Australian Institute of Health and Welfare (2021) Alcohol, tobacco & other drugs in Australia., AIHW, Australian Government, accessed 28 January 2022
Australian Institute of Health and Welfare. (2021). 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, 15 December 2021, 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, 2021 [cited 2022 Jan. 28]. Available from: https://www.aihw.gov.au/reports/alcohol/alcohol-tobacco-other-drugs-australia
Australian Institute of Health and Welfare (AIHW) 2021, Alcohol, tobacco & other drugs in Australia, viewed 28 January 2022, https://www.aihw.gov.au/reports/alcohol/alcohol-tobacco-other-drugs-australia
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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.
For related content on drug-induced deaths, see also:
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 chronic use (for example, drug-induced cardiac conditions) as determined by toxicology and pathology reports (ABS 2021).
See also the Technical notes. Multiple drug types may have been reported on a single death record as associated causes of death. As a result, the sum of each drug type may be more than the total number of deaths.
Preliminary Australian Bureau of Statistics data on Causes of Death show that in 2020:
Detailed analysis of the AIHW National Mortality Database by the Australian Institute of Health and Welfare (AIHW) showed that in 2019:
This figure shows changes in drug-induced deaths over time for different drug classes. In 2019, the age-standardised rate of drug-induced deaths was 7.4 per 100,000 population, down from 9.1 per 100,000 in 1999.
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In 2019, the highest rates of drug-induced deaths were for people aged 45–54 (15.1 deaths per 100,000 population) and 35–44 (14.2 deaths per 100,000 population). This has changed since the 1990s, when the rate of deaths was highest for people aged 25–34 (Chrzanowska et al. 2021).
Over the past 2 decades, benzodiazepines have remained the most commonly-identified single drug type in drug-induced deaths, and opioids the most common drug class (Figure IMPACT1; Table S1.1a). AIHW analysis of the National Mortality Database showed that, in 2019:
Preliminary mortality data indicate that there has been a recent change in the main type of opioid identified in drug-induced deaths. Over the past decade, opioid-induced deaths were more likely to be due to prescription drugs than illegal drugs, and there has been a rise in the number of deaths with a prescription drug present. However, the proportion and rate of opioid-induced deaths relating to illegal opioids—opium and heroin—is increasing.
Since 1997, the most common other drug involved in opioid-induced deaths was benzodiazepines (55% or 614 deaths in 2019). The majority (78%) of opioid-induced deaths were accidental (Chrzanowska et al. 2021).
In 2020, 5 or more drugs were present in 19.3% of all drug-induced deaths, and a further 17.9% reported 3 drugs present. Females were more likely than males to have 5 or more drugs present at toxicology (23.0% and 17.3%, respectively) (ABS 2021).
AIHW analysis of the National Mortality Database showed that:
Psychosocial risk factors, recorded for coroner-referred deaths in the National Mortality Database, are ‘social processes and social structures which can have an interaction with individual thought or behaviour and health outcomes’ (ABS 2019). Risk factors may not be mutually exclusive and therefore deaths with multiple psychosocial risk factors recorded will be counted in more than one category.
In 2019, at least one psychosocial risk factor was recorded in one-third (33%) of drug-induced deaths. For intentional drug-induced deaths, this proportion was more than 3 in 5 (61%) (Table S1.1b).
Personal history of self-harm was the most commonly identified risk factor (12%), followed by relationship issues including: disruption of family by separation and divorce (5%); disappearance and death of a person in the primary support group (3.6%); and problems in relationship with spouse or partner (3.2%) (Table S1.1c). However, there were some notable differences when they were examined by intent, age and sex:
There were also differences in the most commonly identified risk factors across drug types:
This figure shows that Personal history of self harm was the leading psychosocial risk factor identified in drug-induced deaths for all drug classes and types except for cocaine, where the leading risk factor was Disruption of family by separation and divorce.
Associated causes of death refer to conditions other than the underlying cause of death and can include diseases that are part of the chain of events leading to death, risk factors and co-morbid conditions (ABS 2020). People with multiple associated causes of death recorded will be counted in more than one category.
AIHW analysis of the National Mortality Database showed that of drug-induced deaths in 2019 (Table S1.1c):
A number of nationally representative data sources are available to analyse recent trends in deaths related to drugs and alcohol. The ABS has released data on drug-induced causes of death and opioid-induced deaths, 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.
Causes of death are coded by the ABS to the International Standard Classification of Diseases and Related Health Problems (ICD). Where different numbers of deaths are reported, differences in data collection purpose, scope and terminology (outlined below) account for this variation.
The ABS, AIHW, NDARC and the Penington Institute use the terminology of drug-induced deaths to define those deaths that are directly attributable to drug use (that is, where drug overdose is the underlying cause of death).
Drug-related deaths – where a drug has played a contributory role (for example, a traffic accident) – are excluded.
The ABS, AIHW and NDARC all report drug-induced deaths using the Drug-induced death tabulation (see ABS 3303.0 - Causes of Death, Australia). This tabulation outlines the ICD-10 codes for causes of death attributable to drug-induced mortality. This excludes deaths solely attributable to alcohol and tobacco.
The Penington Institute report drug-induced deaths that include the classification utilised by the above agencies, but also include some deaths attributable to alcohol use. This includes acute alcohol toxicity and harmful use, but may not capture deaths arising from all chronic health conditions that are wholly or partly attributable to alcohol use.
This report includes data on the harmful consumption of alcohol including alcohol-induced and alcohol-related deaths. This provides an update to previous reporting by the ABS (ABS 2018) and uses the same tabulation for alcohol-induced deaths (see ABS 3303.0 - Causes of Death, Australia).
Drug-induced deaths data are reported for the whole of the population across all data sources (Chrzanowska et al. 2021; Penington Institute 2021; see also the Technical notes for information about the AIHW analysis of the National Mortality Database).
For related content on deaths due to harmful alcohol consumption, see also:
Alcohol-induced deaths are defined as those that can be directly attributable to alcohol use (i.e. where an alcohol-related condition is recorded as the underlying cause of death), as determined by toxicology and pathology reports. This may be the result of a chronic condition directly related to alcohol use (e.g. alcoholic liver cirrhosis) or from an acute condition directly related to harmful consumption (e.g. alcohol poisoning).
Alcohol-related deaths include deaths directly attributable to alcohol use (as defined above) and deaths where alcohol was listed as an associated cause of death (e.g. a motor vehicle accident where a person recorded a high blood alcohol concentration) (ABS 2018). See also the Technical notes.
Australian Bureau of Statistics data on Causes of Death show that in 2020:
Australian Institute of Health and Welfare (AIHW) analysis of the AIHW National Mortality Database (Table S1.1d) showed that in 2019:
The Australian Burden of Disease Study 2018 shows that tobacco use (8.6%) and alcohol use (4.5%) collectively accounted for 13.1% of the total burden of disease in Australia in 2018. Declines were observed for most leading risk factors with the exception of illicit drug use for which the age-standardised DALY rate increased by 35% between 2003 and 2018 (AIHW 2021c).
Burden of disease analysis is used to compare the impact of different diseases, conditions or injuries on a population (AIHW 2021ca). 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 and are among the leading risk factors contributing to disease burden in Australia (AIHW 2021c) (Figure IMPACT3). Analysis of data from the Australian Burden of Disease Study 2018 for tobacco, alcohol and illicit drug use based on the latest evidence of linked diseases indicated the following:
The Australian Burden of Disease Study 2018: key findings for Aboriginal and Torres Strait Islander people was released in October 2021. Full results from the Study are planned for release in early 2022.
Analysis of key findings from the Study shows risk factors contributing to the burden of disease for Indigenous Australians included:
This figure shows that in 2015, for males, alcohol dependence contributed the largest burden (34.2%), followed by injuries (27.8%). For females, the largest burden was for alcohol dependence (26.8%), followed by cancers (25.8%).
2019 NDSHS data on injury and hospitalisation for people who have recently used illicit drugs have a high relative standard error and should be interpreted with caution (AIHW 2020).
For related content on drug-related hospitalisations, see also:
A hospitalisation is an episode of admitted patient care ending with discharge, death, or transfer, or a portion of a hospital stay (AIHW 2021a). Drug-related hospitalisations are hospitalisations where the principal diagnosis (considered to be responsible for an episode of admitted patient care to hospital) relates to a substance use disorder or direct harm due to selected substances (AIHW 2018). For more information, see the Glossary and Technical notes.
In 2019–20, there were 11.1 million hospitalisations in Australia’s public and private hospitals (AIHW 2021a). Drug-related principal diagnoses accounted for 1.3% of these hospitalisations (Table S1.8a). This is a similar proportion to the previous year, when 1.2% of hospitalisations had a drug-related principal diagnosis.
AIHW analysis of the National Hospital Morbidity Database (NHMD) showed:
This figure shows that there were 550.5 drug-related hospitalisations per 100,000 population in 2019–20, down from 565.1 per 100,000 in 2015–16. Alcohol has remained the most common drug involved in drug-related hospitalisations from 2015–16 to 2019–20. A filter lets the user select number or crude rate per 100,000 as the unit of measurement.
In the 5 years to 2019–20, alcohol remained the most common drug type involved in drug-related hospitalisations (Table S1.8b; Figure IMPACT4). AIHW analysis of the NHMD showed that, among hospitalisations with a drug-related principal diagnosis in 2019–20:
The most recent analysis of the NHMD by the National Drug and Alcohol Research Centre (NDARC) identified 61,780 drug-related hospitalisations in 2018–19 (Man et al. 2021). This is lower than the number estimated from AIHW analysis for that period (140,570 hospitalisations; Tables S1.8b). This is primarily due to the exclusion of alcohol-related hospitalisations from the NDARC analysis (see Box IMPACT2).
According to the NDARC analysis:
Box IMPACT2: National data on drug-related hospitalisations
The Australian Institute of Health and Welfare (AIHW) and the National Drug and Alcohol Research Centre (NDARC) routinely publish findings from the National Hospital Morbidity Database (NHMD), including drug-related hospitalisations. Methodological differences in the analyses mean that NDARC reports a lower number of drug-related hospitalisations than the AIHW.
Key differences in the analyses are:
Overdose and misuse of alcohol and other drugs (AOD) are public health concerns that affect the community on many levels. Surveillance and monitoring of AOD overdose and misuse can help to form an evidence base in relation to trends and emerging patterns of harms (Moayeri et al. 2020).
Data from the Illicit Drug Reporting System (IDRS) and the Ecstasy and Related Drugs Reporting System (EDRS) show rates of self-reported overdose among people who regularly use stimulant drugs (EDRS) and who regularly inject drugs (IDRS). In 2021:
1 in 10 (9%) IDRS participants reported experiencing a non-fatal heroin overdose in the last 12 months (Sutherland et al. 2021b).
16% of EDRS participants reported experiencing a non-fatal stimulant overdose in the last 12 months (Sutherland et al. 2021a).
Data collection for 2021 took place from April–August for the EDRS and June–July for the IDRS. Due to COVID-19 restrictions being imposed in various jurisdictions during data collection periods for both the IDRS and the EDRS, interviews in 2020 and 2021 were delivered face-to-face as well as via telephone. This change in methodology should be considered when comparing data from the 2020 and 2021 samples relative to previous years.
For related content on ambulance attendances, see also:
Data on alcohol and other drug-related ambulance attendances are sourced from the National Ambulance Surveillance System for Alcohol and Other Drug Misuse and Overdose. Data for 2020 are currently available for New South Wales, Victoria, Queensland, Tasmania and the Australian Capital Territory. Data are reported for 4 snapshot months per year, specifically March, June, September and December. Please see the data quality statement for further information.
For the 5 jurisdictions that supplied data in 2020:
Across all jurisdictions, the highest number (and rate) of ambulance attendances were alcohol intoxication-related (with rates ranging from 143.3 per 100,000 population in New South Wales to 198.9 per 100,000 population in Queensland).
Ambulance attendance rates were considerably lower for all other drugs reported here, including meth/amphetamines (10.7 per 100,000 population in Tasmania to 27.4 per 100,000 population in Victoria).
With the exception of NSW, benzodiazepine and opioid analgesic-related ambulance attendances were predominantly for females, while attendances for alcohol and other drugs across all jurisdictions were predominantly for males.
Around 90% of benzodiazepine-related ambulance attendances resulted in transfer to hospital (ranging from 85% to 94% of attendances), while heroin had the lowest rates of transfer to hospital, ranging from 44% to 81% of attendances.
The involvement of multiple drugs (excluding alcohol) was reported in over half of all benzodiazepine and opioid analgesic-related ambulance attendances (Table S2.81).
For related content on people with mental health conditions, see also:
There is a strong association between illicit drug use and mental health issues. According to the 2019 NDSHS:
Over half (58%) of participants of the 2021 EDRS reported mental health issues in the preceding 6 months, an increase from 52% in 2020. The primary issue of concern reported among this population of people who regularly use ecstasy and other stimulants was anxiety (71%) and depression (62%) (Sutherland et al. 2021a) (refer to Box HARM1 for more information).
Data collection for the EDRS for 2021 took place from April–August. Due to COVID-19 restrictions in various jurisdictions, interviews were delivered via face-to-face interview and by telephone. This change in methodology should be considered when comparing data from the 2020 and 2021 samples relative to previous years.
Supporting the health and wellbeing of women throughout pregnancy helps to ensure healthy outcomes for mothers and their babies. Encouraging healthy behaviours during pregnancy can reduce the risk of adverse outcomes for mothers and their babies.
Tobacco smoking in pregnancy is the most common preventable risk factor for pregnancy complications. Smoking 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 that, in 2019 compared to babies of mothers who did not smoke, babies of mothers who smoked at any time during pregnancy were more likely to be:
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 are currently no data available indicating the prevalence of FASD in Australia, however there have been some jurisdictional based studies which reported birth prevalence of FAS of between 0.01 and 0.68 per 1000 live births. Higher prevalence of FAS is commonly found among Indigenous communities, likely reflecting socioeconomic factors and patterns of alcohol use (Burns et al. 2013).
New Australian guidelines to reduce health risks from drinking alcohol were released in December 2020. Data for alcohol risk in this report are measured against the 2009 guidelines (see Box ALCOHOL1). National Drug Strategy Household Survey data relating to the updated guidelines are available in the Measuring risky drinking according to the Australian alcohol guidelines report.
The latest Australian Guidelines to reduce Health risks from Drinking Alcohol advise that to prevent harm from alcohol to their unborn child, women who are pregnant or planning a pregnancy should not drink alcohol (NHMRC 2020).
The 2019 NDSHS showed that 65% of pregnant women (aged 14–49) abstained from drinking alcohol during their pregnancy; this is an increase from 40% in 2007 and 56% in 2016. The remaining women reported that they reduced their drinking during pregnancy (35%) compared with when they were not pregnant, and less than 1% reported drinking the same (AIHW 2020).
Questions on substance using during pregnancy were updated in the 2013 NDSHS to provide a more accurate picture of drinking during pregnancy—see 2019 NDSHS Technical notes for further information. Each question collects information about slightly different concepts. The measure about what women consumed before and after knowledge of pregnancy is likely to give the most accurate estimate on the amount of alcohol consumed during pregnancy but has only been collected since 2013.
Results from the 2019 NDSHS showed that among pregnant women aged 14–49 who were unaware of their pregnancy, about 1 in 2 (55%) consumed alcohol before they knew they were pregnant, and this declined to 14.5% once they knew they were pregnant. Among all pregnant women, regardless of whether they knew they were pregnant, 3 in 10 (30%) reported drinking alcohol during pregnancy and this has declined from 42% in 2013 (AIHW 2020).
For related content on injecting drug use, see also:
> People who inject drugs: Illicit drugs
The 2019 NDSHS estimates that a very low proportion of the Australian general population aged 14 and over have injected drugs, either in their lifetime (1.5%) or in the past 12 months (0.3%) (AIHW 2020) (tables S2.31 & S2.32). However, people who inject drugs are at a higher risk of health problems, including HIV and hepatitis C (UNODC 2021).
ABS (Australian Bureau of Statistics) 2018. Causes of Death, Australia, 2017. ABS cat. no. 3303.0. Canberra: ABS. Viewed 12 October 2018.
ABS 2019. 1351.0.55.062 - Research Paper: Psychosocial risk factors as they relate to coroner-referred deaths in Australia, 2017. Canberra: ABS. Viewed 30 April 2021.
ABS 2020. Associated causes of death in mortality. Causes of Death, Australia, 2019. Canberra: ABS. Viewed 30 April 2021.
ABS 2021. Causes of Death, Australia, 2020. ABS cat. no. 3303.0. Canberra: ABS. Viewed 29 September 2021.
AIHW (Australian Institute of Health and Welfare) 2018. Drug related hospitalisations. Cat. no. HSE 220. Canberra: AIHW. Viewed 18 August 2021.
AIHW 2020. National Drug Strategy Household Survey 2019. Drug statistics series no. 32. Cat. no. PHE 270. Canberra: AIHW. Viewed 16 July 2020.
AIHW 2021a. Admitted patients. Canberra: AIHW. Viewed 10 August 2021.
AIHW 2021b. Australia's mothers and babies 2019. Cat. no. PER 101. Canberra: AIHW. Viewed 28 June 2021.
AIHW 2021c. Australian Burden of Disease Study: Impact and causes of illness and death in Australia 2018, AIHW, Australian Government. doi:10.25816/5ps1-j259
AIHW 2021d. Australian Burden of Disease Study 2018: key findings for Aboriginal and Torres Strait Islander people. Cat. no. BOD 28. Canberra: AIHW. Viewed 20 October 2021.
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, Man N, Sutherland R, Degenhardt L & Peacock A 2021. Trends in drug-induced deaths in Australia, 1997–2019. Drug Trends Bulletin Series. Sydney: National Drug and Alcohol Research Centre, UNSW. Viewed 3 May 2021.
Man N, Chrzanowska A, Sutherland R, Degenhardt L & Peacock A 2021. Trends in drug-related hospitalisations in Australia, 1999–2019. Drug Trends Bulletin Series. Sydney: National Drug and Alcohol Research Centre, UNSW. Viewed 24 June 2021.
Moayeri F, Ogeil R, Faulkner A, Wilson J, Matthews S, Lubman D, Scott D. National Surveillance System for Alcohol and Other Drug Misuse and Overdose. Melbourne: Turning Point.
NHMRC (National Health and Medical Research Council) 2009. Australian guidelines to reduce health risks from drinking alcohol. Canberra: NHMRC. Viewed 12 October 2017.
NHMRC 2020. Australian guidelines to reduce health risks from drinking alcohol. Canberra: NHMRC. Viewed 20 May 2021.
Sutherland R, Peacock A, Karlsson A, Uporova J, Price O, Chandrasena U, Swanton R, Gibbs D, Bruno R, Wilson Y, Dietze P, Hall C, Eddy S, Lenton S, Grigg J, Salom C, Daly C, Thomas N, Juckel J, Degenhardt L, & Farrell M (2021a). Australian Drug Trends 2021: Key Findings from the National Ecstasy and Related Drugs Reporting System (EDRS) Interviews. Sydney: National Drug and Alcohol Research Centre, UNSW Sydney.
Sutherland R, Uporova J, Chandrasena U, Price O, Karlsson A, Gibbs D, Swanton R, Bruno R, Dietze P, Lenton S, Salom C, Daly C, Thomas N, Juckel J, Agramunt S, Wilson Y, Woods E, Moon C, Degenhardt L, Farrell M and Peacock A (2021b). Australian Drug Trends 2021: Key Findings from the National Illicit Drug Reporting System (IDRS) Interviews. Sydney: National Drug and Alcohol Research Centre, UNSW Sydney.
Penington Institute 2021. Australia’s annual overdose report 2021. Melbourne: Penington Institute. Viewed 31 August 2021.
United Nations Office on Drug and Crime (UNODC) 2021. World Drug Report 2021. Vienna: UNODC. Viewed 18 August 2021.
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