2.17 Drug and other substance use including inhalants
Why is it important?
Drug and other substance use is a contributing factor to illness and disease, accident and injury, violence and crime, family and social disruption and workplace problems (SCRGSP 2014a). Estimates of the burden of disease and injury in Aboriginal and Torres Strait Islander peoples attribute 3.7% of the total burden to drug use (AIHW, 2016f).
Substance use is often associated with mental health problems (Catto & Thomson, 2008) and has been found to be a factor in suicides (Robinson, G et al, 2011). The use of drugs or other substances including inhalants is linked to various medical conditions. Injecting drug users, for example, have an increased risk of contracting blood-borne viruses such as hepatitis or HIV (Kratzmann et al, 2011) and around half of heroin and opioid users report overdosing (Catto & Thomson, 2008).
For communities, there is increased potential for social disruption, such as that caused by domestic violence, crime and assaults. Research has identified relationships with loss of control and abusive behaviour, ranging from physical to emotional violence (Franks, 2006). Alcohol and substance use has been found to be a factor in assault (Mitchell, 2011; Mouzos & Makkai, 2004). Risky sexual behaviour is associated with alcohol and illicit drug use, leading to increased STIs among younger people (Wand et al, 2016). Drugs and other substance use play a significant role in Aboriginal and Torres Strait Islander peoples’ involvement in the criminal justice system (see measure 2.11).
Glue sniffing, petrol sniffing, inhalant abuse and solvent abuse are difficult to control because the active substances are found in many common products that have legitimate uses. People who use these products as inhalants risk long-term health problems or sudden death. Continued use can also lead to the social alienation of those who sniff, violence and reduced self-esteem (Karam et al, 2014; Midford et al, 2011). There is also reported high use of kava in some Arnhem Land communities (Clough et al, 2002).
The latest data on substance use for Aboriginal and Torres Strait Islander peoples comes from the 2014–15 Social Survey. Data was collected on substance use in the last 12 months for those aged 15 years and over. In 2014–15,31% of Indigenous Australians aged 15 years and over reported having used drugs and other substances in the last 12 months, an increase from 2008 (23%). These increases were found in both remote areas (from 17% in 2008 to 21% in 2014–15), and non-remote areas (from 24% to 33%). Substance use was higher in non-remote areas (33%) compared with remote areas (21%). Longer time-series data between 2002 and 2014–15 is limited to non-remote areas only. Between 2002 and 2014–15, there was an increase in substance use in the last 12 months, from 26% to 33%. In 2014–15, Indigenous males had higher rates for recent use in the last 12 months (34%) compared with Indigenous females (27%).
Comparisons with non-Indigenous Australians are available from the National Drug Strategy Household Survey, which included a small sample of Indigenous Australians. According to this survey, in 2013 Indigenous Australians aged 14 years and over were 1.5 times as likely to report using substances in the last 12 months compared with non-Indigenous Australians (around 23% and 15% respectively) (AIHW, 2014f). Between 2001 and 2013 the proportion of non-Indigenous Australians who used substances in the last 12 months did not show a clear trend. There was an increase for those who had ever used substances over this period (from 37% to 41%).
Cannabis was the most common illicit substance used in the last 12 months for Aboriginal and Torres Strait Islander peoples (19%), followed by pain-killers or analgesics for non-medical use (12%) and amphetamines/speed/ice (5%). Approximately 21% of Indigenous Australians reported having used one substance in the last 12 months and 10% two or more substances.
Between 2008 and 2014–15, there was a significant increase in the proportion of the Indigenous population who had used marijuana in the last 12 months in remote areas (14% to 18%), but no change in non-remote areas or overall. In this period, there was a large increase in the use of pain-killers or analgesics for non-medical purposes (5% to 12%) and in the use of tranquilisers or sleeping pills for non-medical uses (1.4% to 3.4%). There was an increase in the use of amphetamines or speed (including ice), between 2012–13 and 2014–15 (2.4% to 4.8%).
In 2014–15, 17% of Indigenous Australians aged 15 years and over reported drug-related problems as a stressor experienced by self, family or friends in the last 12 months with rates similar for females and males (18% and 15% respectively) and across remote and non-remote areas (17% and 16%). Indigenous Australians reported alcohol or drug-related problems as a personal stressor at 1.3 times the rate of non-Indigenous Australians.
Results from a 2011–13 Goanna study on sexual and drug-related risk among Indigenous Australians aged 16–29 years found that 37% had used an illicit substance in the last year. Cannabis was the most frequently used drug; around one-third of respondents had used this drug in the previous 12 months. Weekly or more frequent use of cannabis reported by 18% of participants in urban areas, 22% in regional and around 14% in remote areas reported (note the remote sample was small and results should be interpreted with caution).
Around 10% reported using ecstasy in the last year, followed by amphetamines (9%) and cocaine (4%). Injecting drug use was reported by 3% of respondents, with methamphetamine (37%), heroin (36%) and methadone (26%) being the most commonly injected drugs. In urban and regional areas, frequent drug use was more likely among those who had been in prison, had lower levels of education and had sought advice on alcohol and other drug use (Bryant et al, 2016).
In 2014–15, a higher proportion of Indigenous Australians aged 15 years and over who were recent substance users reported they were current smokers (60%) and drank at levels exceeding the single occasion risk (45%) than Indigenous persons who had not recently used illicit substances (33% and 25% respectively). Approximately 4% of mothers with a child aged 0–3 years reported having used substances during pregnancy in 2014–15.
A 2014 study of 41 Aboriginal communities in the NT, WA and SA found 204 people were currently sniffing petrol, a decline of 29% since 2011–12 (d'Abbs & Shaw, 2013). Nearly 80% of people sniffing were male and over half were aged 15–24 years. There was a significant reduction in the prevalence of petrol sniffing in 17 communities with time-series data following the introduction of low aromatic fuel in those communities. Across the sample there were 647 people sniffing petrol in 2005–06, dropping to 98 in 2011–12 and declining to 78 by 2013–14, an 88% decrease in the number of people sniffing between baseline and the current survey. The report indicates that petrol sniffing levels have dropped in regions where there has been an uptake of low aromatic fuel and that the regions with the highest levels of sniffing are those where regular unleaded petrol is still available (d'Abbs & Shaw, 2016). Between 2007–08 and 2011–12, there was a steady decline in the number of people sniffing petrol across all age groups, and between 2011–12 and 2013–14 only among those aged 15–24 years. A very slight increase across other age groups occurred between 2011–12 and 2013–14.
For the period July 2013 to June 2015, there were 8,455 hospitalisations of Indigenous Australians related to substance use. Indigenous Australians were hospitalised for conditions related to substance use at rates 2.7 times as high as non-Indigenous Australians.
The Drugs Use Monitoring in Australia programme run by the Australian Institute of Criminology reports on drug use among police detainees at 5 police stations in metropolitan areas in SA, NSW, Qld and WA. In 2015, the proportion of detainees that tested positive for drugs was higher for Indigenous detainees than for non-Indigenous detainees in all police stations surveyed. Cannabis was the most frequently detected drug.
Aboriginal and Torres Strait Islander peoples aged 15 years and over, substance use by remoteness and sex, 2014–15
Used substances in last 12 months
|Marijuana, hashish or cannabis resin||19.6||18.4||25.3||13.8||19.2|
|Pain-killers or analgesics for non-medical use||14.7||2.5||9.6||14.1||12.0|
|Amphetamines or speed||5.9||0.7||6.4||3.2||4.8|
|Tranquilisers or sleeping pills for non-medical use||4.3||0.6||3.1||3.7||3.4|
|Total used substances in last 12 months||33.2||20.9||34.2||27.3||30.6|
|Has not used substances in last 12 months||66.9||79.2||65.7||72.7||69.5|
|Persons who accepted form ('000)||318||86||191||213||404|
|Persons 15 years and over ('000)||347||97||213||231||443|
Source: AIHW and ABS analysis of 2014–15 NATSISS
In 2014–15, around 3 out of every 10 Aboriginal and Torres Strait Islander peoples aged 15 years and over had used substances in the last 12 months. Higher rates of substance use are related to a lack of housing security and low income.
The National Drug Strategy (NDS) 2010–2015 provides the framework for an integrated and coordinated approach across all levels of government that aims to reduce drug-related harm and drug use in Australia, with the next NDS 2016–2025 currently under development. The National Aboriginal and Torres Strait Islander Peoples Drug Strategy (NATSIPDS) 2014–2019 has been developed as a sub‑strategy of the NDS, and provides a guide for governments, communities, service providers and individuals to identify priority areas for action relating to the harmful use of alcohol and other drugs (AOD). The strategy builds on the national framework provided by the NDS, and has been informed by community consultation.
In 2015, all governments agreed to the National Ice Action Strategy which will see a joint national focus on tackling ice use in Australia, prioritising families and communities who are most affected. As part of the response to the National Ice Taskforce’s Final Report, $241.5 million has been allocated to Primary Health Networks to commission additional AOD treatment services. Of this, $78.6 million has been allocated specifically for AOD treatment services for Aboriginal and Torres Strait Islander people.
Other Australian Government programmes that provide funding for combatting alcohol and other substance misuse (see measure 3.11) include the Indigenous Australians’ Health Programme; the Substance Misuse Service Delivery Grants Funds; the Non-Government Organisation Treatment Programme and the Indigenous Advancement Strategy (IAS).
The IAS provides for Indigenous AOD treatment services and the continuation of the rollout of low aromatic fuel to combat the effects of petrol sniffing. In 2015, legislative changes to the Low Aromatic Fuel Act 2013 prohibited the supply and sale of regular unleaded petrol in three locations (Katherine and Tennant Creek in the NT and Palm Island in Qld) to mitigate the negative impacts of petrol sniffing and help reduce the potential harm to the health of people in those locations.
In WA, the Strong Spirits, Strong Minds campaign aims to prevent and/or delay the early uptake of alcohol and other drugs by young Aboriginal people in the Perth metropolitan area. This multi-faceted communication strategy includes mainstream mass communication channels to deliver Aboriginal specific messages. The project was developed from a strong cultural foundation with input from an Aboriginal youth advisory panel, with evaluation results indicating it is a highly effective and successful strategy.