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1. What is the size of the problem

MORTALITY

Drug-related deaths account for almost one in five deaths among all age groups. .(1)

In the 15-34 year age group, the rate of drug-caused deaths increases to one in three deaths.

Age group differences are also important to note:

MORBIDITY AND SOCIAL DYSFUNCTION

Drug use, particularly tobacco and alcohol, is a major factor in over 20% of general hospital admissions in Australia, and in over 20% of general practitioner consultations.

Alcohol use is a major factor in marital disharmony, violent crime, chronic invalidity and road accidents. It is the principal drug problem for a majority of clients of drug and alcohol treatment agencies throughout Australia (refer Appendix 2).

Illegal drug use is associated with poor social functioning and crime.

Indirect drug problems are often experienced by the parents, spouse and children of the drug user.

The following list represents the major pathology developing from drug use.

Tobacco

Alcohol

Other drugs

ROAD ACCIDENTS

Alcohol use is a major cause of road accidents leading to serious injury or death.

It has been estimated that in 34% of road deaths alcohol is a contributing factor (before 1979 the figure was over 50%) and the total number of road deaths is falling (3730 in 1979; 1971 in 1992).

Although there is no firm epidemiological evidence linking the use of other drugs as a causative factor in road accidents there is much anecdotal evidence. The risk of harm is high when some drugs, either illicit or prescribed, eg cannabis or diazepam, are combined with alcohol.

TRENDS IN DRUG USE AND DRUG PROBLEMS

Tobacco

Recent figures from the 1991 National Campaign Against Drug Abuse (NCADA) Household Survey indicate that tobacco was used in the past year by 31% of males and 25% of females aged 14 and over. Similar proportions of high school students also report using tobacco. Although levels of smoking among teenagers have fallen in recent years, the number of female teenagers who smoke still exceeds that of males. In 1991, 21% of boys and 35% of girls between 14-19 years reported smoking in the past year. (Appendix 3 provides information on use of various drugs by persons aged 14-19 years.)

There has been a greater decline of smoking among males than females in the past 15 years. The proportion of female smoking increased from 26% in 1945 to 31% in 1976-80 but has since fallen to 27% in 1989. The proportion of males smoking has fallen since 1945 (when it was 72%) to 30% in 1989. This represents no statistical difference between male and female smoking rates for the first time.

In 1989 the highest smoking rate of Australian adult smokers was found among 20-24 year olds for both males (41%) and females (38%).

Mortality rates due to smoking have decreased by 5% between 1987 and 1990 (from 111.7 to 106 deaths per 100 000 population).

Alcohol

The trend since the mid-1970s has been towards a decrease in the amount of alcohol consumed in Australia (per capita consumption of alcohol fell from 13.2 litres in 1978 to 7.9 litres in 1990-91).

Between 1985-86 and 1990-91 consumption of beer has decreased by 6%, wine consumption has decreased by 19%, while overall, total alcohol consumption (expressed as pure alcohol) decreased by 7%.

In 1991, over 18% of all beer consumed was low alcohol beer. (Low alcohol beer was not consumed before 1985.)

A 1989 survey highlighted increasing concern about heavy drinking among young people – 38% of 16 year olds and 40% of 17 year olds consumed five or more drinks on their last drinking occasion. It was also reported that in the 12-16 year age group, 22% of boys and 18% of girls reported weekly use of alcohol.

Alcohol continues to play a major role in domestic violence.

Surveys by the National Heart Foundation have shown that despite drinking less often than older groups, young people (aged 20-24 years) tend to drink more heavily on the occasions when they do drink.

Death rates due to alcohol have fallen by 20% since 1979 (from 48.7 deaths per 100 000 population in 1979 to 39.0 in 1990).

People are now spending less of their total budget on alcohol than previously (5.6% in 1981-82, 4.1% in 1991).

Pharmaceutical products

There is no reliable evidence to demonstrate authoritatively patterns or trends in the use of pharmaceutical products such as sedatives, minor tranquillisers and analgesics. Restrictions on the prescription of barbiturates over the past decade have produced a fall in their use, and deaths from overdosage have decreased by 75%.

The most commonly used prescribed drugs are cardiovascular system drugs (19%) followed by psychotropic drugs (10%). There is some concern about the use of psychotropic drugs because of their ability to alter a person's mood, behaviour or perception.

Minor tranquillisers, particularly benzodiazepines, are the most commonly used psychotropic drugs in the Australian community. The overuse of this drug, particularly by women and the elderly, has been an area of concern for some time.

The use of benzodiazepines for long or continuous therapy, in particular for night time sedation, is an undesirable practice.

Benzodiazepines are commonly taken in overdosage both by accident and with suicidal intent. Approximately 1% of drug-related deaths are due to the misuse of prescribed and unprescribed pharmaceuticals.

Minor analgesics are easily available and, although analgesic nephropathy has decreased, the level of this disorder among women in Australia remains high by international standards.

Cough mixtures and antihistamines are commonly used for their psychotropic effects, occasionally leading to dependence.

Illegal drugs

The 1991 NCADA Household Survey reported that 32% of persons over the age of 14 years had tried cannabis and 8% had used amphetamines (excluding ecstasy).

Apart from the use of cannabis, it seems that the level of use of illegal drugs in Australia remains very low. This use has remained at approximately the same level for the past ten years. Appendix 4 provides a breakdown of persons using illicit drugs in the past year.

The use of hallucinogens (eg LSD) seems to have remained at a minimum level despite media reports about 'designer drugs' (ecstasy, etc.).

Heroin use may be gradually diminishing in line with trends in other countries.

The use of amphetamines and cocaine in general remains low in the Australian population. (Appendix 5 provides information on the proportion of the population who have ever tried various illicit drugs.) However, recent evidence suggests that the number of persons trying amphetamines is increasing, particularly among males aged 25-39 (from 12% in 1988 to 19% in 1991) and among females aged 14-24 (4% in 1988 to 11% in 1991).

Illegal drug use, however, remains a major social problem.

Deaths caused by opiates seem to be still increasing although the numbers remain relatively small (117 in 1979 to 457 in 1991).

Most deaths involving illegal drugs are caused by overdosage or an impure drug. Some of these deaths are suicides. Many injecting drug users are infected with hepatitis B and hepatitis C and an increasing number are infected with HIV/AIDS. Intravenous use of amphetamines and cocaine is still causing little morbidity, but an increasing number are presenting for treatment centres. Needle-sharing and unsafe sexual practices continue to be a significant problem.

Cannabis is the most widely used illicit drug in the Australian population, with approximately one in three persons aged 14 and over having tried this drug. This represents a slight increase in use since 1988.

It is possible that cannabis use may precipitate psychotic episodes in those who are predisposed or have a history of psychosis. Cannabis impairs psychomotor function but epidemiological evidence to link cannabis with road accidents is still lacking.


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