1. What is the size of the problem
Drug-related deaths account for almost one in five
deaths among all age groups. .(1)
In the 15-34 year age group, the rate of drug-caused deaths increases to one in three
deaths.
Age group differences are also important to note:
- Tobacco is responsible for the majority of drug-caused deaths in older persons aged 35
years and over (75% of drug deaths in this age group)
- Alcohol is responsible for the majority of drug deaths in younger persons aged 15-34
years (60%)
- Opiates are responsible for 23% of drug-related deaths in the 15-34 age group compared
to less than 1% in the 35 and over age group.
In 1990, of the estimated 25 524 deaths
attributed to drug use, 71% were due to tobacco, 26% to alcohol, 2% to opiates and 1% to
other drugs, including pharmaceuticals and over-the-counter medications.
Appendix 1 shows the number of drug-caused deaths by cause of death and age grouping
for 1990.
Drug use, particularly
tobacco and alcohol, is a major factor in over 20% of general hospital admissions in
Australia, and in over 20% of general practitioner consultations.
Alcohol use is a major
factor in marital disharmony, violent crime, chronic invalidity and road accidents. It is
the principal drug problem for a majority of clients of drug and alcohol treatment
agencies throughout Australia (refer Appendix 2).
Illegal drug use is
associated with poor social functioning and crime.
Indirect drug problems are
often experienced by the parents, spouse and children of the drug user.
The following list
represents the major pathology developing from drug use.
- Carcinoma of oropharynx and
oesophagus
- Oesophageal varices, gastric
bleeding
- Hypertension
- Alcohol-related brain damage,
eg Wernicke-Korsakoff syndrome
- Peripheral neuritis,
cerebellar impairment
- Alcoholic liver disease,
hepatic carcinoma
- Pancreatitis, diabetes
- Gout
- Psychoses: depression,
paranoia
- Suicide
- Acute withdrawal effects:
anxiety, delirium tremens, 'rum fits'
- Trauma: accidents, injuries
purposely inflicted, falls, head injury, drowning
- Acute toxic effects: death
from overdose, paranoia.
Alcohol use is a major cause of road accidents
leading to serious injury or death.
It has been estimated that in 34% of road
deaths alcohol is a contributing factor (before 1979 the figure was over 50%) and the
total number of road deaths is falling (3730 in 1979; 1971 in 1992).
Although there is no firm epidemiological
evidence linking the use of other drugs as a causative factor in road accidents there is
much anecdotal evidence. The risk of harm is high when some drugs, either illicit or
prescribed, eg cannabis or diazepam, are combined with alcohol.
Recent figures from the
1991 National Campaign Against Drug Abuse (NCADA) Household Survey indicate that tobacco
was used in the past year by 31% of males and 25% of females aged 14 and over. Similar
proportions of high school students also report using tobacco. Although levels of smoking
among teenagers have fallen in recent years, the number of female teenagers who smoke
still exceeds that of males. In 1991, 21% of boys and 35% of girls between 14-19 years
reported smoking in the past year. (Appendix 3 provides information on use of various
drugs by persons aged 14-19 years.)
There has been a greater
decline of smoking among males than females in the past 15 years. The proportion of female
smoking increased from 26% in 1945 to 31% in 1976-80 but has since fallen to 27% in 1989.
The proportion of males smoking has fallen since 1945 (when it was 72%) to 30% in 1989.
This represents no statistical difference between male and female smoking rates for the
first time.
In 1989 the highest
smoking rate of Australian adult smokers was found among 20-24 year olds for both males
(41%) and females (38%).
Mortality rates due to
smoking have decreased by 5% between 1987 and 1990 (from 111.7 to 106 deaths per 100 000
population).
The trend since the
mid-1970s has been towards a decrease in the amount of alcohol consumed in Australia (per
capita consumption of alcohol fell from 13.2 litres in 1978 to 7.9 litres in 1990-91).
Between 1985-86 and
1990-91 consumption of beer has decreased by 6%, wine consumption has decreased by 19%,
while overall, total alcohol consumption (expressed as pure alcohol) decreased by 7%.
In 1991, over 18% of all
beer consumed was low alcohol beer. (Low alcohol beer was not consumed before 1985.)
A 1989 survey
highlighted increasing concern about heavy drinking among young people – 38% of 16
year olds and 40% of 17 year olds consumed five or more drinks on their last drinking
occasion. It was also reported that in the 12-16 year age group, 22% of boys and 18% of
girls reported weekly use of alcohol.
Alcohol continues to
play a major role in domestic violence.
Surveys by the National
Heart Foundation have shown that despite drinking less often than older groups, young
people (aged 20-24 years) tend to drink more heavily on the occasions when they do drink.
Death rates due to
alcohol have fallen by 20% since 1979 (from 48.7 deaths per 100 000 population in 1979 to
39.0 in 1990).
People are now spending
less of their total budget on alcohol than previously (5.6% in 1981-82, 4.1% in 1991).
There is no reliable
evidence to demonstrate authoritatively patterns or trends in the use of pharmaceutical
products such as sedatives, minor tranquillisers and analgesics. Restrictions on the
prescription of barbiturates over the past decade have produced a fall in their use, and
deaths from overdosage have decreased by 75%.
The most commonly used
prescribed drugs are cardiovascular system drugs (19%) followed by psychotropic drugs
(10%). There is some concern about the use of psychotropic drugs because of their ability
to alter a person's mood, behaviour or perception.
Minor tranquillisers,
particularly benzodiazepines, are the most commonly used psychotropic drugs in the
Australian community. The overuse of this drug, particularly by women and the elderly, has
been an area of concern for some time.
The use of
benzodiazepines for long or continuous therapy, in particular for night time sedation, is
an undesirable practice.
Benzodiazepines are
commonly taken in overdosage both by accident and with suicidal intent. Approximately 1%
of drug-related deaths are due to the misuse of prescribed and unprescribed
pharmaceuticals.
Minor analgesics are
easily available and, although analgesic nephropathy has decreased, the level of this
disorder among women in Australia remains high by international standards.
Cough mixtures and
antihistamines are commonly used for their psychotropic effects, occasionally leading to
dependence.
The 1991 NCADA Household
Survey reported that 32% of persons over the age of 14 years had tried cannabis and 8% had
used amphetamines (excluding ecstasy).
Apart from the use of
cannabis, it seems that the level of use of illegal drugs in Australia remains very low.
This use has remained at approximately the same level for the past ten years. Appendix 4
provides a breakdown of persons using illicit drugs in the past year.
The use of hallucinogens
(eg LSD) seems to have remained at a minimum level despite media reports about 'designer
drugs' (ecstasy, etc.).
Heroin use may be
gradually diminishing in line with trends in other countries.
The use of amphetamines
and cocaine in general remains low in the Australian population. (Appendix 5 provides
information on the proportion of the population who have ever tried various illicit
drugs.) However, recent evidence suggests that the number of persons trying amphetamines
is increasing, particularly among males aged 25-39 (from 12% in 1988 to 19% in 1991) and
among females aged 14-24 (4% in 1988 to 11% in 1991).
Illegal drug use,
however, remains a major social problem.
Deaths caused by opiates
seem to be still increasing although the numbers remain relatively small (117 in 1979 to
457 in 1991).
Most deaths involving
illegal drugs are caused by overdosage or an impure drug. Some of these deaths are
suicides. Many injecting drug users are infected with hepatitis B and hepatitis C and an
increasing number are infected with HIV/AIDS. Intravenous use of amphetamines and cocaine
is still causing little morbidity, but an increasing number are presenting for treatment
centres. Needle-sharing and unsafe sexual practices continue to be a significant problem.
Cannabis is the most
widely used illicit drug in the Australian population, with approximately one in three
persons aged 14 and over having tried this drug. This represents a slight increase in use
since 1988.
It is possible that
cannabis use may precipitate psychotic episodes in those who are predisposed or have a
history of psychosis. Cannabis impairs psychomotor function but epidemiological evidence
to link cannabis with road accidents is still lacking.
|
