Epidemiology

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Epidemiology Impact of Alcohol and Drug (AOD)
Use in Australia
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Relevance to GPs

• Psychoactive drug problems are in the top 1020
  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.

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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 individuals 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.

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Drugs in Context
Figure 1 Attributable risk factor DALYs as a
proportion () of total DALYs (AIHW 2000)
Epidemiology Impact
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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)
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Top 10 Major Causes of Death
6. COPD 7. Road traffic accidents 8. Breast
cancer 9. Diabetes Mellitis 10. Dementia.

• 1. Ischaemic Heart Disease (IHD)
• 2. CVA
• 3. Lung cancer
• 4. Suicide
• 5. Colorectal cancer

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Drug-induced Deaths
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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.

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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

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Epidemiology Impact
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Recent Drug Use
AIHW (2002)
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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)
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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.

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Australias Drinking Guidelines

• Australias drinking guidelines were developed by
  the NHMRC.
• See www.nhmrc.gov.au

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A Standard Drink
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Risky Drinking Patterns

• 34 of drinkers (gt14 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 1419, and over one
  in six males aged 2029, put themselves at risk
  of alcohol-related harm, in the short term
• 60 of 2029 yr olds drink in a risky manner
• 12 do so at least weekly.

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Who drinks?
Age
19
Drinking Patterns for Acute Harm
High Risk M gt 11 SD p.d. F gt 7 SD p.d.

ABSTAINERS
Risky M gt 7 SD p.d. F gt 5 SD p.d.
RISKY / HIGH RISK
Low Risk M 6 SD p.d. F 4 SD p.d.
LOW RISK
1 Standard Drink (SD) 10g of alcohol
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Risky Drinking Patterns
Percentage of the population who drink at medium
to high risk levels for acute harm at least once
a month (2001)
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Drinking Patterns for Chronic Harm
ABSTAINERS
High Risk M gt7 SD p.d. F gt5 SD p.d.
LOW RISK
HIGH RISK
Risky M 5 - 6 SD p.d. F 3 - 4 SD p.d.
RISKY
Low Risk M 4 SD per day F 2 SD per day
1 Standard Drink (SD) 10g of alcohol
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Indigenous Drinking Patterns

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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 gt40 years
• 6.6 female drinkers aged gt40 years
• 2030 of all other age groups.

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Alcohol and Days of Work or Study Missed
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NDRI (2000)
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Recent Illicit Drug Use
Drug

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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.

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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 2029 (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.

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Patterns of Illicit Drug Use (2)

• Illicit drug use peaks at age 2029, 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).

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Recent Injecting Drug Use
AIHW (2003)
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Injecting Drug Use

• In 2001
• 0.6 of Australians reported injecting in past
  12 months
• 60,000 persons aged 2029 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)
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Injecting Drug Use and AIDS
WHO (2003)
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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.
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Epidemiology Impact
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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 2029 years
• Lifetime prevalence 1.6.

AIHW (2002)
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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)
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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 2029 had used amphetamines in
  the last 12 months

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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)
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Ecstasy

• Recent use prevalence 2.9
• Highest recent use among males 2029 years (13)
• Significant increases in use by females 2029
  years and females overall
• Ever used 6, up slightly from 1998.

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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)
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Volatile Substances

• Sporadic patterns of use
• Mostly young males
• Disadvantaged and dislocated young people most at
  risk.

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Cannabis (1)

• 13 recent use, down from 18 in 1998
• 24 reported opportunity to use
• One in four teenagers, and one in three 2029
  years, used in past 12 months
• Males rates higher than females for all age
  groups
• 33 ever used.

AIHW (2003)
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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)
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Cannabis Users, Preferred Concurrent Use
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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).

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Profiles of Harm
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Drugs and Young People
(1417 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.

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Principal Drugs of Concern
Proportion of clients seeking treatment by
principal drugs of concern and jurisdiction,
2002-03
NMDS (200203)
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Client Registrations by Source of Referral

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All Drugs Health Care Costs
59.2M
225 M
1094.9M
Collins Lapsley (2002)
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All Drugs Total Social Costs
6 075M
7 560M
6 075m
7 560m
21 063M
21 063m
Total social costs of AOD use 31 439.8m
Collins Lapsley (2002, p. 59)
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All Drugs Tangible Social Costs
5 107M
5 541M
5 107m
5 541m
7 587M
7 587m
Collins Lapsley (2002, p. 58)