By Dr Nadine Ezard, Clinical Director Alcohol and Drug Service St Vincent’s Hospital Sydney, Director, National Centre for Research on Emerging Drugs of Concern

Information in this blog was presented at the Australia Federation of AIDS Organisations (AFAO) Members Meeting, 24-25 July 2018.

Substance use invites stigma and stereotype. But just as the code of silence around domestic violence and mental health is finally breaking down, perhaps a shift is also required in our national conversation about drug use.

It’s certainly overdue. The 2016 National Drug Strategy Household Survey found more than four in ten Australians over 14 have used an illicit drug. Theoretically, this places almost half the population on the wrong side of the law.

However, only one in ten people who use illicit drugs had done so in the past month. And the vast majority of people using illicit drugs – 85 per cent – report good to excellent health.

The study also indicates we need a bit of perspective on illicit drugs. While methamphetamine and heroin grab the headlines, only 6.3 per cent of people have ever used methamphetamine, with only 1.4% reporting recent use. Heroin use is even rarer. Only a little more than one in every hundred people reported ever using heroin, with only 0.2 per cent reporting recent use.

In fact, alcohol and tobacco remain the most commonly reported drugs followed by cannabis and then pharmaceuticals (used for a purpose other than that prescribed). The most commonly used illicit drugs in the past twelve months include cannabis, opioids, cocaine and ecstasy.

Perhaps unsurprisingly, of the reasons for drug use, curiosity was reported by 65% of respondents in the survey. 50 per cent reported friends or family offered it or were using it, 32% used drugs to enhance experiences, and 15 per cent to improve mood.

It also found that gay/bisexual people and Aboriginal and Torres Strait Islander people had higher rates of illicit drug use, smoking and risky drinking than other population groups.

Globally, 247 million people, or around five per cent of the global adult population, used drugs at least once in 2016. 29.5 million of those drug users experience drug use disorders and only 1 in 6 people with drug use disorders have access to treatment. 12 million people inject drugs globally, 1.6 million people who inject drugs are living with HIV and 6 million are living with hepatitis C.

There can of course be harms associated with alcohol and other drugs. Drug use alters behaviour and with that, finances, relationships, and work, leaving people vulnerable to instability. Approximately 60 per cent of people incarcerated are in jail for drug-related crimes. Some drug use can also provide a potential route for exposure to infections, affect behaviour (such as sexual disinhibition, and adherence to medications) and can have more immediate health issues with reactions to the drugs. There can also be health and disease implications for long-term use.

For those people that do experience problematic use of alcohol or other drugs, prompt and effective interventions and treatments are required. These can include brief interventions, specialist counselling and support services, withdrawal with medical support, pharmacotherapies, post-withdrawal care, self-help groups and residential rehabilitation.

Alcohol, tobacco, prescription opioids and GHB are drugs that are of particular concern. For any alcohol and other drug use, the promotion of safer use through education and communication is vital.