4808.0 - Illicit Drug Use, Sources of Australian Data, 2001
Latest ISSUE Released at 11:30 AM (CANBERRA TIME) 28/11/2001
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Examples of available data
This chapter looks at data sources which describe the people who are using illicit drugs and the types of drugs they are using. Information on the numbers and characteristics of illicit drug users, types of drugs used and the circumstances of that use, is necessary to understand the effects of illicit drug use on our society and to develop policies in response. The public health threat of disease transmission and increasing community concerns about the prevalence of illicit drug use among younger Australians have resulted in considerable money and effort being put into gaining information about illicit drug use in recent years, under the coordination of the National Drug Strategy.
A small number of sources provide detailed information concerning the extent of illicit drug use in various parts of Australia and the characteristics of those who use them. These collections provide a number of sociodemographic data items, as well as information on the type of drugs used and frequency and method of use. These main sources of data on prevalence and patterns of use are discussed in some detail in the following sections.
Nearly all of the sources listed throughout this publication provide some information relevant to this topic, such as the age and sex of those who use illicit drugs, the types of illicit drug used and the method of use. Some of these sources provide further details about their sample population, such as ethnicity, field of employment and area of usual residence, although many provide information about particular sub-populations of illicit drug users only, such as injecting drug users or those convicted of a drug offence. These data sources are referred to briefly in 2.2.2 Other sources of data and a more thorough discussion of each is given elsewhere in this publication.
Further details regarding the data sources are available in Appendix 1. The data quality issues discussed in Chapter 7 are relevant to each of the data sources mentioned here.
2.2 Data sources
2.2.1 Major sources of data
National Drug Strategy Household Survey (NDSHS) (Appendix 1, A1.16)
The Commonwealth Government has funded a series of national household surveys, initially known as the National Campaign Against Drug Abuse Social Issues Survey. As the survey has been repeated in similar format every 2-3 years since 1985, results enable changes in prevalence, patterns and attitudes to be monitored. The seventh survey in this series is being conducted during 2001 by the Australian Institute of Health and Welfare (AIHW), with results due during 2002.
The 2001 National Drug Strategy Household Survey asks people from across Australia for information about their use of drugs, including illicit drugs. Respondents are questioned regarding the circumstances of use of each particular drug (age of first use, place of use, where the drug was obtained), prevalence of use among friends, days lost from work or education because of drug use and health problems experienced. Demographic data are also collected, including age, sex, marital status, household composition, industry and occupation of employment, ethnicity, education and income.
It is anticipated there will be approximately 20,000 respondents to the 2001 questionnaire. Households in the survey have been selected randomly and respondents selected from residents aged 14 years or over. Weighting procedures will be applied to give results consistent with the age and sex distribution of the population within each State and Territory. The National Drug Strategy Household Survey is often used as an indication of the extent of drug use in our community.
The AIHW report 1998 National Drug Strategy Household Survey: Detailed findings by Adhikari and Summerill (2000), gives information from the 1998 survey and some comparisons with the 1995 survey results are available in the publication 1998 National Drug Strategy Household Survey: First results, published by the AIHW in 1999. Both are available on the AIHW website http://www.aihw.gov.au. Records from the surveys are available by application to the Social Science Data Archives at the Australian National University (Appendix 2, A2.5).
In their 1998 paper Patterns of drug use in Australia, 1985-95, Makkai and McAllister examined trends evident from the responses to five household surveys between 1985 and 1995. In addition, they combined responses across the five surveys to pool the available information about infrequent behaviours such as the use of hallucinogens.
In 1994, a special supplementary survey of the National Drug Strategy Household Survey was conducted, collecting similar data nationally for Aboriginal and Torres Strait Islander peoples living in urban areas. The results of these personal interviews were published in National Drug Strategy Household Survey, Urban Aboriginal and Torres Strait Islander Peoples Supplement 1994 (Commonwealth Department of Human Services and Health, 1994). This publication gives information on the prevalence of use of each drug type, demographics of users, age of first use, attitude toward others’ use of drugs, and the number of days lost from work or education.
Australian School Students Alcohol and Drugs Survey (ASSADS) (Appendix 1, A1.3)
Prior to 1996, national surveys of secondary students were conducted to monitor the prevalence of tobacco and alcohol use, but did not include questions on illicit drugs. However, Health Departments of several States and Territories had conducted separate, independent surveys on the use of illicit drugs.
The Australian School Students Alcohol and Drugs Survey (ASSADS) was the first national survey of students which obtained data on the use of illicit drugs. The first ASSADS survey was conducted in 1996, with questions asked of approximately 31,000 school students aged 12-17 years, selected randomly from government and independent schools. The sample was stratified by State and type of school. The survey was conducted jointly by State and Territory Health Departments, the Commonwealth Department of Education, Training and Youth Affairs and the Commonwealth Department of Health and Aged Care (DHAC). The Anti-Cancer Council of Victoria acted as the coordinating agency.
In ASSADS, students were asked about the number of times they had used specific drugs during the last week, during the last four weeks, in the last year and in their lifetime. Further questions were asked about the circumstances of their use of alcohol and tobacco and about sun protection behaviours. These data can be related to age, sex, school year/level, spending money available, language spoken at home, and whether they identified as an Aboriginal or Torres Strait Islander.
Results of the 1996 survey are available in Australian secondary students’ use of over-the-counter and illicit substances in 1996 (Letcher and White, 1999). A similar survey was conducted in 1999, with results to be published in late 2001.
ASSADS can provide information about illicit drug use by secondary students aged 12-17 years across the nation. However, it may not represent the situation for all adolescents within that age group, as the prevalence and patterns of use shown may not be the same for those of the same age group who had left school.
Illicit Drug Reporting System (IDRS) (Appendix 1, A1.10)
The Illicit Drug Reporting System (IDRS) monitors the extent and patterns of drug use in the illicit drug market, aiming to identify emerging trends of local and national concern. It gives timely information of trends in illicit drug markets, with particular emphasis on injecting drug users in Australia’s capital cities. Information from this group of heavy users, who tend to use a variety of drugs, may also indicate emerging trends in illicit drug markets for those who do not inject.
The IDRS is an annual schedule of surveys and data analysis, funded by DHAC and the National Drug Law Enforcement Research Fund, and coordinated by the National Drug and Alcohol Research Centre (NDARC). Commencing in Sydney in 1996, the coverage of the IDRS has gradually expanded to most capital cities in Australia. The IDRS aims to monitor the price, purity, availability and usage patterns of heroin, amphetamines, cocaine and cannabis, and make this information on emerging trends available quickly. During 2000 and 2001, the IDRS has been trialling the inclusion in its collection in three cities of amphetamine-type stimulants such as ecstasy.
The IDRS collates results from three sources:
When interpreting data from the IDRS surveys of illicit drug users, it should be kept in mind that the surveys are conducted in capital cities only and use respondent-initiated sampling rather than random sampling. A valuable part of the IDRS is its timely dissemination strategy, including quarterly bulletins, the early release of annual survey results at a public seminar, an annual publication for each State and Territory and an annual national publication, the latest being Australian Drug Trends 2000: Findings from the Illicit Drug Reporting System (IDRS) (Topp et al., 2001).
National Survey of Mental Health and Wellbeing of Adults (SMHWB) (Appendix 1, A1.24)
The purpose of this national household survey was to assess the prevalence of major mental disorders in the Australian adult population. Data were also collected on a range of demographic and socioeconomic characteristics such as sex, age, employment status, marital status, country of birth, education and source of income. Conducted in 1997 by the ABS, the survey was an initiative of, and funded by, DHAC.
Approximately 10,600 people aged 18 years and over were interviewed. The survey used a modified version of the Composite International Diagnostic Interview (CIDI) schedule which is a standard mental health questionnaire endorsed by the World Health Organization (WHO). This version of the CIDI was designed to identify disorders using the International Classification of Diseases, 10th revision (ICD-10).
Substance-use disorders, both harmful use and dependence, were among the mental disorders covered in the survey, with data collected separately on alcohol and other drug use. The section on drug-use disorders asked about the use of classes of drugs, rather than individual drugs. However, as some of the classes contained a mixture of illicit and prescribed drugs, the survey data do not entirely separate the use of illicit drugs from the misuse of prescription drugs.
The 1998 ABS publication Mental Health and Wellbeing: Profile of Adults, Australia, 1997 (Cat. no. 4326.0), presented the prevalence of drug-use disorders by age group, separately for men and women. More comprehensive results from this survey regarding the use of drugs within the community have been published by NDARC. These publications are referenced in Appendix 1, A1.24. Further data are available on request from the ABS to explore illicit drug use and the misuse of prescription drugs.
2.2.2 Other sources of data
The data sources discussed in 2.2.1 Major sources of data provide a wide range of information on the extent and type of illicit drug use and characteristics of the users. Other data sources provide less information regarding the prevalence of use, often just the age and sex of users and the types of drugs used. The administrative datasets and surveys in the following list provide some indication of the characteristics of those who use particular illicit drugs. As their main contribution to our knowledge of illicit drug use is in the fields of either health or law enforcement, a more comprehensive description of each is included in either Chapter 3 Health issues or Chapter 5 Law and order. Further details about each dataset are provided in Appendix 1.
Information about the demographics of those who die as a result of illicit drug use is available from the ABS Causes of Death collection (Appendix 1, A1.5), the AIHW National Mortality Database (Appendix 1, A1.21) and the National Coroners Information System (Appendix 1, A1.15) established by the Monash University National Centre for Coronial Information (MUNCCI). Data available include age and sex, region of usual residence, birthplace and marital status of the deceased. These datasets are not, however, representative of all illicit drug users. Heroin users dominate this mortality data as other illicit drugs do not often result in death. Other indicators (such as the National Drug Strategy Household Survey) show that only a small proportion of those who use illicit drugs use heroin.
Demographic information about the characteristics of those who have been treated for physical and mental illness resulting from illicit drug use can be obtained from the AIHW National Hospital Morbidity Database (Appendix 1, A1.19) and the annual survey of doctors in general practice known as Bettering the Evaluation and Care for Health (BEACH) (Appendix 1, A1.4), conducted by the General Practice Statistics and Classifications Unit. Similarly, information about those who access drug and alcohol treatment services comes from the NDARC survey Clients of Treatment Service Agencies (Appendix 1, A1.6) and in future will be available from the requirements of the AIHW National Minimum Data Set for Alcohol and Other Drug Treatment Services (Appendix 1, A1.20).
Injecting drug users
Information about injecting drug users who access drug and alcohol treatment services and other health services is available from the surveys mentioned above. In addition, the following sources provide data specific to injecting drug users.
The Australian Needle and Syringe Program Survey (Appendix 1, A1.2) is an annual survey, coordinated by the National Centre in HIV Epidemiology and Clinical Research (NCHECR), which gives an indication of the characteristics of those accessing drug-injecting equipment. DHAC has recently commissioned a health economic study calculating costs and savings from needle and syringe programs across Australia. This work has the potential to provide some data relevant to the prevalence of injecting drug use, such as the types of distribution points, their locations and the numbers of needles and syringes distributed.
Basic demographics can be obtained about injecting drug users who are diagnosed with a blood-born virus, from the National AIDS Registry (Appendix 1, A1.14) and National HIV Database (Appendix 1, A1.17), both maintained by NCHECR. Care needs to be exercised in assuming that information from these records is representative of others who inject drugs.
A different perspective of those involved with illicit drugs is provided by the Commonwealth, State and Territory records of police, customs, courts and prisons. A national compilation of data from these sources is presented annually by the Australian Bureau of Criminal Intelligence in the Australian Illicit Drug Report (Appendix 1, A1.1).
Further information about the characteristics of those who have come into contact with the crime and justice system and who use illicit drugs, comes from a number of sources. The annual ABS National Prisoner Census (Appendix 1, A1.23) provides the demographics of prisoners whose most serious offence is a drug offence. The Drug Use Careers of Offenders survey (Appendix 1, A1.8) conducted by the Australian Institute of Criminology (AIC) should in future provide information on a cross-section of prisoners. The AIC Drug Use Monitoring in Australia program (Appendix 1, A1.9) provides data on the demographics and drug use habits of detainees at a few selected police stations across Australia.
The association of drugs with homicide can be ascertained from the AIC National Homicide Monitoring Program (Appendix 1, A1.18), which maintains a database of information concerning homicides, including demographic data and type of drugs used, for both the victim and offender. Concerning less serious transgressions, the data reporting requirements of the DHAC National Diversion Minimum Dataset (see 5.2.2 Other crime issues related to illicit drug use) will in future provide some national data on people whose drug habits are of concern to those involved in law and order agencies.
Nearly all of the sources of national data mentioned in this publication also provide data for each State or Territory. Some of these sources can give reliable information for sub-State regions, and indicate that there are considerable differences between the extent and characteristics of illicit drug use in various locations across the country.
The capacity of national surveys to provide regional data is limited by the size of the sample population in any category and the method used for sample selection. The Illicit Drug Reporting System (Appendix 1, A1.10) conducted by NDARC provides data for each capital city, and publishes an annual report for each State and Territory. The Australian School Students Alcohol and Drugs Survey (Appendix 1, A1.3), the National Drug Strategy Household Survey (Appendix 1, A1.16) and the National Survey of Mental Health and Wellbeing of Adults (Appendix 1, A1.24) can provide data for each State and Territory, but their sample size is too small to provide reliable sub-State data on illicit drug use.
The administrative datasets of the MUNCCI National Coroners Information System (Appendix 1, A1.15), ABS Causes of Death collection (Appendix 1, A1.5) and AIHW National Hospital Morbidity Database (Appendix 1, A1.19) each include a sub-State geographic data item and thus may be able to provide some data on regions within each State or Territory. In order to provide reliable information for unusual events, it may be necessary to aggregate data across several years.
Although it is outside the scope of this publication to list all sources of regional data, those with an interest in a particular State or region may find that relevant data are available from their State or Territory health and law authorities and more localised surveys.
Many of the surveys and administrative datasets include one or more items concerning ethnicity, country of birth, language spoken at home, or self-identification as an Aboriginal or Torres Strait Islander. The small number of respondents within each category may limit the use which can be made of these items. Often the only output available is in broad categories; for example in the National Survey of Mental Health and Wellbeing of Adults (Appendix 1, A1.24), the only output categories for language usually spoken at home are either ‘English’ or ‘Other languages’.
The 1994 Urban Aboriginal and Torres Strait Islander Peoples Supplement to the National Drug Strategy Household Survey (Appendix 1, A1.16) provided a unique national view of illicit drug use by the urban Indigenous population.
2.3 Data issues
Despite the fact that there is no direct measurement of the total number of users of illicit drugs and their characteristics, there is a range of data sources available with some information on the prevalence and patterns of illicit drug use. Differences between the information gathered from these various data sources can be due to the sources measuring different subgroups of the user population, or to differences in the methods used to obtain the data. The relevance of data from these various sources to any particular research question will need to be individually assessed and data quality issues (such as those discussed in Chapter 7) will need to be taken into account.
When the data gathered from a number of independent sources agree, or indicate a similar trend, we can more confidently expect that the data are providing some useful insights into a complex situation. Further, it may be possible to construct a more integrated measure from these independent sources. An example of where a number of indicators are used in order to estimate the prevalence of an illicit activity is the study conducted in 2000 by Hall and associates at NDARC, called How many dependent opioid users are there in Australia?.
2.4 Data gaps
Prevalence and patterns of use among minority populations
The 1994 Urban Aboriginal and Torres Strait Islander Peoples Supplement to the National Drug Strategy Household Survey provided snapshot information about drug use by this group, but changes in the drug use of this group since 1994 have not been captured. Very little information is available about other ethnic groups from the national datasets, as discussed in 2.2.2 Other sources of data.
As the limited available data indicate that homeless people are among the most disadvantaged in society and likely to have different patterns of drug use, they are a population group of interest. Surveys of the Australian population generally draw their samples from people living in private dwellings, so the homeless are not included in these surveys. Data on homeless people would be included in many datasets obtained from agencies providing law enforcement and health services, but generally they are not identifiable in these datasets.
Each of the datasets mentioned above provides a snapshot view only of illicit drug users. They provide little information on whether individuals display any patterns of progression in their drug-using habits and lifestyles and the circumstances of such changes. In contrast, longitudinal or cohort studies would provide information from the same people over a period of time. The longitudinal study Women’s Health Australia (see 3.2.5 Other sources of data on health issues), which is funded by DHAC and conducted by the University of Newcastle and the University of Queensland, has the potential to supply this type of data.
Different methods of using drugs
An emphasis has been placed on gaining information about injecting drug users, due to the increasing prevalence of heroin overdose and extra harm implications of contracting of blood-borne virus diseases. Less information is available on the more widespread non-injecting use of illicit drugs.
The choice to use or not use illicit drugs
Limited information is available on the background and circumstances of people’s choice to use or not use illicit drugs. The National Drug Strategy Household Survey (Appendix 1, A1.16) may in future provide some relevant data, as the 2001 survey contains questions relating to the motivations for using drugs.