Australian Institute of Health and Welfare 2021. Alcohol, tobacco & other drugs in Australia. Cat. no. PHE 221. Canberra: AIHW. Viewed 11 May 2021, https://www.aihw.gov.au/reports/alcohol/alcohol-tobacco-other-drugs-australia
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, 16 April 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 2021 May. 11]. 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 11 May 2021, 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.
Drug-induced deaths are defined as those that can be directly attributable to drug use, as determined by toxicology and pathology reports (ABS 2017). Multiple drug types may have been reported on a single death record. As a result, the sum of each drug type may be more than the total number of deaths.
Australian Institute of Health and Welfare (AIHW) analysis of the AIHW National Mortality Database (Figure IMPACT1; Table S1.1) showed:
Figure IMPACT1: Drug-induced deaths by common drug classes and types, 1997 to 2019 (age-standardised rate per 100,000 population)
This figure shows changes in drug-induced deaths over time for different drug classes. In 2019, by drug type, most drug-induced deaths were related to benzodiazepines (3.3 deaths per 100,000 population), followed by all psychostimulants (2.0 per 100,000) and heroin (1.9 per 100,000).
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.
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 (i.e. where drug overdose is the underlying cause of death).
The ABS, AIHW and NDARC use the terminology of drug-related deaths to define deaths where a drug has played a contributory role (e.g. a traffic accident). The Penington Institute however uses the terms drug-related and drug-induced deaths interchangeably to describe deaths directly attributable to drug use.
The ABS, AIHW and NDARC all report drug-induced deaths using the same classification (see ABS 3303.0 - Causes of Death, Australia). This classification excludes deaths solely attributable to alcohol and tobacco. In addition, the ABS report on the harmful consumption of alcohol including alcohol-induced and alcohol-related deaths (ABS 2018).
The Penington Institute report drug-induced deaths that include the classification utilised by the above agencies, but they 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.
Drug-induced deaths data are reported for the whole of the population across all data sources (ABS 2019; Man et al. 2019; Penington Institute 2020; see also the Technical notes for information about the AIHW analysis of the National Mortality Database).
The harmful consumption of alcohol can contribute to mortality in a number of different ways, and deaths can be directly attributable or partially attributable to harmful alcohol consumption. In Australia, deaths that are certified as being directly attributable to alcohol are coded as the underlying cause of death (the condition which initiated the train of morbid events). Alcohol-induced deaths are defined as those that can be directly attributable to alcohol use, as determined by toxicology and pathology reports (ABS 2018).
Alcohol may also play a substantial role in a person’s death, yet not be recognised as the underlying cause of death. In such cases, the alcohol use would be referred to as an associated cause of death. Alcohol-related deaths are defined as deaths directly attributable to alcohol and together with deaths where alcohol was listed as an associated cause of death (ABS 2018).
Data from the ABS showed:
The most common cause of alcohol-induced death was alcoholic liver disease; while mental and behavioural conditions due to alcohol use, including alcohol addiction, is the most common contributor to alcohol-related deaths. Mental and behavioural disorders due to alcohol abuse also made up about 20% of alcohol-induced deaths in 2017 (ABS 2018).
Burden of disease analysis is used to compare the impact of different diseases, conditions or injuries on a population (AIHW 2019a). 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 2019a) (Figure IMPACT2). Analysis of data from the Australian Burden of Disease Study 2015 including revised analysis of estimates for tobacco, alcohol and illicit drug use based on the latest evidence of linked diseases indicated the following:
Figure IMPACT2: Burden due to alcohol and illicit drug use by selected linked disease and sex, 2015
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 2020b).
Information on drug-related hospitalisations is drawn from the National Hospital Morbidity Database.
Figure IMPACT3: Number of hospital separations by selected drug-related principal diagnosis, 2014–15 to 2018–19
This figure shows that the number of hospital separations has fluctuated over time for different drug types. In 2019, most hospital separations were for methamphetamines (12.042 separations), followed by opioids (8,651) and non-opioid analgesics (7,197).
The most recent analysis of the National Hospital Morbidity Database by the National Drug and Alcohol Research Centre (NDARC) identified a lower number of drug-related hospital separations in 2017–18 (60,627) (Chrzanowska et al. 2019) than the AIHW analysis for that period (136,156; tables S1.8a-c). This is primarily due to the exclusion of alcohol-related hospital separations from the NDARC analysis (see Box IMPACT2).
According to the NDARC analysis:
Box IMPACT2. National data on drug-related hospital separations
The Australian Institute of Health and Welfare (AIHW) routinely publishes findings from the National Hospital Morbidity Database (NHMD), including drug-related hospitalisations. The National Drug and Alcohol Research Centre (NDARC) recently released analysis of this database and reported a lower number of drug-related hospital separations than the AIHW.
Key differences identified 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 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 2020:
EDRS and IDRS data for 2020 were collected after COVID-19 restrictions were introduced in Australia, and may not be comparable to previous years.
Data on alcohol and other drug-related ambulance attendances, sourced from the National Surveillance System for Alcohol and Other Drug Misuse and Overdose report, are currently available for New South Wales, Victoria, 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 4 jurisdictions that supplied data in 2019:
Data on alcohol and other drug-related ambulance attendances can be found in the specific drug types sections. See also: Harms in the Cannabis; Meth/amphetamine; Non-medical use of pharmaceuticals; and Illicit opioids, including heroin sections.
There is a strong association between illicit drug use and mental health issues. According to the 2019 NDSHS:
Over half of the participants of the 2020 EDRS reported mental health issues in the preceding 6 months. The primary issue of concern reported among this population of people who regularly use ecstasy and other stimulants was anxiety (69%) and depression (64%) (Peacock et al. 2020) (refer to Box HARM1 for more information). It should be noted that this time period reflects behaviours both before and during the COVID-19 period.
Tobacco smoking in pregnancy is the most common preventable risk factor for pregnancy complications, and 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, in 2018, that babies of mothers who smoked during pregnancy were more likely than babies of mothers who did not smoke 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).
The 2009 Australian Guidelines to reduce Health risks from Drinking Alcohol from the National Health and Medical Research Council state, that for women who are pregnant or planning a pregnancy or breastfeeding, not drinking is the safest option (NHMRC 2009).
The 2019 NDSHS showed that 65% of pregnant women 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 2020c).
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 2020c) (tables S2.31 & S2.32).
See also: Illicit drugs in the People who inject drugs section.
ABS (Australian Bureau of Statistics) 2017. Causes of Death, Australia, 2016. ABS cat. no. 3303.0. Canberra: ABS. Viewed 4 January 2018.
ABS 2018. Causes of Death, Australia, 2017. ABS cat. no. 3303.0. Canberra: ABS. Viewed 12 October 2018.
ABS 2019. Causes of Death, Australia, 2018. ABS cat. no. 3303.0. Canberra: ABS. Viewed 15 October 2019.
AIHW (Australian Institute of Health and Welfare) 2019a. Australian burden of disease study: Impact and causes of illness and death in Australia 2015. Series no.19. BOD 22. Canberra: AIHW. Viewed 13 June 2019.
AIHW 2019b. Burden of tobacco use in Australia: Australian Burden of Disease Study 2015. Australian Burden of Disease series no. 21. Cat. no. BOD 20. Canberra: AIHW.
AIHW 2020a. Admitted patients. Canberra: AIHW. Viewed 16 October 2020.
AIHW 2020b. Australia’s mothers and babies 2018 – in brief. Perinatal statistics series no. 36. Cat. no. PER 108. Canberra: AIHW. Viewed 29 May 2020.
AIHW 2020c. National Drug Strategy Household Survey 2019. Drug statistics series no. 32. Cat. no. PHE 270. Canberra: AIHW. Viewed 16 July 2020.
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, Degenhardt L, Dobbins T & Peacock A 2019. Trends in drug-related hospitalisations in Australia, 1999-2018. Drug Trends Bulletin Series. Sydney: National Drug and Alcohol Research Centre, UNSW. Viewed 8 January 2020.
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 8 April 2021.
Heard S, Iversen J, Geddes L & Maher L 2020. Australian NSP Survey: Prevalence of HIV, HCV and injecting and sexual behaviour among NSP attendees, 25-year National Data Report 1995–2019. Sydney: Kirby Institute, UNSW.
Man N, Chrzanowska A, Dobbins T, Degenhardt L & Peacock A 2019.Trends in drug-induced deaths in Australia, 1997-2018. Drug Trends Bulletin Series. Sydney: National Drug and Alcohol Research Centre, UNSW Sydney. Viewed 8 January 2020.
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, Melbourne.
NHMRC (National Health and Medical Research Council) 2009. Australian guidelines to reduce health risks from drinking alcohol. Canberra: NHMRC. Viewed 12 October 2017.
Peacock A, Karlsson A, Uporova J, Price O, Chan R, Swanton R et al. 2020. Australian Drug Trends 2020: Key Findings from the National Ecstasy and Related Drugs Reporting System (EDRS) Interviews. Sydney: National Drug and Alcohol Research Centre, UNSW.
Peacock A, Uporova J, Karlsson A, Price O, Gibbs D, Swanton R et al. 2021. Australian Drug Trends 2020: Key findings from the National Illicit Drug Reporting System (IDRS) interviews. Sydney: National Drug and Alcohol Research Centre, UNSW.
Penington Institute 2020. Australia’s annual overdose report 2020. Melbourne: Penington Institute. Viewed 31 August 2020.
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