Transcript Epidemiology and Impact of AOD use in Australia

Epidemiology & Impact of
Alcohol and Drug (AOD) Use
in Australia
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.
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.
Epidemiology & Impact
Drugs in Context
Figure 1: Attributable risk factor DALYs as
a proportion (%) of total DALYs (AIHW 2000)
Epidemiology
Epidemiology&&Impact
Impact
Drugs and the
Global Burden of Disease
Tobacco, alcohol and illicit drugs
were responsible for
8.9%
of the total global burden of
disease world wide in 2000.
WHO (2003)
Epidemiology & Impact
Top 10 Major Causes of Death
1. Ischaemic Heart
Disease (IHD)
6. COPD
2. CVA
7. Road traffic
accidents
3. Lung cancer
8. Breast cancer
4. Suicide
9. Diabetes Mellitis
5. Colorectal cancer
10. Dementia.
Other rankings:
13. Cirrhosis of liver
18. Opioid overdose
Epidemiology & Impact
Drug-induced Deaths
U n d e rlyin g c a u s e /
c irc u m s ta n c e
D ru g in d u c e d d e a th (b y ye a r o f
re g is tra tio n ):
1997
1998
1999
2000
1323
1645
1739
1569
 A c c id e n ta l
916
1243
1403
1274
 In te n tio n a l s e lf-h a rm
309
310
278
273
4
6
2
1
94
86
56
21
D ru g s c o n trib u tin g to d e a th :
 D ru g s o f a b u s e
887
1072
1275
1091
 A n tid e p re s s a n ts
233
215
300
268
 B e n zo d ia ze p in e s
352
347
503
403
 A s s a u lt
 U n d e te rm in e d
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.
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
Epidemiology & Impact
Epidemiology & Impact
Epidemiology
Epidemiology&&Impact
Impact
Recent Drug Use
IV
2001
1998
1993
ecstasy
halluc
cocaine
speed
heroin
inhalants
analgesics
cannabis
alcohol
tobacco
0
AIHW (2002)
10
20
30
40
50
60
70
80
90
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)
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.
Epidemiology & Impact
Australia’s Drinking Guidelines
• Australia’s drinking
guidelines were
developed by the
NHMRC.
• See
www.nhmrc.gov.au
Epidemiology & Impact
A Standard Drink
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.
Epidemiology & Impact
Who drinks?
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
73.6
90.1
87
86
82.8
72.5
Recent drinker
Ex-drinker
Never drank
4.8
21.6
14-19
12.8
7.6
9.6
4.5
5.4
7.1
5.9
6.4
7.6
20-29
30-39
40-49
50-59
14.7
60+
Age
Epidemiology & Impact
Drinking Patterns for Acute Harm
High Risk
M: > 11 SD p.d.
F: > 7 SD p.d.
ABSTAINERS 18%
Risky
M: > 7 SD p.d.
F: > 5 SD p.d.
Low Risk
M: 6 SD p.d.
F: 4 SD p.d.
RISKY /
HIGH RISK
LOW RISK
34%
48%
1 Standard Drink (SD) = 10g of alcohol
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)
30
25
Males
Females
20
%15
10
5
0
14-19
20-29
30-39
Age
40-49
50-59
60+
Epidemiology & Impact
Drinking Patterns for Chronic Harm
High Risk
M: >7 SD p.d.
F: >5 SD p.d.
ABSTAINERS 17%
HIGH RISK 3%
Risky
M: 5 - 6 SD p.d.
F: 3 - 4 SD p.d.
LOW RISK
73%
RISKY 7%
Low Risk
M: 4 SD per day
F: 2 SD per day
1 Standard Drink (SD)
= 10g of alcohol
Epidemiology & Impact
Indigenous Drinking Patterns
70
60
50
%
40
Non-Indigenous
Indigenous
30
20
10
0
occasional
regular
hazardous
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.
Epidemiology & Impact
Alcohol and
Days of Work or Study Missed
13.2
14
12
10.4
10
8
7.2
6.9
men
women
6
3.7
4
2.7
2
2.1
0.3
0
14-19
20-29
30-39
40+
Age (yrs)
Epidemiology & Impact
O ve ra ll a g e d is trib u tio n a m o n g a lc o h o l re la te d s e rio u s ro a d in ju rie s o c c u rrin g o n
A u s tra lia n ro a d s (e x c lu d in g V ic to ria ),
1990–1997
23%
0 -1 4 y rs
11%
1 5 -2 4 y rs
2 5 -3 4 y rs
3 5 -4 4 y rs
6%
4 5 -5 4 y rs
5 5 + y rs
5%
52 %
3%
NDRI (2000)
Epidemiology & Impact
Recent Illicit Drug Use
methadone
0.1
0.2
0.2
0.2
0.3
0.4
0.6
1.1
1.1
1.3
heroin
barbiturates
steroids
opiates
Drug
inhalants
injected drugs
hallucinogens
tranquilisers
cocaine
ecstasy
2.9
3.1
3.4
analgesics
amphetamines
cannabis
12.9
0
2
4
6
%
8
10
12
14
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.
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.
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%).
Epidemiology & Impact
Recent Injecting Drug Use
E stim ate/drug
NSW
V ic
Q ld
WA
SA
Tas
AC T
NT
Aust
3,700
800
2,700
90,800
(num ber)
Injecting drug users
18,000
17,700
18,700
19,300
D rugs recently injected
9,600
(per cent)
H eroin
37
35
12
21
3
9
78
2
23
M ethadone
25
–
3
5
3
7
–
12
8
6
32
21
19
3
41
–
7
18
A m phetam ines
72
53
86
89
78
86
39
89
77
C ocaine
18
24
10
12
7
–
–
–
14
–
4
–
4
8
–
–
–
3
E cstasy
10
28
–
20
12
2
–
3
14
S teroids
6
12
–
3
11
0
–
–
5
B enzodiazepines
4
7
–
–
3
2
20
3
3
O ther drugs
–
5
6
7
8
–
–
7
5
O ther opiates
H allucinogens
AIHW (2003)
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)
Epidemiology & Impact
Injecting Drug Use and AIDS
E stim a te d n um b er of d ea ths from
A ID S u p till n o w : 2 5 m illio n
E stim a te d n um b er of p eo ple w ith
H IV infe ctio n in 2 0 02 /20 0 3:
4 2 m illion
E stim a te d n um b er of a dditio n al
H IV infe ctio ns till 20 1 0:
4 5 m illion .
WHO (2003)
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.
Epidemiology & Impact
Epidemiology
Epidemiology&&Impact
Impact
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)
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)
Epidemiology & Impact
GROWTH IN METHADONE TREATMENT 1986-2001
35000
25000
20000
15000
10000
5000
YEAR
Epidemiology & Impact
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
0
1986
NUMBER IN TREATMENT
30000
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
Epidemiology & Impact
Epidemiology & Impact
Methamphetamine
Methamphetamine is the more commonly used
form of ATS:
• 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)
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.
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)
Epidemiology & Impact
Volatile Substances
• Sporadic patterns
of use
• Mostly young males
• Disadvantaged and
dislocated young
people most at risk.
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)
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)
Epidemiology & Impact
Cannabis Users,
Preferred Concurrent Use
100
90
80
70
60
50
40
30
20
10
0
5 ye a rs o r le s s
A lc o h o l
6 to 1 0 ye a rs
H e ro in
C o c a in e
1 1 to 2 0 ye a rs
2 1 ye a rs o r m o re
A m p h e ta m in e s
E c s ta s y
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).
Epidemiology & Impact
Profiles of Harm
D ru g T yp e
R is k P ro file
A g e P ro file
T obacco
S e rio u s h e a lth c o m p la in ts w ith
lo n g -te rm re g u la r u s e
5 5 ye a rs +
A lc o h o l
T w o -th ird s o f th e ye a rs o f life
lo s t fro m ris k y d rin k in g
a s s o c ia te d w ith p ro b le m s o f
in to x ic a tio n
M o s tly 1 8 to 3 4
ye a rs
Illic it d ru g s
P re d o m in a n tly re la te d to u n s a fe
m o d e s o f a d m in is tra tio n o r
in to x ic a tio n – b lo o d -b o rn e
viru s e s , H IV in fe c tio n ,
h e p a titis C , live r d is e a s e
Y o u n g a d u lts
Epidemiology & Impact
Drugs and Young People
(14–17 yrs)
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.
Epidemiology & Impact
Principal Drugs of Concern
Proportion of clients seeking treatment by principal
drugs of concern and jurisdiction, 2002-03
80
70
NSW
60
Vic
Qld
WA
50
SA
Tas
ACT
NT
40
30
20
10
0
Alcohol
NMDS (2002–03)
Am phetam ines
Benzodiazepines
Cannabis
Heroin
Epidemiology & Impact
Client Registrations by
Source of Referral
35
30
self
family
25
%
GP/specialist
psychiatric/hospitals
20
Community MH services
AOD treatment
15
10
Community Health
Community Corrections
Police/court diversions
other
5
0
Epidemiology & Impact
All Drugs: Health Care Costs
Tobacco
4%
16%
Alcohol
$59.2M
Illicits
$225 M
$1094.9M
80%
Collins & Lapsley (2002)
Epidemiology & Impact
All Drugs: Total Social Costs
22%
18%
$6 075M
$6 075m
Alcohol
Tobacco
Illicits
$7 560M
$7 560m
$21 063M
$21 063m
60%
Total social costs of AOD use = $31 439.8m
Collins & Lapsley (2002, p. 59)
Epidemiology & Impact
All Drugs: Tangible Social Costs
Alcohol
Tobacco
Illicits
28%
$5 107M
$5 107m
$5 541M
$5 541m
30%
$7 587M
$7 587m
42%
Collins & Lapsley (2002, p. 58)
Epidemiology & Impact