Alcohol and Other Drug Use in Regional and Remote Australia: Consumption, Harms and Access to Treatment 2016–17

Alcohol and other drug use in regional and remote Australia: consumption, harms and access to treatment 2016–17

Alcohol and other drug use in regional and remote Australia: consumption, harms and access to treatment 2016–17 The Australian Institute of Health and Welfare is a major national agency whose purpose is to create authoritative and accessible information and statistics that inform decisions and improve the health and welfare of all Australians.

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Suggested citation Australian Institute of Health and Welfare 2019. Alcohol and other drug use in regional and remote Australia: consumption, harms and access to treatment, 2016–17. Cat. no. HSE 212. Canberra: AIHW.

Australian Institute of Health and Welfare Board Chair Mrs Louise Markus Chief Executive Officer Mr Barry Sandison

Any enquiries about or comments on this publication should be directed to: Australian Institute of Health and Welfare GPO Box 570 Canberra ACT 2601 Tel: (02) 6244 1000 Email: [email protected]

Published by the Australian Institute of Health and Welfare.

Please note that there is the potential for minor revisions of data in this report. Please check the online version at for any amendments. Contents

Summary...... v

1 Introduction...... 1 Regional and remote Australia...... 1 Population decline in regional and remote Australia...... 2 Remoteness and harms...... 2 Quality and access to health care in regional and remote areas...... 3

2 Alcohol and other drug consumption across Australia...... 5 Alcohol...... 5 Consumption...... 5 Who consumes alcohol at risky levels?...... 6 Where is alcohol consumed at risky levels?...... 9 Other drug use...... 10 Consumption...... 10 Who uses illicit drugs?...... 11 Where are illicit drugs consumed?...... 13 Wastewater analysis...... 13

3 Harms from alcohol and other drug use...... 14 Burden of disease...... 14

Burden of alcohol use...... 16 Burden of illicit drug use...... 17 Ambulance attendances...... 18

Drug-related hospitalisations...... 19

Drug-induced deaths...... 21

Usual residence...... 24 Alcohol-induced deaths...... 24

4 Alcohol and other drug treatment services...... 26 Agencies...... 26

Clients...... 27

Client profile...... 27 Principal drug of concern...... 28

Source of referral...... 29 Main treatment type...... 30

Alcohol and other drug use in regional and remote Australia: consumption, harms and access to treatment 2016–17 iii Treatment delivery setting...... 31

Treatment delivery setting by principal drug of concern...... 32 Treatment delivery setting by main treatment type...... 32 Treatment duration...... 33 Reason for ending treatment...... 34 Cessation by main treatment type...... 35 Indigenous treatment services...... 36

Substance-use services...... 36 Substance use issues...... 38

5 Access to treatment...... 39 Travel time and distance...... 39

Client demographics...... 40 Principal drugs of concern...... 41 Treatment provided...... 43

6 Conclusion...... 46

Appendix A: Data sources...... 47

Appendix B: Methodology for measuring client travel time/distance to services...... 53

Acknowledgments...... 55

Abbreviations...... 56

Symbols...... 56

Glossary...... 57

References...... 61

List of tables...... 63

List of figures...... 64

Related publications...... 66

iv Alcohol and other drug use in regional and remote Australia: consumption, harms and access to treatment 2016–17 Summary

Australians who live in areas outside Major cities tend to have poorer health outcomes than those living in Major cities (AIHW 2017b). This can be due to lower educational attainment and higher levels of unemployment and poorer access to, and use of, health services. It can also reflect the higher proportion of the population living outside Major cities who are Aboriginal and Torres Strait Islander (AIHW 2017a; Roche & McIntee 2017).

This report identifies trends and differences in alcohol and other drug use, harms and treatment in Major cities and Regional and remote Australia and includes online supplementary interactive maps and tables (those with a prefix of S).

People living in Regional and remote areas of Australia were more likely than people living in Major cities to have consumed alcohol at quantities that placed them at risk of harm from an alcohol-related disease or injury

• Results from the 2016 National Drug Strategy Household Survey (NDSHS) showed that people aged 14 or older living in Regional and remote areas were significantly more likely than people living in Major cities to:

– consume alcohol daily (8.0% compared with 5.0%)

– drink in excess of the lifetime risk guideline (21% compared with 15.4%) and of the single occasion risk guideline (at least monthly) (29% compared with 24%).

Levels of recent drug use were similar between remoteness areas, however the type of illicit drug used varied

• People aged 14 or older living in Major cities and in Regional and remote areas had similar levels of drug use in the past 12 months (both 15.6%). However, those in Major cities were significantly more likely than those in Regional and Remote areas to have recently used ecstasy (2.5% compared with 1.5%) and cocaine (3.2% compared with 1.1%).

The burden of drug and alcohol use increases with remoteness

• Remote and Very remote areas experienced 2.1 and 2.7 times, respectively, the burden of disease attributable to alcohol use, compared with Major cities in 2011.

• Major cities experienced the highest burden for Illicit drug dependence overall in 2011, compared with other areas. However, the rate of burden due to Illicit drug use increased as remoteness increased, for Suicide and self-inflicted injuries, Chronic liver disease and Road traffic injuries—motor vehicle occupant.

• Over the past decade, the rate of drug-induced deaths has increased at a faster rate in Regional and remote areas, up 41% since 2008, compared with a 16% increase in Major cities over the same period. As a result, the rate of drug-induced deaths was higher in Regional and remote areas than in Major cities between 2012 and 2016.

Alcohol and other drug use in regional and remote Australia: consumption, harms and access to treatment 2016–17 v Higher rates of alcohol and other drug treatment outside of Major cities

• In 2016–17, agencies in Regional and remote areas had a higher rate of clients who sought treatment, compared with agencies in Major cities (652 clients per 100,000 population compared with 586 clients per 100,000).

• Of all remoteness areas, agencies in Remote and very remote areas had the highest rate of clients who sought treatment (1,294 clients per 100,000 population) in 2016–17, despite having the smallest number of clients, and smallest average number of episodes per client.

Clients who sought treatment in Regional and remote areas were more likely than clients in Major cities to travel 1 hour or longer to treatment services

• In 2016–17, clients who sought treatment in Regional and remote areas travelled 1 hour or longer in 28% of closed treatment episodes, compared with 10% of closed treatment episodes in Major cities. This varied by principal drug of concern and main treatment type.

vi Alcohol and other drug use in regional and remote Australia: consumption, harms and access to treatment 2016–17 1 Introduction

Alcohol and other drug use are major health issues in Australia and are associated with a number of harms both physical and social, including chronic disease, mental illness, injury, premature death and dependence (AIHW 2018d).

Australians living in remote areas often have worse outcomes, compared with people living 1 in metropolitan areas. This can be due to lower educational attainment and higher levels of unemployment, poorer access to, and use of, health services. It can also reflect the higher proportion of the population who are Aboriginal and Torres Strait Islander (AIHW 2017b; Roche & McIntee 2017).

Recent evidence indicates that people living in Remote areas were more likely than those people living in Major cities to have used illicit drugs in the preceding 12 months and to have consumed Introduction alcohol in a risky manner (AIHW 2017a).

Where alcohol and drug use become problematic, this may lead people to seek treatment. However, for people in remote areas of Australia, access to alcohol and other drug treatment agencies is difficult, with only 7% of services located within these areas (AIHW 2018c).

The Australian Government has recognised this as an issue, identifying the enhancement of ‘access to evidence-informed, effective and affordable treatment and support services for the whole population’ as a priority issue under the 2017–2026 National Drug Strategy (DoH 2017). The National Drug Strategy has also identified Indigenous Australians as a priority population due to the level of harm suffered from alcohol and drug use.

The purpose of this report is to identify trends in alcohol and other drug use in Regional and remote Australia, with a primary focus on treatment and variation in treatment types and completion rates. This is provided in the context of available geographic data reflecting consumptions and harms. Further information about the data sources used in this report can be found in Appendix A.

Regional and remote Australia

The term Regional and remote generally covers all areas outside Australia’s Major cities, as classified by the Australian Statistical Geography Standard (ASGS). The ASGS classifies remoteness into 5 categories: Major cities, Inner regional, Outer regional, Remote and Very remote Australia (ABS 2018a). These are classified in terms of accessibility to services and population centres (see Appendix A for further information). In 2017, the majority of Australians (17.7 million or 72%) lived in Major cities (Table S1.1).

Not all jurisdictions contain every one of the 5 remoteness categories. For example, Hobart and Darwin are not classified asMajor cities; while the Australian Capital Territory only contains Major cities and Inner regional areas.

This report presents comparisons between people living in Major cities and Regional and remote areas, where possible. Differences may exist between the remoteness areas that form theRegional and remote area and these differences are highlighted where necessary. For example, additional alcohol and other drug use figures are presented forRemote and very remote Australia, due to substantial differences in usage.

Alcohol and other drug use in regional and remote Australia: consumption, harms and access to treatment 2016–17 1 Population decline in regional and remote Australia Over the past 10 years, the population grew at a higher rate in Major cities (up 21.3%) than in Inner regional Australia (13.2%), Outer regional Australia (7.7%), Remote (0.5%) or Very remote Australia (4.1%). In terms of annual changes, Major cities continue to experience the greatest growth, up 2% in 2016–17 compared with the previous year (Table S1.1). Furthermore, Sydney, Melbourne and 1 Brisbane accounted for over 70% of Australia’s annual population growth in 2016–17 (ABS 2018d). In contrast, Remote and Very remote Australia declined in population (both by 0.5%).

Remoteness and harms People living in Remote and Very remote areas of Australia are more likely to engage in risky behaviours associated with poor health outcomes. Figure 1.1 shows that the proportion of health Introduction risk factors increased as remoteness increased, particularly daily smoking; low or no levels of exercise; exceeding the lifetime alcohol risk guideline; and mental health problems.

Figure 1.1: Proportion of different health behaviours and risk factors, by remoteness area, 2014–15 (%)

Per cent Major cities Inner regional Outer regional and remote 80

0 Current daily Overweight or No/low levels Exceed High blood Mental health smoker obese of exercise lifetime pressure problems alcohol risk guideline

Health behaviours and risk factors

Notes 1. ‘%’ represents prevalence of risk factor in each region (excluding Very remote areas of Australia). 2. ‘Proportions’ are not age-standardised and, in some instances, higher prevalence may reflect the older age profiles in Inner regional and Outer regional and remote areas. Source: S1.2.

2 Alcohol and other drug use in regional and remote Australia: consumption, harms and access to treatment 2016–17 Life expectancy at birth for Australians was lowest in areas outside of Major cities in 2015‍17, a pattern that was particularly evident for Indigenous Australians in Remote and very remote areas (ABS 2018c). Compared with Major cities, the life expectancy at birth for Indigenous Australians in Remote and very remote areas was 6.2 and 6.9 years lower for males and for females, respectively. For non-Indigenous Australians, life expectancy at birth in 2015–17 was lowest in Inner and outer regional areas—a gap of 1.6 and 0.9 years for males and for females—compared with Major cities (ABS 2018c). 1 Quality and access to health care in regional and remote areas The Patient Experience Survey is an annual survey which collects data on access and barriers to health care services for Australians aged 15 and over. Health care services include general practitioners (GPs); medical specialists; imaging and pathology tests; dental professionals; hospital admissions; and emergency department visits (ED) (ABS 2017b). Introduction

Data from 2016–17 shows that, in the last 12 months:

• the proportion of people who reported seeing a GP and were living in Outer regional, remote and very remote areas (81.5%) was slightly lower than for those living in Inner regional areas (83.8%) or Major cities (82.4%)

• 5.8% of persons living in Outer regional, remote and very remote areas reported that they saw an after-hours GP, compared with 9.3% of those living in Major cities

• fewer people living in Outer regional, remote and very remote areas reported that they saw a dental professional (41.3%), compared with those living in Major cities (50%)

• almost 18% of persons living in Outer regional, remote and very remote areas reported visiting a hospital emergency department, compared with 12.7% living in Major cities (Table 1.1).

Table 1.1: Experience of health services in the last 12 months, by remoteness area, persons aged 15 and over, 2016–17 (%)

Outer regional, remote and Health care service Major cities Inner regional very remote

Saw a GP 82.4 83.8 81.5

Saw a GP for urgent medical attention 8.9 9.8 10.8

Saw an after-hours GP 9.3 6.6 5.8

Received a prescription for medication 67.4 71.3 69.5 from a GP

Saw a dental professional 50.0 44.6 41.3

Saw a medical specialist 36.3 36.4 33.6

Visited a hospital emergency department 12.7 15.8 17.9

GP = general practitioner Source: ABS 2017b.

Alcohol and other drug use in regional and remote Australia: consumption, harms and access to treatment 2016–17 3 Experiences with general practitioner care and out-of-pocket costs (additional patient costs paid for health services subsidised by Medicare) varied by remoteness.

In 2016–17:

• 21% of people in Outer regional, remote and very remote areas waited longer 1 than they felt was acceptable to get an appointment with a general practitioner (compared with 19% in Inner regional areas and 18% in Major cities)

• 33% of people in Outer regional, remote and very remote areas reported they could not see their preferred general practitioner on 1 or more occasions

Introduction (compared with 28% in Inner regional areas and 25% in Major cities) (ABS 2017b)

• The median total out-of-pocket costs per patient was highest in Major cities. Outside of Major cities, the median cost was higher in Inner regional local areas ($123) than in Outer regional ($117) and Remote ($106) local areas (AIHW 2018f).

Hospital admissions In 2016–17, the number of hospital separations per 1,000 increased as remoteness increased, with the separation rate for patients living in Very remote areas (823.6 separations per 1,000 population) almost twice the rate for those living in Major cities (419.7 separations per 1,000 population) (AIHW 2018b).

‘Potentially preventable hospitalisations’ are those that are thought to be avoidable if timely and adequate non-hospital care had been provided, either to prevent the condition occurring or to prevent hospitalisation for the condition. These conditions are divided into 3 categories: vaccine preventable, acute conditions and chronic conditions. In 2016–17, potentially preventable hospitalisations increased by remoteness for all categories. Overall, potentially preventable hospitalisations were highest for patients living in Remote and Very remote areas (43 and 67 per 1,000, respectively) and lowest for patients living in Major cities (26 per 1,000) (AIHW 2018b).

4 Alcohol and other drug use in regional and remote Australia: consumption, harms and access to treatment 2016–17 • • • were significantlymorelikelythanAustraliansin injury fromasingledrinkingoccasion.Specifically, Australianslivingin at riskofharmfromanalcohol-relateddiseaseor injuryoveralifetimeoratriskofalcohol-related Regional andremote those livinginregionalareasand people livingin purposes ofthisreport,itisclearthattheconsumptionalcoholincreaseswithremoteness, regional, Remote Australia wasconsistentlyhigherthanforthoselivingin The consumptionofalcoholbypeopleaged14orolderlivingin Consumption particularly thosethatarelikelytoresultinpeopleneedingtreatment. This reportusesseveralmeasurestoshowtrendsintheuseassociatedwithharmfuleffects, and areoutlinedinthe The short- and long-term harms of alcohol use are usually associated with different drinking patterns bystanders andthebroadercommunity(NHMRC2009). drink atlevelsthatincreasetheirriskofharm—affectingnotonlythemselvesbutalsofamilies, While mostAustraliansdrinkalcoholatlevelsthatcausefewharmfuleffects,alargeproportion Alcohol iswidelyconsumedinAustraliaandassociatedwithmanysocialculturalactivities. Alcohol 2 (see guideline2inBox2.1) drink inexcessofthesingle occasionriskguideline,atleastmonthly(29% comparedwith24%) drink inexcessofthelifetime riskguideline(21%comparedwith15.4%) (seeguideline1inBox2.1) consume alcoholdaily(8.0%comparedwith5.0%) • • recommendations: the healthrisksofdrinkingalcohol.Thedatapresentedinthisreportfocuson2those The Box 2.1:SummaryoftheAustralianguidelinestoreducehealthrisksfromdrinkingalcohol proportion exceedingthisguidelinehasbeenreportedonamonthlyandyearlybasis. drink nomorethan4standarddrinksonany1occasion(NHMRC or injury),ahealthyadultshoulddrinknomorethan2standarddrinksday. Guideline 2:Toreducetheriskofinjuryona Guideline 1:Toreducetheriskofalcohol-relatedharmovera National HealthandMedicalResearchCouncil(NHMRC) Alcohol andotherdrugconsumption across Australia Alcohol and otherdrug useinregional andremoteAustralia: consumption, harmsand accesstotreatment 2016–17 Remote andveryremote and Australianswerealsomorelikelytodrinkalcohol inquantitiesthatplacedthem Veryremote Australian guidelinestoreducehealthrisksfromdrinkingalcohol areas havebeengroupedas Major cities areas (Figure2.1).

generally reportinghigherlevelsofconsumption than Major cities single occasion Major cities. to: Regional andremote publishesguidelinesforreducing Regional andremote of drinking, a healthy adult should ofdrinking,ahealthyadultshould lifetime While

2009). Forthisreport,the Regional andremote Inner regional,Outer (suchaschronicdisease areas forthe areasof (see Box 2.1). (see Box2.1). areas

5 Alcohol and other drug consumption across Australia 2 2

6 Alcohol and other drug consumption across Australia very remote varied byage,sex,Indigenous status,educationstatusandremoteness area. disease orinjuryoveralifetime,atriskofalcohol-related injuryfromasingledrinkingoccasion, The consumptionofalcoholatquantitiesthatplace apersonatriskofharmfromanalcohol-related Who consumesalcoholatriskylevels? (16.7% in2013comparedwith15.4%2016)(Table S2.2). compared with5.0%in2016)andconsumed,on average,morethan2standarddrinksperday For peoplelivingin areas ofAustraliabetween2013and2016(TableS2.2). There werenosignificantchangesinalcoholconsumptionforpeopleliving • • • Alcohol and otherdrug useinregional andremoteAustralia: consumption, harmsand accesstotreatment 2016–17 The consumptionofalcoholatriskylevelswassignificantlydifferentforpeoplelivingin consume 11standarddrinksormoreatleastonceamonth(8.8%comparedwith6.3%)(TableS2.1). consume 11standarddrinksormoreatleastonceayear(17.9%comparedwith14.4%) Source: (c) ‘Atleastyearly’andmonthly’arenotmutuallyinclusive. (b) Hadmorethan4standarddrinksatleastonceamonth. (a) Onaverage,hadmorethan2standarddrinksperday. Figure 2.1:Drinkingstatus,peopleaged14andover,byremotenessarea,2016(%) 1 1 2 2 3 3 4 P 0 5 0 5 0 5 0 0 5 e r

c TableS2.2. e n t areas, comparedwiththoselivingin Daily Major cities Major cities Lifetime risk: , significantlyfewerpeopleconsumedalcoholdaily (5.7%in2013 Risky Inner regional (a) Single occasion: occasion: Single D At least monthly least At r i n k Major cities i n g

s t Outer regional regional Outer a t u s (b) (Figure 2.1). 11 drinks: more or At least yearly least At Remote and very remote very and Remote (c) Regional andremote 11 drinks: more or At least monthly least At Remote and (c)

remote The 2016NDSHSdatashowthattheharmfulconsumption ofalcoholbypeoplelivingin Age (tables S2.4andS2.5). than femalesin Similarly, femaleslivingin • • • • • more likelythanmaleslivingin According tothe2016NDSHS,maleslivingin Sex (Table S2.5). (Table S2.4) consume 11standarddrinksormoreatleastonceamonth(13.5%comparedwith9.8%) consume 11standarddrinksormoreatleastonceayear(26%comparedwith21%)(TableS2.5) drink inexcessofthesingleoccasionriskguideline,atleastmonthly(39%comparedwith33%) drink inexcessofthelifetimeriskguideline(30%comparedwith22%)(Figure2.2) consume alcoholdaily(10.8%comparedwith6.3%)(TableS2.3) Source (a) Onaverage,hadmorethan2standarddrinksperday. by age,sexandremotenessarea,2016(%) Figure 2.2:Drankinexcessofthelifetimeriskguideline 10 15 20 25 30 35 Per cent 0 5 areaswassignificantlyhigherthanforpeopleliving in : TableS2.4. 14 Alcohol and otherdrug useinregional andremoteAustralia: consumption, harmsand accesstotreatment 2016–17 – 19 Major cities 20 – 29 Regional andremote toconsumealcoholatharmfullevels,butlowerlevelsthanmales 30 Major cities – 39 Major cities 40 – to: 49 Regional andremote areasofAustraliaweresignificantlymorelikely 50 – 59 Regional and remote remote and Regional 60 Major cities – (a) 69 , peopleaged14andover, areas ofAustraliaweresignificantly 70+ across mostagegroups. Male Regional and Female

7 Alcohol and other drug consumption across Australia 2 2

8 Alcohol and other drug consumption across Australia • • • consume11standard drinks ormoreatleastonceayear(30%compared with20%) • drinkinexcessofthesingle occasionriskguideline,atleastmonthly(42% comparedwith29%) • drinkinexcessofthelifetimeriskguideline(29% comparedwith18.5%) • consumealcoholdaily(7.4%comparedwith3.5%) degree orhigherto: completed aCertificateIIIorIVbeing significantlymorelikelythanthosewithabachelor’s In • • consume11standarddrinksormoreatleastonceayear(24%comparedwith15.8%) • drinkinexcessofthesingleoccasionriskguideline,atleastmonthly(38%comparedwith26%) • drinkinexcessofthelifetimeriskguideline(21%comparedwith14.8%) • consumealcoholdaily(4.1%comparedwith2.3%) significantly morelikelythanthosewithabachelor’sdegreeorhigherto: In consume alcoholatharmfullevels(TableS2.7). a CertificateIIIorIVweremorelikelythanthosewithbachelor’sdegreeofhigher to consumption. Forexample,2016NDSHSdataindicatedthatpeopleaged18–60whohadcompleted In Australia,thereappearstobearelationshipbetweenperson’seducationlevelandalcohol Education status Australians livingin occasion riskguideline,atleastonceayear(33%comparedwith25%),Indigenous consumed alcoholinexcessofthelifetimeriskguideline(16%comparedwith12%)andsingle (NATSISS), ahigherproportionofIndigenousAustralianswholivedin According todatafromthe2014–15NationalAboriginalandTorresStraitIslanderSocialSurvey Aboriginal andTorresStraitIslanderpeople 11 standarddrinksormoreatleastonceayearandmonth(tablesS2.4S2.5). drank inexcessofthesingleoccasionriskguideline,atleastmonthly,andwhoconsumed Similar patternswereevidentfortheproportionofpeopleagedintheir20s,30s,40sand50swho • • • • • exceeded thelifetimeriskguideline,includingpeopleagedintheir: living in For example,peoplelivingin Alcohol and otherdrug useinregional andremoteAustralia: consumption, harmsand accesstotreatment 2016–17 (Table S2.7). consume 11standarddrinks ormoreatleastonceamonth(15.0%compared with7.4%)(TableS2.7). consume 11standarddrinksormoreatleastonce amonth(10.3%comparedwith5.5%) 60s (21%comparedwith16.9%)(Figure2.2). 50s (26%comparedwith17.8%) 40s (25%comparedwith18.6%) 30s (22%comparedwith16.4%) 20s (26%comparedwith16.8%) Regional andremote Major cities, Major cities people aged18–60whohadcompletedaCertificateIIIorIVwere to have Major cities areassimilartrendswereidentified,withpeople aged18–60whohad

consumed morethan2standarddrinksperdayonaverageandtohave Regional andremote (Table S2.6;seeBox2.1fordrinkingguidelines). areasweresignificantlymorelikelythanthose Regional andremote areas

Source: remoteness, 2016 them atharmonasingleoccasion,leastmonthly,bytopandbottom5areasof Table 2.2:Proportionofpeopleaged14orolderdrinkingalcoholatlevelsthatplace of The remotenessareaswiththelowestproportionsweremostlyin in more than4standarddrinksonasingledrinkingoccasionatleastoncemonthwereconcentrated Similar tolifetimerisk,theremotenessareaswithhighestproportionofpeoplewhoconsumed Source: Note them atharmoveralifetime,bytopandbottom5areasofremoteness,2016 Table 2.1:Proportionofpeopleaged14orolderdrinkingalcoholatlevelsthatplaced Tasmania (Table2.1). exceeding thelifetimeriskguidelinewerelivingin at harmoveralifetime.Conversely,theremotenessareaswithlowestproportionofpeople Australia (36%)hadthehighestproportionofpeoplewhodrankalcoholatlevelsthatplacedthem areas ofQueensland,WesternAustraliaandtheNorthernTerritory.Overall, more than2standarddrinksperday,onaverage,weremainlylivingwithin The highestproportionofpeopleexceedingtheNHMRCguidelinesforlifetimeriskbyconsuming highest in the pointthatconsumptionofalcoholatlevelsplacingpeopleriskalcohol-relatedharmis Analysis ofdrinkingpatternsbyremotenessareawithineachstateandterritoryfurtherillustrates Where isalcoholconsumedatriskylevels? Outer regionalNorthern Territory Outer regionalWesternAustralia Very remoteNorthernTerritory Remote WesternAustralia Very remoteWesternAustralia Remoteness areaandstate Top 5 Remote Queensland Very remoteWesternAustralia Outer regionalNorthernTerritory Very remoteNorthernTerritory Remote WesternAustralia Remoteness areaandstate Top 5 Outer regional Inner regional : *Estimateshavearelativestandarderrorbetween25%and50%shouldbeusedwithcaution. TableS2.8. TableS2.8. Alcohol and otherdrug useinregional andremoteAustralia: consumption, harmsand accesstotreatment 2016–17 Remote WesternAustralia(Table2.2). , Remote and Veryremote and Veryremote areasandlowestin Per cent Per cent areasofWesternAustraliaandtheNorthernTerritory. *29% 35% 35% 43% 44% 44% 29% 29% 36% 25% Inner regionalWesternAustralia Major citiesSouthAustralia Major citiesVictoria Major citiesNewSouthWales Major citiesAustralianCapitalTerritory Remoteness areaandstate Bottom 5 Major citiesAustralianCapitalTerritory Major citiesVictoria Outer regionalTasmania Remoteness areaandstate Bottom 5 Major citiesNewSouthWales Major citiesSouthAustralia Major cities Major cities —with theexceptionof . Major cities Remote Remote , withtheexception and Western Outer regional Veryremote

Per cent Per cent

24.1% 23.8% 23.1% 22.6% 22.6% 14.3% 14.0% 13.4% 14.9% 14.5%

9 Alcohol and other drug consumption across Australia 2 2

10 Alcohol and other drug consumption across Australia (25% comparedwith15.6%)andforcannabis(17.0%10.4%)(TableS2.1). was significantlydifferentcomparedwiththoselivingin However, forpeoplelivingin • cocaine(3.2%comparedwith1.1%)(TableS2.1) • ecstasy(2.5%comparedwith1.5%) areas tohaverecentlyused: People livingin and remote (1.4% comparedwith1.5%)usewereatsimilarlevelsforpeoplelivingin Specifically, levelsofrecentcannabis(10.4%comparedwith10.5%)andmeth/amphetamine 15.6%), howeverthetypeofillicitdrugusedvaried(TableS2.1). people aged14orolderlivingin According tothe2016NDSHS,overallconsumptionofillicitdrugsinpast12monthsby Consumption 2004–05 (Collins&Lapsley2008). (DoH 2017).TheuseofillicitdrugswasestimatedtocosttheAustraliansociety8.19billiondollarsin with awiderangeofassociatedhealth,socialandeconomicharmsconcerntothecommunity The useandmisuseoflicitillicitdrugsiscommonlyrecognisedasahealthprobleminAustralia, Other druguse Alcohol and otherdrug useinregional andremoteAustralia: consumption, harmsand accesstotreatment 2016–17 Source: (b) Fornon-medicalpurposes. (a) Usedintheprevious12months. Figure 2.3:Recent Meth/amphetamine TableS2.2. areas(TableS2.1). Drug type Drug Cannabis Major cities Cocaine Ecstasy (a) (b) illicitdruguse,peopleaged14andover,byremotenessarea,2016(%) 0 weresignificantlymorelikelythanthoselivingin Remote andveryremote Major cities 5 andin Regional andremote areas therecentconsumptionofillicitdrugs Major cities Per cent 10 Major cities Inner regional Remote and very remote very and Remote regional Outer , inparticularforanyillicitdrug areaswassimilar(both Major cities Regional andremote 15 and Regional

recently usedecstasy. in Conversely, peopleintheir20s(7.7%comparedwith5.1%)and30s(2.9%1.7%)living (14.2% areas weresignificantlymorelikelythoselivingin very remote compared with6.3%)(TableS2.10).Asaresult,recentcannabisuse,particularlyin significantly morelikelythanthoselivingin and remotenessarea.Forexample,peopleintheir50sliving The 2016NDSHSdatashowthattheconsumptionofillicitdrugsvariedconsiderablybyage Age than thosein Males andfemaleslivingin those in Similarly, femaleslivingin • cocaine(1.4%comparedwith3.8%). • ecstasy(1.8%comparedwith2.9%) • painkillers/analgesics more likelythanmaleslivingin According tothe2016NDSHS,maleslivingin Sex status andremotenessarea. The useofillicitdrugsintheprevious12monthsvariedbyage,sex,Indigenousstatus,education Who usesillicitdrugs? in 2013(3.2%comparedwith2.6%). Conversely, thereweresignificantlymorepeoplein in Compared with2013,therewasasignificantlylowerproportionofpeopleaged14orolderliving Major cities Major cities

compared with10.5%)(Figure2.4). Major cities Alcohol and otherdrug useinregional andremoteAustralia: consumption, harmsand accesstotreatment 2016–17 areas,was1ofthemainreasonswhypeopleintheir50sliving weresignificantlymorelikelythanpeoplelivingin whohadrecentlyusedmeth/amphetaminein2016(1.4%comparedwith2.1%). Major cities tohaverecentlyusedecstasyandcocaine(TableS2.9). and to haverecentlyusedanyillicitdrug(Figure2.4). Regional andremote Remote andveryremote opioids (4.4%comparedwith3.4%)andlesslikelytohaverecentlyused: Major cities tohaverecentlyused: Major cities Regional andremote areasofAustraliaweresignificantlylesslikelythan Major cities areas ofAustraliaweresignificantlymorelikely Major cities tohaverecentlyusedcannabis(9.2% tohaverecentlyusedanyillicitdrug whohadusedcocainein2016than Regional andremote Regional andremote areas ofAustraliaweresignificantly Regional andremote Remote areaswere areastohave

and

Alcohol and other drug consumption across Australia 2 2

12 Alcohol and other drug consumption across Australia • anypharmaceuticalfor non-medicalpurposes(6.6%comparedwith3.6%) (TableS2.7). • pain-killers/analgesics and opioids fornon-medicalpurposes(5.5%compared with2.2%) • meth/amphetamine(3.1% comparedwith1.2%) • ecstasy(4.1%comparedwith2.7%) • cannabis(16.9%comparedwith10.0%) • anyillicitdrug(24%comparedwith15.0%) significantly morelikelythanthosewithabachelor’s degreeorhighertohaverecentlyused: In consumption inthepast12months(TableS2.7). aged 18–60whohadcompletedaCertificateIII or CertificateIVhadthehighestrateofanyillicitdrug and illicitdruguse.Forexample,2016NDSHSdataindicatedthatacrossalleducationlevels,people As withalcohol,inAustraliathereappearstobearelationshipbetweenperson’seducationlevel Education status lowest proportion(18%)ofpeoplewhohadusedasubstanceinthelast12months(TableS2.6). 25%) (ABS2016).Ofallremotenessareas,IndigenousAustralianslivingin Regional andremote (NATSISS), ahigherproportionofIndigenousAustralianswholivedin According todatafromthe2014–15NationalAboriginalandTorresStraitIslanderSocialSurvey Aboriginal andTorresStraitIslanderpeople Alcohol and otherdrug useinregional andremoteAustralia: consumption, harmsand accesstotreatment 2016–17 area, 2016(%) Figure 2.4:Recentillicitdruguse,peopleaged14andover,byage,sexremoteness Sources Note: Major cities, Per cent 10 15 20 25 30 35 40 0 5 Recentillicitdrugusefiguresforpeople70orolderin : TablesS2.9andS2.10. 20 – 29 peopleaged18–60whohadcompletedaCertificate IIIorCertificateIVwere Major cities areasreportedtheuseofasubstanceinlast12months(35%comparedwith 30 – 39 40 – Inner regional 49 50 Remote andveryremote – 59 Outer regional regional Outer 60 – 69 areaswerenotreportedduetoreliabilityissues. 70+ Major cities Remote and very remote very and Remote Very remote Male thanthosein areashadthe Female and bottom5areasofremoteness,2016 Table 2.3:Proportionofpeopleaged14orolderwhorecentlyusedanillicitdrug,bytop while theareawithlowestwas The areawiththehighestproportionofrecentillicitdrugusewas shows that,ofthetop5areas,4werelocatedin Analysis ofillicitdruguseinthepast12monthsbyremotenessareawithineachstateandterritory Where areillicitdrugsconsumed? • cannabis(15.6%comparedwith11.3%). • anyillicitdrug(21%comparedwith14.7%) were significantlymorelikelythanthosewithabachelor’sdegreeorhighertohaverecentlyused: Similarly, in • • • • • the averagecannabisconsumptioninregionalsites wasmorethandoublethatforcapitalcities key estimatesinclude: depends onthetypeofdrugused.AcrossmaintypessmeasuredbyNWDMP, Findings fromtheNWDMPshowthatvariationbetweencapitalcitiesandregionalareas the AustralianStatisticalGeographyStandard,whichareusedthroughoutthisreporttoclassifydata. state andterritoryaswellfromregionalareas.Thisreportingdifferstotheclassificationsused in National WastewaterDrugMonitoringProgram(NWDMP)collectsdatafromcapitalcitieswithineach of drugmetabolites(excretedintothesewersystemafterconsumption)inwastewatersamples.The Wastewater analysisprovidesestimatesofdrugusageinapopulationbymeasuringconcentrations Wastewater analysis Source: TableS2.8. Remote Queensland Remote NorthernTerritory Outer regionalWesternAustralia Very remoteNorthernTerritory Remote WesternAustralia Remoteness areaandstate Top 5 at higherlevelsinregional areasthanincapitalcity(ACIC2019). average inregionalareas, whichisconsistentwithfindingsfromthe2016 NDSHS in regionalsites reported tobegenerallylowacrossthecountry with theaveragebeinglowerincapitalcitiesthan regional sites—higherinsitesthancapital cities the licitandillicitconsumption ofpharmaceuticalopioidsoxycodoneand fentanylweredetected cocaine wastypicallyacapital citydrugwiththeconsumptionincapital city siteshigherthanthe based onanalysisofthepresenceMDMAmetabolites, theconsumptionofecstasy(MDMA)is there wasahighpresenceofmethamphetamine metabolitesinwastewateracrosscapitalcityand Alcohol and otherdrug useinregional andremoteAustralia: consumption, harmsand accesstotreatment 2016–17 Regional andremote areas,peopleaged18–60whohadaCertificateIIIorIV Outer regional Per cent 22% 22% 24% 36% 22% Remote NewSouthWales(11.4%)(Table Major citiesAustralianCapitalTerritory Outer regionalVictoria Inner regionalVictoria Outer regionalNewSouthWales Remoteness areaandstate Bottom 5 Outer regionalQueensland and Very remote Remote areas. WesternAustralia(36%),

2.3).

Per cent 12.9% 12.8% 11.5% 11.4% 13.1%

Alcohol and other drug consumption across Australia 2 3

14 Harms from alcohol and other drug use of diseaseanalysis. disease burden(AIHW2018d).SeeBox3.1formoreinformationoncommontermsusedin injuries, andthecontributionof30riskfactors—includingalcoholuseillicitdruguse—tothis The AustralianBurdenofDiseaseStudyestimatestheburdenaround200specificdiseases and Burden ofdisease substantial harmsinthesecommunities,particularfor and deaths.Thedatashowthatalcoholillicitdrugusein disease’ data.Italsopresentsdatabyremotenessareaforambulanceattendances,hospitalisations This sectionofthereportpresentsdataonalcoholanddrug-relatedharms,using‘burden Islander Australians(AIHW2015). reflect the higherproportionofthepopulationinthoseareaswhoareAboriginalorTorresStrait Higher deathratesandpoorerhealthoutcomesoutside treatment (AIHW2017b). range offactorssuchasaccesstohealthservices,includingspecialisedservicesAOD with poorerhealth,isgenerallyhigherinareasoutside who tendtoengageinbehaviourssuchasillicitdruguseandalcoholmisuse,whichareassociated Major cities Australians living in areas outside 3 Alcohol and otherdrug useinregional andremoteAustralia: consumption, harmsand accesstotreatment 2016–17 by theriskfactorinquestion. Linked disease illness orinjury(yearslivedwithdisability,YLD). the ideallifespan(yearsoflost,orYLL)—or, equivalently, throughlivingwithillhealthdueto measure (inyears)ofhealthylifelost,eitherthrough prematuredeath—definedasdyingbefore disability. Inthisreportisreportedas Non-fatal burden which apersondiesandthenumberofyearsthey couldhavepotentiallygoneontolive. years oflifelost(YLL) Fatal burden burden’—for thishealthloss. burden, theanalysisestimatescontributionofvariousriskfactors—termed‘attributable conditions andinjuries,inaconsistentcomparableway.Aswellasdescribingthedisease living withdisease.Ittakesintoaccountageatdeathandseverityofdiseaseforalldiseases, Burden ofdiseaseanalysismeasuresthecombinedimpactdyingprematurely,aswell Box 3.1:Burdenofdisease Harms fromalcoholandotherdruguse —including shorterlivesandhigherlevelsofdiseaseinjury.Theproportionadults istheimpactofdyingprematurelyfromdiseaseorinjury.Itmeasuredusing isadiseaseorinjuryforwhichthereevidence thatitslikelihoodisincreased istheimpactoflivingwithillhealthasmeasured byyearslivedwith duetoprematuredeath,whichistheyearslostbetweenageat Major cites tend to have worse health outcomes than those living in disability-adjusted lifeyears(DALY), Major cities Major cities Remote Regional andremote and . Theseoutcomesmaybeduetoa , especiallyinremoteareas,also Very remote areas. areasresultsin whichisa (continued) (142.9 YLLper1,000population)(Figure3.1). YLL rate(73.7per1,000population)andpeoplein burden ofdiseaseincreaseswithremoteness,peoplelivingin The AustralianBurdenofDiseaseStudy2015fatalburdenpreliminaryestimatesshowthat • ‘illicitdruguse’(ariskfactor,alsoreferredtoas‘druguse’). • ‘illicitdrugdependence’(alsoreferredtoas‘drugusedisorders(excludingalcohol))’ • ‘alcoholdependence’(alsoreferredtoasusedisorders’) report andmaydifferfromthosepreviouslyusedinAustralianBurdenofDiseasereports: for otherdiseasesandinjuries(forexample,alcoholuse).Thefollowingtermsareusedinthis both asdistinctdependencydisorders(forexample,alcoholdependence)andriskfactors This reportexaminesthehealthburdeninAustraliaattributabletoalcoholandillicitdruguse, Box 3.1(continued):Burdenofdisease Source: 2. 1. Notes area, 2015 Figure 3.1:Fatalburdenofdiseaseage-standardisedYLLrate,allpersons,byremoteness The 2015databyremotenessareaispreliminaryandexcludedeaths thatwerenotregistereduntil2016,dueto Rates wereage-standardisedtothe2001AustralianStandardPopulation andareexpressedper1,000persons. of diseaseestimatesfromtheAustralianBurdenDiseaseStudy 2015(expectedmid-2019). missing statisticallevelarea(SA)2informationatthetime.This datawillbeupdatedinthefinalreleaseofburden Age-standardised rate (per 1,000 population) 120 150 TableS3.1. 30 60 90 0 Alcohol and otherdrug useinregional andremoteAustralia: consumption, harmsand accesstotreatment 2016–17 Major cities Inner regional Outer regional Outer Very remote areashavingthehighestYLL Major cities Remote havingthelowest Very remote Very

Harms from alcohol and other drug use 3 3

16 Harms from alcohol and other drug use • • • areas experiencedthehighestDALYratesfor: When examiningthetypeoflinkeddiseaseattributabletoriskfactoralcoholuse, respectively, oftheburdenattributabletoalcoholuse,comparedwith The burdenwasgreatestin a clearpatternofalcoholattributableburdenincreasingasremotenessincreased(TableS3.3). areas (4,382DALY).However,afteradjustmentforpopulationsizeandagestructure,therewas attributable burdenwasexperiencedin of diseaseandinjuryexperiencedbyAustraliansin2011(AIHW2018e).Overall,thegreatestalcohol Alcohol use,asariskfactorforotherdiseasesandinjuries,contributedto4.6%ofthetotalburden Burden ofalcoholuse remoteness. Theseresultsarepresentedbelow. alcohol andillicitdruguseonthehealthburdenofdiseaseinjuryinAustralia,includingby Additional analysisfromtheAustralianBurdenofDiseaseStudy2011examinedimpact per 1,000population).Theburdenofthesedisordersincreaseswithremoteness(TableS3.2). 2.9 timeshigherin 0.22 YLLper1,000population).Similarly,theage-standardisedratefor was 3.4timeshigherin Analysis bydiseasegroupshowedthat,in2015,theage-standardisedYLLrateforalcoholdependence Alcohol and otherdrug useinregional andremoteAustralia: consumption, harmsand accesstotreatment 2016–17 Chronic liverdisease Suicide andself-inflictedinjuries Alcohol dependence Source: Note: diseases, byremotenessarea,2011 Figure 3.2:Age-standardisedattributableDALYrateduetoalcoholuse,byselectedlinked Age-standardised DALY rate (per 1,000 population) 1 2 3 4 5 6 Rates wereage-standardisedto the2001AustralianStandardPopulationandareexpressedper 1,000persons. 0 TableS3.4. dependence Alcohol Alcohol Major cities Very remote (5.1per1,000attributableDALYS) Sucicide and and Sucicide (1.4 per1,000attributableDALYs)(Figure3.2). self-inflicted self-inflicted injuries Very remote Remote areas,comparedwith (3.5per1,000attributableDALYs) motor vehicle vehicle motor Road traffic traffic Road Inner regional occupants and injuries– areas,comparedwith Very remoteareas Major cities Chronic Chronic disease L liver i n (141,119DALY)andthesmallestin k Outer regional regional Outer e Major cities d

d i , whichexperienced2.1and2.7times, s Epilepsy e a Major cities s e (0.19YLLcomparedwith0.06 Accidential Accidential poisoning Major cities (0.76 Remote Remote Illicit drugdependence

YLL comparedwith cancer Bowel (TableS3.3). Very remote Very Very remote Very remote cancer Breast was

injuries—motor vehicleoccupants and with 0.9–1.0per1,000)(Figure3.3).Therateofburdenduetoillicitdrugusewashigherin highest DALYratesfor When examining the type of linked disease attributable to illicit drug use, areas (arateratioof1.0). of 1.3each);slightlylowerin compared with attributable toillicitdruguseemergedacrossthedifferentremotenessareas(Table After adjustmentforpopulationsizeandagestructure,differencesintheoverallrateofburden there weresimilarproportionsofthetotalburdendiseaseineacharea(1.7%–2.7%)(TableS3.5). (76,951 DALY)andthesmallestin by remoteness.Thegreatestburdenattributabletoillicitdrugusewasexperiencedin burden attributabletoalcoholuse,therateofillicitdrugusein2011varied burden ofdiseaseandinjuryexperiencedbyAustraliansin2011(AIHW2018e).Similartothe Illicit druguse,asariskfactorforotherdiseasesandinjuries,contributedto2.3%ofthetotal Burden ofillicitdruguse • • • for IndigenousAustralians(4.2%),behind: Alcohol dependence consumption (resultingininjury)andthelong-termimpact(chronicdiseases). injury inIndigenousAustralians(AIHW2016a).Thiscapturesboththeimmediateimpactofalcohol In 2011,alcoholuseasariskfactorwasresponsiblefor8%ofthetotalburdendiseaseand regarding differencesinthemethodologyforcalculatingattributableburdenalcoholuse.) of theburdenalcoholuseonIndigenousAustralians.(PleaserefertoAppendixAforinformation areas ofAustralia—inparticularin Indigenous Australiansmakeupasubstantialproportionofpeoplelivingin Burden ofalcoholuseforIndigenousAustralians Anxiety disorders Suicide andself-inflictedinjuries Coronary heartdisease Very remote Alcohol and otherdrug useinregional andremoteAustralia: consumption, harmsand accesstotreatment 2016–17 Major cities areasfor (4.4%). wasrankedasthe4thhighestspecificdiseasecontributingtototalburden(DALY) Illicit drugdependence (7.2%) Suicide andself-inflictedinjuries,Chronicliverdisease , theburdenwashigherforboth Inner regional . (4.5%) Very remote Very remote areas(arateratioof0.9)andsimilarin , comparedwithotherareas(1.8per1,000 areas(1,322 areas.Assuch,itisimportanttoexaminetheimpact

DALY). However,acrossremotenessareas Remote and Very remote Major cities Regional andremote and Road traffic Outer regional areas(rateratios

S3.5). When experienced the Major cities Remote

Harms from alcohol and other drug use 3 3

18 Harms from alcohol and other drug use increase between2011–12 and2014–15(Turning the rateofambulanceattendances hasbeenrelativelystablesince2014–15, followingalarge areas (365.1per100,000 populationor16,988attendances).Formetropolitan andregionalareas, Victoria was366.6per100,000 population(5,595attendances),whileitwas similarinmetropolitan In 2016–17,inVictoria,therateofalcoholintoxication-related ambulanceattendancesinregional Statistical GeographyStandardwhichisutilised throughout thisreport.) areas. (Note:thegeographicaltermsusedinthis sectiondiffertothoseusedintheAustralian available datashowthenumberandratesofattendances inVictorianmetropolitanandregional National dataonalcoholanddrug-relatedambulance attendancesarecurrentlynotavailable,but Ambulance attendances gap indiseaseburdenbetweenIndigenousandnon-IndigenousAustralians2011(AIHW2016a). opioid, amphetamineandcannabisdependence.Illicitdrugusewasresponsiblefor Indigenous Australiansin2011.Thiscapturestheimpactofinjectingdruguseaswellcocaine, Illicit drugusecontributedto3.7%ofthetotalburdendiseaseandinjuryexperiencedby methodology forcalculatingattributableburdenillicitdruguse.) Australians (AIHW2016a).(PleaserefertoAppendixAforinformationregardingdifferencesin the self-inflicted injuries Of thelinkeddiseasesanalysed, Burden ofillicitdruguseforIndigenousAustralians Alcohol and otherdrug useinregional andremoteAustralia: consumption, harmsand accesstotreatment 2016–17 linked diseases,byremotenessarea,2011 Figure 3.3:Age-standardisedattributableDALYrateduetoillicitdruguse,byselected Source: Note: Age-standardised DALY rate (per 1,000 population) 0.0 0.5 1.0 1.5 2.0 Rates wereage-standardisedtothe2001AustralianStandardPopulationandareexpressedper1,000persons. TableS3.6. dependence Illicit drug drug Illicit Major cities wereresponsibleforthegreatestburdenduetoillicitdruguseIndigenous Accidential Accidential poisoning Inner regional Illicit drugdependence Sucicide and and Sucicide self-inflicted self-inflicted injuries L i n

Point 2017). k Chronic Chronic disease e Outer regional regional Outer liver d

d i , s Chronic liverdisease e a s e cancer Liver Remote Remote motor vehicle vehicle motor Road traffic traffic Road occupants injuries– and Suicide and Very remote Very

4% ofthetotal motorcyclists Road traffic traffic Road injuries–

proportion similar topreviousyears (AIHW2018b). episode ofadmittedcare tohospital)accountedforabout1%(or137,000) ofthose(TableS3.7)—a combined (AIHW2018b). Drug-relatedprincipaldiagnoses(consideredto beresponsibleforan In 2016–17,therewerea totalofabout11.0millionhospitalisationsinpublic andprivatehospitals in thesedatamightmeantheburdenonhospitalsystemappearslargerthanwouldbeexpected. from thetherapeuticuseofdrugs;thatisdrugsusedtotreatdisease.Theinclusion use As aresult,proportionoftheseparationsreportedinthischaptermightresultfromharmarising • drugsgenerallynotobtainedthroughlegalmeans,suchasheroinandecstasy. • drugsavailablebyprescriptionorover-the-counter,suchasanalgesicsandantidepressants • legal,accessibledrugs,suchasalcoholandtobacco Drugs describedinthissectioninclude: (See Box3.2forthedefinitionofdrug-relatedhospitalseparations.) (NHMD), whichincludesalmostallpublichospitalsthatprovideddataforthiscollectionin2016–17. Information ondrug-relatedhospitalisationsistakenfromtheNationalHospitalMorbidityDatabase Drug-related hospitalisations and regionalareasforalcoholintoxicationanyillicitdruguse(TurningPoint2017). Males andyoungpeopleaged15–24hadthehighestrateofambulanceattendancesinmetropolitan (Turning Point2017). per 100,000),comparedwith1.8timesinmetropolitanareas(from112.1attendances100,000) drug-related attendanceshasrisenfasterinregionalareas—up2.3times(from53.6 areas (125.7per100,000populationor1,918attendances).Since2011–12,therateofanyillicit was higherinVictorianmetropolitanareas(196.5per100,000or9,145attendances)thanregional For anyillicitdrug-relatedambulanceattendancesin2016–17,therateof drugs liketobaccoandalcohol)havebeenexcluded. principal diagnosis(suchasproblemsrelatedto certainchronicconditionscausedbytheuseof Hospital separationswherethediagnosisofdrug-related harmordisorderisadditionaltothe self-inflicted) duetoselectedsubstances. care) ofsubstance-usedisorderorharm(allforms ofharm,includingaccidental,intended,or diagnosis establishedtobechieflyresponsible for occasioninganepisodeofadmittedpatient Drug-related separations subsequently, withthecareprovidedtothemasadmittedpatientsbeingincludedinNHMD. outpatient clinicsoremergencydepartments.Patientstreatedinthesesettingsmightbeadmitted Hospital separationsdatadonotincludeepisodesofnon-admittedpatientcareprovidedin of care(forexample,fromacutetorehabilitation). death, ortransfer,aportionofhospitalstaystartingendinginchangetoanothertype A Database Box 3.2:Definitionofdrug-relatedseparationsintheNationalHospitalMorbidity hospital separation Alcohol and otherdrug useinregional andremoteAustralia: consumption, harmsand accesstotreatment 2016–17 is acompletedepisodeofadmittedhospitalcareendingwithdischarge, refertohospitalcarewithselectedprincipaldiagnoses (thatis,the 19

Harms from alcohol and other drug use 3 3

20 Harms from alcohol and other drug use Remote andveryremote The proportionofseparationsforcannabinoids(5.7%)washigherpeopleusuallyresidingin • methamphetamines(2.8%). • othersedativesandhypnotics(2.4%) • opioids(2.2%) areas therewasalowerproportionofseparationswheretheprincipaldiagnosisrelatedto: Compared withallotherremotenessareas,forpeopleusuallyresidingin • methamphetamines(6.4%comparedwith5.0%). • othersedativesandhypnotics(7.8%comparedwith7.1%) • cannabinoids(4.5%comparedwith5.1%) • opioids(includingheroin,opium,morphineandmethadone)(6.6%comparedwith5.5%) evident forseparationswheretheprincipaldiagnosisrelatedto: For peopleusuallyresidingin highest proportionofallremotenessareas. for nearlythree-quarters(72%)ofhospitalisationswithadrug-relatedprincipaldiagnosis—the people usuallyresidingin remote areas was consistentforhospitalisationspeopleusuallyresidingin highest numberwereforalcohol,whichaccountedabouthalf(51%)ofthoseseparations.This NHMD datashowedthat,ofhospitalisationswithadrug-relatedprincipaldiagnosisin2016‍17,the Alcohol and otherdrug useinregional andremoteAustralia: consumption, harmsand accesstotreatment 2016–17 Other sedatives and hypnotics and sedatives Other Source: by remotenessarea,2016–17(%) Figure 3.4:Proportionofhospitalseparationsfordrug-relatedprincipaldiagnoses, Drug ofDrug diagnosis concern TableS3.7. Non-opioid analgesics Non-opioid Methamphetamines (that is,inareasoutsideof Cannabinoids Opioids Alcohol areas,comparedwithotherremotenessareas(Figure3.4). Remote andveryremote 0 Major cities 10 Major cities andin 20 Regional andremote areas,hospitalseparationsforalcoholaccounted . SeeAppendixAforfurtherinformation).For 30 Per cent 40 Major cities areas, minimaldifferenceswere 50 Remote andveryremote Outer regional regional Outer Inner regional Remote and very remote very and Remote Major cities andin 60 Regional and 70

80 cities As aresult,therateofdrug-induceddeathswas higherin remote Over thepastdecade,rateofdrug-induceddeaths hasincreasedatafasterratein Regional andremote drug-induced deathswasslightlyhigherin Major cities By remotenessarea,thenumberofdrug-induceddeathsin2017wassubstantiallyhigher (Table S3.9). then felltoalowof4.6deathsper100,000populationin2006andhasbeentrendingupwardssince than thatofdrug-induceddeathsrecordedin1999(9.1per100,000population).Therate the numberofdrug-induceddeathsin2017wassecondhighestonrecord,rateisstilllower In 2017,1,795deathsweredrug-induced(arateof7.4per100,000population)(TableS3.9).While number ofdeaths. reported onasingledeathrecord.Asresult,thesumofeachdrugtypemaybemorethan total determined bytoxicologyandpathologyreports(ABS2017a).Multipledrugtypesmayhavebeen Drug-induced deathsaredefinedasthosethatcanbedirectlyattributabletodruguse, Drug-induced deaths • othersedativesandhypnotics(1.2times)(TableS3.8). • opioids(1.4times) • methamphetamines(1.8times) • non-opioidanalgesics(3.0times) and veryremote Hospital separationratesper100,000populationwerehigherforpeopleusuallyresidingin compared with24.9per100,000population). Remote in The rate of drug-related hospital separations for cannabinoids was similar for people usually residing residing in very remote of drug-related hospital separations foralcohol was highest for people usually residing in 100,000 populationcomparedwith272.1perpopulation).Ofallremotenessareas,therate was similarforpeopleusuallyresidingin Data fromthe2016–17NHMDshowedthatrateofdrug-relatedhospitalseparationsforalcohol Major cities between2012and2016(Figure3.5). areas,up41%since2008,comparedwitha16% increasein

and veryremote Alcohol and otherdrug useinregional andremoteAustralia: consumption, harmsand accesstotreatment 2016–17 thanin Major cities areas(1,624.9per100,000population)—almost6timeshigherthanforpeopleusually and areas,comparedwith Regional andremote Regional andremote areas(7.2per100,000population)(Table (Table areas,comparedwiththosein

S3.8) . areas,butwas5timeshigherforpeopleusuallyresidingin Major cities areas(1,294comparedwith483)(TableS3.10).Therateof Major cities Major cities for: and in (7.4per100,000population),comparedwith Major cities Regional andremote Regional andremote

S3.11). (129.0 per100,000population Major cities areasthanin overthesameperiod. areas(286.7per Regional and Remote and Remote Major

Harms from alcohol and other drug use 3 3

22 Harms from alcohol and other drug use population comparedwith1.1deathsper100,000 population). was identifiedhigherin evident byremotenessarea.Forexample,in2017therateofdrug-induceddeathswhereheroin Opioids arecommonlyidentifiedindrug-induceddeathsAustralia,withcleardifferences remote rose sharplybetween2008and2016in (tables S3.10andS3.11).Thenumberofdrug-induceddeathswherebenzodiazepineswerepresent Major cities In 2017,benzodiazepineswerethedrugtypemostcommonlyidentifiedindrug-induceddeaths in Alcohol and otherdrug useinregional andremoteAustralia: consumption, harmsand accesstotreatment 2016–17 2008 to2017 Figure 3.5:Rateofdrug-induceddeathsinMajorcitiesandRegionalremoteareas, Source: 2. 1. Notes ‘ Very remote

Regional andremote Rate per 100,000 population Drug-induced deathscapturetheunderlyingcausesof(includinganyassociatedcauses)thatalignwith definition ofdrug-induceddeathsusedbytheABSreportingin3303.0-Causesdeath,Australia,2015,Appendix2. areas(104to221deaths,up113%)(Table 0 1 2 3 4 5 6 7 8 9 TableS3.11. (592deaths)andin 2008 ). ’ includesallareasoutside 2009 Major cities 2010 Regional andremote Major cities thanin 2011 Major cities Major cities Regional andremote 2012 (thatis,

S3.10). (297to592deaths,up99%)and areas(221deaths),withasimilarrateofdeath Inner regional,OuterRemote 2013 Regional and remote and Regional 2014 areas(1.9 2015

deaths per100,000 and Regional and 2016

2017 (Table S3.11). 3.3 deathsper100,000population).Ratesforotherdrugtypesweresimilaracrossremotenessareas remote opioids (includingfentanylandtramadol)anyopioidexcludingheroinwashigherin and methadone(Figure3.6).Overall,in2017,therateofdruginduceddeathsforothersynthetic remote In 2017,drug-induceddeathsinvolvingprescriptionopioidsoccurredatasimilarratein 2008 and2017 Figure 3.6:Rateofopioid-induceddeathsinMajorcitiesandRegionalremoteareas, Source: 2. 1. Notes Rate per 100,000 population Multiple drugtypesmayhavebeenreportedonasingledeathrecord.Asresult,thesumofeachtypebemore than thetotalnumberofdeaths. Regional andremote 0 1 2 3 4 5 6 areasthanin areasandin Heroin TableS3.11. Alcohol and otherdrug useinregional andremoteAustralia: consumption, harmsand accesstotreatment 2016–17 opioid Other Other Major cities includesallareasoutside Methadone Major cities Major cities 2 synthetic Regional and remoteRegional opioid Other Other forthedrugtypesotheropioids(includingoxycodoneandcodeine) (1.5

and 4.0deathsper100,000populationcomparedwith0.9 opioid Any Any Major cities Any opioid opioid Any excluding excluding heroin (thatis, 0 1 2 3 4 5 6 Inner regional,OuterRemote Heroin opioid Other Other Major cities Methadone 2 synthetic opioid Other Other Regional and remoteRegional 1 and opioid Any Any Very remote Regional and Regional and Any opioid opioid Any excluding excluding heroin ). 23

Harms from alcohol and other drug use 3 3

24 Harms from alcohol and other drug use deaths wherealcoholwas mentionedasacontributingfactortomortality (ABS2018b). There were1,366alcohol-induceddeathsrecorded in2017,withanadditional2,820(alcohol-related) stable (ABS2018b). 6.6 in1997.Since2013,therateofalcohol-induced deathsper100,000populationhasremained In 2017,therewere5.1alcohol-induceddeathsper 100,000population(TableS3.13),downfrom (ABS 2018). determined byadoctororcoroneraspart of apolice,toxicology,pathologyorcoronialreports Alcohol-induced deathsaredefinedasthosethat canbedirectlyattributabletoalcoholuse,as Alcohol-induced deaths where slightlymorethanhalfthepopulationlivesoutsidecapitalcity(ABS2018d). with 44.6%inacapitalcity)(TableS3.12).ThismayreflectthepopulationdistributionQueensland, where theproportionofdrug-induceddeathswashigheroutsidecapitalcity(55.1%compared to diefromdruguseinthecapitalcity(Figure3.7).Interestingly,Queenslandwasonlystate (ABS 2017a).However,inWesternAustralia,SouthAustraliaandTasmaniapeopleweremorelikely In general,peoplelivingoutsideofacapitalcityin2016weremorelikelytodiefromdruguse Usual residence Alcohol and otherdrug useinregional andremoteAustralia: consumption, harmsand accesstotreatment 2016–17 Figure 3.7:Rateofdrug-induceddeaths,byregionusualresidence,2016 Source: 3. DeathsregisteredonNorfolkIslandfrom1July2016areincludedinthispublicationforthefirsttime. 2. 1. Notes

Causes ofdeathdatafor2016arepreliminaryandsubjecttorevision. Standardised deathrates.Deathsper100,000ofestimatedmid-yearpopulation. Standardised death rate per 100,000 population 1 1 1 0 2 4 0 2 4 6 8 TableS3.12. NSW Vic Qld Capital city Capital SA Rest of state of Rest WA Tas ACT Aust

100,000 persons(Figure3.8). highest alcohol-induceddeathratewasintheNorthernTerritory’s‘rest-of-state’region,at28.5per was highestintheNorthernTerritory(3.2times)andlowestQueensland(1.2times).Overall, in regionsoutsideofcapitalcitieswereabout1.5timeshigherthancities;thedifference in alljurisdictionsforregionsoutsideofcapitalcities.Onaverage,theratealcohol-induceddeaths Alcohol-induced deaths,byregion,showthathigherratesofalcohol-induceddeathswererecorded made upabout20%ofalcohol-induceddeathsin2017(ABS2018b). contributor toalcohol-relateddeaths. and behaviouralconditionsduetoalcoholuse The mostcommoncauseofalcohol-induceddeathwas Figure 3.8:Rateofalcohol-induceddeaths,byregionusualresidence,2017 Source: 3. 2. 1. Causesofdeathdatafor2017arepreliminaryandsubjecttoarevisionsprocess. Notes Standardised deathrates.Deathsper100,000ofestimatedmid-year population. The datapresentedforalcohol-induceddeathsarebasedonandeathtabulationcreatedbythe Office ofNationalStatisticsintheUnitedKingdom. Standardised death rate per 100,000 population 1 1 2 2 3 TableS3.13. 0 5 0 5 0 5 0 Alcohol and otherdrug useinregional andremoteAustralia: consumption, harmsand accesstotreatment 2016–17 N S W V i c Q l d Mental andbehaviouraldisordersduetoalcoholabuse Capital city Capital S (includingalcoholaddiction)isthemostcommon A WA Alcoholic liverdisease Rest of state of Rest T a s N T , while A C Mental T

also A u s t 25

Harms from alcohol and other drug use 3 4

26 Alcohol and other drug treatment services Source: 2. 1. Notes Table 4.1:Closedtreatmentepisodes,byremotenessarea,statesandterritories,2016–17 (%) Major cities (Table 4.1).Overall,agenciesin episodes. Agenciesin Treatment agenciesin exception ofWesternAustralia(23%)andtheNorthernTerritory(57%)(AIHW2018c). states andterritories,theproportionofagenciesin areas, withrelativelyfewagencieslocatedin For agenciesin Nationally, in2016–17,overhalf(482or58%)ofthetreatmentagencieswerelocated Agencies coverage oftheAODTSNMDS.) National MinimumDataSet(AODTSNMDS).(RefertoAppendixAforinformationonthescopeand the peopleanddrugstreated,arecollectedthroughAlcoholOtherDrugTreatmentServices Australian Government.InformationonpubliclyfundedAODtreatmentservicesinAustralia,and Most oftheseservicesarefundedbystateandterritorygovernments,whilesomethe In Australia,publiclyfundedtreatmentservicesforAODuseareavailableinallstatesandterritories. non-residential settings(AIHW2018c). and rehabilitation,counsellingpharmacotherapy,aredeliveredinresidential to supportthefamilyandfriendsofpeopleusingdrugs.Treatmentservicesincludedetoxification as wellimprovingsocialandpersonalfunctioning. and assistancemayalso beprovided Treatment through arangeoftreatments.Treatmentobjectivescanincludereductionorcessationdruguse, Specialist alcoholandotherdrug(AOD)treatmentservicesassistpeopletotackletheiruse 4 Alcohol and otherdrug useinregional andremoteAustralia: consumption, harmsand accesstotreatment 2016–17 Total Regional andremote v Remote Very remote Remote Outer regional Inner regional Major cities ery remote In Victoria,alcoholandotherdrug treatmentactivityisgenerallyrecordedagainstaserviceprovider’s administrativeaddress collection fromOctober 2018. the actualdistributionacross state.Itisanticipatedthatthiswillbeimprovedwiththeimplementation ofanewdata rather thanthelocationwhere activitywasdelivered.Asaresult,Victoria’sremotenessreporting maynotaccuratelyreflect Regional andremote

AIHW2018c. Alcohol andotherdrugtreatmentservices and —see AppendixAforfurtherinformation)provided29%ofallclosedtreatmentepisodes.

Regional andremote includesallareasoutside Remote andveryremote Major cities 100.0 NSW 30.0 65.8 34.2 1.2 1.2 3.1 — Regional andremote providedalmostthree-quarters(71%)ofallclosedtreatment 100.0 areas, mostwerein 15.0 80.6 19.4 4.3 Vic Major cities — — — 100.0 16.9 12.6 66.8 Remote andveryremote 33.2 areasprovided1inevery29(3.5%)treatmentepisodes Qld 0.5 3.7 (thatis, 3.2 areas(all treatmentserviceslocatedoutside Remote andveryremote Inner regional 100.0 78.3 21.7 5.3 WA 1.4 7.3 7.7 6.7 Inner regional 100.0 73.9 26.1 , 5.5 9.6 1.6 9.3 Outer regional 7.2 SA areas(7%intotal).Acrossmost 100.0 (22%)and 100.0 23.7 76.3 Tas — — — — , Remote areaswaslow,withthe 100.0 100.0 ACT and Outer regional — — — — — 0 Very remote 100.0 100.0 38.7 53.1 46.9 Major cities 8.2 NT — —

). (13%) 100.0 Aust 16.3 71.2 28.8 0.6 2.9 9.0 3.5 . being Indigenous(TableS4.3). treatment increaseswithremoteness,3in5clients(62%) in A higherproportionofIndigenousclientsreceivedtreatmentin compared with39%in very remote Compared withclientsin remote difference intheageprofileofclientswhoreceivedtreatment remoteness area(AIHW2018c).Mostclientswereagedbetween20and39therewaslittle About 2inevery3clients(66%)whoreceivedtreatment2016–17weremale,irrespectiveof Client profile (1.3 episodesperclientor7,088episodes)(TableS4.1). having thesmallestnumberofclients(5,486),andaverageepisodesperclient treatment (1,294clientsper100,000population),comparedwithotherremotenessareas,despite Overall, agenciesin remote population in in (Table S4.1).Therewereanestimated39,521clientswhoreceived57,871closedtreatmentepisodes clients receiving142,880closedtreatmentepisodesorabout1.6perclient More thantwo-thirds(69%)ofclientsreceivedtreatmentin for theirowndruguse(AIHW2018c). clients per100,000 population (Table S4.1). The majority(122,413 or 96%) of clientssought treatment episodes frompubliclyfundedAODtreatmentagenciesacrossAustralia,whichequatesto605 In 2016–17,anestimated127,404clientsaged10andoverreceived200,751closedtreatment Clients Major cities Regional andremote areas(Figure4.1). areas. Alcohol and otherdrug useinregional andremoteAustralia: consumption, harmsand accesstotreatment 2016–17 areaswasyounger,withahigherproportionofclientsagedbetween10and 29(46% (28%comparedwith9.0%).TheproportionofIndigenousclientswhoreceived Major cities, Remote andveryremote areas(about1.5episodesperclient).Thisequatesto586clients100,000 Major cities Major cities comparedwith652clientsper100,000populationin ) (TableS4.2). , theageofclientswhoreceivedtreatmentin areas hadthehighestrateofclientswhosought Major cities Regional andremote Major cities Remote and , withanestimated87,883 andin

very remote Regional and Remote and Regional and areas than areas

Alcohol and other drug treatment services 4 4

28 Alcohol and other drug treatment services among clients(TableS4.5). remote and 11%,respectively).Cannabismadeupahigher proportionoftreatmentepisodesin cities By remotenessarea,amphetaminesmadeupa higher proportionoftreatmentepisodesin and 24%ofclients)(tablesS4.4S4.5). episodes (26%ofclosedand24%clients), followedbycannabis(22% ofclosedepisodes Amphetamines werethesecondmostcommon principal drugofconcernallclosedtreatment a principaldrugofconcern(tablesS4.4andS4.5). treatment episodes(61%)andofclients(60%)in compared with with 30%)andofclientsreceivingtreatment(38%compared28%)in By remotenessarea,alcoholmadeupahigherproportionoftreatmentepisodes(39% compared S4.5). for people’sowndruguse(32%ofallclosedtreatmentepisodesand31%clients)(tablesS4.4 and In 2016–17,alcoholwasthemostcommonprincipaldrugofconcernallclosedtreatmentepisodes Principal drugofconcern Alcohol and otherdrug useinregional andremoteAustralia: consumption, harmsand accesstotreatment 2016–17 Figure 4.1:Proportionofclientsbyageandremotenessarea,2016–17(%) Source: of anewdatacollectionfromOctober2018. accurately reflecttheactualdistributionacrossstate.Itisanticipatedthatthiswillbeimprovedwithimplementation address ratherthanthelocationwhereactivitywasdelivered.Asaresult,Victoria’sremotenessreportingmaynot Note: P 1 1 2 2 3 3 0 5 0 5 0 5 0 5 e thaninboth r

c In Victoria,alcoholandotherdrugtreatmentactivityisgenerallyrecordedagainstaserviceprovider’sadministrative areasthanin e S4.2. n t 1 0 – 1 Major cities 9 Regional andremote Major cities Major cities 2 . Thisdisparityincreaseswithremoteness,morethanhalfofthe 0 – 2 9 (26%comparedwith20%) (TableS4.4).Similarpatternswereevident Inner regional

and 3 0 Remote – 3 9 Remote andveryremote and Outer regional regional Outer very remote 4 0 – 4 9 areas(27% comparedwith23% 5 0 areastreatedforalcoholas Remote and very remote very and Remote – Regional andremote 5 9 6 0 Regional and + Major areas

source foreachremoteness areaexcept (Table S4.6). For cannabis,policeandcourt-baseddiversion programswasthemostcommonreferral drugs ofconcernandremoteness areas,includingin With theexceptionofcannabis, thiswasaconsistentpatternacrossthe mostcommonprincipal • policeandcourt-baseddiversionprograms(17%) (TableS4.6). • healthservices(28%) • self/family(37%) For closedtreatmentepisodesin2016–17forown druguse,themostcommonreferralsourceswere: Source ofreferral or providingdosingservicesforopioidpharmacotherapy fromtheAODTSNMDS(AIHW2018c). difference maybegreaterduetotheexclusionoftreatmentagencieswhosesolefunctionisprescribing higher in The proportionofclosedtreatmentepisodeswhereheroinwasthedrugprincipalconcern but lowerin concern wassimilarin The proportionofclosedtreatmentepisodeswhereapharmaceuticalwasthedrugprincipal of concernandremotenessarea,2016–17(%) Figure 4.2:Proportionofclosedtreatmentepisodesforowndruguse,byprincipal Source: of anewdatacollectionfromOctober2018. accurately reflecttheactualdistributionacrossstate.Itisanticipatedthatthiswillbeimprovedwithimplementation address ratherthanthelocationwhereactivitywasdelivered.Asaresult,Victoria’sremotenessreportingmaynot Note: 10 20 30 40 50 60 70 Per cent Per 0 In Victoria,alcoholandotherdrugtreatmentactivityisgenerallyrecordedagainstaserviceprovider’sadministrative TableS4.4. Major cities Alcohol and otherdrug useinregional andremoteAustralia: consumption, harmsand accesstotreatment 2016–17 Alcohol Remote andveryremote Major cities thanin Major cities Amphetamines Regional andremote andin Inner regional Inner areas(1.3%,Figure4.2). Principal drug of concern of drug Principal Remote andveryremote Regional andremote Cannabis areas(6.4%comparedwith2.2%)(TableS4.4).This Outer regional regional Outer Major cities areas(4.8% comparedwith5.3%), Pharmaceuticals andin areas. Remote and very remote very and Remote Regional andremote Heroin areas

Alcohol and other drug treatment services 4 4

30 Alcohol and other drug treatment services • withdrawalmanagement(13.9%comparedwith8.6%)(Figure4.3). • supportandcasemanagementonly(16.3%comparedwith9.2%) • pharmacotherapy(2.6%comparedwith1.5%) areas forthemaintreatmenttypes: The proportionofclosedtreatmentepisodesin episodes in more distinctin higher in The proportionofclosedtreatmentepisodeswherethemaintypewascounselling, • withdrawalmanagement(12%)(TableS4.7). • supportandcasemanagementonly(14%) • assessmentonly(16%) alcohol andotherdrugproblem)wascounselling(39%).Thisfollowedby: In 2016–17,themostcommonmaintypeoftreatment(theprimaryactivityusedtotreatclient’s Main treatmenttype Alcohol and otherdrug useinregional andremoteAustralia: consumption, harmsand accesstotreatment 2016–17 Support and case management only management and case Support Source: of anewdatacollectionfromOctober 2018. accurately reflecttheactualdistribution acrossthestate.Itisanticipatedthatthiswillbeimproved withtheimplementation address ratherthanthelocation wheretheactivitywasdelivered.Asaresult,Victoria’sremoteness reportingmaynot Note: type, andremotenessarea,2016–17(%) Figure 4.3:Proportionofclosedtreatmentepisodesforowndruguse,bymain Information and education only In Victoria,alcoholandotherdrug treatmentactivityisgenerallyrecordedagainstaserviceprovider’s administrative TableS4.7. Regional andremote Withdrawal management Withdrawal Regional andremote Main treatment type Main treatment Remote andveryremote Pharmacotherapy Assessment only Assessment Rehabilitation Counselling Other areasthanin areasthanin 0 areas(57%).Rehabilitationmadeupahigherproportionof 1 Major cities 0 Major cities Major cities 2 (47%comparedwith36%)—adifference 0 (8.2% comparedwith4.8%)(TableS4.7). washigherthanin Per cent 3 0 Remote and very remote very and Remote Outer regional regional Outer regional Inner Major cities 4 0 Regional andremote 5 0 6

0 • residentialfacilities(17%comparedwith13%)(Figure4.4). • outreachsettings(23%comparedwith12%) with 66%in was lowerinnon-residentialtreatmentfacilities(51% Compared with facilities (68%comparedwith66%)andinoutreachsettings(15%12%). areas and Differences inthetreatmentdeliverysettingappearedtobeminimalbetween (76%) wereinnon-residentialtreatmentfacilities(TableS4.8). of concern—alcohol(68%),amphetamines(70%),cannabis(71%),pharmaceuticals(72%)andheroin More thantwo-thirdsofclosedtreatmentepisodesprovidedforthemostcommonprincipaldrugs • residentialtreatmentfacilities(13%). • were providedbynon-residentialtreatmentfacilities(66%).Thiswasfollowedby: In 2016–17,themajorityoftreatmentepisodesforclientsreceivingtheirowndruguse Treatment deliverysetting amphetamines, cannabisandpharmaceuticals(TableS4.7). These trendsweresimilaramongothercommonprincipaldrugsofconcernincludingheroin, • withdrawalmanagement(10%comparedwith21%). but lowerfor: • rehabilitation(9.6%comparedwith4.8%) • counselling(51%in closed treatmentepisodesin remoteness area.Forexample,wherealcoholwastheprincipaldrugofconcern,proportion There weredifferencesinthemaintreatmenttypereceivedbyprincipaldrugofconcernand from themainservicelocation,oramobileservice)(13%) outreach settings(whichincludeanypublicorprivatelocationwhereservicesareprovidedaway Alcohol and otherdrug useinregional andremoteAustralia: consumption, harmsand accesstotreatment 2016–17 Major cities Major cities Major cities , withasimilarproportionofclosedtreatmentepisodesinnon-residential Regional andremote ) buthigherfor: , theproportionoftreatmentepisodesin Regional andremote areas comparedwith39%in areaswashigherthanin Remote andveryremote Remote andveryremote Major cities Major cities Regional andremote areascompared ), and for: areas

Alcohol and other drug treatment services 4 4

32 Alcohol and other drug treatment services treatment facilities washighestin Of allremotenessareas, theproportionoftreatmentepisodeswithcounselling innon-residential • informationandeducation only(11%). • assessmentonly(18%) • counselling(50%) a non-residentialtreatmentfacilityin In 2016–17,themaintreatmenttypeswithlargest proportionoftreatmentepisodeswithin Treatment deliverysettingbymain treatmenttype (15% comparedwith13%),andpharmaceuticals (17%comparedwith15%)(TableS4.8). Regional andremote For treatmentinoutreachsettings,therewerehigherproportionsofepisodes with 66%)(TableS4.8). (69% comparedwith66%),amphetamines(70% compared67%),andheroin(77% proportion ofclosedtreatmentepisodesin principal drugsofconcerns(TableS4.8).Forexample,innon-residentialfacilitiestherewasahigher Differences byremotenessareaintreatmentdeliverysettingwereevidentamongthemostcommon Treatment deliverysettingbyprincipaldrugofconcern Alcohol and otherdrug useinregional andremoteAustralia: consumption, harmsand accesstotreatment 2016–17 delivery settingandremotenessarea,2016–17(%) Figure 4.4:Proportionofclosedtreatmentepisodesforowndruguse,by Source: of anewdatacollectionfromOctober2018. accurately reflecttheactualdistributionacrossstate.Itisanticipatedthatthiswillbeimprovedwithimplementation address ratherthanthelocationwhereactivitywasdelivered.Asaresult,Victoria’sremotenessreportingmaynot Note: Per cent 10 20 30 40 50 60 70 80 0 In Victoria,alcoholandotherdrugtreatmentactivityisgenerallyrecordedagainstaserviceprovider’sadministrative TableS4.8. treatment facility Non-residential areasthanin Major cities Residential treatment facility Major cities Remote and very remote Inner regional Major cities Treatment setting delivery Major cities for heroin(17%comparedwith4%),alcohol were: Home Outer regional regional Outer thanin areas(85%) (TableS4.9). Regional andremote Outreach setting Outreach Remote and very remoteRemote and very areasforalcohol Other

being imprisoned(other thanadrugcourtsanction)(Table S4.13). treatment episode(Table S4.12).Asmallproportion(1.2%)ofepisodesended duetotheclient advice, withoutnoticedue tonon-compliance),while1in20episodesended duetoachangein About 1in5(21%)episodesendedunexpectedly (thatis,theclientceasedtoparticipateagainst In 2016–17,every3in5(62%)closedtreatment episodes endedwithanexpectedcessation. Reason forendingtreatment generally shorterin management only(TableS4.12).Conversely,the durationofpharmacotherapyepisodeswas in By maintreatmenttype,durationofepisodes wasgenerallyshorterin (Table S4.11). episodes weregenerallylongerin cannabis generallyshorterin duration ofclosedtreatmentepisodesforheroin,alcohol,amphetamines,pharmaceuticalsand This wasaconsistentpatternacrossthemostcommonprincipaldrugsofconcern,withtreatment and remote Overall, aslightlyhigherproportionoftreatmentepisodeslastedfor365daysorlongerin areas lastedfor29daysorless(61%comparedwith45%). areas. Ahigherproportionofclosedtreatmentepisodesin In 2016–17,treatmentdurationwasgenerallyshorterin Treatment duration (Table S4.9). and educationonly(24%)wasamorecommontreatmenttypethaninanyotherremotenessarea In • counselling(23%comparedwith40%). • assessmentonly(25%comparedwith15%) • areas, althoughtheproportionofepisodesforeachvaried: In anoutreachsetting,themaintreatmenttypesweresimilarin withdrawal management(TableS4.9). treatment facilitieswereforamaintypeofrehabilitationandabout1in10(9%) In • assessmentonly(8%comparedwith20%). • rehabilitation(31%comparedwith50%) • withdrawalmanagement(52%in and remote In residentialtreatmentfacilities,themaintypesweresimilarin remote support andcasemanagementonly(35%in Regional andremote Remote andveryremote Remote andveryremote areas) Alcohol and otherdrug useinregional andremoteAustralia: consumption, harmsand accesstotreatment 2016–17 areas,althoughtheproportionofclosedtreatmentepisodesforeachvaried: areasthanin Regional andremote areas,inparticularforwithdrawalmanagement andsupportcase Major cities areas,counselling(43%)wasthemaintreatmenttype,whileinformation areasonly,almosttwo-thirds(63%)oftreatmentepisodesinresidential Major cities Remote andveryremote Major cities (2.7% comparedwith2.1%)(TableS4.10). areasthanin thanin comparedwith19%in Major cities Regional andremote Major cities Major cities comparedwith21%in areas thaninanyotherremotenessarea Major cities Major cities . thanin areas.Treatmentdurationof Regional andremote thanin Major cities and Regional andremote Regional andremote Regional andremote Regional and Major cities and areas) Regional Regional than

Alcohol and other drug treatment services 4 4

34 Alcohol and other drug treatment services heroin (41%)thelowest (Figure 4.5). lower forallprincipaldrug ofconcerns,withalcohol(52%)havingthehighest proportionand Levels ofexpectedcessation forclosedepisodesin with 44%)andalcohol(69% comparedwith56%). (Figure 4.5).Thelargestdifferencesinexpected cessationwereforpharmaceuticals(62%compared episodes thatendedwithexpectedcessationin Across themostcommonprincipaldrugsofconcern, therewasahigherproportionoftreatment was slightlyhigherin proportion oftreatmentepisodesthatendedwithimprisonment(otherthanadrugcourtsanction) (18%); inparticular,unexpectedcessationwashigher Levels ofunexpectedcessationwerehigherin lower (52%)(Figure4.5). areas, theproportionoftreatmentepisodesthatendedwithexpectedcessationwassubstantially in By remotenessarea,forclosedtreatmentepisodes,thereweresimilarlevelsofexpectedcessation (Table S4.13). was theprincipaldrugofconcernthathadhighestproportion(29%)unexpectedcessation proportion ofexpectedcessation(74%)andpharmaceuticals(56%)hadthelowest.Amphetamines Of themostcommonprincipaldrugsofconcern,treatmentepisodesforcannabishadhighest Alcohol and otherdrug useinregional andremoteAustralia: consumption, harmsand accesstotreatment 2016–17 expectedly, byprincipaldrugofconcernandremotenessarea,2016–17(%) Figure 4.5:Proportionofclosedtreatmentepisodesforowndrugusethatended Source: of anewdatacollectionfromOctober2018. accurately reflecttheactualdistributionacrossstate.Itis anticipated thatthiswillbeimprovedwiththeimplementation address ratherthanthelocationwhereactivitywasdelivered. Asaresult,Victoria’sremotenessreportingmaynot Note: Major cities P 1 2 3 4 5 6 7 8 9 0 0 0 0 0 0 0 0 0 0 e r

c In Victoria,alcoholandotherdrugtreatmentactivityisgenerally recordedagainstaserviceprovider’sadministrative e TableS4.13. n t Alcohol (63%)andin Remote andveryremote Major cities Amphetamines Regional andremote Inner regional Principal of drug concern Cannabis areas(2.1%)comparedwith areas(59%).However,in Regional andremote Major cities Remote andveryremote Pharmaceuticals Outer regional regional Outer Remote andveryremote thanin areas (27%)thanin Regional andremote Major cities Remote and very remote very and Remote Remote andveryremote Heroin areas weresubstantially areas(31%).The (1.0%)(TableS4.13). Major cities Total areas

46%) (Figure4.6). remote Levels ofunexpectedcessationforeachmaintreatmenttypeweregenerallyhigherin (59% comparedwith36%and8.3%,respectively)(TableS4.14). Major cities For pharmacotherapy,theproportionoftreatmentepisodesthatendedwithexpectedcessationin • rehabilitation(43%comparedwith42%). • The exceptionstothiswere: with expectedcessationwashigherin In general,bymaintreatmenttype,theproportionofclosedepisodesthatwereended Cessation bymaintreatmenttype remote treatment episodesthatendedinunexpectedcessationboth Of allcommonprincipaldrugsofconcern,amphetamineshadthehighestproportionclosed Major cities support andcasemanagementonly(61%in Source: of anewdatacollectionfromOctober 2018. accurately reflecttheactualdistribution acrossthestate.Itisanticipatedthatthiswillbeimproved withtheimplementation address ratherthanthelocationwhereactivitywasdelivered. Asaresult,Victoria’sremotenessreportingmaynot Note: unexpectedly, bymaintreatmenttypeandremotenessarea,2016–17(%) Figure 4.6:Proportionofclosedtreatmentepisodesforowndrugusethatended Per cent 10 20 30 40 50 60 0 Counselling InVictoria,alcoholandotherdrugtreatmentactivityisgenerally recordedagainstaserviceprovider’sadministrative areasthanin areas(34%)(TableS4.13). TableS4.14. Alcohol and otherdrug useinregional andremoteAustralia: consumption, harmsand accesstotreatment 2016–17 wassubstantiallyhigherthanin ) Withdrawal Withdrawal management Major cities Major cities, Assess- ment ment only exceptforthetreatmenttypeofrehabilitation(42%comparedwith management management Inner regional and case case and Support Support Major cities only Main treatment type Main treatment Regional andremote Regional andremote Rehabilitation thanin Outer regional regional Outer Regional andremote cotherapy Pharma- and Major cities areascomparedwith37%in Remote andveryremote Information Information education education Remote and very remote very and Remote only and and (27%)and areas(TableS4.14). Other Regional and Regional and areas Total

Alcohol and other drug treatment services 4 4

36 Alcohol and other drug treatment services very remote (65%) andofepisodes(63%). About2inevery5clients(44%)andepisodes (40%)werein Organisations in with 20%in almost 2inevery5(39%)organisationswerelocated in By remotenessarea,about80%ofagencieswere locatedin • • • In 2016–17,OSRsubstance-useservicesprovided: Substance-use services purposes, scopeandcountingrules(seeBox4.2fordetails). provided toIndigenouspeopleinAustralia.TheOSRandAODTSNMDShavedifferentcollection Minimum DataSet(AODTSNMDS),itdoesnotrepresentallalcoholandotherdrugtreatments Islander peopleisreportedthroughtheAlcoholandOtherDrugTreatmentServicesNational Advancement Strategy.WhilethenumberoftreatmentepisodesforAboriginalandTorresStrait services arefundedbytheDepartmentofPrimeMinisterandCabinet,underIndigenous after-care serviceforAboriginalandTorresStraitIslanderpeople.Indigenoussubstance-use culturally appropriateAODprevention,education,counselling,treatment,rehabilitationand projects fundedbytheAustralianGovernmentaredesignedtoreducesubstanceabusethrough substance-use servicesareavailablefromtheOnlineServicesReport(OSR)datacollection.Many Information onthemajorityofAustralianGovernment-fundedAboriginalandTorresStraitIslander Indigenous treatmentservices Alcohol and otherdrug useinregional andremoteAustralia: consumption, harmsand accesstotreatment 2016–17 by 80organisations(AIHW2018a). to 39,448clients 197,671 episodesofcare (OSR) andAODTSNMDS Box 4.2:ComparisonoftreatmentepisodedefinitionsintheOnlineServicesReport These differencesmeanthatthe2collectionsarenotdirectlycomparable. whereas theAODTSNMDSreportsonlyonclientsaged10andover. The OSRcollection,managedbytheAIHW,recordsinformationaboutclientsofanyage, smaller estimatesofactivitythantheAODTSNMDSconcept‘closedtreatmentepisode’. (‘substance/drug’) changes.Itisthereforelikelythatthisconceptof‘episodecare’produces ‘episode ofcare’whenthemaintreatmenttype(‘treatmenttype’)orprimarydrugconcern the AODTSNMDS,definitionusedinthiscollectiondoesnotrequireagenciestobeginanew calls undertakenwithclients.Incontrasttothedefinitionof‘closedtreatmentepisode’usedin programs wherethedefinitionof‘episodecare’relatesmoretonumbervisitsorphone treatment/rehabilitation andsobering-up/respite).‘Othercare’referstonon-residential The OSRdefinitionof‘episodecare’startsatadmissionandendsdischarge(forresidential areas(Table4.2). Major cities Regional andremote . areasprovidedservicestoalmosttwo-thirdsof OSRclients Remote Regional andremote

and veryremote areas,incomparison areas.Specifically, Remote

and increase inthenumberofagenciesreporting(AIHW2018a). increased from37%in2008–09to44%2016–17(Figure Major cities Regional andremote 2016–17—a 70%increase(TableS4.15).Inthistime,theproportionofsubstance-useclientsfrom Over time,thenumberofsubstance-useclientsincreasedfrom23,178in2008–09to39,448 Source: 2. 1. Notes clients andepisodes,byremotenessarea,2016–17 Table 4.2:NumberofAboriginalandTorresStraitIslandersubstance-useorganisations, Total Regional andremote Very remote Remote Outer regional Inner regional Major cities Per centsmaysumtomorethan100duerounding. Regional andremoteincludesallareasoutsideMajorcities(thatis, Source: Note: to 2016–17(%) Figure 4.7:Proportionofsubstance-useIndigenousclients,byremotenessarea,2008–09 100 Per cent 10 20 30 40 50 60 70 80 90 0 AIHW2018(OSR). In 2014–15,thereportingperiod was 1June2014to31May2015.Inotheryears,itthefinancial yearfrom1Julyto30June. 2008 TableS4.15. Alcohol and otherdrug useinregional andremoteAustralia: consumption, harmsand accesstotreatment 2016–17 . Inparticular,theproportionofsubstance-useclientsin – 09 2009 areasincreasedfrom52%to65%,withadeclineintheproportionofclients – 10 2010 – 11 No. 16 12 19 21 12 80 64 2011 Organisations – 12 2012 15.0 23.8 26.3 15.0 20.0 80.0 100 – % 13 2013 Inner regional,OuterRemote – 39,448 12,802 13,802 25,646 14 4,634 6,229 1,981 No.

4.7). Theseincreasesmaybeduetoan 2014 – 15 Clients 2015 Remote andveryremote 11.7 32.5 15.8 35.0 65.0 100 5.0 – % 16 2016 197,671 125,309 – 48,038 30,495 33,033 13,743 72,362 and 17 No. Very remote Very remote Very Inner regional Outer regional regional Outer Remote Major cities areas Episodes ).

24.3 15.4 16.7 36.6 63.4 100 7.0 %

Alcohol and other drug treatment services 4 4

38 Alcohol and other drug treatment services Source: 2. 1. Notes area, 2016–17 Table 4.3:Numberoforganisationsreportingcommonsubstance-useissues,byremoteness cities Conversely, amphetamineswereamorecommonsubstance-useissuefororganisationsin (73% comparedwith38%oforganisations)amongthe mostcommonsubstance-useissues. were morelikelytoreportcannabis(98%comparedwith81%oforganisations)andtobacco/nicotine By remotenessarea,organisationsin the most commonsubstance-useissues. the 80organisations(16in organisational resources,werealcohol,cannabisandamphetamines(Table4.2).In2016‍17,allof The mostcommonsubstance-useissuesreportedin2016–17,termsofstafftimeand Substance useissues Alcohol and otherdrug useinregional andremoteAustralia: consumption, harmsand accesstotreatment 2016–17 Multiple druguse Tobacco/nicotine Amphetamines Cannabis/marijuana Alcohol issue Substance-use Organisations wereaskedtoreportontheir5mostimportantsubstance-useissuesintermsofstafftimeandorganisational Regional andremote resources. thanin AIHWanalysesofOSRdata Regional andremote includesallareasoutside Major cities collection, Major 10 14 13 16 6 areas(88%comparedwith78%)(Table4.2). 2016–17. cities and64in regional Regional andremote Major cities Inner 12 12 12 8 8 (thatis, regional Regional andremote Outer Inner regional 21 20 21 14 15 areas,comparedwiththosein Remote , Outer regional 10 19 19 10 13 areas)reportedalcoholas1of remote Very , Remote 12 12 11 7 6 and Regional remote Very remote and 50 63 64 38 47 Major cities, Major cities, Major ). Total 48 53 64 76 80

while in4.2% theclienttravelledmore than300kilometres(Table S5.5). of closedtreatmentepisodes theclienttravelledlessthan100kilometres tothetreatmentservice, while in5.2%ofepisodes, theclienttravelledformorethan3hours(Table S5.2).Similarly,in89% In 85%ofclosedtreatment episodes,theclienttravelledlessthan1hour tothetreatmentservice, service (TableS5.1). AOD treatmenttravelledamedianof17.9minutes and12.9kilometrestoaccesstheirtreatment conducted inotherepidemiologicalfields(AIHW 2016b).In2016–17,allclientswhosoughtspecialist required bytheclientwasestimatedforeachclosed treatmentepisode.Similaranalysishasbeen To measuregeographicaccesstotreatmentservices, thetraveltimeanddistancebyroadvehicle Travel timeanddistance Source: AODTSNMDS,2016–17. 2. 1. Notes residence totheStatisticalAreaLevel3(SA3)ofagencyandsizearea(km Table 5.1:Proportionofclosedepisodes,bylocationtheclient’slastknownusual information aboutthemethodologyusedtomeasuredclientstraveltime/distancetreatment). in 2016–17,wereestimatedtoprovideanindicationofgeographicaccessibility(seeAppendixB for NMDS, thetimesanddistancesbyroad,travelledclientswhosoughtspecialistAODtreatment is throughthetraveltimeanddistancesrequiredofaclientseekingtreatment.UsingAODTS One wayinwhichgeographicaccessibilityofAODspecialisttreatmentservicescanbemeasured distance requiredofclientstoaccessspecialistAODtreatment. episodes wasthemotivationforconductingtraveltimeanalysistofurtherexploreand were providedtoaclientwholivedoutsideofthisarea(Table5.1).Thisnotableproportion geographical areas(thatis, the treatmentagencywaslocated(seeAppendixBforgeographicalspecifications).Inlarger clients whoselastknownusualplaceofresidencewasoutsidethegeographicalareainwhich In the2016–17AODTSNMDS,justover3in5(61%)closedtreatmentepisodeswereprovidedto Remote impacting theaccessibilityofaservice,particularlyforclientslivingorseekingtreatmentin the accessibilityofthatservicetoclient.Geographiclocationis1prominentfactors socio-economic benefits(Lubmanetal.2014).Engagementwithatreatmentserviceislimitedby Engagement withspecialistAODtreatmenthelpsreduceproblematicsubstance-use,amongother 5 All SA3’s 1 million+km 100,001–1 millionkm 0–100,000 km Size ofSA3 Totals maynotequal100%,asrecordswithaninvalidpostcode areexcludedfromtheanalysisand/orresultsrounded. The SA3oftheclient’slastknownusualresidencewasassignedfrompostcode. and Access totreatment Alcohol and otherdrug useinregional andremoteAustralia: consumption, harmsand accesstotreatment 2016–17 Very remote 2 2 2 areasofAustralia.

pisodes those exceeding1,000,000squarekm),30%ofclosedtreatmentepisodes The client’slastknownusual residence isinsidethe SA3 oftheagency(%) 69 43 17 37

The client’slastknownusual residence isoutsidethe SA3 oftheagency(%) 2 ), 2016–17

30 55 80 61

5 Access to treatment 5

40 Access to treatment (15% comparedwith8%, respectively)(TableS5.2). episodes wheretheclienttravelledfor1houror longertotreatmentforanother’sdruguse for 1hourorlongertotreatmenttheirowndrug usewasgreaterthantheproportionofclosed (AIHW 2018c).In2016–17,theproportionofclosed treatmentepisodeswheretheclienttravelled of clientsin2016–17)andforthosewhoseektreatment foranother’sdruguse(4.7%in2016–17) The AODTSNMDScollectsinformationonclients whoseektreatmentfortheirowndruguse(96% Client demographics located in Differences intraveltimeanddistancemayreflecttheavailabilityofservices,withfewerservices treatment episodes,comparedwith10%ofclosedepisodesin Clients whosoughttreatmentin for amediantimeofjustover1.5hours(91.6 minutes),or102.7kilometres. or 10.7kilometres.However,clientswhosoughttreatmentina from aservicelocatedwithin 18.2 minutesandamediandistanceof13.2kilometres(TableS5.1).Thosewhosoughttreatment Clients whosoughttreatmentfromaservicelocatedwithin Alcohol and otherdrug useinregional andremoteAustralia: consumption, harmsand accesstotreatment 2016–17 2016–17 (%) Figure 5.1:Closedepisodes,traveltimebyremotenessareaoftreatmentservice, Source: of anewdatacollectionfromOctober2018. accurately reflecttheactualdistributionacrossstate.Itisanticipatedthatthiswillbeimprovedwithimplementation address ratherthanthelocationwhereactivitywasdelivered.Asaresult,Victoria’sremotenessreportingmaynot Note: eote n e eote e n eote InVictoria,alcoholandotherdrugtreatmentactivityisgenerallyrecordedagainstaserviceprovider’sadministrative TableS5.2. Regional andremoteareas te eionl te nne eionl o citie Regional andremote Regional andremote thanin Major cities Closed episodes treatment (%) o areas travelled 1 hour or longer in 28% of closed areastravelled1hourorlongerin28%ofclosed areatravelledamediantimeof13.9minutes, (seechapter4). Major cities Remote and o travelledamediantimeof Major cities v ery remote (TableS5.2). areatravelled

• • • • • drugs ofconcern,including: consistently higherin The proportionofclientswhotravelledmorethan1hourtotreatmentservicesin2016–17was Travelled for1hourorlonger • • • • • alcohol ordrugusevariedslightlybytheprincipalofconcern.Clientstravelledamedianof: In 2016–17,themediantraveltimeanddistanceforclientswhosoughttreatmenttheirown Median traveltimeanddistance Principal drugsofconcern compared with9%in episodes ofnon-Indigenousclientsbyremotenessarea(25%in episodes forIndigenousclientsin service inmorethan13(37%)closedtreatmentepisodes,comparedwith13%of who soughttreatmentin Travel timeforIndigenousandnon-Indigenousclientsvariedbyremoteness. non-Indigenous clientshadatraveltimeof1hourorlongertotheirtreatmentservice(TableS5.6). 1 in4(26%)closedtreatmentepisodes.About8(13%)episodesfor In 2016–17,Indigenousclientstravelledfor1hourorlongertotheirtreatmentserviceinabout to theirtreatmentservicewasforclientsaged60orolder. smallest proportionofclosedtreatmentepisodes(10%)whereclientstravelledfor1hourorlonger clients aged30–39travelledfor1hourorlongertotheirtreatmentservice consistent in 1 hourorlongertotheirtreatmentservicewasforclientsaged20–29(Table S5.4).This In 2016–17,thegreatestproportionofclosedtreatmentepisodes(17%)whereclientstravelledfor pharmaceuticals (25%comparedwith9%)(Figure 5.2). heroin (33%comparedwith7%) cannabis (25%comparedwith7%) amphetamines (31%comparedwith10%) alcohol (29%comparedwith7%) 15.4 minutesor11.4kilometresforpharmaceuticals(TableS5.9). 16.3 minutesor11.4kilometresforheroin 14.4 minutesor11kilometresforcannabis 18.7 minutesor13.5kilometresforamphetamines 16.3 minutesor12kilometresforalcohol Alcohol and otherdrug useinregional andremoteAustralia: consumption, harmsand accesstotreatment 2016–17 Major cities Major cities Regional andremote (12%),whilein Regional andremote ) (TableS5.6). Major cities Regional andremote areasthanin areastravelledfor1hourorlongertothetreatment . Asimilarpatternexistedfortheclosedtreatment Major cities areasaslightlyhigherproportionof Regional andremote forthemostcommonprincipal

(29%). Incontrast,the areas,

5 Access to treatment 5

42 Access to treatment in As previouslynoted,differences intraveltimeanddistancemayreflect theavailabilityofservices in in Similar patternsexistedfornon-Indigenousclients, withahigherproportionwhosoughttreatment • • • • • most commonprincipaldrugsofconcern,including: with Indigenousclientsin Regional andremote A higherproportionofclosedtreatmentepisodesforIndigenousclientswhosought in Aboriginal andTorresStraitIslanderpeople Alcohol and otherdrug useinregional andremoteAustralia: consumption, harmsand accesstotreatment 2016–17 pharmaceuticals (28%comparedwith19%)(Table S5.12). heroin (36%comparedwith7%) cannabis (34%comparedwith13%) amphetamines (37%comparedwith16%) alcohol (38%in concern andremotenessareaofthetreatmentservice,2016–17 for theirowndruguseandtravelled1hourorlongertotheservice,byprincipalof Figure 5.2:Proportionofclosedtreatmentepisodeswheretheclientsought Source: of anewdatacollectionfromOctober2018. accurately reflecttheactualdistributionacrossstate.Itisanticipatedthatthiswillbeimprovedwithimplementation address ratherthanthelocationwhereactivitywasdelivered.Asaresult,Victoria’sremotenessreportingmaynot Note: Regional andremote Major cities Regional andremote Closed treatment episodes InVictoria,alcoholandotherdrugtreatmentactivityisgenerallyrecordedagainstaserviceprovider’sadministrative TableS5.15. across themostcommon principaldrugsofconcern(TableS5.12). lcool Regional andremote areasfortheirownalcoholordrugusetravelled1hourlonger,compared areas. areaswhotravelled1hourorlonger,compared withnon-Indigenousclients Major cities etine areascomparedwith11%in (37% and14%,respectively o citie P r i n c i p a nni l

d r u g

o eionl n eote n eionl f

c o n c e r n ) . Thiswasconsistentacrossthe Major cities eoin ) ceticl

(23% comparedwith19%ofclosedepisodes,respectively). longer tothetreatmentservicethanclientswho soughttreatmentin a maintreatmenttypeofsupportandcasemanagement only,weremorelikelytotravel1houror Unlike othertreatmenttypes,clientswhosought treatmentin compared with9%in a maintreatmenttypeofassessmentonlytravelled1hourorlongerin41%closedepisodes, (Table S5.17).Clientswhosoughttreatmentin closed treatmentepisodesin when rehabilitationwasthemaintreatmenttype:clienttravelled1 hourorlongerin50%of Major cities remote Where counsellingwasthemaintreatmenttype,clientswhosoughtin travelled (onmedian)thelongesttimetotheirtreatmentservice(32.3 minutesor29.5kilometres). types (TableS5.16).Conversely,clientswhowereprovidedamaintreatmenttypeofrehabilitation 10.5 kilometrestotheservice,shortestmediantraveltimeanddistanceofallmaintreatment (AIHW 2018c).Clientswhowereprovidedwithcounsellingtravelledamedianof13.9 minutesor Counselling wasthemostcommonmaintreatmenttypeprovidedtoallclientsin2016–17(40%) Main treatmenttype Treatment provided Regional andremote the principaldrugofconcernandmaintreatmenttypewaswithdrawalmanagement(43%in and pharmaceuticals(55%comparedwith28%).Thiswasalsoevidentwhereamphetamineswere type wasrehabilitationandtheprincipaldrugofconcernheroin(78% comparedwith15%) compared withthosein Similarly, ahigherproportionofclientswhosoughttreatmentin amphetamines (48%comparedwith12%)(TableS5.15). particularly evidentwheretheprincipaldrugofconcernwasheroin(60% comparedwith6%)and for assessmentonlyastheirmaintreatmenttype,comparedwiththosein treatment fortheiralcoholordrugusein Regardless ofprincipaldrugconcern,asubstantiallyhigherproportionclientswhosought 1 hourorlongerthanclientswhosoughttreatmentin treatment from Across alltreatmenttypesandthemostcommonprincipaldrugsofconcern,clientswhosought Main treatmenttype areasweremorelikelytotravel1hourorlongertreatmentcomparedwiththosein Alcohol and otherdrug useinregional andremoteAustralia: consumption, harmsand accesstotreatment 2016–17 (24%and4%ofclosedtreatmentepisodes,respectively).Asimilarpatternwasevident Regional andremote areascomparedwith16%in Major cities Major cities Regional andremote (Figure5.3). —had totravel1hourorlongerwherethemaintreatment areasfortheiralcoholordruguseweremorelikelytotravel Regional andremote Regional andremote Major cities areas,comparedwith25%in Major cities ) (TableS5.15). areashadtotravel1 hourorlonger Major cities Regional andremote . areaswhowereprovidedwith Regional andremote andwereprovidedwith Major cities Regional and Major cities areas— . Thisis areas

5 Access to treatment 5

44 Access to treatment cities facility travelled1houror longerin5%ofclosedepisodeswhentheservice waslocatedin in or longerin21%ofclosed treatmentepisodes,comparedwith51%ofclosed treatmentepisodes Clients whosoughttreatment fromaresidentialfacilitylocatedwithin facility travelledfor1hourorlongerin11%ofclosed episodes(TableS5.19). to theservicein30%ofclosedepisodes,whilethose whosoughttreatmentfromanon-residential In 2016–17,clientswhosoughttreatmentfroma residentialfacilitytravelledfor1hourorlonger Delivery setting 23% forclientsdivertedfromthecriminaljustice systemto34%forothersourcesofreferral. difference intraveltimebysourceofreferralfor clientsin or moreoftraveltime,comparedwith5.3%–9.2% forallothersourcesofreferral.Therewaslittle service (11%)(TableS5.18).In from thecriminaljusticesystemwereleastlikelytotravel1 hourorlongertheirtreatment followed bytraveltohealthservices(15%)and‘other’sources(14%).Clientswhowerediverted closed treatmentepisodeswheretheytravelledfor1hourorlongertotheirservice(26%), In 2016–17,clientswhowerereferredfromacorrectiveservicehadthegreatestproportionof Source ofreferral Alcohol and otherdrug useinregional andremoteAustralia: consumption, harmsand accesstotreatment 2016–17 service, 2016–17 or longertotheservice,bymaintreatmenttypeandremotenessareaof Figure 5.3:Proportionofclosedtreatmentepisodeswheretheclienttravelledfor1hour Source: of anewdatacollectionfromOctober2018. accurately reflecttheactualdistributionacrossstate.Itisanticipatedthatthiswillbeimprovedwithimplementation address ratherthanthelocationwhereactivitywasdelivered.Asaresult,Victoria’sremotenessreportingmaynot Note: Regional andremote andin24% of closedepisodeswhen theservicewaslocated ina InVictoria,alcoholandotherdrugtreatmentactivityisgenerallyrecordedagainstaserviceprovider’sadministrative TableS5.17. o n t

o t n e i

c t i i t o n n c e

n areas. Bycomparison,clients whosoughttreatmentfromanon-residential

n e l

e e e c c o n o t t e e i n o i n n Major cities, l e e i n t t t e

o o o l t l e i i n n n o n n l l l n t 25%ofreferralsfromacorrectiveserviceinvolved1hour C l o s e Regional andremote d

t r e a t m e n t

e Regional and remote Major cities p i s o d e s

areas,rangingfrom eionl n eote n eionl o citie % travelled1 hour area. Major

• • unexpectedly, forexample,clientswho: There wassomevariationbytreatmenttypeintheproportionofepisodesthatended which wasagenerallyconsistentdifference,regardlessoftraveltimeanddistancetoservice. unexpectedly washigherin hour totreatment(20%)(TableS5.22).Theproportionofclientswithepisodesending in 21%ofclosedepisodes,whichwasasimilarproportiontothosewhotravelledlessthan1 In 2016–17,clientswhotravelled1hourorlongertotheirtreatmentceasedunexpectedly Reasons forendingtreatment areas (43%). unexpectedly thanforanyothertreatmenttypeinboth and rehabilitation(Figure5.4) to endtheirtreatmentunexpectedlyforalltypes,withtheexceptionofassessmentonly travelled morethan1hourtorehabilitationwerelikelyendtheirtreatmentepisode sought treatmentin Source: 2. 1. Notes service, 2016–17 ending unexpectedly,bymaintreatmenttypeandremotenessareaofthe Figure 5.4.Proportionofclosedtreatmentepisodeswithatraveltimeoveranhour In Victoria,alcoholandotherdrugtreatmentactivityisgenerally recordedagainstaserviceprovider’sadministrative Episodes thatendunexpectedlyincludeinstanceswheretheclient ceasedtoparticipateagainstadvice,withoutnotice of anewdatacollectionfromOctober 2018. accurately reflect the actual distribution across the state. It is anticipated that this will be improved with the implementation address ratherthanthelocation wheretheactivitywasdelivered.Asaresult,Victoria’sremoteness reportingmaynot due tonon-compliance. ot n neent ce onl ot Table S5.22. notion n ection onl ection n notion Alcohol and otherdrug useinregional andremoteAustralia: consumption, harmsand accesstotreatment 2016–17 te incte cote itl neent itl eent onl eent Regional andremote eilittion onellin Regional andremote areasandtravelledformorethan1hourwerelikely areasthanin Closed episodes treatment % Major cities Major cities (52%)and (26%comparedwith18%), eionl n eote n eionl o citie Regional andremote

5 Access to treatment 6

46 Conclusion potential clientsofAOD treatment servicesisabarriertocommencingtreatment. about servicedemand.Additional dataisneededtounderstandwhether geographicaccessibilityfor of servicesforthoseclients whoaccessedAODtreatmentservices;itcannot provideinformation The mainlimitationofthis reportisthattheanalysiscanprovideinsights onlyabouttheaccessibility whether traveltimesanddistancesforclientsaccessing AODtreatmenthavechangedovertime. highest proportionswhotravelledmorethan1hour totreatmentservices.Futureanalysiswillexamine were providedwithamaintreatmenttypeofrehabilitation (50%)andassessmentonly(41%)hadthe (33% and31%,respectively).Clientswhosought treatmentin treatment in types in2016–17.Heroinandamphetamineshad thehighestproportionofclientswhosought This patternwasthesameacrossmostcommon principaldrugsofconcernandmaintreatment time anddistancemayreflecttheavailabilityof servicesin likely thanthosein 2016–17. Thedatashowedthatclientswhosoughtservicesin This reportprovidesasnapshotofclients’traveltimeanddistancetotreatmentservicesduring average numberofepisodesperclient. compared withotherremotenessareas,despitehavingthesmallestnumberofclients,and the highestrateofclientswhosoughttreatment(1,294per100,000population)in2016–17, accounted for71%ofclosedtreatmentepisodes.Agenciesin Nationally, in2016–17,overhalf(58%)ofthetreatmentagencieswerelocated Regional andremote population). Therateofdrug-induceddeathsforheroinremainedhigherin and remote rate ofdrug-induceddeathsforanyopioid(excludingheroin)wassubstantiallyhigherin report highlightsthegrowthinrateofdeathsinvolvingopioids remote Over thepastdecade,rateofdrug-induceddeathshasincreasedatafasterin such asmethamphetaminesandopioids,cannabisothersedativeshypnotics. person resides,therateofhospitalseparationsforalcoholissignificantlyhigherthanotherdrugs and washighestforpeopleusuallyresidingin Alcohol remainsthemostcommoncauseofhospitalisationswithadrug-relatedprincipaldiagnosis of opioidssuchasoxycodoneandfentanylinregionalareas. Australia. DatafromtheNationalWastewaterMonitoringProgramalsoshowsahigherprevalence Major cities. however theconsumptionofillicitdrugssuchascocaineandecstasyweremoreprominentin The recentconsumptionofillicitdrugswassimilarin over alifetime,oratriskofalcohol-relatedinjuryfromsingledrinkingoccasion. drink alcoholinquantitiesthatplacedthematriskofharmfromanalcohol-relateddiseaseorinjury Australians livingin Major cities This reporthighlightsthedisparityofconsumptionpatterns,impactsandtreatmentservicesin 6 Alcohol and otherdrug useinregional andremoteAustralia: consumption, harmsand accesstotreatment 2016–17 areas,up41%since2008,comparedwitha16%increasein Conclusion and areas(4.0deathsper100,000population)thanin Forallremotenessareas,cannabisusewashighestin Regional andremote Regional andremote Major cities areas(1.9 comparedwith1.1deathsper100,000population). Regional andremote totravel1hourorlongerreachtheseservices.Differencesin areas andwhotravelledmorethan1hourtotreatment services areasforalcoholandotherdrugs. areasweremorelikelythanthoselivingin Remote andveryremote Major cities Regional andremote Major cities Remote andveryremote Regional andremote Regional andremote and Remote andveryremote Major cities. Regional andremote Regional andremote areas.Regardlessofwherea (3.3deathsper100,000 Major cities areas. In particular,the Major cities areasandwho areasweremore Major cities areashad thanin Regional and areas; Regional areas.The areasof and to

rest ofstateineachjurisdiction. Bureau ofStatistics(ABS) usestheARIA+;othersmayreportdatacomparing capitalcitiesandthe Different datasetsreport dataatdifferentlevelsofremotenessaround Australia.TheAustralian urban centresandlocalitiesin5separatepopulation ranges(Figure University ofAdelaideandisderivedbymeasuring theroaddistancefromapointtonearest The ARIA+wasdevelopedbytheHugoCentrefor MigrationandPopulationResearchatthe Relative remotenessismeasuredusingtheAccessibility andRemotenessIndexofAustralia(ARIA+). representation ofremotenessacrossAustralia. Major cities Darwin arenotclassifiedas Not alljurisdictionscontaineveryoneofthe5remoteness categories.Forexample,Hobartand take intoaccountchangesinpopulationcentresandsize,roadinfrastructureimprovements. across Australiaandovertime.Thisisbecausetheconceptof‘remoteness’dynamicneeds to The 5classesofremotenessaredeterminedusingaprocessthatprovidesconsistentdefinition • • • • • into 5classesofrelativeremotenessacrossAustralia: The AustralianStatisticalGeographyStandard(ASGS)(2018a)wasusedtoclassifyRemotenessAreas Australian StatisticalGeographyStandard(ASGS) have notbeencollectedbefore2012–13,sopopulationratesfortreatmentreported. may havemultipletreatmentepisodesinareferenceperiod. treatment episodesandarenotdirectlycomparablewithdatapresentedonpeople—asaperson Data fromtheAODTSNMDSpresentedinthisreportarebasedoninformationaboutclosed Torres StraitIslanderpeople.TheseagenciesprovidedatatotheOnlineServicesReportCollection. The AODTSNMDSdoesnotcoverallagenciesthatprovidesubstance-useservicestoAboriginaland AIHW’s NationalOpioidPharmacotherapyStatisticsAnnualDataCollection. prescribing orprovidingdosingservicesforopioidpharmacotherapy.Thesedataarecapturedinthe psychiatric hospitalsandprovidetreatmentonlytoadmittedpatients;orhavethesolefunctionof institutions; provideservicesprimarilyconcernedwithhealthpromotion;arelocatedinacutecare/ that primarilyprovideaccommodation(forexample,sobering-upshelters);arebasedincorrectional are notinscopeforthiscollection.Theseincludeagenciesthatdoreceiveanypublicfunding; variety ofsettingsinwhichpeoplereceivetreatmentforalcoholandotherdrug-relatedissuesthat It isdifficulttofullyquantifythescopeofalcoholandotherdrugservicesinAustralia.Therearea Alcohol andOtherDrugTreatmentServicesNationalMinimumDataSet(AODTSNMDS) Appendix A:Datasources Major cities Very remote Remote Outer regional Inner regional Australia(1.2%) Alcohol and otherdrug useinregional andremoteAustralia: consumption, harmsand accesstotreatment 2016–17 and ofAustralia(representing72%Australia’spopulationin2016) Australia(0.8%). Australia(17.8%) Australia(8.3%) Inner regional Major cities areas. Pleasesee ; whiletheAustralianCapitalTerritoryonlycontains online supplementaryinteractivemaps In theAODTSNMDS,dataonpeople

A1). foravisual

Appendix A: Data sources 48 Appendix A: Data sources makes itdifficulttogeneraliseNDSHSresults to thewholeIndigenouspopulation. communities withrelativelylowlevelsofEnglish literacy.Theexclusionofthesecommunities questionnaire isself-completed.In2016,theNDSHS wasunabletoincludemanyAboriginal Indigenous Australians.Itrequiresagoodcomprehension oftheEnglishlanguage,as not done,andthesurveyisspecificallydesigned toobtainreliablenationalestimatesfor hostels, ormotels,thosewhoarehomeless notincluded.Foreignlanguageinterviewsare Not allpopulationgroupsareincludedinthedata: forexample,peopleininstitutionalsettings, to enablegeneralisationoftheresults. The NDSHScoversasignificantvarietyofpeopleandusesmethodthatispowerfulenough Survey samplesizes Table A1:NationalDrugStrategyHousehold consistent comparisonwithearliersurveyresults. Most oftheanalysesarebasedonpopulationaged14andover(unlessspecified),asthisallows institutionalised werenotincludedinthesurvey(consistentwithapproachpreviousyears). and behaviours(TableA1).Thesamplewasbasedonhouseholds,sopeoplewhowerehomelessor In 2016,23,772peopleaged12andovergaveinformationontheirdrugusepatterns,attitudes, manage the2016survey,andAIHWcommissionedRoyMorganResearchtocollectdata. The DepartmentofHealthcommissionedtheAustralianInstituteandWelfare(AIHW)to response todrug-relatedissues. data collectedthroughthesesurveyshavecontributedtothedevelopmentofpoliciesforAustralia’s surveys weredonein1985,1988,1991,1993,1995,1998,2001,2004,2007,2010,and2013.The The 2016surveywasthe12thdoneunderauspicesofNationalDrugStrategy.Previous The NDSHSistheleadingnationalpopulation-basedsurveyoflicitandillicitdruguseinAustralia. National DrugStrategyHouseholdSurvey Alcohol and otherdrug useinregional andremoteAustralia: consumption, harmsand accesstotreatment 2016–17 1993 1995 1998 2001 2004 2007 2010 2013 2016 Survey year Respondents 10,030 26,744 29,445 23,356 26,648 23,855 23,772 3,500 3,850

problems, 10threvision,Australianmodification, 9thedition(ICD-10-AM)(ACCD2014)(seeTableA2). a selectionofcodesfromtheInternationalStatistical ClassificationofDiseasesandRelatedHealth The hospitalseparationsdataincludedinthisreport wereextractedfromtheAIHWNHMDusing Hospital separationsdata hospital facilitiesintheAustralianCapitalTerritory. The greatmajorityofprivatehospitalsalsoprovideddata,exceptforthefree-standingday 2016–17. (TheexceptionwasanearlyparentingcentreintheAustralianCapitalTerritory.) Database (NHMD),whichincludesalmostallpublichospitalsthatprovideddataforthisdatabase in Information ondrug-relatedhospitalisationsistakenfromtheAIHWNationalHospitalMorbidity National HospitalMorbidityDatabase(NHMD) the RPBS). in thedataset(exceptforalimitednumberoflow-dosecodeinepreparationssubsidisedthrough Private prescriptionsandlow-dosecodeinecombinationssoldover-the-counterarenotincluded • • • The PBSdoesnotinclude: available forthisprogram. of the Note thatdrugsusedintheOpiateDependenceTreatmentProgramareprovidedundersection100 Services inremoteareasofAustralia. general schedulemedicinesthataresupplieddirectlytoIndigenouspatientsviaAboriginalHealth Dependence TreatmentProgram(whichincludesopioidsusedinopioidsubstitutiontherapy)and National HealthAct1953 Some drugsaredistributedunderalternativearrangements,andcomesection100ofthe day patients(inalljurisdictionsexceptNewSouthWalesandtheAustralianCapitalTerritory). available inprivatehospitalsandthrougheligiblepublictopatientsondischarge (Section 85)aredispensedthroughcommunitypharmacies,butPBS-subsidiseddrugsalso for eligiblewarveteransandtheirdependants.Mostprescriptionsgeneralschedulemedicines Pharmaceutical BenefitsScheme(PBS)andtheRepatriation(RPBS) The AustralianGovernmentsubsidisesthecostofprescriptionmedicinesthrough Pharmaceutical BenefitsScheme(PBS) medicines suppliedtosomepublichospitalinpatients. over-the-counter medicines private prescriptions National HealthAct1953 Alcohol and otherdrug useinregional andremoteAustralia: consumption, harmsand accesstotreatment 2016–17 . Examplesarethehighlyspecialiseddrugsprogram,includingOpiate andhavebeenexcludedfromtheanalysis,asscript-leveldataarenot

Appendix A: Data sources 50 Appendix A: Data sources regions inthisreportwere derivedusingtheplaceofaperson’sresidence atthetimeofdeath. mortality dataareshown basedontheyearofdeathregistration.Mortality databygeographical death occurredandthe year inwhichitwasregisteredareprovided.For thepurposesofthisreport, such assex;ageatdeath; areaofusualresidence;andIndigenousstatus. Boththeyearinwhich The databasecomprisesinformationaboutcauses ofdeathandothercharacteristicstheperson, the AIHWinNMD. Department of Justice) andincludecauseofdeath codedbytheABS.Thedataaremaintained Deaths andMarriagestheNationalCoronial InformationSystem(managedbytheVictorian onwards. CauseofDeathUnitRecordFile dataare providedtotheAIHWbyRegistriesofBirths, The AIHWNationalMortalityDatabase(NMD)holds recordsfordeathsinAustraliafrom1964 National MortalityDatabase(NMD) Note: Table A2:RelationshipbetweenthedrugofconcernandICD-10-AMcodes Alcohol and otherdrug useinregional andremoteAustralia: consumption, harmsand accesstotreatment 2016–17 Drug ofconcernidentifiedinprincipaldiagnosis by themother’salcohol,tobacco,orotherdrugaddiction) Fetal andperinatal-relatedconditions(includescaused Fetal andperinatal-relatedconditions anabolic andandrogenicsteroids;opiateantagonists) (includes psychotropicdrugsnotelsewhereclassified;diuretics; Unspecified druguseandotherdrugsnotelsewhereclassified Multiple druguse Other andunspecifieddrugsofconcern Volatile solvents Antidepressants andantipsychotics Other stimulants(includesamphetaminesandcaffeine) Tobacco andnicotine Cocaine Hallucinogens (includesLSD) Cannabinoids (includescannabis) Stimulants andhallucinogens benzodiazepines; excludesethanol) Other sedativesandhypnotics(includesbarbiturates Alcohol (includesethanol) Sedatives andhypnotics Non-opioid analgesics(includesparacetamol) Opioids (includesheroin,opium,morphineandmethadone) Analgesics Data for2016–17werereportedtotheNationalHospitalMorbidityDatabaseusingICD-10-AM.

ICD-10-AM codes T46.3 F15.0–15.9, T40.6,T43.6,T46.0, F17.0–17.9, T65.2,Z58.7,Z71.6 F14.0–14.9, T40.5 F16.0–16.9, T40.8,T40.9 F12.0–12.9, T40.7 F13.0–13.9, T41.2,T42.3–42.8 T51.0–51.9, Z71.4 K29.2, K70.0–70.9,K85.2,K86.0, E52, F10.0–10.9,G31.2,I42.6, T39.8, T39.9, F55.2, T39.0,T39.1,T39.3,T39.4, F11.0–11.9, T40.0–40.4 P04.2–4, Q86.0 T50.7, Z71.5 N14.1–3, T38.7,T43.8–9,T50.1–3, F55.1, F55.3–6,F55.8,F55.9, F19.0–19.9 T59.0, T59.8 F18.0–18.9, T52.0–52.9,T53.0–9, F55.0, T43.0–43.5

Statistics from theABS. Population estimatesunderpinning allestimatesweresourcedfromthe AustralianDemographic standard lifetableforfatal burden,healthstatesanddisabilityweightsfor thenon-fatalburden. Other inputswereobtained fromthe2010or2013GlobalBurdenofDisease. Theseincludedthe of DiseaseStudy 2010 or 2013,fromdirectevidenceAustralian datasourceswhereavailable. registry dataandmonitoringprograms.Relative riskswereobtainedmostlyfromtheGlobalBurden Risk factorexposuredataweresourcedfromavariety ofdatasourcesincludingnationalsurveys, registers, administrativedata,surveysandepidemiological studies. sources ofepidemiologicalmeasures(suchasincidence, prevalenceandmortality)fromdisease AIHW’s NMD.Morbiditydatatoestimatenon-fatal burdenweredrawnfromawidevarietyofexisting obtained frommanydifferentsources.Deaths data toestimatefatalburdenweresourcedfromthe In theAustralianBurdenofDiseaseStudy2011, datatodevelopburdenofdiseaseestimateswere Australian BurdenofDiseaseStudy2011 Table A3:RelationshipbetweenthedrugtypeandICD-10codes < For moreinformationontheAIHWNMDseeDeathsdataat • • quality statementsunderpinningtheAIHWNMDcanbefoundonfollowingABSinternetpages: preliminary data.RevisedanddataaresubjecttofurtherrevisionbytheABS.The registered in2015arebasedonreviseddata;deaths2016and2017 Deaths registeredin2014andearlierarebasedonthefinalversionofcausedeathdata:deaths Non-opioid analgesics Paracetamol Alcohol All antipsychotics Other antipsychotic All antidepressants Other antidepressants Methamphetamine All depressants Benzodiazepam Any opioidexcludingheroin Any opioid Cannabinoids Other unspecifiedopioid Other syntheticopioid Methadone Other opioid Heroin Drug type https://www.aihw.gov.au/about-our-data/our-data-collections/national-mortality-database < < ABS qualitydeclarationsummaryforCausesofdeath,Australia(ABScat.no.3303.0) ABS qualitydeclarationsummaryforDeaths,Australia(ABScat.no.3302.0) http://www.abs.gov.au/ausstats/abs%40.nsf/mf/3303.0 http://www.abs.gov.au/ausstats/abs%40.nsf/mf/3302.0/ Alcohol and otherdrug useinregional andremoteAustralia: consumption, harmsand accesstotreatment 2016–17 T40.0, T40.1,T40.2,T40.3,T40.4,T40.6 T40.0, T40.2,T40.3,T40.4,T40.6 T43.3, T43.4,T43.5 T43.0, T43.1,T43.2 ICD-10 codes T39.0–T39.9 T42.0–T42.9 / >. >

T40.7 T40.6 T40.4 T40.3 T40.2 T40.1 T39.1 T51.9 T43.5 T43.2 T43.6 T42.4

>. 51

Appendix A: Data sources 52 Appendix A: Data sources that havebeenusedbythepopulationcontributedtothiswastewater. available foreachsamplingperiod,thiswillnotaffecttheoverallestimateofamountdrugs in thevolumeofwastewaterthatentersatreatmentplant—butprovidingflow is collected bylocaloperators.Itshouldbenotedthatraineventsmay,forexample,causeanincrease volume of wastewater entering the WWTP (flow volume) that is associated with a given sample is also autosampler (wherethewastewaterenterstreatmentplants).Pertinentinformationon treatment plantoperatorsprovideassistancewithcollectingthesamplesfromtheinfluent (typically 24hours)usingautosamplersthatcollecttimeorflowproportionalsamples.Wastewater To obtainanestimateofdruguse,representativesamplesarecollectedoveragivenperiod laundry appliances,aswellallotherdomestic,industrialorcommercialplumbedstructures. Wastewater consistsofhighlycomplexmixtureswhichderivefromtoilets,bathrooms,kitchenand and isdoneonapopulation-scalelevel,soindividualsarenottargetedprivacyrespected. determine theamountofdrugthatwasusedovercollectionperiod.Themethodisnon-invasive of targetcompoundinthewastewaterstreamallowsforabackcalculationfactortobeapplied where wastewatersamplesarecollectedoveradefinedsamplingperiod.Measuringtheamount Collectively, wasteproductsinthesewersystemarriveatawastewatertreatmentplant(WWTP) compound ormetabolitewilleventuallyarriveinthesewersystem. is consumedand/orinachemicallymodifiedformthatreferredtoasmetabolite).Theexcreted inhaled/smoked orinjected)willsubsequentlybeexcreted(eitherinthechemicalformwhichit the principlethatanygivencompoundisconsumed(irrespectiveofwhetheritswallowed, The methodunderlyingwastewater-basedmonitoringofdruguseinagivenpopulationisbasedon National WastewaterDrugMonitoringProgram(NWDMP),ACIC methods-and-supplementary-material/contents/table-of-contents>.

Australian BurdenofDiseaseStudy2011 availableontheAIHWwebsiteat: Impact ofalcoholandillicitdruguseon . SeeChapter1.6 Australian

Burden

duration andtraveltime;thereforesinglePWCwere usedforcomputationalefficiency. Following testingtheinclusionofmultiplecentroids, nosignificantdifferenceswerefoundinmedian wide populationspread.Onesolutiontothisissue wouldbetodevelopmultiplecentroidsfor1area. Using asinglePWCoverlargeareascouldprovide inaccurateresultsforthoselargeareaswitha by theshortestgeodesicdistance.Thisdidnotincur atime/travelpenalty. the traveltime/distancewascalculatedfromortopointonaroadclosestPWC the nearestvalidlocation.IncaseswhereoriginordestinationPWClocationdidnotlieona road, PWCs thatweregeneratedininvalidareas(forexample,bodiesofwater)manuallyadjusted to This isacommonmethodtobestrepresentthelocationofpeopleandserviceswithinanarea. the populationinrespectiveareas,generatingamedianpopulation-weightedcentroid(PWC). Origin anddestinationgeographicpointswereallocatedbasedonthedistribution of Population-weighted centroids(PWC) geographic centroidwasselected. exactly on50%,ofwhichtheclosestSA3PWC(population-weightedcentroid)topostalarea’s 15 postalareashaveamajoritySA3allocationof50%orless.Oneareahasan cover multipleSA3s,theSA3allocationwithmajorityproportionofpostalareawasselected. compared withPostalArea2011toSA2(aqualityindicatormeasureof‘ concordance qualityofPostalArea2011toSA3(aindicatormeasure‘ The selectionofSA3astheorigingeography,andnotequivalentSA2,wasduetohigher (SA2) ofthetreatmentservicelocation. The last knownplaceofusualresidenceusingtheABSPostalArea2011toSA3correspondence. Statistical AreaLevel32011(SA3).Thiswascalculatedviaconcordanceofthepostcodeclient’s The it wasomittedfromthisanalysisduetothelackofcontemporarydata. between anoriginanddestinationpoints.Whiletheinclusionoftrafficconditionswasavailable, the optimisedtraveltimeanddistancebyroadbasedonrules,speedlimitstypes The traveltime/distancebyroadwasestimatedusingEsriArcGISsoftware.software conducted inotherepidemiologicalfields(AIHW2016b). required bytheclientwasestimatedforeachclosedtreatmentepisode.Similaranalysishasbeen To measuregeographicaccesstotreatmentservices,thetraveltimeanddistancebyroadvehicle client traveltime/distancetoservices Appendix B:Methodologyformeasuring treatment servicelocation(destination) client’s location(origin) Alcohol and otherdrug useinregional andremoteAustralia: consumption, harmsand accesstotreatment 2016–17 wasbasedontheAustralianStandardGeographical(ASGS) wasbasedontheASGS2011StatisticalAreaLevel2 Poor’ ). Aspostcodescan Good’ ),

Appendix B: Methodology for measuring client travel time/distance to services 54 Appendix B: Methodology for measuring client travel time/distance to services • • • • • • Caveats • • origin-destination pathswere‘unreachable’. their travelpathwillrender‘unreachable’andbeexcludedfromtheanalysis.Intotal,19unique Australia; therefore,iftheyreceivedtreatmentonthemainlandwithapostcodeanisland,then the analysis.Forexample,aclientcanresideonanislandwithnovehicleferryaccesstomainland Paths betweenoriginanddestinationPWCthathaveseveredroadnetworkswereexcludedfrom Exclusions Alcohol and otherdrug useinregional andremoteAustralia: consumption, harmsand accesstotreatment 2016–17 where publictransportiscommonlyused(forexample,incentralbusinessdistricts). via publictransport.Thisassumptionmayhaveanimpactontheestimatesforthoselocations times aretypicallyinflatedbyapproximately800to1200minutes. Australia, orviceversa,mayhaveinflatedestimatestoaccountforferrytravel.Thesepaths’travel minimal impactthatinclusionoftraffichad. number ofepisodeswiththisissuewasindeterminable. have aninflatedestimate,astheoriginpointisbasedontheirusualresidence.Thepotential estimates willdecrease,asremotestatisticalareasarelargerinsizethanmetropolitan. indicates that,asremotenessincreases(thatis,becomesmoreremote),theaccuracyof increases, astherearegreaterdistancesbetweenthePWCandpotentiallocalities.Thispotentially outreach setting. episodes hadadeliverysettingofhomeand13%closed destination location.Itisunknownwheretheseepisodesareconducted.In2016–17,1%ofclosed from theanalysis.Boththesecodesrefertoatreatmentdeliverysettingnotequalassigned The analysisassumesprivateroadtravelanddoesnotaccountforclientswhototreatment Travel pathswithanorigincentroidlocatedonTasmaniaandadestinationinmainland Traffic wasomittedfromtheanalysismodel,duetolackofcontemporarytrafficdataand the Clients whoaretemporarilyresidinginalocationandreceivetreatmentnearthatmay The accuracyofthetraveltime/distanceestimatewilldecreaseassizeSA3andSA2 Travel time/distanceisanoptimisedestimationandlimitedbytheroadnetworkofsoftware. Closed episodeswithatreatmentdeliverysettingofhomeoroutreachwereexcluded The analysisexcludestreatmentepisodeswithanunallocatedclientpostcode. Acknowledgments

The authors of this report were Mr Josh Sweeney, Mr Lachlan Facchini and Ms Marissa Veld from the Tobacco, Alcohol and Other Drugs Unit of the Australian Institute of Health and Welfare.

Ms Cathy Claydon and Ms Kristina Da Silva assisted with the data analysis, and Ms Katherine Green, Ms Moira Hewitt, Ms Kristy Raithel and Mr Matthew James provided essential advice and guidance. The contributions, comments and advice of the Alcohol and Other Drug Treatment Services National Minimum Data Set Working Group are gratefully acknowledged.

The Department of Health provided funding for this report.

Thanks are extended to the data managers and staff in the following departments:

• Australian Government Department of Health

• New South Wales Ministry of Health

• Victorian Department of Health and Human Services

• Queensland Department of Health

• Western Australian Mental Health Commission

• South Australian Department of Health

• Tasmanian Department of Health

• Australian Capital Territory Health Directorate

• Northern Territory Department of Health.

Alcohol and other drug use in regional and remote Australia: consumption, harms and access to treatment 2016–17 55 Abbreviations

ABS Australian Bureau of Statistics

AIHW Australian Institute of Health and Welfare

AODTS NMDS Alcohol and Other Drug Treatment Services National Minimum Data Set

ASGS Australian Statistical Geography Standard

NDSHS National Drug Strategy Household Survey

PBS Pharmaceutical Benefits Scheme

NHMRC National Health and Medical Research Council

Symbols

— nil or rounded to zero

. . not applicable

n.a. not available

n.p. not publishable because of small numbers, confidentiality or other concerns about the quality of the data

56 Alcohol and other drug use in regional and remote Australia: consumption, harms and access to treatment 2016–17 Glossary

Aboriginal or Torres Strait Islander: A person of Aboriginal and/or Torres Strait Islander descent who identifies as an Aboriginal and/or Torres Strait Islander. abstainer (alcohol): Has not consumed a full serve of alcohol in the previous 12 months. additional drugs: Clients receiving treatment for their own drug use nominate a principal drug of concern that has led them to seek treatment and additional drugs of concern, of which up to 5 are recorded in the AODTS NMDS. Clients receiving treatment for someone else’s drug use do not nominate drugs of concern. additional treatment type: Clients receive 1 main treatment type in each episode and additional treatment types as appropriate, of which up to 4 are recorded in the AODTS NMDS. administrative cessation: Includes episodes that ended due to a change in main treatment type, delivery setting or principal drug of concern, or where the client was transferred to another service provider. alcohol: A central nervous system depressant made from fermented starches. Alcohol inhibits brain functions, dampens the motor and sensory centres and makes judgement, coordination and balance more difficult. amphetamines: Stimulants that include methamphetamine, also known as methylamphetamine. Amphetamines speed up the messages going between the brain and the body. Common names are speed, fast, up, uppers, louee, goey and whiz. Crystal methamphetamine is also known as ice, shabu, crystal meth, base, whiz, goey or glass. Australian Statistical Geography Standard (ASGS): Common framework defined by the ABS for collection and dissemination of geographically classified statistics. The ASGS replaced the Australian Standard Geographical Classification (ASGC) in July 2011. Australian Statistical Geography Standard (ASGS) Remoteness Area: The ABS ASGS Remoteness Area classification allocates 1 of 5 remoteness categories to areas, based on their relative accessibility to goods and services (such as general practitioners, hospitals and specialist care) as measured by road distance. These classifications reflect the level of remoteness at the time of the 2011 Census. Areas are classified asMajor cities, Inner regional, Outer regional, Remote and Very remote. For analysis, Remote and Very remote are often grouped together. benzodiazepines: Also known as minor tranquillisers, these drugs are most commonly prescribed by doctors to relieve stress and anxiety, and to help people sleep. burden of disease (and injury): The quantified impact of a disease or injury on a population, using the disability-adjusted life year (DALY) measure. client type: The status of a person in terms of whether the treatment episode concerns their own alcohol and/or other drug use or that of another person. Clients may seek treatment or assistance concerning their own alcohol and/or other drug use, or treatment and/or assistance in relation to the alcohol and/or other drug use of another person. closed treatment episode: A period of contact between a client and a treatment provider or team of providers. An episode is closed when treatment is completed, there has been no further contact between the client and the treatment provider for 3 months or when treatment is ceased (see reason for cessation).

Alcohol and other drug use in regional and remote Australia: consumption, harms and access to treatment 2016–17 57 diversion client type: Clients who received at least 1 AOD treatment episode during a collection year resulting from a referral by a police or court diversion program. The 2 subtypes in this group are: diversion-only clients—received treatment as a result of diversion referrals only diversion client with non-diversion episodes—received at least 1 treatment episode of treatment resulting from a diversion referral, but also received at least 1 treatment episode resulting from a non-diversion referral in a collection year. ecstasy (MDMA): The popular street name for a range of drugs containing the substance 3, 4-methylenedioxymethamphetamine (MDMA)—a stimulant with hallucinogenic properties. Common names for ecstasy include Adam, Eve, MDMA, X, E, the X, XTC and the love drug. expected cessation: Includes episodes where the treatment was completed, or where the client ceased to participate at expiation, or by mutual agreement. fatal burden: The burden from dying ‘prematurely’ as measured by years of life lost. Often used synonymously with YLL, and also referred to as ‘life lost’. heroin: One of a group of drugs known as opioids, which are strong pain-killers with addictive properties. Heroin and other opioids are classified as ‘depressant’ drugs. Common names for heroin include smack, skag, dope, H, junk, hammer, slow, gear, harry, big harry, horse, black tar, China white, Chinese H, white dynamite, dragon, elephant, boy, home-bake or poison. hospital separation: The term used to refer to the episode of care, which can be a total hospital stay (from admission to discharge, transfer or death), or a portion of a hospital stay beginning or ending in a change of type of care (for example, from acute to rehabilitation).

illicit drug use: Includes: • the use of illegal drugs—drugs that are prohibited from manufacture, sale, or possession in Australia, such as cannabis, cocaine, heroin and ecstasy

• misuse, non-medical or extra-medical use of pharmaceuticals—drugs that are available from a pharmacy, over-the-counter, or by prescription, which may be subject to misuse, such as opioid-based pain relief medications, opioid substitution therapies, benzodiazepines, over-the-counter codeine and steroids

• use of other psychoactive substances—legal or illegal, potentially used in a harmful way, such as kava, or inhalants such as petrol, paint or glue (but not including tobacco or alcohol).

lifetime risk (alcohol): the accumulated risk from drinking—either on many drinking occasions, or regularly (for example, daily)—over a lifetime. The lifetime risk of harm from alcohol-related disease or injury increases with the amount consumed. main treatment type: The principal activity that is determined, at assessment by the treatment provider, to treat the client’s alcohol or other drug problem for the principal drug of concern. median: The midpoint of a list of observations ranked from the smallest to the largest. nicotine: The highly addictive stimulant drug in tobacco. non-government agency: An agency that receives some government funding, but is not controlled by the government, and is directed by a group of officers or an executive committee. A non-government agency may be an income tax-exempt charity.

58 Alcohol and other drug use in regional and remote Australia: consumption, harms and access to treatment 2016–17 non-medical use: Use of drugs either alone or with other drugs to induce or enhance a drug experience, for performance-enhancement or for cosmetic purposes. In this report, this includes pain-killers/analgesics, tranquilisers/sleeping pills, steroids and meth/amphetamines and other opioids such as morphine or pethidine. principal drug of concern: The main substance that the client stated led them to seek treatment from an alcohol and drug treatment agency. reason for cessation: The reason the client ceased to receive a treatment episode from an alcohol and other drug treatment service. The client can have: • ceased to participate against advice—where the service provider is aware of the client’s intention to stop participating in treatment, and the client ceases despite advice from staff that such action is against the client’s best interests

• ceased to participate at expiation—where the client has fulfilled their obligation to satisfy expiation requirements (for example, participation in a treatment program to avoid having a criminal conviction being recorded against them) as part of a police or court diversion scheme, and chooses not to continue with further treatment

• ceased to participate by mutual agreement—where the client ceases participation by mutual agreement with the service provider, even though the treatment plan has not been completed. This may include situations where the client has moved out of the area

• ceased to participate involuntarily—where the service provider stops the treatment due to non-compliance with the rules or conditions of the program

• ceased to participate without notice

• a change in the delivery setting

• a change in the principal drug of concern

• a change in the main treatment type

• died

• been to a drug court or sanctioned by a court diversion service—where the client is returned to court or jail due to non-compliance with the program

• been imprisoned (other than sanctioned by a drug court or diversion service)

• completed treatment—where the treatment was completed as planned

• been transferred to another service provider—including where the service provider is no longer the most appropriate, and the client is transferred or referred to another service. (For example, transfers could occur for clients between non-residential and residential services, or between residential services and a hospital.) This excludes situations where the original treatment was completed before the client transferred to a different provider for other treatment. referral source: The source from which the client was transferred or referred to the alcohol and other drug treatment service. single occasion risk (alcohol): A single occasion is a sequence of drinks taken without the blood alcohol concentration reaching zero in between. The risk of an alcohol-related injury arising from a single occasion of drinking increases with the amount consumed.

Alcohol and other drug use in regional and remote Australia: consumption, harms and access to treatment 2016–17 59 standard drink: Contains 10 grams of alcohol (equivalent to 12.5 millilitres of alcohol). Also referred to as a ‘full serve’.

tobacco: A plant, Nicotiana tabacum, whose leaves are dried and used for smoking and chewing and in snuff. Its major pharmacologically active substance is the alkaloid nicotine (seenicotine ).

treatment episode: The period of contact between a client and a treatment provider or a team of providers. Each treatment episode has 1 principal drug of concern and 1 main treatment type. If the principal drug or main treatment changes, then a new episode is recorded.

treatment type: The type of activity that is used to treat the client’s alcohol or other drug problem, which includes:

• assessment only—where only assessment is provided to the client (service providers would normally include an assessment component in all treatment types)

• counselling—can include cognitive behaviour therapy, brief intervention, relapse intervention and motivational interviewing

• information and education only

• pharmacotherapy—where the client receives another type of treatment in the same treatment episode, and includes drugs such as naltrexone, buprenorphine and methadone used as maintenance therapies or for relapse prevention for people who are addicted to certain types of opioids. Where a pharmacotherapy is used for withdrawal, it is included in the withdrawal category. Due to the complexity of the pharmacotherapy sector, this report provides only limited information on agencies whose sole function is to provide pharmacotherapy

• rehabilitation—focuses on supporting clients in stopping their drug use, and preventing psychological, legal, financial, social and physical consequences of problematic drug use. Rehabilitation can be delivered in several ways, including residential treatment services, therapeutic communities and community-based rehabilitation services

• support and case management only—‘support’ includes helping a client who occasionally calls an agency worker for emotional support, while ‘case management’ is usually more structured than ‘support’. It can assume a more holistic approach, taking into account all client needs (including general welfare needs) and it includes assessment, planning, linking, monitoring and advocacy

• withdrawal management (detoxification)—includes medicated and non-medicated treatment to help manage, reduce or stop the use of a drug of concern.

unexpected cessation: Includes episodes where the client ceased to participate against advice, without notice, or due to non-compliance.

YLL (years of life lost): Years of life lost due to premature death, defined as dying before the ideal life span. YLL represent fatal burden.

60 Alcohol and other drug use in regional and remote Australia: consumption, harms and access to treatment 2016–17 References

ABS (Australian Bureau of Statistics) 2016. National Aboriginal and Torres Strait Islander Social Survey, 2014–15. ABS cat. no. 4714.0. Canberra: ABS.

ABS 2017a. Causes of death, Australia, 2016. ABS cat no. 3303.0. Canberra: ABS.

ABS 2017b. Patient experiences in Australia: summary of findings, 2016–17. ABS cat. no. 4839.0. Canberra: ABS.

ABS 2018a. Australian Statistical Geography Standard (ASGS): volume 5—Remoteness Structure, July 2016. ABS Cat no. 1270.0.55.005. Canberra: ABS.

ABS 2018b. Causes of death, Australia, 2017. ABS cat no. 3303.0. Canberra: ABS.

ABS 2018c. Life tables for Aboriginal and Torres Strait Islander Australians, 2015–17. ABS cat. no. 3302.0.55.003 Canberra: ABS.

ABS 2018d. Regional population growth, Australia, 2016–17. ABS cat. no. 3218.0. Canberra: ABS.

ACIC (Australian Criminal Intelligence Commission) 2019. National Wastewater Drug Monitoring Program: report 6, December 2018. Canberra: ACIC. Viewed 28 February 2019, .

AIHW (Australian Institute of Health and Welfare) 2015. The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples 2015. Cat. no. IHW 147. Canberra: AIHW.

AIHW 2016a. Australian Burden of Disease Study: impact and causes of illness and death in Aboriginal and Torres Strait Islander people 2011. Australian Burden of Disease Study series no. 6. Cat. no. BOD 7. Canberra: AIHW.

AIHW 2016b. Spatial distribution of the supply of the clinical health workforce 2014: relationship to the distribution of the Indigenous population. Cat. no. IHW 170. Canberra: AIHW.

AIHW 2017a. National Drug Strategy Household Survey 2016: detailed findings. Drug statistics series no. 31. Cat. no. PHE 214. Canberra: AIHW. Viewed 14 December 2017.

AIHW 2017b. Rural and remote health. Web report. Canberra: AIHW. Viewed 1 July 2018, .

AIHW 2018a. Aboriginal and Torres Strait Islander health organisations: Online Services Report—key results 2016–17. Aboriginal and Torres Strait Islander health services report no. 9. Cat. no. IHW 196. Canberra: AIHW.

AIHW 2018b. Admitted patient care 2016–17: Australian hospital statistics. Health services series no. 84. Cat. no. HSE 201. Canberra: AIHW.

AIHW 2018c. Alcohol and other drug treatment services in Australia: 2016–17. Drug treatment series no. 31. Cat no. HSE 207. Canberra: AIHW.

AIHW 2018d. Australian Burden of Disease Study 2015: fatal burden preliminary estimates. Web report. Canberra: AIHW. Viewed 1 August 2018, .

Alcohol and other drug use in regional and remote Australia: consumption, harms and access to treatment 2016–17 61 AIHW 2018e. Impact of alcohol and illicit drug use on the burden of disease and injury in Australia: Australian Burden of Disease Study 2011. Australian Burden of Disease Study series no. 17. Cat. no. BOD 19. Canberra: AIHW.

AIHW 2018f. Patients’ out-of-pocket spending on Medicare services 2016–17. Cat. no. HPF 35. Canberra: AIHW.

Collins DJ & Lapsley HM 2008. The costs of tobacco, alcohol and illicit drug abuse to Australian society in 2004/05. National Drug Strategy Monograph Series No. 64.

DoH (Department of Health) 2017. National Drug Strategy 2017–2026. Canberra: Department of Health.

Lubman D, Manning V, Best D, Berends L, Mugavin J, Lloyd B et al. 2014. A study of patient pathways in alcohol and other drug treatment: Patient Pathways National Project final report. Fitzroy: Turning Point.

NHMRC (National Health and Medical Research Council) 2009. Australian guidelines to reduce health risks from drinking alcohol. Canberra: NHMRC. Viewed 12 October 2017, .

Roche A & McEntee A 2017. Ice and the outback: patterns and prevalence of methamphetamine use in rural Australia. Australian Journal of Rural Health 25(4):200–9.

Turning Point 2017. Ambo-AODstats. Melbourne: Victoria. Viewed 17 September 2018, .

62 Alcohol and other drug use in regional and remote Australia: consumption, harms and access to treatment 2016–17 List of tables

Table 1.1: Experience of health services in the last 12 months, by remoteness area, persons aged 15 and over, 2016–17 (%)...... 3

Table 2.1: Proportion of people aged 14 or older drinking alcohol at levels that placed them at harm over a lifetime, by top and bottom 5 areas of remoteness, 2016...... 9

Table 2.2: Proportion of people aged 14 or older drinking alcohol at levels that place them at harm on a single occasion, at least monthly, by top and bottom 5 areas of remoteness, 2016...... 9

Table 2.3: Proportion of people aged 14 or older who recently used an illicit drug, by top and bottom 5 areas of remoteness, 2016...... 13

Table 4.1: Closed treatment episodes, by remoteness area, states and territories, 2016–17 (%)...... 26

Table 4.2: Number of Aboriginal and Torres Strait Islander substance-use organisations, clients and episodes, by remoteness area, 2016–17...... 37

Table 4.3: Number of organisations reporting common substance-use issues, by remoteness area, 2016–17...... 38

Table 5.1: Proportion of closed episodes, by location of the client’s last known usual residence to the Statistical Area Level 3 (SA3) of the agency and size of area (km2), 2016–17...... 39

Table A1: National Drug Strategy Household Survey sample sizes...... 48

Table A2: Relationship between the drug of concern and the ICD-10-AM codes...... 50

Table A3: Relationship between the drug type and ICD-10 codes...... 51

Alcohol and other drug use in regional and remote Australia: consumption, harms and access to treatment 2016–17 63 List of figures

Figure 1.1: Proportion of different health behaviours and risk factors, by remoteness area, 2014–15 (%)...... 2

Figure 2.1: Drinking status, people aged 14 and over, by remoteness area, 2016 (%)...... 6

Figure 2.2: Drank in excess of the lifetime risk guideline(a), people aged 14 and over, by age, sex and remoteness area, 2016 (%)...... 7

Figure 2.3: Recent illicit drug use, people aged 14 and over, by remoteness area, 2016 (%)...... 10

Figure 2.4: Recent illicit drug use, people aged 14 and over, by age, sex and remoteness area, 2016 (%)...... 12

Figure 3.1: Fatal burden of disease age-standardised YLL rate, all persons, by remoteness area, 2015...... 15

Figure 3.2: Age-standardised attributable DALY rate due to alcohol use, by selected linked diseases, by remoteness area, 2011...... 16

Figure 3.3: Age-standardised attributable DALY rate due to illicit drug use, by selected linked diseases, by remoteness area, 2011...... 18

Figure 3.4: Proportion of hospital separations for drug-related principal diagnoses, by remoteness area, 2016–17 (%)...... 20

Figure 3.5: Rate of drug-induced deaths in Major cities and Regional and remote areas, 2008 to 2017...... 22

Figure 3.6: Rate of opioid-induced deaths in Major cities and Regional and remote areas, 2008 and 2017...... 23

Figure 3.7: Rate of drug-induced deaths, by region of usual residence, 2016...... 24

Figure 3.8: Rate of alcohol-induced deaths, by region of usual residence, 2017...... 25

Figure 4.1: Proportion of clients by age and remoteness area, 2016–17 (%)...... 28

Figure 4.2: Proportion of closed treatment episodes for own drug use, by principal drug of concern and remoteness areas, 2016–17 (%)...... 29

Figure 4.3: Proportion of closed treatment episodes for own drug use, by main treatment type, and remoteness area, 2016–17 (%)...... 30

Figure 4.4: Proportion of closed treatment episodes for own drug use, by treatment delivery setting and remoteness area, 2016–17 (%)...... 32

Figure 4.5: Proportion of closed treatment episodes for own drug use that ended expectedly, by principal drug of concern and remoteness area, 2016–17 (%)...... 34

Figure 4.6: Proportion of closed treatment episodes for own drug use that ended unexpectedly, by main treatment type and remoteness area, 2016–17 (%)...... 35

Figure 4.7: Proportion of substance-use Indigenous clients, by remoteness area, 2008–09 to 2016–17 (%)...... 37

64 Alcohol and other drug use in regional and remote Australia: consumption, harms and access to treatment 2016–17 Figure 5.1: Closed episodes, travel time by remoteness area of treatment service, 2016–17 (%)...... 40

Figure 5.2: Proportion of closed treatment episodes where the client sought treatment f or their own drug use and travelled 1 hour or longer to the service, by principal drug of concern and remoteness area of the treatment service, 2016–17...... 42

Figure 5.3: Proportion of closed treatment episodes where the client travelled for 1 hour or longer to the service, by main treatment type and remoteness area of the treatment service, 2016–17...... 44

Figure 5.4. Proportion of closed treatment episodes with a travel time of over an hour ending unexpectedly, by main treatment type and remoteness area of the treatment service, 2016–17...... 45

Alcohol and other drug use in regional and remote Australia: consumption, harms and access to treatment 2016–17 65 Related publications

This report is part of an annual series. The 3 earlier editions and any published subsequently can be downloaded from the AIHW website . The website also includes information on ordering printed copies.

The following AIHW publications relating to alcohol and other drugs may also be of interest:

• AIHW 2017. National Drug Strategy Household Survey 2016: detailed findings. Drug statistics series no. 31. Cat. no. PHE 214. Canberra: AIHW.

• AIHW 2018. Alcohol and other drug treatment services in Australia 2016–17. Drug treatment services no. 31. Cat. no. HSE 207. Canberra: AIHW.

• AIHW 2018. Alcohol, tobacco, & other drugs in Australia—Notes. Cat. no. PHE 221. Canberra: AIHW.

• AIHW 2018. Impact of alcohol and illicit drug use on the burden of disease and injury in Australia: Australian Burden of Disease Study 2011. Australian Burden of Disease Study series no. 17. Cat. no. BOD 19. Canberra: AIHW.

66 Alcohol and other drug use in regional and remote Australia: consumption, harms and access to treatment 2016–17

This report identifies trends and differences in alcohol and other drug use, harms and treatment in Major cities and Regional and remote Australia. The consumption of alcohol at levels placing people at risk of alcohol-related harm was higher for clients in Regional and remote Australia compared with those in Major cities. While the consumption of illicit drugs was similar for clients in Major cities and Regional and remote areas, the type of illicit drug used varied. Clients in Regional and remote areas were more likely than those in Major cities to travel 1 hour or longer to access services.

aihw.gov.au

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