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The National Wastewater Drug Monitoring Program (NWDMP) measures the presence of substances in sewerage treatment plants across Australia. This includes estimated population-weighted average consumption of oxycodone and fentanyl. It should be noted that wastewater analysis cannot differentiate between prescribed and illicit use. Estimated consumption of oxycodone and fentanyl have plateaued at historically low levels (ACIC 2023).
Data from Report 18 of the NWDMP indicate that nationally:
- In August 2022, oxycodone population-weighted average consumption continued to be higher in regional areas than capital cities, nearly double the level of consumption in capital cities.
- Between April and August 2022, oxycodone consumption increased in both capital city and regional locations (ACIC 2023).
Between April and August 2022, nationally the estimated population-weighted average consumption of fentanyl increased in both capital cities and regional areas. Data from Report 18 of the NWDMP indicate:
- In August 2022, consumption levels in regional areas continued to be higher than in capital cities.
- Fentanyl consumption peaked in mid to late 2018, this has been trending down since.
- Since mid-2020, the gap between capital city and regional consumption is narrowing (ACIC 2023).
For state and territory data, see the National Wastewater Drug Monitoring Program reports.
Poly drug use
Poly drug use is defined as the use of mixing or taking another illicit or licit drug whilst under the influence of another drug. In 2019, the NDSHS showed that just over half (52%) of people who reported the non-medical use of pharmaceuticals in the last 12 months said they did not use any other illicit drug. The most common other drugs concurrently used were alcohol (50% exceeded the single occasion risk guideline at least monthly), cannabis (40%) and cocaine (27%) (AIHW 2020, Table 1.3).
Data on alcohol and other drug-related ambulance attendances are sourced from the National Ambulance Surveillance System (NASS). Monthly data for 2021 are currently available for New South Wales, Victoria, Queensland, Tasmania and the Australian Capital Territory It should be noted that some data for Tasmania and the Australian Capital Territory have been suppressed due to low numbers. Please see the data quality statement for further information.
In 2021, multiple drugs (excluding alcohol) were involved in at least half of ambulance attendances related to benzodiazepines and opioid analgesics. For benzodiazepines, this ranged from 68% of attendances in New South Wales to 75% of attendances in Tasmania; for opioid analgesics the range was from 73% in New South Wales to 81% in Victoria (Table S1.10).
For related content on multiple drug involvement see Impacts: Ambulance attendances.
Concomitant dispensing of prescription drugs
Due to the compounding effects of respiratory depression, patients using opioids and benzodiazepines at the same time may be at higher risk of harm (Boon et al. 2020; RACGP 2022). Data from the Pharmaceutical Benefits Scheme (PBS) indicate that most opioid scripts are dispensed to patients who have not received a recent supply of a benzodiazepine, and vice versa. However, concomitant dispensing is not uncommon (that is, dispensing multiple medicines at the same time or almost the same time). In 2020–21:
- Around 2.6 million opioid scripts were dispensed to patients who had already received a PBS supply of a benzodiazepine in the past 30 days, and 382,000 patients who were dispensed an opioid had also received a benzodiazepine (a rate of 10,100 scripts and 1,500 patients per 100,000 population) (tables PBS37–40).
- Around 1.7 million benzodiazepine scripts were dispensed to patients who had received a PBS supply of an opioid in the past 30 days, and 378,000 patients who received a benzodiazepine had received an opioid (a rate of 6,400 scripts and 1,500 patients per 100,000) (tables PBS41–44).
Rates of concomitant dispensing of opioids and benzodiazepines declined overall between 2013–14 and 2020–21 but fluctuated over time (tables PBS37–44). For more information on dispensing of prescription drugs under the PBS, see Prescription drug dispensing.
For related content on non-medical use of pharmaceutical drugs impacts and harms, see also:
There are a range of short and long-term health, social and economic harms associated with the non-medical use of pharmaceutical drugs (Table PHARMS1). People who use opioids for chronic pain are more likely than the general population to use pharmaceutical drugs for non-medical purposes (Currow, Phillips & Clark 2016; Vowels et al. 2015). Iatrogenic dependence occurs when patients become dependent on medications that they were medically prescribed for legitimate purposes. Iatrogenic dependence is an increasing concern among people living with chronic non-cancer pain.
Table PHARMS1: Short and long term effects associated with use of pharmaceuticals
- Respiratory depression
- Dry mouth
- Overdose (fatal and non-fatal)
- Decreased cognitive function
- Psychiatric co-morbidity
- Occlusion of blood vessels
- Gastro-intestinal bleeding
- Mental health conditions including depression
- Relaxation, sedation, and lack of energy
- Ataxia and slowed reaction times
- Respiratory depression
- Visual distortions
- Short-term memory loss
- Anxiety, irritability, paranoia, aggression and depression
- Muscle weakness, rashes, nausea and weight gain
- Sexual problems
- Menstrual irregularities
- Memory loss, cognitive impairment, dementia and falls
- Confusion, lethargy and sleep problems
Source: Adapted from Currow, Phillips & Clark 2016; DCPC 2007; Nicholas, Lee & Roche 2011; NSW Ministry of Health 2017.
Data on alcohol and other drug-related ambulance attendances are sourced from the National Ambulance Surveillance System (NASS). Monthly data are presented in 2021 for people aged 15 years and over for New South Wales, Victoria, Queensland, Tasmania and the Australian Capital Territory.
Any pharmaceutical drug
In New South Wales, Victoria, Queensland, Tasmania and the Australian Capital Territory, in 2021, for ambulance attendances where any pharmaceutical drug was reported:
- Rates of attendances ranged from 168.4 per 100,000 population in New South Wales to 295.1 per 100,000 population in Queensland.
- Unlike most other drug types, most attendances were for females, 3 in 5 (60%) of total attendances.
- The highest rates of attendances were in people aged 15–24, ranging from:
- 344.5 per 100,000 population in New South Wales (3,371 attendances), to 662.0 per 100,000 population in the Australian Capital Territory (363 attendances) (Table S1.10; PHARMS5)
Figure PHARMS5: Ambulance attendances for pharmaceuticals, by age, sex and selected states and territories, 2021