1. Epidemiology & Impact Epidemiology & Impact of Alcohol and Drug (AOD) Use in Australia

2. Epidemiology & Impact Relevance to GPs Psychoactive drug problems are in the top 10–20 problem areas managed by GPs GPs encounter AOD-related problems across wide age ranges (e.g. from 12-year-olds using volatile substances to older people with alcohol and sedatives) Basic information on patterns and prevalence will assist GPs to identify patients with potential AOD problems.

3. Epidemiology & Impact Emphasising Diversity AOD patterns of use vary across local, state and national levels Variations also exist between city, urban, rural and remote areas Types of drugs used and patterns of use vary within communities and culturally diverse populations An individual’s pattern of use also changes over time, and requires regular monitoring Drug use is determined by numerous factors including: availability, access, cost, social norms and sanctions, social controls, cultural diversity.

4. Epidemiology & Impact Drugs in Context Epidemiology & Impact Figure 1: Attributable risk factor DALYs as a proportion (%) of total DALYs (AIHW 2000)

5. Epidemiology & Impact Tobacco, alcohol and illicit drugs were responsible for 8.9% of the total global burden of disease world wide in 2000. Drugs and the Global Burden of Disease WHO (2003)

6. Epidemiology & Impact 6. COPD 7. Road traffic accidents 8. Breast cancer 9. Diabetes Mellitis 10. Dementia. Top 10 Major Causes of Death 1. Ischaemic Heart Disease (IHD) 2. CVA 3. Lung cancer 4. Suicide 5. Colorectal cancer Other rankings:13. Cirrhosis of liver 18. Opioid overdose

7. Epidemiology & Impact Drug-induced Deaths

8. Epidemiology & Impact Predicted Changes in Drug Use 1.Tobacco: decrease in developed countries, increase in developing countries 2.Alcohol: will continue to be problematic for younger people 3.Illicit drug use: increasing numbers of young people and females 4.Patterns of illicit drug use will vary increasingly rapidly 5.Polydrug use will continue 6. New illicit drugs will continue to emerge with advances in creative pharmacology.

9. Epidemiology & Impact Key Sources of Alcohol and Drug Epidemiological Data Better Evaluation and Care of Health (BEACH) Project –database of GP / patient encounter information National Drug Strategy (NDS) Household Surveys –population based data on patterns and prevalence of use Illicit Drug Reporting System (IDRS) –early warning system to identify drug use trends National Minimum Data Set for Alcohol and Other Drugs of Concern (NMDS-AODTS) –annual survey of all Australian AOD treatment services

10. Epidemiology & Impact

12. Recent Drug Use AIHW (2002)

13. Epidemiology & Impact Tobacco National prevalence of daily smoking 19.5% Drop of over 2% from 1998 I in 5 teenagers smoked in 2001, 15% smoked daily 26% of the pop. had ceased smoking GP interventions esp. important. AIHW (2002)

14. Epidemiology & Impact Alcohol Still the most popular ‘drug’ — –over 80% of population drinks 8% drink daily, peak in males +60 (23%) 40% drink weekly At-risk drinking now defined by NHMRC as: –risks of harm in the long term –risks of harm in the short term Important role for GPs in giving advice consistent with NHMRC risk levels.

15. Epidemiology & Impact Australia’s Drinking Guidelines Australia’s drinking guidelines were developed by the NHMRC. See www.nhmrc.gov.au

16. Epidemiology & Impact A Standard Drink

17. Epidemiology & Impact Risky Drinking Patterns 34% of drinkers (>14 yrs) put themselves at risk of alcohol-related harm, in the short term, on at least one occasion over 12 months Over one in 10 females aged 14–19, and over one in six males aged 20–29, put themselves at risk of alcohol-related harm, in the short term 60% of 20–29 yr olds drink in a risky manner 12% do so at least weekly.

18. Epidemiology & Impact Who drinks? Age

19. Epidemiology & Impact High Risk M: > 11 SD p.d. F: > 7 SD p.d. Low Risk M: 6 SD p.d. F: 4 SD p.d. Risky M: > 7 SD p.d. F: > 5 SD p.d. Drinking Patterns for Acute Harm LOW RISK ABSTAINERS RISKY / HIGH RISK 1 Standard Drink (SD) = 10g of alcohol

20. Epidemiology & Impact Risky Drinking Patterns Percentage of the population who drink at medium to high risk levels for acute harm at least once a month (2001)

21. Epidemiology & Impact Drinking Patterns for Chronic Harm Risky M: 5 - 6 SD p.d. F: 3 - 4 SD p.d. Low Risk M: 4 SD per day F: 2 SD per day LOW RISK ABSTAINERS HIGH RISK RISKY 1 Standard Drink (SD) = 10g of alcohol High Risk M: >7 SD p.d. F: >5 SD p.d.

22. Epidemiology & Impact Indigenous Drinking Patterns %

23. Epidemiology & Impact Alcohol Induced Memory Loss Teenagers (28.4%) were most likely to have memory loss incident following drinking: –4.4% reported ‘blackouts’ occurred on weekly basis –10.9% reported ‘blackouts’ on a monthly basis Memory loss occurred after drinking for: –12% male drinkers aged >40 years –6.6% female drinkers aged >40 years –20–30% of all other age groups.

24. Epidemiology & Impact Age (yrs) Days Alcohol and Days of Work or Study Missed

25. Epidemiology & Impact NDRI (2000)

26. Epidemiology & Impact % Drug Recent Illicit Drug Use

27. Epidemiology & Impact Illicit Drug Users’ Characteristics People who used drugs recently were more likely to: have post-school qualifications not be the most socio-economically disadvantaged live in urban, rather than rural or remote areas be unemployed.

28. Epidemiology & Impact Patterns of Illicit Drug Use (1) Approx. 1 in 5 Australians have ever used an illicit drug, other than cannabis 1.3 million people (8.4% pop.) used an illicit, other than cannabis, in past 12 months Recent users were most likely to be: –males –aged 20–29 (one in five males used illicits, other than cannabis, in last 12 months) Average age of first use ranged from 17.6 years (inhalants) to 22.8 years (tranquillisers) 13% pop. used cannabis in last 12 months.

29. Epidemiology & Impact Patterns of Illicit Drug Use (2) Illicit drug use peaks at age 20–29, then declines with age Teenagers are the next group most likely to use illicit drugs: –28% teenagers have used an illicit drug (cannabis is most common – 25%) Reasons for using illicit drugs: –curiosity (82%) –peer pressure (55%) –excitement (22%) –to take a risk (10%).

30. Epidemiology & Impact Recent Injecting Drug Use AIHW (2003)

31. Epidemiology & Impact Injecting Drug Use In 2001: 0.6% of Australians reported injecting in past 12 months 60,000 persons aged 20–29 years reported injecting illicits in past 12 months almost 10,000 teenagers reported injecting in 2001 average age of first injecting was 20.2 years males were more likely to have ever injected. AIHW (2002)

32. Epidemiology & Impact Injecting Drug Use and AIDS WHO (2003)

33. Epidemiology & Impact The Threat from HIV By 2010, HIV will have caused more deaths than any disease outbreak in history. Injecting drug use is an important contributor to the spread of HIV/AIDS.

34. Epidemiology & Impact

35. Heroin Around 0.2% prevalence of recent use - down from 0.8% in 1998 50% of population consider heroin the main drug ‘problem’ – up from 37% in 1998 Highest usage amongst 20–29 years Lifetime prevalence 1.6%. AIHW (2002)

36. Epidemiology & Impact Heroin Trends Availability tended to increase from 2002 to 2003 (after sharp decrease in 2001) Price decreased from 2002 to 2003 Cheapest in NSW, most expensive in NT Purity and number of seizures has decreased. Breen et al. (2003)

37. Epidemiology & Impact

38. Amphetamines Amphetamines make up the illicit drug group most likely to have been: ever injected most recently injected In 2001: 8.9% pop. reported trying amphetamines 3.4% pop. had used in the last 12 months 1 in 9 people aged 20–29 had used amphetamines in the last 12 months

39. Epidemiology & Impact

40. Methamphetamine Methamphetamine was cheapest in SA Powder and base easiest to obtain Availability was stable Crystal meth often more difficult to obtain in some places Methamphetamine use has decreased or stabilised in most jurisdictions in 2002. Breen et al. (2003) Methamphetamine is the more commonly used form of ATS:

41. Epidemiology & Impact Ecstasy Recent use prevalence 2.9% Highest recent use among males 20–29 years (13%) Significant increases in use by females 20–29 years and females overall Ever used 6%, up slightly from 1998.

42. Epidemiology & Impact Cocaine Decreased in frequency and prevalence of use in NSW In other states remains uncommon, therefore infrequently used NSW showed an association between increased heroin use and decreased cocaine use Median purity of domestic seizures was lower than in recent years, though purity at border seizures was higher. Breen et al. (2003)

43. Epidemiology & Impact Volatile Substances Sporadic patterns of use Mostly young males Disadvantaged and dislocated young people most at risk.

44. Epidemiology & Impact Cannabis (1) 13% recent use, down from 18% in 1998 24% reported opportunity to use One in four teenagers, and one in three 20–29 years, used in past 12 months Males rates higher than females for all age groups 33% ever used. AIHW (2003)

45. Epidemiology & Impact Cannabis (2) Most stable of illicit drug markets Easy to obtain Prices have decreased slightly since last IDRS Dominant form is hydroponically grown version, though bush, hash and hash oil was available across all jurisdictions. Breen et al. (2003)

46. Cannabis Users, Preferred Concurrent Use

47. Epidemiology & Impact Polydrug Use Most people who use illicit drugs use a variety of different drugs Polydrug use is the norm among drug users Particular combinations of drugs are preferred Particular patterns of drug substitution also occur (e.g., alcohol is widely used as a substitute drug for heroin when the latter is in short supply).

48. Epidemiology & Impact Profiles of Harm

49. Epidemiology & Impact Alcohol use: 66% had a full glass of alcohol in the last 12 months, about 20% drank weekly 34% drinking at risky/high risk levels for short term harm (same as general population). Illicit drug use: 31% had used an illicit drug (including cannabis) 12% had used an illicit drug other than cannabis. Drugs and Young People (14–17 yrs)

50. Epidemiology & Impact NMDS (2002–03) Principal Drugs of Concern Proportion of clients seeking treatment by principal drugs of concern and jurisdiction, 2002-03

51. Epidemiology & Impact % Client Registrations by Source of Referral

52. Epidemiology & Impact All Drugs: Health Care Costs $ 225 M $1094.9M $59.2M Collins & Lapsley (2002)

53. Epidemiology & Impact $7 560m $6 075m $21 063m Total social costs of AOD use = $31 439.8m All Drugs: Total Social Costs $6 075M$7 560M $21 063M Collins & Lapsley (2002, p. 59)

54. Epidemiology & Impact $5 107m$5 541m $7 587m All Drugs: Tangible Social Costs $5 107M$5 541M $7 587M Collins & Lapsley (2002, p. 58)