2021, 5% of respondents had last injected more than one drug.
Use of cannabis by PWID is also common. The 2022 IDRS showed that:
PWID also use pharmaceutical drugs, particularly prescription opioids, at higher rates than the general population (Sutherland et al. 2022). This likely reflects the practice of substituting pharmaceutical drugs for illicit drugs, such as heroin. Data from the 2022 IDRS showed that, in the last 6 months:
Use of cocaine is also common among PWID, with 15% of participants in the 2022 IDRS reporting using cocaine in the last 6 months, stable from 15% in 2021 (Sutherland et al. 2022).
Injecting drug use is a major risk factor for transmitting blood-borne viruses, including HIV, hepatitis B and hepatitis C. 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).
The Australian Burden of Disease study, 2018, found that unsafe injecting practices were responsible for 0.9% of the total burden of disease and injuries in 2018 (AIHW 2021).
Unsafe injecting practices are linked to Hepatitis B, Hepatitis C, HIV/AIDS, liver cancer and chronic liver disease. Liver cancer and chronic liver disease are the long-term consequences of contracting hepatitis B and hepatitis C infection. Acute hepatitis C and B were responsible for 74% and 33% of burden (respectively) (AIHW 2021). Chronic liver disease and liver cancer were each responsible for 27% of the burden due to unsafe injecting practices (AIHW 2021).
The IDRS report on trends in self-reported past year non-fatal overdose and responses to overdose found that, between 2009 and 2020, the proportion of participants who reported receiving no treatment on the occasion of their overdose fluctuated, but remained above 10% (Thomas et al. 2021).
Data from the Australian Needle Syringe Program Survey (ANSPS) provides some evidence of the risk of harms related to injecting drug use in people who regularly inject drugs in Australia:
Data from the 2022 IDRS provide additional evidence of risks for harms, including:
The figure shows that injecting risk behaviours have fluctuated between 2000 and 2021. Re-use of own needles overall decreased from 53% in 2008 to 38% in 2021. Borrowing needles fell from 16% in 2000 to 6% in 2020, though lending of needles remained relatively stable (11% in 2000 and 10% in 2021). Sharing of other equipment decreased from 51% in 2000 to 5% in 2019, before increasing to 18% in 2021.
In 2022, 26% of IDRS participants reported experiencing an injection-related health problem in the last month stable from 2021 (26%). Of those who responded (n=879), in the last month:
National HIV antibody prevalence is low, the ANSPS found that among survey participants, there was an decrease in prevalence from 2.1% in 2017 to 1.5% in 2021 (Heard et al. 2022, Table 1.2.1). Some populations of PWID are at greater risk of HIV than others.
This figure shows that HIV antibody prevalence has fluctuated across time and was lower in 2021 (1.5% of persons) than 2020 (2.5%). HIV antibodies have typically been more prevalent among males (1.8% in 2021) than females (0.6% in 2021).
According to the ANSPS, Hepatitis C (HCV) is more common than HIV among PWID. Almost 2 in 5 (36%) of respondents were HCV antibody positive in 2021, a decline from 49% in 2017 (Heard et al. 2022, Table 1.3.1).
Data collection for the 2021 ANSPS was impacted by COVID-19 restrictions. The survey took place in several phases from September to December 2021, instead of the usual October timeframe. Victoria and NSW experienced outbreaks between June and November 2021, resulting in a reduction in the amount of participating NSP services. This should be taken into account when comparing data from 2021 with previous years.
Data from the 2022 IDRS found that:
Of participants not receiving treatment in 2021, 13% reported difficulties accessing treatment. Among these same participants, methamphetamine (60%) and heroin (27%) were the main substances for which participants intended to seek treatment (Sutherland et al. 2021).
For related content on policy related to injecting drug use, see also:
The 2019 NDSHS showed that most people support measures to reduce problems associated with injecting drugs. About two-thirds of the population aged 14 and over supported rapid detoxification therapy (69%), methadone/buprenorphine maintenance programs (67%), needle and syringe programs (64%), treatment with drugs other than methadone (66%) and the use of naltrexone (65%), which is a medication that blocks the effect of opioids such as heroin. In addition:
All Australian states and territories operate needle syringe programs (NSPs), providing a range of services to PWID (Heard et al. 2022). See Harm reduction: Minimising risky behaviours
According to the IDRS, in 2017, NSPs were by far the most common source of needles and syringes in the preceding 6 months (94%), followed by NSP vending machines (19%). Chemists were used by 16% of participants nationally (Karlsson & Burns 2018, Table 51). This is supported by the findings of the 2019 NDSHS that NSPs were the most commonly reported source (39%), followed by chemists (34%) (AIHW 2020, Table 4.95). This is likely to reflect the different sampling of the 2 surveys whereby the NDSHS is targeted at the general population, while the IDRS accesses PWID.
Medically supervised injecting centres (MSIC) are places where people can use and inject drugs under the supervision of registered nurses, counsellors and health education professionals. This service aims to prevent injury and death by being present when someone injects in order to provide immediate medical assistance as required. Kings Cross in Sydney has been home to an MSIC since 2001 (Uniting 2017), and a second opened in Richmond, Victoria in July 2018.
AIHW (Australian Institute of Health and Welfare) 2012. Australia’s health 2010. Australia’s health series no. 12. Cat. no. AUS 122. Canberra: AIHW.
AIHW 2020. National Drug Strategy Household Survey 2019. Drug Statistics series no. 32. Cat. no. PHE 270. Canberra: AIHW. Viewed 21 July 2020.
AIHW 2021b. Australian Burden of Disease Study: Impact and causes of illness and death in Australia 2018, AIHW, Australian Government. doi:10.25816/5ps1-j259
Dolan K, MacDonald M, Silins E & Topp L 2005. Needle and syringe programs: a review of the evidence. Canberra: Australian Government Department of Health and Ageing. Viewed 25 January 2018.
Heard S, Iversen J, Maher L, 2022. Australian Needle Syringe Program Survey. National Data Report 2017–2021: Prevalence of HIV, HCV and injecting and sexual behaviour among NSP attendees. Sydney: Kirby Institute, UNSW Sydney.
Karlsson A & Burns L 2018. Australian Drug Trends 2017. Findings from the Illicit Drug Reporting System (IDRS). Australian Drug Trend Series. No. 181. Sydney, National Drug and Alcohol Research Centre, UNSW Australia.
Sutherland R, Uporova J, King C, Jones F, Karlsson A, Gibbs D, Price O, Bruno R, Dietze P, Lenton S, Salom C, Daly C, Thomas N, Juckel J, Agramunt S, Wilson Y, Que Noy W, Wilson J, Degenhardt L, Farrell M and Peacock A. 2022. Australian Drug Trends 2022: Key Findings from the National Illicit Drug Reporting System (IDRS) Interviews. Sydney: National Drug and Alcohol Research Centre, UNSW Sydney. Viewed 13 October 2022.
Thomas N, Juckel J ,Daly C, Maravilla J & Salom C R 2021. Trends in self-reported past year non-fatal overdose and responses to overdose: Findings from the Illicit Drug Reporting System. Sydney. National Drug and Alcohol Research Centre, UNSW.
UNODC (United Nations Office on Drugs and Crime) 2022. World Drug Report 2022. Vienna: UNODC. Accessed 6 July 2022.
Uniting 2017. Uniting Medically Supervised Injecting Centre: get to know our story. Viewed 25 January 2018.
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