Drug data highlights stark regional divides

Australian’s illicit drug use continues to be determined by where they live, according to a new report highlighting the stark differences between those living in capital cities and regional towns.
 
The 23rd National Wastewater Drug Monitoring Program report, released on Thursday, revealed a ‘mixed picture of national drug consumption’. 
 
Conducted by the Australian Criminal Intelligence Commission (ACIC), the report collected data on 12 different substances in both April and June 2024 across regional and capital city sites.
 
It found that Australians are using ketamine at a record-breaking rate, with the drug’s popularity in both cities and regional towns skyrocketing.
 
Overall, alcohol and nicotine were the highest consumed drugs in all states and territories in April, followed by cannabis and methylamphetamine.
 
But when looking at different regions, the ACIC found capital city cocaine, heroin, fentanyl and ketamine average consumption exceeded regional consumption.
 
Alternatively, regional alcohol, nicotine, oxycodone, methylamphetamine, MDMA, and cannabis average consumption exceeded capital city consumption.
 
RACGP Specific Interests Addiction Medicine Chair Dr Hester Wilson told newsGP the report is further evidence that ‘people will use what they can access’.
 
‘The thing with wastewater is that it doesn’t discriminate – it tells us about the overall exposure to those substances,’ she said.
 
‘We see that heroin consumption is higher in capital cities, and it comes down to access – heroin comes in from overseas, it’ll come in through Sydney mostly, so there’s a glut in Sydney, and then there are smaller and smaller amounts the further you go out.
 
‘And then the stuff that’s locally produced is easier to access in the country.
 
‘We also see, for example, oxycodone being more likely to be prescribed in regional areas because of limited access to other treatments, to pain clinics, hydrotherapy, physiotherapy, all those things that we know are really important in terms of chronic pain.’
 
The report found that over the past two years, the amount of alcohol consumed has decreased in some states and territories, however, a higher average consumption of alcohol was recorded in the Northern Territory and Hobart in April and June.
 
Overall, between December 2023 and April 2024, the population-weighted average capital city consumption decreased for alcohol, nicotine, methylamphetamine, cocaine, MDMA, MDA, heroin, and fentanyl, but increased for ketamine and cannabis.
 
Regionally, consumption of alcohol, nicotine, cocaine, MDA, oxycodone, and fentanyl decreased, while use of MDMA, heroin, cannabis, and ketamine increased, and methylamphetamine remained the same.
 
Dr Wilson said a regional decrease in the use of opioids could be linked to decreased prescribing.
 
‘We know that one of the issues that happens with prescribing is those medicines then do turn up on the informal markets as well, so it’s hard to know exactly everything that’s driving that,’ she said.
 
‘But certainly, the changes to PBS so it’s now exceptional circumstances, and all the education that has happened for doctors around the risks of opioids and lower doses – there’s been a real shift in what we’re seeing here.
 
‘There’s also an interesting dynamic where potentially people are using different substances for their mental health, so we have cases of people that are microdosing to manage their depression, for example.’
 
But Dr Wilson said that while trends will always change over time, the most important takeaway for GPs is to have non-judgemental conversations with their patients about drug use.
 
‘Just because people are using drugs, it doesn’t necessarily mean that they’re having problems, and the great irony of history is that the two drugs that are legal, tobacco and alcohol, are the ones that cause cancer,’ she said.
 
‘For me as a GP, I want to set the scene with a patient, saying “I’m concerned about your health and wellbeing, is it okay if I asked you about your smoking, about your drinking, about your drug use, your gambling, about your exercise, about your diet”.
 
‘And I’ve never had anybody say no when I set that up, and ask permission, and explain why I’m asking.’
 
The new data comes following a recent spate of ‘bad batch’ street drugs being blamed for overdoses across Australia, with people impacted in New South Wales, Victoria and other states.
 
Dr Wilson is encouraging GPs to speak with their patients about carrying naloxone, a medicine that can quickly reverse or reduce the effects of opioids, which can be accessed for free at participating pharmacies.
 
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