Technical notes
Comparison of national data sources on smoking and alcohol consumption
A number of nationally representative data sources are available to analyse recent trends in tobacco smoking and alcohol consumption. This includes the AIHW National Drug Strategy Household Survey (NDSHS) and the ABS National Health Survey (NHS) for the general population. In addition, the National Aboriginal and Torres Strait Islander Health Survey (NATSIHS), National Aboriginal and Torres Strait Islander Social Survey (NATSISS) and the Australian Aboriginal and Torres Strait Islander Health Survey (AATSIHS) collected by the ABS are designed to obtain a representative sample of Indigenous Australians.
Differences in scope, collection methodology and design may account for variation in estimates reported and comparisons between collections should be made with caution.
For a summary of the methodological differences see Table T1: Methodological differences between surveys (XLSX 19kB).
National Hospital Morbidity Database
Coding of drug-related hospitalisations
The hospitalisation data included in this report were extracted from the AIHW National Hospital Morbidity Database using a selection of codes from the International statistical classification of diseases and related health problems, 10th revision, Australian modification 11th edition (ICD-10-AM). These codes are outlined in the table below.
| Drug identified in principal diagnosis | ICD-10-AM codes |
|---|---|
Alcohol (including ethanol) | E52, F10.0–10.9, G31.2, I42.6, K29.2, K70.0–70.9, K85.2, K86.0, T51.0–51.9, Z71.4 |
| Opioids (including heroin, opium, morphine and methadone) | F11.0–11.9, T40.0–40.4, T40.6 |
| Non-opioid analgesics (including paracetamol) | F55.2, N14.0, T39.0–39.4, T39.8, T39.9 |
Antiepileptic, sedative-hypnotic and antiparkinsonism drugs (excluding alcohol) | T42.4, F13.0–13.9, T41.2, T42.0–42.3, T42.5–42.8 |
| Benzodiazepines | T42.4 |
Other sedatives and hypnotics (including barbiturates; excluding alcohol) | F13.0–13.9, T41.2, T42.0–42.3, T42.5–42.8 |
| Cannabinoids (including cannabis) | F12.0–12.9, T40.7 |
| Hallucinogens (including LSD) | F16.0–16.9, T40.8, T40.9 |
| Cocaine | F14.0–14.9, T40.5 |
| Nicotine | F17.0–17.9, T65.2, Z58.7, Z71.6 |
| Amphetamines and other stimulants | F15.01–15.02, F15.11–15.12, F15.21–15.22, F15.31–15.32, F15.41–15.42, F15.51–15.52, F15.61–15.62, F15.71–15.72, F15.81–15.82, F15.91–15.92, T43.61–43.62, 15.00, F15.09, F15.10, F15.19, F15.20, F15.29, F15.30, F15.39, F15.40, F15.49, F15.50, F15.59, F15.60, F15.69, F15.70, F15.79, F15.80, F15.89, F15.90, F15.99. |
| Methamphetamine | F15.01–15.02, F15.11–15.12, F15.21–15.22, F15.31–15.32, F15.41–15.42, F15.51–15.52, F15.61–15.62, F15.71–15.72, F15.81–15.82, F15.91–15.92, T43.61–43.62 |
Other stimulants (includes other amphetamines and caffeine) | 15.00, F15.09, F15.10, F15.19, F15.20, F15.29, F15.30, F15.39, F15.40, F15.49, F15.50, F15.59, F15.60, F15.69, F15.70, F15.79, F15.80, F15.89, F15.90, F15.99. |
| Antidepressants | F55.0, T43.0–2 |
| Antipsychotics and neuroleptics | T43.3–5 |
| Volatile solvents | F18.0–18.9, T52.0–52.9, T53.0–9, T59.0, T59.8 |
| Multiple drug use | F19.0–19.9 |
Unspecified drug use and other drugs not elsewhere classified (including psychotropic drugs not elsewhere classified; diuretics; laxatives; anabolic and androgenic steroids and opioid receptor antagonists) | F55.1, F55.3–6, F55.8, F55.9, K85.3, N14.1–3, T38.7, T43.8–9, T47.2–47.4, T50.1–3, T50.7, Z71.5 |
Fetal and perinatal related conditions (including conditions caused by the mother’s alcohol, tobacco or other drug addiction) | Q86.0 |
Note: Data for 2018–19 were reported to the NHMD using the ICD-10-AM (10th edition). Revision of ICD-10-AM (10th edition) mapping to drugs of concern was applied in 2017–18. The mapping has been applied to the time series.
Calculation of population rates
Crude rates reported in time series analysis of NHMD data were calculated using the Australian Bureau of Statistics estimated resident population (ERP) as at 31 December of the reference year. For example, rates for the 2020–21 collection period were calculated using the ERP as at 31 December 2020.
In the year ending 30 June 2021, the estimated residential population in Victoria decreased. This decline was driven by a relatively large net negative overseas migration, likely due to the closure of Australia's international border in March 2020 in response to the COVID-19 pandemic. This may result in increased rates even if the number of clients did not increase. Other states and territories were also impacted by border closures; caution should be taken when comparing population data for 2021 with previous years. This does not impact rates by remoteness area, which were calculated using the ERP as at 30 June 2020.
References
AIHW (Australian Institute of Health and Welfare) (2018) Drug related hospitalisations, AIHW, Australian Government, accessed 15 June 2022.
AIHW (2019) Alcohol and other drug use in regional and remote Australia: consumption, harms and access to treatment, 2016–17, AIHW, Australian Government, accessed 16 June 2022.
AIHW (2022) Admitted patients, AIHW, Australian Government, accessed 15 June 2022.
Chrzanowska A, Man N, Sutherland R, Degenhardt L and Peacock A (2021) Trends in drug-related hospitalisations in Australia 1999–2020, National Drug and Alcohol Research Centre, University of New South Wales, accessed 16 June 2022.
National Mortality Database
The Medical Certificate of Cause of Death includes all diseases, morbid conditions or injuries that either resulted in or contributed to death and the circumstances of the accident or violence that produced any such injuries.
The underlying cause of death is the disease or injury that initiated the train of morbid events (deaths are referred to as being directly attributable to the disease or injury). Associated causes of death are other causes listed on a death certificate, other than the underlying cause.
Causes of death are coded by the ABS to the International Statistical Classification of Diseases and Related Health Problems (ICD). Deaths in this report are counted according to year of registration of death, which is not necessarily the year in which the death occurred. Further, mortality data by geographical regions were derived using the place of a person’s usual residence at the time of death.
The ICD is revised periodically to incorporate changes in the medical field. In 2020, the definition for alcohol-induced deaths was revised to include ICD-10 code K85.2 alcohol-induced acute pancreatitis. See Post release changes in Causes of Death, Australia.
Deaths registered in 2019and earlier are based on the final version of cause of death data; deaths registered in 2019 are based on revised data; deaths registered in 2020 and 2021 are based on preliminary data. Revised and preliminary data are subject to further revision by the ABS.
This report includes data on drug-induced deaths, alcohol-induced deaths and alcohol-related deaths.
Drug-induced deaths
Drug-induced deaths are defined as those that can be directly attributable to drug use, as determined by toxicology and pathology reports. The underlying causes of deaths align with the definition of drug-induced deaths used by the ABS reporting on drug-induced deaths as defined in 3303.0 - Causes of Death, Australia. Deaths solely attributable to alcohol and tobacco are excluded. Drug-induced deaths are classified according to their intent–accidental, intentional (including assault and suicide) or undetermined intent. They include deaths from illicit drugs (for example, heroin, amphetamines and cocaine) and licit drugs (for example, benzodiazepines and anti-depressants).
Drug-induced causes exclude accidents, homicides, and other causes indirectly related to drug use. Also excluded are newborn deaths associated with mother’s drug use.
The drug-induced deaths data included in this report were extracted from the AIHW NMD using the codes outlined in the table below.
Drug type | ICD-10 codes | Examples |
|---|---|---|
Heroin | T40.1 |
|
Natural and semi-synthetic opioids | T40.2 | e.g. Oxycodone, Codeine, Morphine |
Methadone | T40.3 |
|
Synthetic opioids | T40.4 | eg. Fentanyl, Tramadol, Pethidine |
All opioids | T40.0, T40.1, T40.2, T40.3, T40.4, T40.6 |
|
All opioids excluding heroin | T40.0, T40.2, T40.3, T40.4, T40.6 |
|
Cocaine | T40.5 |
|
Cannabinoids | T40.7 |
|
Benzodiazepines | T42.4 |
|
All depressants | T42.0–T42.8 |
|
All psychostimulants | T43.6 |
|
All antidepressants | T43.0, T43.1, T43.2 |
|
All antipsychotics | T43.3, T43.4, T43.5 |
|
Paracetamol | T39.1 |
|
Ibuprofen and aspirin | T39.3 |
|
All non-opioid analgesics | T39.0–T39.9 |
|
Alcohol | T51.0, T51.1, T51.2, T51.3, T51.8, T51.9 |
|
Note: The underlying causes of deaths align with the definition of drug-induced deaths used by the ABS reporting on drug-induced deaths as defined in 3303.0 - Causes of Death, Australia. This classification excludes deaths solely attributable to alcohol and tobacco.
Deaths from external causes are assessed to determine intent. This may also determine how a death is investigated and influence the type of information that can be included on the death record (ABS 2020).
| Intent | ICD-10 codes |
|---|---|
| Accidents | X40–X44 |
| Intentional (suicide and assault) | X60–X64 |
| Undetermined intent | Y10–Y14 |
| Psychosocial risk factor | ICD-10 codes |
|---|---|
| Personal history of self-harm | Z915 |
| Disruption of family by separation and divorce | Z635 |
| Disappearance and death of family member | Z634 |
| Problems in relationship with spouse or partner | Z630 |
| Problems related to other legal circumstances | Z653 |
| Release from prison | Z652 |
| Limitation of activities due to disability | Z736 |
| Other problems related to housing and economic circumstances | Z598 |
| Unemployment, unspecified | Z560 |
| Family history of other mental and behavioural disorders | Z818 |
| Associated cause of death | ICD-10 codes |
|---|---|
| Injuries to multiple body regions, crushing, asphyxiation, poisoning by drugs, other | T00–T98 |
| Mental and behavioural disorders due to psychoactive substance use | F10–F19 |
| Mood (affective) disorders | F30–F39 |
| Factors influencing health status and contact with health services | Z00–Z99 |
| Other ill-defined causes | R00–R94, R96–R99, I46.9, I95.9, I99, J96.0, J96.9, P28.5 |
| Neurotic, stress-related and somatoform disorders | F40–F48 |
| Coronary heart disease | I20–I25 |
| Accidental poisoning | X40–X49 |
| Diseases of the musculoskeletal system and connective tissue | M00–M99 |
| Viral hepatitis excl. vaccine-preventable diseases | B15–B19 excl. B15, B16, B17.0, B18.0, B18.1, B18.9, B19 |
Alcohol-induced deaths
Alcohol-induced deaths are defined as deaths that can be directly attributable to alcohol use, as determined by toxicology and pathology reports. The underlying causes of deaths align with the definition of alcohol-induced deaths used by the ABS as defined in 3303.0 - Causes of Death, Australia.
Alcohol-induced causes exclude accidents, homicides, and other causes indirectly related to alcohol use. This category also excludes newborn deaths associated with maternal alcohol use.
Alcohol-induced deaths may be due to a chronic condition which is directly related to alcohol use (e.g. alcoholic liver cirrhosis) or from an acute condition directly related to harmful consumption (e.g. alcohol poisoning which led to respiratory depression).
Alcohol-related deaths
Alcohol-related deaths include deaths directly attributable to alcohol use and deaths where alcohol was listed as an associated cause of death (e.g. a death due to a motor vehicle accident where a person recorded a high blood alcohol concentration).
Pharmaceutical Benefits Scheme (PBS) data collection
Data include all claims processed by Services Australia up to 19 January 2022.
The medicines reported from PBS data are classified based on the ATC (Anatomical Therapeutic Chemical) classification system, defined by the World Health Organisation Collaborating Centre for Drug Statistics Methodology. Please refer to the WHO ATC Index for more information on the structure of the ATC classification system and specific ATC codes: WHOCC - ATC/DDD Index.
Data contained in this report include prescriptions for the following patient entitlements:
- General
- Concessional
- Repatriation.
Medicines supplied under prescriber bag orders were removed from the dataset prior to analysis. Analysis includes under-co-payment data which include information on prescriptions priced below the co-payment as defined in the National Health Act 1953.
Drugs selected for this report were extracted from the PBS data using the ATC codes outlined in the table below.
| Drug classification | ATC codes |
|---|---|
Opioids Drugs used in opioid dependence (note that opioid pharmacotherapy is not recorded in the PBS) Codeine as cough suppressant (excluding combinations with expectorants) | N02A N07BC
R05DA04 |
| Benzodiazepines | N03AE, N05BA, N05CD |
Gabapentinoids Gabapentin Pregabalin | N02BF N02BF01 N02BF02 |
| Smoking cessation medicines | N07BA |
| Alcohol cessation medicines | N07BB |
| Cancer treatment medicines | L01AA01–L01AX04, L01BA01b, L01BA03–L01XX53, L02AE02b, L02AE03b, L02BA01b, L02BG03, L02BG04, L02BG06, L02BB01–L02BB04, L02BX01–L02BX03, L04AX02, L04AX04, L04AX06 |
(a) Pregabalin and gabapentin are classified as N02BG when listed to manage pain.
(b) These ATC codes have multiple indications in the PBS. Data for these codes were extracted using PBS item codes for medicines that were specifically indicated for cancer treatment. This methodology is consistent with that used by Lalic et al. (2019).
Calculations of Defined Daily Doses for Statistical purposes (S-DDDs)
S-DDDs were calculated as follows for each opioid prescription:
Number of S-DDDs = (Number of units × Amount of specified opioid in each unit) / (DDD amount for the specified opioid)
- Units are the individual forms of the opioids, such as tablets or patches
- DDD amounts match WHO DDD definitions, except for codeine. The WHO DDD amount for codeine (100mg) is for the indication of cough suppression. These results use the International Narcotics Control Board definition of 240mg as the DDD for codeine used for pain relief (INCB 2021).
Opioid dispensing related to palliative care and cancer treatment
Data for opioids were further disaggregated by dispensing that was in relation to palliative care or cancer treatment.
- Opioid dispensing was classified as being related to palliative care where a patient received a PBS supply of any drug under the Palliative Care Section in the previous 365 days. For more information on palliative care items in the PBS, refer to the PBS website: Pharmaceutical Benefits Scheme (PBS) | Palliative Care Items.
- Opioid dispensing was classified as being related to cancer treatment where a patient received a supply of a medicine used to treat cancer within the previous 365 days. Drugs related to cancer treatment were extracted using the ATC codes in the table above.
Patients using opioids and benzodiazepines at the same time
The PBS does not contain information related to how dispensed prescriptions are intended to be used, in terms of quantity or frequency. As such, it is not possible to derive how long any given prescription is likely to last.
As a result, after consulting with researchers with experience in prescription drug research, this report uses a fixed window of 30 days from the point of prescription as the time in which a prescription of another drug type is considered to be 'at the same time' as the first drug.
This may count some people who were dispensed one drug for a short time (for example, two weeks) and then dispensed a prescription for the other drug type. Conversely, it may not count some patients who are dispensed long-term courses of one drug (over many months) and were then dispensed a prescription of the other drug type. As a result, numbers should be considered indicative only.
References
Lalic S, Ilomäki J, Bell J S, Korhonen M J and Gisev, N (2019) Prevalence and incidence of prescription opioid analgesic use in Australia, British Journal of Clinical Pharmacology 85:202–215.
INCB (International Narcotics Control Board) (2021) Narcotic Drugs: Estimated World Requirements for 2021 – Statistics for 2019, International Narcotics Control Board, United Nations, Vienna.
Primary Health Networks
This release includes the following indicator by Primary Health Network (PHN):
Lifetime risky alcohol consumption
New Australian guidelines to reduce health risks from drinking alcohol were released in December 2020. Data for alcohol risk in this report are measured against the 2009 guidelines. NDSHS data relating to the updated guidelines are available here.
- Percentage of adults who consume more than 2 standard drinks per day on average.
Lifetime risky alcohol consumption was determined if alcohol consumption exceeded the 2009 guidelines for reducing health risks associated with alcohol consumption (NHMRC 2009).
The guidelines recommend that healthy men and women drink no more than 2 standard drinks of alcohol per day on average, to reduce their lifetime risk of harm from alcohol-related disease or injury.
Daily smokers
- Percentage of adults who are daily smokers.
Participants in the ABS NHS 2017–18 were asked whether they currently smoked at least once per day. A current daily smoker was defined as a person who smokes one or more cigarettes, roll-your-own cigarettes, cigars or pipes at least once a day. Chewing tobacco, electronic cigarettes (and similar) and the smoking of non-tobacco products were excluded.
About the data
Primary Health Networks (PHNs) are local organisations that connect health services across a specific geographic area, with the boundaries defined by the Australian Government Department of Health.
The quality of estimates from the NHS can vary across PHN areas, as the survey was not specifically designed to produce estimates at this level of geography.
As an indication of the accuracy of proportions, 95% confidence intervals were produced. These were calculated by the ABS using relative standard error (RSE) estimates of the proportion.
To ensure robust reporting of these data by PHN areas, suppression or interpret with caution rules were developed and applied by the Australian Institute of Health and Welfare.
Estimates of a percentage or its complement that had a relative standard error greater than 50% were suppressed. These estimates were considered unreliable for most practical purposes.
Data for PHN areas were suppressed if there was the likelihood of a non-representative sample, that is, where the survey sample count in the PHN area was less than 20% of the expected number of adults.
The ‘interpret with caution’ flag was applied to the data if the relative standard error associated with the percentage or its complement was greater than 25%. This indicates the proportion derived is subject to high sampling error and should be used with caution.
Data for Northern Territory should be interpreted with caution as the NHS excluded discrete Aboriginal and Torres Strait Islander communities and Very remote areas, which comprise around 28% of the estimated resident population of the Northern Territory.