Illicit drug use

Illicit drug use affects individuals, families and the broader Australian community. These harms are numerous and include:

• health impacts such as burden of disease, death, overdose and hospitalisation
• social impacts such as violence, crime and trauma
• economic impacts such as the cost of health care and law enforcement.

Some specific population groups are at greater risk of experiencing disproportionate harms associated with illicit drug use, including young people, people with mental health conditions and people who are gay, lesbian, bisexual, transgender or intersex (Department of Health 2017).

How common is illicit drug use?

According to the 2019 National Drug Strategy Household Survey (NDSHS), an estimated 9.0 million (43%) people aged 14 and over in Australia had illicitly used a drug at some point in their lifetime (including the non-medical use of pharmaceuticals), and an estimated 3.4 million (16.4%) had used an illicit drug in the previous 12 months. This was similar to proportions in 2016 (43% and 15.6%, respectively) but has increased since 2007 (38% and 13.4%, respectively) (Figure 1).

In 2019, the most common illicit drug used in the previous 12 months was cannabis (11.6%),  followed by cocaine (4.2%) and ecstasy (3.0%) (Figure 1). A number of changes were reported in the recent use of illicit drugs between 2016 and 2019, including increases in the use of:

• cannabis (from 10.4% to 11.6%)
• cocaine (from 2.5% to 4.2%)
• ecstasy (from 2.2% to 3.0%)  
• hallucinogens (from 1.0% to 1.6%)
• inhalants (from 1.0% to 1.4%)
• ketamine (from 0.4% to 0.9%) (Figure 1) (AIHW 2020).

Overall, in 2019, an estimated 900,000 people (4.2%) aged 14 and over used a pharmaceutical drug for non-medical purposes in the previous 12 months, a decline from 4.8% (an estimated one million people) in 2016 (AIHW 2020). Between 2016 and 2019, the proportion of people using ‘pain-killers and opioids’ for non-medical purposes declined from 3.6% to 2.7%. This decline is most likely due to a reclassification of medications containing codeine that was implemented in 2018. Under the change, drugs with codeine (including some painkillers) can no longer be bought from a pharmacy without a prescription. The proportion of people using codeine for non-medical purposes has halved since 2016, from 3.0% to 1.5% in 2019.

In 2016, pain-killers and opioids used for non-medical purposes were the second most commonly used illicit drug in the previous 12 months after cannabis, but in 2019, they were fourth, after cannabis, cocaine and ecstasy (AIHW 2020).

Due to the changes in the recent use of a number of illicit drugs between 2016 and 2019, meth/amphetamines are no longer in the top 5 illicit drugs most likely to be used in the previous 12 months. Meth/amphetamine use has been declining since it peaked at 3.4% in 2001 and stabilised in 2019 (1.4% in 2016 and 1.3% in 2019).

To better understand illicit drug use in Australia, it is important to consider the frequency of drug use and not just the proportion of people who have used a drug in the previous 12 months. Some drugs are used more often than others, and the health risks of illicit drug use increase with the frequency, type, and quantity of drugs used (Degenhardt et al. 2013). While cocaine and ecstasy were used by more people in the previous 12 months, most people used these drugs infrequently with 57% of people who used cocaine and 51% of people who used ecstasy reporting they only used the drug once or twice a year in the 2019 NDSHS. Conversely, monthly or more frequent drug use was more commonly reported among people who had used cannabis (50%) or meth/amphetamines (33%).

Figure 1: Proportion of people aged 14 and over who recently used selected illicit drugs, 2001 to 2019

Impact of COVID-19 on illicit drug use

In 2021, the Illicit Drug Reporting System (IDRS) was adapted to collect information about the experiences during COVID-19 of people who regularly inject drugs. Data collection took place between June–July 2021.

• 12% of IDRS participants had difficulties accessing sterile needles and syringes, and 5% had difficulties safely disposing of used needles and syringes.
• 49% of IDRS participants had a disruption of their drug treatment since COVID-19 (Sutherland et al. 2022b).

Health impact

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 those due to chronic use (for example, drug-induced cardiac conditions) as determined by toxicology and pathology reports (see Glossary for more information).

Analysis of the AIHW National Mortality Database (Figure 2) showed that:

• In 2021, 1,704 deaths were drug-induced, equivalent to 6.6 per 100,000 population, age-standardised – the fourth consecutive decrease since 2017 (8.2 deaths per 100,000).
• Opioids continue to be the most common drug class present in drug-induced deaths over the past decade (3.8 per 100,000 population in 2021). Opioids include the use of a number of drug types, including heroin, opiate-based analgesics (such as codeine and oxycodone) and synthetic opioid prescriptions (such as tramadol and fentanyl).
• In 2021, benzodiazepines were the most common single drug type present in drug-induced deaths (2.9 per 100,000 population) (benzodiazepines are included in the drug class ‘depressants’).
• Over the past decade there has been a substantial rise in deaths involving psychostimulants. The rate has increased from 0.7 per 100,000 population (163 deaths) in 2012 to 1.8 (431 deaths) in 2021.

In 2021, 5 or more drugs were present in 20.8% of all drug-induced deaths, and a further 15.4% reported 3 drugs present. Females were more likely than males to have 5 or more drugs present at toxicology (25.6% and 17.9%, respectively) (ABS 2022). 

Figure 2: Drug-induced deaths, by selected drug type and drug class and rate, 1997 to 2021

Burden of disease

According to the Australian Burden of Disease Study 2018, illicit drug use contributed to 3% of the total burden of disease and injury in 2018 (AIHW 2022b). This included the impact of opioids, amphetamines, cocaine, cannabis and other illicit drug use, as well as unsafe injecting practices. The rate of total burden of disease and injury attributable to illicit drug use increased by 35% between 2003 and 2018 (AIHW 2022b).

Opioid use accounted for the largest proportion (31%) of the illicit drug use burden, followed by amphetamine (24%), unsafe injecting practices (18%), cocaine (11%) and cannabis (10%) use. Illicit drug use was responsible for almost all burden due to drug use and disorders (excluding alcohol) (AIHW 2022a). See Burden of disease.

Hospitalisations

In 2020–21, hospitalisations with a drug-related principal diagnosis accounted for 1.3% of all hospitalisations (152,000). Amphetamines and other stimulants accounted for 10% (15,100) of drug-related hospitalisations and most of these related to methamphetamines (82% or 12,400).

In 2020–21, drug-related hospitalisations for:

• Amphetamines and other stimulants decreased to 59 hospitalisations per 100,000 people from 71 hospitalisations per 100,000 people in 2019–20.
• Opioids decreased to 26 hospitalisations per 100,000 people from 38 hospitalisations per 100,000 people in 2015–16 (Figure 3).

Non-opioid analgesics saw an increase from 27 hospitalisations per 100,000 people in 2019–2020 to 32 hospitalisations per 100,000 people in 2020–21.

See Alcohol for information on drug-related hospitalisations where alcohol was the drug.

Figure 3: Hospitalisations by selected drug-related principal diagnosis, number and crude rate, 2015–16 to 2020–21

Ambulance attendances

2021 data on alcohol and other drug-related ambulance attendances are currently available for 5 jurisdictions: New South Wales, Victoria, Queensland, Tasmania, and the Australian Capital Territory. Across reporting jurisdictions:

• The highest number and rate of ambulance attendances for illicit drugs were for cannabis, amphetamines (any) and benzodiazepines.
• '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.
• The highest proportion of ambulance attendances where police co-attended involved Amphetamines (any). This was less likely where a pharmaceutical drug was involved.

Over half (55%) of any pharmaceutical drug-related attendances involved at least one other drug (excluding alcohol) (AIHW 2022b).

Non-fatal overdose

Data from the 2022 IDRS and Ecstasy and related Drugs Reporting System (EDRS) include rates of self-reported overdose:

• Of the 2022 IDRS participants, 12% reported a non-fatal opioid overdose in the past 12 months (Sutherland et al. 2022c).
• Of the 2022 EDRS participants, 16% reported experiencing a non-fatal stimulant overdose in the past 12 months, stable relative to 2020 (18%) (Sutherland et al. 2022a).

Treatment

Amphetamines were the most common principal illicit drug of concern in 2021–22. The Alcohol and other drug treatment services in Australia annual report for 2021–22 reported that amphetamines accounted for 24% of treatment episodes, followed by cannabis at 19% then heroin at 4.5% (AIHW 2023).

Between 2012–13 and 2021–22, treatment episodes for amphetamines as a principal drug of concern increased from 22,300 to 49,700 and increased for cannabis from 36,600 to 40,200 episodes (AIHW 2023).

See Alcohol and other drug treatment services.

Social impact

The social impacts of illicit drug use are pervasive and include criminal activity, engagement with the criminal justice system and victimisation. For example:

• Just under 2 in 5 participants of the 2022 IDRS (39%) and 2022 EDRS (37%) reported participating in criminal activities. The most common criminal activities were property crime and selling and/or dealing of drugs (Sutherland et al. 2022a, 2022c).
• In 2019, 1 in 10 (10.5%) people aged 14 and over had been a victim of an illicit drug-related incident (experiencing verbal abuse, physical abuse or being put in fear) in the previous 12 months, an increase from 9.2% in 2016 (AIHW 2020).
• In 2020–21, almost one-quarter of victims (23%) and 9% of offenders had consumed illicit drugs or non-therapeutic levels of pharmaceutical drugs before a homicide incident (Bricknell 2023).

Priority populations

The National Drug Strategy 2017–2026 specifies priority populations who have a high risk of experiencing direct and indirect harm as a result of drug use, including young people, people with mental health conditions and people who are gay, lesbian, bisexual, transgender or intersex (Department of Health 2017).

Young people

Young people are susceptible to permanent damage from alcohol and other drug use as their brains are still developing, which makes them a vulnerable population (Department of Health 2017).

Young people (aged 14–29) in 2019 were less likely to have used an illicit drug in the previous 12 months than young people in 2001 – with a particularly large difference seen among teenagers and people in their 20s. For example, in 2001, 28% of 14–19 year olds had used an illicit drug in the previous 12 months, but by 2019, this was 16% (AIHW 2020).

In 2019, people aged 20–29 were the most likely to have used an illicit drug in the previous 12 months (31%), a similar proportion to 2016 (28%). There have been significant changes in the types of drugs used by people in their 20s. Ecstasy use among people in their 20s declined from 12.0% in 2004 to 7.0% in 2016 then rose again to 9.8% in 2019. This was the first time an increase was reported in ecstasy use for people in this age group in over a decade, with use returning to a similar level reported in 2001 (10.4%) (Figure 4). Cocaine use among people in their 20s was at its highest level in 2019. Much of the rise in cocaine use among people in this age group occurred between 2016 and 2019 – from 4.3% in 2001 to 6.9% in 2016 and up to 12.0% in 2019. On the other hand, use of methamphetamines among people in their 20s is at its lowest level since 2001 (declined from 11.2% in 2001 to 2.4% in 2019) (AIHW 2020).

See Health of young people.

Figure 4: Proportion of people aged 20–29 who recently use ecstasy, cocaine, or meth/amphetamine, 2001 to 2019

People with mental health conditions

The presence of a mental health condition may lead to a drug use disorder, or vice versa. In some cases where there is a comorbidity, the person who uses drugs can develop a drug use disorder as a consequence of repeated use to relieve or cope with mental health symptoms (Marel et al. 2016).

In 2019, the NDSHS showed that the proportion of people self-reporting a mental health condition was higher among people aged 18 and over who reported the use of illicit drugs in the previous 12 months (26%) than those who had not used an illicit drug over this period (15.2%) (AIHW 2020). For example, mental health conditions were reported by:

• 31% of people who recently used meth/amphetamines (compared with 16.6% of non-users)
• 27% of people who recently used cannabis (compared with 15.4% of non-users)
• 22% of people who recently used ecstasy (compared with 16.7% of non-users)
• 22% of people who recently used cocaine (compared with 16.6% of non-users) (AIHW 2020).

The EDRS reported an increase in self-reported mental health conditions between 2014 and 2020 (from 28% to 52%) (Peacock et al. 2021a). See Physical health of people with mental illness.

Lesbian, gay, bisexual, transgender, intersex or queer people

People who are lesbian, gay, bisexual, transgender, intersex or queer can be at an increased risk of licit and illicit drug use. These risks can be increased by a number of issues such as stigma and discrimination, familial issues, fear of discrimination and fear of identification (Department of Health 2017). The NDSHS provides substance use estimates by sexual identity for people who are gay, lesbian or bisexual, however it does not include estimates for people identifying as transgender or intersex (AIHW 2020).

The NDSHS has consistently shown that the proportion of people reporting illicit drug use has been higher among people who are gay, lesbian or bisexual than among heterosexual people – 40% compared with 15.4% had used an illicit drug in the previous 12 months in 2019. After adjusting for differences in age, in comparison to heterosexual people, gay, lesbian or bisexual people were:

• 9.0 times as likely to use inhalants in the previous 12 months
• 3.9 times as likely to have used meth/amphetamines in the previous 12 months
• 2.6 times as likely to have used ecstasy in the previous 12 months (AIHW 2020).

The types of illicit drugs people had used in the last 12 months varied quite considerably by a person’s sexual orientation and it is important to note that there are differences in substance use between people who identified as gay or lesbian and people who identified as bisexual (AIHW 2020). 

The Writing Themselves In National Report describes findings from the national survey of health and wellbeing among lesbian, gay, bisexual, trans, queer, asexual (LBGTQA+) young people in Australia. The survey was conducted from September to October 2019 and participants needed to be aged between 14 and 21 years. The survey shows that in the previous 6 months:

• 27% of participants aged 14 to 17 years and 43% of participants aged 18 to 21 years reported using any drug for non-medical purposes
• 28% of participants reported using cannabis
• 7.0% of participants reported using ecstasy/MDMA (Hill et al. 2022a).

The Private Lives survey is Australia’s largest national survey of the health and wellbeing of lesbian, gay, bisexual, transgender, intersex and queer (LGBTIQ) people, with the age of participants ranging from 18 to 88 years. The survey showed that 44% of participants reported using one or more drugs for non-medical purposes in the previous 6 months. Of this, cannabis was the highest at 30%, followed by Ecstasy/MDMA at 13.9%. 

Within the past 6 months, 14.0% of participants reported experiencing a time when they had struggled to manage their drug use or where it negatively impacted their everyday life (Hill et al. 2022b).

Where do I go for more information?

For more information on illicit drug use, see:

• Alcohol, tobacco & other drugs in Australia
• National Drug Strategy Household Survey 2019
• Alcohol and other drug treatment services in Australia annual report
• Australian Burden of Disease Study 2018: interactive data on risk factor burden
• National Drug and Alcohol Research Centre

Visit Illicit use of drugs for more on this topic.

References

ABS (Australian Bureau of Statistics) (2022) Causes of Death, Australia, 2021, ABS cat. no. 3303.0, ABS, Australian Government, accessed 14 November 2022.

AIHW (Australian Institute of Health and Welfare) (2020) National Drug Strategy Household Survey 2019, Drug statistics series no. 32. Cat. No. PHE 270. AIHW, Australian Government, accessed 5 April 2022.

AIHW (2022a) Australian Burden of Disease Study 2018: Interactive data on risk factor burden, AIHW, Australian Government, accessed 28 September 2021.

AIHW (2022b) Alcohol, tobacco & other drugs in Australia, AIHW, Australian Government, accessed 17 August 2022.

AIHW (2023) Alcohol and other drug treatment services in Australia annual report, AIHW, Australian Government, accessed 21 June 2023.

Bricknell S (2023) Homicide in Australia 2020–21 Statistical Report no. 42. Canberra: Australian Institute of Criminology, accessed 31 March 2023.

Degenhardt L, Whiteford HA, Ferrari AJ, Baxter AJ, Charlson FJ et al. (2013) Global burden of disease attributable to illicit drug use and dependence: findings from the Global Burden of Disease Study 2010, The Lancet 382(9904):1564–74, accessed 5 April 2022

Department of Health (2017) National Drug Strategy 2017–2026, Department of Health website, accessed 13 October 2019.

Department of Health (2021) Types of drugs, Department of Health website, accessed 22 March 2022.

Hill AO, Lyons A, Jones J, McGowan I, Carman M, Parsons M, Power J, Bourne A (2022a) Writing Themselves In 4: The health and wellbeing of LGBTQA+ young people in Australia, National report, monograph series number 124. Australian Research Centre in Sex, Health and Society, La Trobe University, accessed 22 March 2022.

Hill AO, Bourne A, McNair R, Carman M & Lyons A (2022b) Private Lives 3: The health and wellbeing of LGBTIQ people in Australia, ARCSHS Monograph Series No. 122. Australian Research Centre in Sex, Health and Society, La Trobe University, accessed 22 March 2022

Marel C, Mills KL, Kingston R, Gournay K, Deady M, Kay-Lambkin F, Baker A, Teesson M (2016) Guidelines on the management of co-occurring alcohol and other drug and mental health conditions in alcohol and other drug treatment settings (2nd edition). Centre of Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, University of New South Wales, accessed 5 April 2022.

Sutherland, R, Karlsson A, Price O, Uporova J, Chandrasena U, Swanton R, et al. (2022a) Australian Drug Trends 2022: Key findings from the National Ecstasy and Related Drugs Reporting System (EDRS) Interviews, National Drug and Alcohol Research Centre, University of New South Wales, accessed 14 November 2022.

Sutherland R, Uporova J, Chandrasena U, Price O, Karlsson A, Gibbs D, et al. (2022b) Australian Drug Trends 2021: Key Findings from the National Illicit Drug Reporting System (IDRS) Interviews, National Drug and Alcohol Research Centre, University of New South Wales, accessed 22 March 2022.

Sutherland R, Uporova J, King C, Jones F, Karlsson A, Gibbs D, Price O, et al. (2022c) Australian Drug Trends 2022: Key Findings from the National Illicit Drug Reporting System (IDRS) Interviews, National Drug and Alcohol Research Centre, University of New South Wales, accessed 14 November 2022.