Drug harms

The use and misuse of both legal and illicit drugs inflict a financial cost on the Australian community. For recent years, the costs of legal and illicit drug use in Australia were estimated at:

• Tobacco: $136.9 billion in 2015-16
• Opioids: $15.76 billion in 2015-16
• Cannabis: $4.5 billion in 2015-16
• Methamphetamine: over $5 billion in 2013-14
• Alcohol: $14.35 billion in 2010

Tobacco use costs were assessed as comprising:

Tangible costs	Intangible costs
$19.2 billion in tangible costs, including: Health care for smokers and diseases related to passive smoking Reduced workplace productivity, including for those who care for someone with a smoking-related disease	$118 billion in intangible costs, such as the pain and suffering that can be caused by ill health related to smoking

Alcohol use statistics identify the highest costs are associated with:

More than half of the economic costs of cannabis— $2.4 billion—is related to the criminal justice system and includes:

• Imprisonment
• Administering community supervision orders
• Impact on victims of crime.

Costs associated with opioid use, including illegal opioids and the use of pharmaceutical opioids not as prescribed, include costs related to:

• Early death
• Criminal justice
• Health care.

Provisional estimates have also been reported separately for loss of quality of life for co-residents, such as partners and children, because of substance abuse of others ($11.98 billion); and reduced quality of life for the drug user ($14.93 billion).

While cannabis is the highest-reported consumed illicit drug in Australia, the social costs attributed to cannabis use are much lower than for opioid use. This could be because a small number of deaths are attributed to cannabis use as compared with deaths attributed to the use of pharmaceutical opioids used off prescription.

Methamphetamine economic costs are associated with a range of areas, including:

• Prevention, harm reduction and treatment
• Health care
• Early death
• Crime
• Child mistreatment and protection
• Workplace accidents and productivity.

Household Costs

Household expenditure on alcohol, tobacco and other drugs can have a negative impact on the quality of life of families and other relationship units. The reported proportion of household expenditure on alcohol in the 2015–16 Survey was 2.2%, down from 3.4% in 1984.

The proportion of household spending on tobacco products has also diminished in 2015–16 to 0.9%, down from 1.6% in 1984.

Alcohol

According to the Australian Bureau of Statistics (ABS), there were 1366 alcohol-induced deaths in 2017, with an additional 2820 alcohol-related deaths, where alcohol was a contributing factor to death.

The 2019 Survey reported 1.2% of recent drinkers were injured while under the influence of alcohol and required medical attention:

• 0.4% required hospital admission for their injuries
• 0.3% required medical attention
• 0.2% required hospitalisation because they were intoxicated

These statistics all increase significantly for people who engage in risky drinking over a lifetime or oneoff drinking. Alcohol caused 54% of all drug-related hospitalisations in 2019.

Health Effects of Alcohol

The human body rapidly absorbs alcohol into the bloodstream. It begins to affect the brain in around five minutes (it varies for each person depending on body mass and general state of health). While the short-term effects of alcohol, such as a sense of relaxation and reduced inhibitions, may add to the allure of drinking, excessive drinking can produce unpleasant effects, including nausea and vomiting and can influence drinkers to engage in harmful behaviour.

Short-term Effects	Long-term Effects
A sense of relaxation Blurred or double vision Disturbed sexual functioning Disturbed sleep patterns Impaired memory and judgement Decreased alertness or coordination and slower reaction times Nausea, shakiness and vomiting Reduced inhibitions	Brain damage and dementia Liver cirrhosis Oral, throat and breast cancers Some forms of heart disease and stroke

Opioids

In this section, we will discuss the non-medical use of prescription opioids, such as codeine and oxycodone, as well as illicit opioids, such as heroin. All opioids work the same way in the human body, binding to receptors in the brain, blocking pain signals and slowing breathing.

Medical Opioids

The non-medical use of pharmaceutical drugs is a continuing concern internationally. The use of opioids in Australia and New Zealand is higher than the global average, with the non-medical use of pharmaceutical opioids being the most used opioid.

In the past 10 years, drug-induced deaths have been more likely from prescription drugs than illegal drugs.

There has been a significant rise in deaths where a prescription drug was present or synthetic opioids, such as fentanyl and tramadol, were used. In 2018, there were 655 deaths ascribed to pharmaceutical opioids, 322 to illicit opioids only and 108 deaths to polydrug use where pharmaceutical and illicit opioids were present.

People who use opioids for chronic pain conditions are at increased risk of using pharmaceutical drugs for non-medical purposes compared with the general population. Dependence in users with chronic pain develops when a patient’s tolerance increases, and they require more and more of the medications prescribed for legitimate purposes to carry out their normal daily lives.

In 2018–19, of all hospitalisations for drug-related principal diagnosis, 11% were for analgesics, with heroin, opium, morphine and methadone accounting for 6.2%.

Watch

Addiction can happen to anyone. The following story explains how people with no previous history of drug abuse or addictive behaviour can become addicted: ‘Jayne: My Addiction Started Out Very Innocently. (Extended)’ by Avoid Opioid SD on YouTube

Health Effects of Medical Opioids

The health effects of medical opioids include:

Short-Term Effects	Long-Term Effects
Constipation Dizziness Dry mouth Itching Nausea Overdose (fatal and non-fatal) Sedation Vomiting	Decreased cognitive function Dependence Gastrointestinal bleeding Mental health conditions, including depression Occlusion of blood vessels Psychiatric comorbidity

Illicit Opioids

Heroin can be smoked, snorted or swallowed. It is usually melted from a powdered or rock form and injected intravenously. Injecting drugs creates a variety of additional harms from unsanitary sharing of injecting equipment, for example, the transmission of blood-borne viruses such as hepatitis C and human immunodeficiency virus (HIV). Opioid overdose can cause respiratory failure, aspiration, hypothermia and death.

Heroin users have a high risk of overdose, especially in polydrug use with other sedating drugs, such as benzodiazepines (e.g. alprazolam, diazepam) and alcohol.

In the last 20 years, opioids have been the number one drug present in the systems of people who have suffered drug-induced death, and the number continues to rise—474 of the 1865 drug-induced deaths in Australia in 2019 were due to heroin. The increase in deaths has been attributed to increasing purity and availability of the drug, but also because the cohort of heroin users is ageing, and they have a range of medical conditions that have resulted from long-term drug use that make them more vulnerable to overdose.

Health Effects of Illicit Opioids

The health effects of illicit opioids include:

Short-Term Effects	Long-Term Effects
Analgesia Suppressed coughing Drowsiness Dry mouth Euphoria Heavy feeling in hands and feet Nausea and vomiting Severe itch Respiratory depression resulting in fatal and non-fatal overdose, especially when used in conjunction with other sedative substances, including benzodiazepines and alcohol	Impotence in males Irregular menstrual periods in females Loss of appetite and weight Memory impairment Mental health issues, including depression Neurochemical changes in the brain Physical dependence and associated withdrawal, which manifest as flu-like symptoms Severe constipation Tooth decay (from lack of saliva)

Cannabis

The effects of cannabis are different from user to user and depend on the amount consumed, the user’s previous experience, how it is taken, and the mood and body weight of the user. The active substances in cannabis move into the blood more swiftly when it is smoked rather than when it is swallowed or eaten.

Continuing use of cannabis can be linked to a number of negative long-term effects, and regular users can become physically dependent and report symptoms of withdrawal that include anxiety, sleep diffculties, appetite disturbance and depression.

When compared with other drugs, cannabinoids are less likely to be attributed to drug-induced death—in 2019, there were 206 drug-induced deaths recorded where cannabinoids were present in the body of the deceased.

However, the short-term effects of cannabis can raise the risk of road traffc incidents because of diminished driving capability in response to emergencies. Cannabis was the second most frequent drug named at toxicology for transport incident deaths.

Hospitalisation in 2018–19 for issues related to cannabinoids accounted for 22.8 per 100,000 persons admitted in major cities, and in regional and remote areas, it was 26.5 per 100,000 persons admitted.

Hospitalisation for cannabinoid-related issues was highest in remote and very remote areas: 56.3 per 100,000 persons admitted.

Health Effects of Cannabis

The health effects of cannabis include:

Short-Term Effects	Long-Term Effects
Dizziness, with impaired balance and coordination Feelings of hunger Increased heart rate for up to three hours after smoking Mild euphoria, relaxation and reduced inhibitions Nausea, headache and reddened eyes Panic reactions, confusion and feelings of paranoia—mainly reported by naïve users Perceptual alterations, including time distortion and intensification of ordinary experiences	Cardiovascular system damage Mental health conditions, including depression Physical dependence Poor adolescent psychosocial development Upper respiratory tract cancers, chronic bronchitis and permanent damage to the airways when smoked

Polydrug Use and Cannabis

Cannabis use correlates greatly with smoking tobacco, drinking alcohol and using other drugs. This potentially increases risks for users and makes it tricky for researchers to measure the effects of cannabis alone.

Alcohol is the drug most used concurrently with cannabis, and users who also consume alcohol are 62% more likely to go above the single-occasion risk guidelines, and 39% are likely to exceed the lifetime risk guidelines.

Other drugs commonly used concurrently by cannabis users are:

• Tobacco (29%)
• Cocaine (25%)
• Ecstasy (19.7%)
• Pharmaceuticals (non-medical use) (14.1%).

Benzodiazepines and Other Sedatives and Hypnotics

Benzodiazepines and other sedatives and hypnotics (including barbiturates, excluding ethanol) caused 6.8% of all drug-related hospitalisations in 2018–19.

Benzodiazepines and other sedatives and hypnotics (excluding alcohol) resulted in more drug-related hospitalisations than opioids between 2014–15 and 2018–19. Hospitalisations for benzodiazepines have been on the decrease, falling from 6,361 hospitalisations in 2016–17 to 5,204 in 2018–19.

In 2019 benzodiazepines were present in 43% of the 1865 drug-induced deaths, and between 2010 and 2019, deaths where benzodiazepines were present rose from 544 to 811.

Watch

Prescription drug addiction can happen to anyone. People who are given addictive drugs for pain medication can become inadvertently addicted. Watch the following video for a first-hand account. ‘Rustie’s Story’ by ScriptWise on YouTube

Health Effects of Benzodiazepines

Health effects of benzodiazepines include:

Short-Term Effects	Long-Term Effects
Confusion Dizziness Euphoria Moodiness Relaxation, sleepiness and lack of energy Short-term memory loss Visual distortions	Anxiety, irritability, paranoia, aggression and depression Confusion, lethargy and sleep problems Memory loss, cognitive impairment, dementia and falls Menstrual irregularities in females Muscle weakness, rashes, nausea and weight gain Sexual problems

Polydrug Use and Benzodiazepines

It is important to note that benzodiazepines often occur in the context of polydrug use, and they may not be recorded as the underlying cause in drug-related death. However, researchers found that, in 2019, benzodiazepines were recorded as a contributing factor to 693 opioid-related deaths. In 2018, benzodiazepines were present in over 97% of drug-induced deaths in conjunction with other drugs, including alcohol.

Watch

Visit the following link to watch more about Benzodiazophones such as its role, the risks and long-term effects of using this drug. 'Benzodiazophones' by ScriptWise on YouTube.

Meth/Amphetamines

In 2015, amphetamine use had the highest toll of all illicit drugs on social and economic factors and the health and well-being of individuals and communities.

Amphetamines contributed to:

• 28% of drug use disorders (excluding alcohol)
• 5% of poisonings
• 4.3% of suicides or self-inflicted harms.

These statistics were counted in the 21% of the total illicit drug use burden on the community. Amphetamine use is also a contributor to road traffc injuries: 3.2% of motorcyclists injured had amphetamines in their system, and 2.5% of motor vehicle occupants had amphetamines present in their system.

Health Effects of Meth/Amphetamines

Short-Term Effects

Long-Term Effects

Big burst of energy – making the user talkative, restless and excited Increase in heart rate and breathing High blood pressure (hypertension) Dry mouth and jaw clenching Sweating Dilated pupils Loss of appetite Increased sex drive Nosebleeds and damage to the nasal passage (from snorting)

‘Amphetamine psychosis’ (including hallucinations and paranoia) Extreme weight loss and malnutrition Dry mouth and dental problems Regular infections (such as colds and flu) – due to reduced immunity Mood swings, panic attacks, anxiety and/or depression Drug dependence – this may include an increase in use or reliance on other drugs (such as sedatives) to balance the effects Out-of-character behaviour – aggression and violence Heart and kidney problems Increased risk of stroke Increased risk of contracting sexually transmissible infections (STIs) as a result of unprotected sex

Family, domestic or sexual violence frequently happen alongside the use of alcohol and other drugs—it is far more likely to happen under the influence of AOD than other forms of violence. Statistics show that people who are dependent on methamphetamines or cannabis are more likely to perpetrate violence against an intimate partner or former partner than the rest of the population.

Women are at significantly higher risk of being a victim of male-perpetrated violence by a former or current partner while the partner is under the influence of AOD.

Young people are more likely to take up drug use if there is a history of family violence or drug use by parents.

The majority of people who use alcohol or illicit drugs regularly do not report engaging in risky behaviours or criminal activity. However, the use of alcohol and other drugs can influence people to engage in risky or criminal activities, such as driving a motor vehicle while under the influence, offensive conduct, and verbal or physical violence.

The illegal drug trade is frequently associated with different kinds of crimes, such as property crime, fraud and violence. People who regularly take drugs, particularly those who inject drugs, are more likely to participate in criminal activity (other than drug buying and using) than the general population. Driving under the influence of drugs or alcohol is the most reported criminal or risky behaviour undertaken by users.

Twenty-one per cent of people aged 14 and over have been victims of verbal or physical abuse or have been made fearful by a person under the influence of alcohol. Individuals who use illicit drugs are three times more likely to report suffering violence, and the frequency of violent incidents among drug users is six times higher than the general population.

While statistics for 2019 showed a decline in criminal, risky and antisocial behaviours relating to drug and alcohol use, it continues to be a contributing factor to social harms, with the victimisation of children, young people and women being of ongoing concern:

• In 2019, 21% of Australians aged 14 and over were victims of an alcohol-related incident.
• In 2016, 4.8% of Australians experienced physical abuse, and 17.7% of people experienced verbal abuse from persons affected by alcohol.

The most recent census data (2018) regarding population and housing identified that approximately 116,000 people experienced homelessness in Australia in 2016. This data includes people who were living in supported accommodation for the homeless, in temporary accommodation or in overcrowded dwellings as well as people ‘sleeping rough’.

Individuals who experienced homelessness or housing instability reported that they engaged in risky drinking behaviours (57%), used illicit drugs (39%) and injected drugs (14%) in the 6 to 12 months prior to the report.

Research carried out in Melbourne identified that over half of individuals experiencing homelessness had drug or alcohol problems before they became homeless, and the remaining two-thirds reported that, after they became homeless, they engaged in risky alcohol consumption and used other drugs.

People who are homeless tend to use AOD for longer than the general population, possibly because their social networks, lack of access to support services and supportive social and familial connections may prolong their alcohol and other drug problems.

Drugs, mental health and domestic violence are a toxic combination that increase an individual’s vulnerability to becoming homeless.

In 2019–20, 44% of clients of specialist homelessness services (SHS) with problematic drug and/or alcohol use also reported an existing mental health issue, and 31% (almost 8700 people) reported an existing mental health issue and family and domestic violence.

The relationship between mental health and drug use is complex and fraught with tensions between correlation and causation. Some research points to people with predispositions towards some mental health issues being more inclined to have AOD issues, but it is often hard to determine if mental illness precedes drug use or if drug use precipitates mental illness.

Compared with people without a diagnosis or treatment, people who report mental health issues are more likely to:

• Smoke
• Drink alcohol at risky levels
• Use any illicit drug
• Use Cannabis
• Use meth/amphetamines
• Use ecstasy or cocaine
• Use pharmaceuticals for non-medical purposes

People who inject drugs were almost twice as likely(47%) than the general population to report mental health problems, most commonly depression and anxiety.

According to estimates from the National Drug Strategy Household Survey 2019, there were increasing numbers of people aged over 14 being diagnosed or treated for a mental health condition from 2016 to 2019, up approximately 1%. The percentage of people aged 18 and over experiencing high or very high levels of psychological distress also increased by 2019 by approximately 3%. This could be accounted for by increasing mental health literacy and awareness, but there are likely to be other factors, including changing trends and patterns of use of alcohol and other drugs.