Australia

Subsections:

Page last updated June 9, 2020 by Doug McVay, Editor/Senior Policy Analyst.

21. Australian Prisoner Population

"Australia’s prisoner population is growing at a rate well in excess of natural population growth. There were 29 700 adults in full-time custody at 30 June 2010, representing a 15% increase in the incarceration rate from 2000 to 2010. Women comprise 8% of adult prisoners but this proportion is increasing annually. Indigenous Australians2 are over-represented by a factor of 14, and the gap between Indigenous and non-Indigenous incarceration rates continues to widen.1"

Stuart A Kinner, David B Preen, Azar Kariminia, Tony Butler, Jessica Y Andrews, Mark Stoové and Matthew Law, "Counting the cost: estimating the number of deaths among recently released prisoners in Australia," Medical Journal of Australia, 2011; 195 (2): 64-68.
https://www.mja.com.au/journal...
https://www.mja.com.au/system/...

22. Prevalence of Injection Drug Use

"It has been estimated that a very low proportion of the Australian general population aged 14 years and over have ever injected or recently injected drugs. In 2010, 1.8% of the population had injected a drug in their lifetime, with 0.4% having injected a drug in the past year. More than one-quarter (27.1%) of recent users injected daily and the majority obtained their needles and syringes from a chemist (64.5%). Males were more likely to have recently injected drugs in the past year than females (0.6% versus 0.3%). Those in the 20-29 and 30-39 year age groups had a higher proportion of past-year injecting drug use (0.9% for each) than those in other age groups (Australian Institute of Health and Welfare, 2011).
"Another recent prevalence estimate of injecting in Australia in 15-64 year olds is 1.09% (range = 0.65%-1.50%) which equates to approximately 149,591 persons (range = 89,253-204,564) (Mathers, Degenhardt, Phillips et al., 2008)."

Stafford, J. and Burns, L. (2013). Australian Drug Trends 2012. Findings from the Illicit Drug Reporting System (IDRS). Australian Drug Trend Series No. 91. Sydney, National Drug and Alcohol Research Centre, University of New South Wales. p. 104.
http://www.ndarc.med.unsw.edu.au...

23. Prevalence of Hepatitis B and C Among Injection Drug Users in Australia

"In 2012, IDRS participants were asked questions about BBVI [Blood-Borne Viral Infection] testing and vaccinations. Of those who commented, 93% reported testing for HBV in their lifetime compared to 96% for HCV and 94% for HIV.
"Of those who were tested for HBV, two-thirds (62%) had a test within the past year and one-third (30%) within the last three months. Six percent reported a positive result and 4% had been treated for HBV (anti-viral therapy only). Two-thirds (61%) had been vaccinated again HBV, with 87% having completed the course. The main reason for HBV vaccination was due to a history of injecting drug use (38%) (Table 81).
"Among those tested for HCV, two-thirds (65%) had a test within the past year and one-third (31%) within the last three months. Nearly half reported a positive result. Ten percent of those who commented had been treated for HCV (anti-viral therapy only), with 22% receiving HCV treatment (currently or in the last 12 months). The main reason for HCV testing on the last occasion was a ‘matter of routine’ (38%) and ‘it was a responsible thing to do’ (14%; Table 82)."

Stafford, J. and Burns, L. (2013). Australian Drug Trends 2012. Findings from the Illicit Drug Reporting System (IDRS). Australian Drug Trend Series No. 91. Sydney, National Drug and Alcohol Research Centre, University of New South Wales. pp. 110-111.
http://www.ndarc.med.unsw.edu....

24. Prevalence of HIV Among Injection Drug Users in Australia

(Prevalence of HIV Among Injection Drug Users in Australia) "The prevalence of HIV among people who inject drugs in Australia has remained low at 2.1% or less since 1995. The prevalence of HIV in 2011 was 1.2% (Figure 46). HCV prevalence among this group was much higher at 61% to 62% from 2005 to 2008, however this figure was lower at 53% 2011 (Figure 46) (Iversen and Maher, 2012)."

Stafford, J. and Burns, L. (2013). Australian Drug Trends 2012. Findings from the Illicit Drug Reporting System (IDRS). Australian Drug Trend Series No. 91. Sydney, National Drug and Alcohol Research Centre, University of New South Wales. p. 112.
http://www.ndarc.med.unsw.edu....

25. HIV, HCV, and Injection Drug Use in Australia

"In Australia it is estimated that about 13 per cent of people with HIV also have HCV. HIV shares major routes of transmission with both HCV and HBV. People who inject drugs are at particularly high risk for HCV and HIV co-infection.
"While HIV was not established in the Australian IDU population when NSPs were introduced, the prevalence of HCV was already high. HCV is a more robust virus than HIV and is transmitted more efficiently though blood-to-blood contact. Approximately 80 per cent of current HCV infections and 90 per cent of new infections are attributable to unsafe injecting practices (Commonwealth of Australia, 2005b). This explains IDUs being identified as a priority population within The Third National Hepatitis C Strategy."

Victorian Department of Human Services (2010), National needle and syringe programs strategic framework 2010-2014, Commonwealth of Australia, p. 12.
http://www.health.gov.au...

26. Hepatitis C and Injection Drug Use in Australia

"Approximately 83 per cent of HCV infections have resulted from unsafe injecting drug use practices. In Australia in 2006 it was estimated that approximately 264,000 people had been exposed to HCV and had HCV antibodies with around 197,000 living with chronic hepatitis C. The estimated number of new cases of HCV infection has declined from 16,000 per annum in 2001 to 10,000 in 2005. The majority (65 per cent) of people with HCV are aged between 20 and 39 years and 35 per cent of national notifications of HCV are in women.
"While 25 per cent of HCV infections clear spontaneously within two to six months 75 per cent develop into chronic infections. Chronically infected persons will continue to be able to transmit the virus including those who experience no noticeable illness or symptoms. After 20 years, between 5 and 10 per cent of infections will have resulted in cirrhosis of the liver, with 2 to 5 per cent progressing to liver failure or a form of liver cancer known as hepatocellular carcinoma."

Victorian Department of Human Services (2010), National needle and syringe programs strategic framework 2010-2014, Commonwealth of Australia, pp. 11-12.
http://www.health.gov.au...

27. Cocaine Use and Health

"In 2010, there appeared to be a relationship between a person’s cocaine use and his or her mental health, psychological distress (see Glossary for definition of the Kessler Psychological Distress Scale) and body mass index (Table 9.7). In addition:
"• people who recently used cocaine were more likely to have been diagnosed with or treated for a mental illness (17.4% for recent users compared with 11.9%), and have high or very high levels of psychological distress (17.5% for recent users compared with 9.7%) than those who had not used cocaine in the previous 12 months
"• recent cocaine users were more likely to be underweight (5.0% for recent users compared with 2.3%), and considerably less likely to be obese (8.2% for recent users compared with 22.0%) than those who had not used cocaine in the previous 12 months."

Australian Institute of Health and Welfare 2011. 2010 National Drug Strategy Household Survey report. Drug statistics series no. 25. Cat. no. PHE 145. Canberra: AIHW, p. 142.
http://www.aihw.gov.au/WorkAre...

28. Australia - Data - 12-13-12

(Methamphetamine Use and Health) "This section compares meth/amphetamines use patterns with general health, selected health conditions, psychological distress (see Glossary for definition of the Kessler Psychological Distress Scale) and body mass index in people aged 18 years or older. The data are based on self-reported assessments and are not empirically verified. Table 8.7 shows there was a relationship between recent use of meth/amphetamines and a person’s mental health and body mass index. In addition:
"• recent users were twice as likely to report high or very high levels of psychological distress as those who had not used meth/amphetamines in the last 12 months (20.8% compared with 9.6%)
"• recent users were also twice as likely as non-recent users to report being diagnosed or treated for a mental illness in the previous 12 months (25.6% compared with 11.7%)
"• recent users of meth/amphetamines were less likely to be obese than non-users (14.6% and 21.8%, respectively)."

Australian Institute of Health and Welfare 2011. 2010 National Drug Strategy Household Survey report. Drug statistics series no. 25. Cat. no. PHE 145. Canberra: AIHW, p. 132.
http://www.aihw.gov.au/WorkAre...

29. Oxycodone-Related Deaths

"There were 465 oxycodone-related deaths identified between 2001 and 2009. Box 3 shows deaths by year from 2002 to 2008, with the largest number occurring in 2007. Deaths adjusted for quantity of oxycodone prescribed each year fluctuated between 3.8 and 8 deaths per million defined daily doses (Box 3). Only 10% of these deaths were due to oxycodone toxicity alone. Multiple drug toxicity was more predominant (82% of deaths), with benzodiazepines and alcohol commonly implicated in these deaths. The remaining 8% were from other causes (eg, pneumonia or cardiac failure), with drug toxicity (including oxycodone toxicity) being a contributory cause (data not shown)."

Amanda Roxburgh, Raimondo Bruno, Briony Larance and Lucy Burns, "Prescription of opioid analgesics and related harms in Australia," Medical Journal of Australia, 2011; 195 (5): 280-284. doi: 10.5694/mja10.11450
https://www.mja.com.au/journal...
https://www.mja.com.au/system/...

30. Heroin Toxicity and Opiate Overdose

"A striking finding from the toxicological data was the relatively small number of subjects in whom morphine only was detected. Most died with more drugs than heroin alone 'on board', with alcohol detected in 45% of subjects and benzodiazepines in just over a quarter. Both of these drugs act as central nervous system depressants and can enhance and prolong the depressant effects of heroin."

Zador, Deborah, Sunjic, Sandra, and Darke, Shane, "Heroin-related deaths in New South Wales, 1992: toxicological findings and circumstances," The Medical Journal of Australia, 1996; 164 (4): 204-207.
https://www.mja.com.au/journal...

31. Overdose - Opiates

"The disadvantage of continuing to describe heroin-related fatalities as 'overdoses' is that it attributes the cause of death solely to heroin and detracts attention from the contribution of other drugs to the cause of death. Heroin users need to be educated about the potentially dangerous practice of concurrent polydrug and heroin use."

Zador, Deborah, Sunjic, Sandra, and Darke, Shane, "Heroin-related deaths in New South Wales, 1992: toxicological findings and circumstances," The Medical Journal of Australia, 1996; 164 (4): 204-207.
https://www.mja.com.au/journal...

32. Treatment Episodes for Problematic Morphine vs Oxycodone Use

"Treatment episodes for problematic morphine use remained relatively stable during 2002–03 to 2007–08 (0.07 per 1000 population in 2007–08). Episodes for problematic oxycodone use doubled, from 0.01 per 1000 population in 2002–03 to 0.02 per 1000 population in 2007–08 (Box 2B)."

Amanda Roxburgh, Raimondo Bruno, Briony Larance and Lucy Burns, "Prescription of opioid analgesics and related harms in Australia," Medical Journal of Australia, 2011; 195 (5): 280-284. doi: 10.5694/mja10.11450
https://www.mja.com.au/journal...
https://www.mja.com.au/system/...

33. Syringe Exchange Activity in Australia

"• The number of needles and syringes distributed in Australia increased during the past decade (from ~27 million to ~31 million).
"• Expenditure on NSPs increased by 36% (adjusted for inflation) over this time period, mostly associated with personnel and not principally for equipment (Table a); a significant portion of the increased investment has been the Illicit Diversion Supporting Measures for NSPs to increase referrals to drug treatment and other services.
"Over the last decade there has been
"• Increases in funding for primary sites.
"• Increases in the number of secondary sites.
"• Increases (by 15%) in the numbers of units of equipment provided.
"• Stable spending on sterile injection equipment.
"• At the time of writing there were 85 primary sites, 737 secondary sites, 20 enhanced secondary sites, and 118 vending machines."

National Centre in HIV Epidemiology and Clinical Research (2009). Return on investment 2: Evaluating the cost-effectiveness of needle and syringe programs in Australia 2009. The University of New South Wales, Sydney, p. 8.
http://www.health.gov.au...

34. Access to Needles and Syringes

"Needle and syringe programs (NSP) were by far the most common source of needles and syringes in the preceding six months (95%), followed by chemists (16%). NSP vending machines were used by 33% of participants in TAS and 29% in NSW. Proportions reporting a friend, partner and/or dealer varied by jurisdiction. Hospitals and outreach/peer workers were also accessed (Table 75).
"In comparison, data from the 2010 National Drug Strategy Household survey reported that around 65% of recent injectors (used in the previous 12 months) obtained needles and syringes from a chemist, followed by 37% at NSP (Australian Institute of Health and Welfare, 2011)."

Stafford, J. and Burns, L. (2013). Australian Drug Trends 2012. Findings from the Illicit Drug Reporting System (IDRS). Australian Drug Trend Series No. 91. Sydney, National Drug and Alcohol Research Centre, University of New South Wales. p. 104.
http://www.ndarc.med.unsw.edu....

35. Cost Effectiveness of Needle and Syringe Programs

"It was estimated that:
"• For every one dollar invested in NSPs, more than four dollars were returned (additional to the investment) in healthcare cost-savings in the short-term (ten years) if only direct costs are included; greater returns are expected over longer time horizons.
"• NSPs were found to be cost-saving over 2000-2009 in seven of eight jurisdictions and cost-effective in the other jurisdiction. Over the longer term, NSPs are highly cost saving in all jurisdictions.
"• The majority of the cost savings were found to be associated with HCV-related outcomes. However, when only HIV-related outcomes were considered in the analysis, it cost $4,500 per DALY gained associated with HIV infection.
"• If patient/client costs and productivity gains and losses are included in the analysis, then the net present value of NSPs is $5.85bn; that is, for every one dollar invested in NSPs (2000-2009), $27 is returned in cost savings. This return increases considerably over a longer time horizon.
"• NSPs are very cost-effective compared to other common public health interventions, such as vaccinations (median cost per QALY of $58,000), allied health, lifestyle, and in-patient interventions (median cost of $9,000 per DALY gained), and interventions addressing diabetes and impaired glucose tolerance or alcohol and drug dependence (median cost of $3,700 per DALY gained)[2]."

National Centre in HIV Epidemiology and Clinical Research (2009). Return on investment 2: Evaluating the cost-effectiveness of needle and syringe programs in Australia 2009. The University of New South Wales, Sydney, pp. 8-9.
http://www.health.gov.au...

36. Return on Investment for Needle and Syringe Programs

"Investment in NSPs (2000-2009) has resulted in:
"• An estimated 32,050 HIV infections and 96,667 HCV infections averted;
"• Substantial healthcare cost savings to government related to HCV and HIV;
"• Substantial gains in Disability Adjusted Life years.
"For every dollar currently spent on the activities of NSP, more than four dollars will be returned (in addition to the investment; i.e., five times the investment) and approximately 0.2 days of disability-adjusted life gained. Over a longer time horizon there is even greater return."

National Centre in HIV Epidemiology and Clinical Research (2009). Return on investment 2: Evaluating the cost-effectiveness of needle and syringe programs in Australia 2009. The University of New South Wales, Sydney, p. 9.
http://www.health.gov.au...

37. Cost Savings from Syringe Exchange in Australia

"In Australia the [Needle and Syringe] Program is the single most important and cost-effective strategy in reducing drug-related harms among IDUs. Australian Governments invested $130 million in NSPs between 1991 and 2000 resulting in the prevention of an estimated 25,000 HIV infections and 21,000 HCV infections, with savings from avoided treatment costs of up to $7.8 billion (Health Outcomes International et al., 2002). In the decade 2000-2009, the gross funding for NSPs was $243 million. This investment yielded healthcare cost savings of $1.28 billion; a gain of approximately 140,000 Disability-Adjusted Life Years (DALYs); and a net cost saving of $1.03 billion. During this time, NSPs have averted 32,061 new HIV infections and 96,918 new HCV infections (NCHECR, 2009)."

Victorian Department of Human Services (2010), National needle and syringe programs strategic framework 2010-2014, Commonwealth of Australia, p. 14.
http://www.health.gov.au...

38. Heroin Injection Room Run by Nuns

"Nuns who run one of Australia's best known hospitals are to operate the country's first legal and medically supervised heroin injecting room after a radical overhaul of the drug laws in New South Wales. The 18 month trial will be administered by the Sisters of Charity, who also run Sydney's inner city St Vincent's Hospital.
"An estimated 50 000 visits a year by drug users are expected at the centre, which will be staffed by a medical supervisor, a registered nurse, and security staff. The controversial plan will include the provision of clean needles and syringes; users must supply their own drugs."

Zinn, Christopher, "Nuns To Run First Heroin Injecting Room," British Medical Journal, Vol. 319, Aug. 14, 1999, p. 400.
http://www.ncbi.nlm.nih.gov/pm...

39. Effectiveness of Australian SIF

According to the final report of the evaluation of the Sydney, Australia, Medically Supervised Injecting Centre (MSIC) by the MSIC Evaluation Committee (established by the New South Wales Dept. of Health):
"In summary, the evidence available from this Evaluation indicates that:
"• operation of the MSIC in the King Cross area is feasible;
"• the MSIC made service contact with its target population, including many who had no prior treatment for drug dependence;
"• there was no detectable change in heroin overdoses at the community level;
"• a small number of opioid overdoses managed at the MSIC may have been fatal had they occurred elsewhere;
"• the MSIC made referrals for drug treatment, especially among frequent attenders;
"• there was no increase in risk of blod borne virus transmission;
"• there was no overall loss of public amenity;
"• there was no increase of crime;
"• the majority of the community accepted the MSIC initiative;
"• the MSIC has afforded an opportunity to improve knowledge that can guide public health responses to drug injecting and its harms."

MISC Evaluation Committee, "Final Report on the Sydney Medically Supervised Injecting Centre" (New South Wales, Australia: MISC Evaluation Committee, 2003), p. xiv.
http://www.indro-online.de/syd...

40. Social and Economic Costs of Drug Use in Australia

"Of the total social cost of drug abuse in 2004/05 of $55.2 billion, alcohol accounted for $15.3 billion (27.3 per cent of the unadjusted total), tobacco for $31.5 billion (56.2 per cent), and illicit drugs $8.2 billion (14.6 per cent). Alcohol and illicit drugs acting together accounted for another $1.1 billion (1.9 per cent)."

Collins, David J. and Lapsley, Helen M., The costs of tobacco, alcohol and illicit drug abuse to Australian society in 2004/05, Monograph 64, Report prepared for the Department of Health and Ageing, 2008, p. xi.
http://www.nationaldrugstrategy.gov.au...

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