Australian Institute of Health and Welfare 2021. Alcohol, tobacco & other drugs in Australia. Cat. no. PHE 221. Canberra: AIHW. Viewed 17 June 2021, https://pp.aihw.gov.au/reports/alcohol/alcohol-tobacco-other-drugs-australia
Australian Institute of Health and Welfare. (2021). Alcohol, tobacco & other drugs in Australia. Retrieved from https://pp.aihw.gov.au/reports/alcohol/alcohol-tobacco-other-drugs-australia
Alcohol, tobacco & other drugs in Australia. Australian Institute of Health and Welfare, 16 April 2021, https://pp.aihw.gov.au/reports/alcohol/alcohol-tobacco-other-drugs-australia
Australian Institute of Health and Welfare. Alcohol, tobacco & other drugs in Australia [Internet]. Canberra: Australian Institute of Health and Welfare, 2021 [cited 2021 Jun. 17]. Available from: https://pp.aihw.gov.au/reports/alcohol/alcohol-tobacco-other-drugs-australia
Australian Institute of Health and Welfare (AIHW) 2021, Alcohol, tobacco & other drugs in Australia, viewed 17 June 2021, https://pp.aihw.gov.au/reports/alcohol/alcohol-tobacco-other-drugs-australia
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More information is available in the People who inject drugs fact sheet.
People who inject drugs (PWID) are among the most marginalised and disadvantaged drug users. They experience multiple negative health consequences including higher risk of fatal overdoses and are disproportionately affected by blood-borne infectious diseases (such as HIV and hepatitis C) (UNODC 2020). In 2018 it was estimated that there were 11.3 million people worldwide who injected drugs (UNODC 2020).
In Australia, a low proportion of the general population report injecting drugs. Information on data sources referred to in this section are in Box PWID1. The National Drug Strategy Household Survey (NDSHS) found that in 2019, 1.5% of the population aged 14 and over had injected a drug in their lifetime (Table S2.31), with 0.3% having injected a drug in the past year (both stable from 2016) (Table S2.32, Figure PWID1). Males who were aged 14 and over were more likely to have recently injected drugs (in the past year) than their female counterparts (2.2% compared to 0.9%) (AIHW 2020).
As PWID are likely to be underrepresented as respondents of the NDSHS, this section will largely draw upon data from other sources that are specifically targeted at PWID including the Illicit Drug Reporting System (IDRS) coordinated by the National Drug and Alcohol Research Centre (NDARC) and the Australian Needle and Syringe Program Survey (ANSPS) coordinated by the Kirby Institute.
Figure PWID1: Lifetime and recent injecting drug use, people aged 14 and over, 2001 to 2019 (per cent)
The figure shows that both lifetime and recent injecting drug use were lower in 2019 than in 2001. Lifetime drug use decreased slightly from 1.8% of people aged 14 and over in 2001, to 1.5% in 2019. Similarly, recent drug use fell from 0.6% to 0.3%.
Heroin and methamphetamine are the most commonly injected drugs in Australia and are often cited as preferred drugs among PWID (Heard et al. 2020; Peacock et al. 2021).
Estimates from the Illicit Drug Reporting System (IDRS) show that heroin remains the most common drug of choice among PWID, with a recent increase in use. Conversely, use of methamphetamine has decreased (Peacock et al. 2021).
Estimates from the 2020 IDRS showed that, among PWID who responded:
Data collection for the 2020 IDRS took place from June–September 2020, after COVID-19 restrictions were introduced in Australia (Peacock et al. 2021). This should be taken into account when comparing data from 2020 with previous years.
Injecting drug use among PWID is often assessed by asking people to report the drug that they most recently injected (last drug injected). Data from the 1995–2019 Australian Needle Syringe Program Survey showed that methamphetamine and heroin are the most common last drugs injected (Figure PWID2).
Other drugs that are often reported as the last drug injected include performance and image enhancing drugs (PIEDs; such as steroids, peptides or hormones) (Table S3.61).
Figure PWID2: Percentage of respondents by last drug injected, 2012 to 2018 (per cent)
The figure shows that in 2019, methamphetamine was the most common drug that was last injected (49%), followed by heroin (27%) and pharmaceutical opioids (6%). In 2019, 5% of respondents had last injected more than one drug.
Use of cannabis by PWID is also common. The 2020 IDRS showed that:
PWID also use pharmaceutical drugs, particularly prescription opioids, at higher rates than the general population (Peacock et al. 2021). This likely reflects the practice of substituting pharmaceutical drugs for illicit drugs, such as heroin. Data from the 2020 IDRS showed that, in the last 6 months:
Use of cocaine is also common among PWID, with 17% of participants in the 2020 IDRS reporting using cocaine in the last 6 months. This represents an increase from 13% in 2019 (Peacock et al. 2021).
Injecting drug use is a major risk factor for transmitting blood-borne viruses, including HIV, hepatitis B and hepatitis C. Needle and syringe sharing among people who inject drugs is partly responsible for transmitting infection, although unsafe sexual behaviours also play a role (AIHW 2012).
Unsafe injecting practices were responsible for 0.5% of the total burden of disease and injuries in 2015 (AIHW 2019).
Unsafe injecting practices are linked to Hepatitis B, Hepatitis C, HIV/AIDS, liver cancer and chronic liver disease. Liver cancer and chronic liver disease are the long-term consequences of contracting hepatitis B and hepatitis C infection. Acute hepatitis C and B were responsible for 75% and 37% of burden (respectively) (AIHW 2019). Chronic liver disease and liver cancer were each responsible for 24% of the burden due to unsafe injecting practices (AIHW 2019).
Data from the Australian Needle Syringe Program (ANSP) provides some evidence of the risk of harms related to injecting drug use in persons who regularly inject drugs in Australia:
Data from the 2020 IDRS provide additional evidence of risks for harms, including:
Figure PWID3: Injecting risk behaviours in the last month among people who inject illicit drugs surveyed in the Illicit Drug Reporting System, 2000 to 2020 (per cent)
The figure shows that injecting risk behaviours have fluctuated between 2000 and 2020. Re-use of own needles overall decreased from 53% in 2008 to 44% in 2020, but has risen from 38% in 2016. Borrowing needles fell from 16% in 2000 to 5% in 2020, though lending of equipment remained relatively stable (11% in 2000 and 9% in 2020). Sharing of other equipment decreased from 51% in 2000 to 5% in 2019, before increasing to 25% in 2020.
In 2020, 29% of IDRS participants reported experiencing an injection-related health problem in the last month. This represents a decline from 45% in 2019 (Peacock et al. 2021). Of those who commented (n=879), in the last month:
The ANSPS found that HIV antibody prevalence is low and stable nationally (1.7% to 2.3% between 2015 and 2019) (Table S3.65). Some populations of PWID are at greater risk of HIV than others.
Figure PWID4: HIV antibody prevalence by gender, 1995 to 2019 (per cent)
The figure shows that HIV antibody prevalence has fluctuated across time, but was lower in 2019 (2.3% of persons) than 1995 (2.1%). HIV antibodies have typically been more prevalent among males (3.0% in 2019) than females (0.7% in 2019).
According to the ANSPS, Hepatitis C (HCV) is more common than HIV among PWID. Less than half (45%) of respondents were HCV antibody positive in 2019, a decline from 57% in 2015 (Table S3.66).
The 2019 NDSHS showed that most people support measures to reduce problems associated with injecting drugs. About two-thirds of the population aged 14 and over supported rapid detoxification therapy (69%), methadone/buprenorphine maintenance programs (67%), needle and syringe programs (64%), treatment with drugs other than methadone (66%) and the use of naltrexone (65%), which is a medication that blocks the effect of opioids such as heroin. In addition:
All Australian states and territories operate needle syringe programs (NSPs), providing a range of services to PWID (Heard et al. 2019). See Harm reduction: Minimising risky behaviours.
According to the IDRS, in 2017, NSPs were by far the most common source of needles and syringes in the preceding 6 months (94%), followed by NSP vending machines (19%). Chemists were used by 16% of participants nationally (Karlsson & Burns 2018) (Table S3.69). This is supported by the findings of the 2019 NDSHS that NSPs were the most commonly reported source (39%), followed by chemists (34%) (AIHW 2020) (Table S3.70). This is likely to reflect the different sampling of the 2 surveys whereby the NDSHS is targeted at the general population, while the IDRS accesses PWID.
Medically supervised injecting centres (MSIC) are places where people can use and inject drugs under the supervision of registered nurses, counsellors and health education professionals. This service aims to prevent injury and death by being present when someone injects in order to provide immediate medical assistance as required. Kings Cross in Sydney has been home to an MSIC since 2001 (Uniting 2017), and a second opened in Richmond, Victoria in July 2018.
AIHW (Australian Institute of Health and Welfare) 2012. Australia’s health 2010. Australia’s health series no. 12. Cat. no. AUS 122. Canberra: AIHW.
AIHW 2019. Australian burden of disease study: Impact and causes of illness and death in Australia 2015. Series no.19. BOD 22. Canberra: AIHW. Viewed 13 June 2019.
AIHW 2020. National Drug Strategy Household Survey 2019. Drug Statistics series no. 32. Cat. no. PHE 270. Canberra: AIHW. Viewed 21 July 2020.
Dolan K, MacDonald M, Silins E & Topp L 2005. Needle and syringe programs: a review of the evidence. Canberra: Australian Government Department of Health and Ageing. Viewed 25 January 2018.
Heard S, Iversen J, Geddes L & Maher L 2020. Australian NSP Survey: Prevalence of HIV, HCV and injecting and sexual behaviour among NSP attendees, 25-year National Data Report 1995–2019. Sydney: Kirby Institute, UNSW.
Karlsson A & Burns L 2018. Australian Drug Trends 2017. Findings from the Illicit Drug Reporting System (IDRS). Australian Drug Trend Series. No. 181. Sydney, National Drug and Alcohol Research Centre, UNSW Australia.
Peacock A, Uporova J, Karlsson A, Price O, Gibbs D, Swanton R et al. 2021. Australian Drug Trends 2020: Key findings from the National Illicit Drug Reporting System (IDRS) interviews. Sydney: National Drug and Alcohol Research Centre, UNSW.
United Nations Office on Drug and Crime (UNODC) 2020. World Drug Report 2020. Vienna: UNODC. Viewed 28 July 2020.
Uniting 2017. Uniting Medically Supervised Injecting Centre: get to know our story. Viewed 25 January 2018.
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