Drug survey backs RACGP’s calls for harm reduction

Morgan Liotta

29/02/2024 2:35:33 PM

The college’s Addiction Medicine Chair believes the results should be used as leverage to better support GPs providing care in this area.

Alcohol and other drugs spread on table
Results from the national survey uncover the use of, and attitudes toward, alcohol and other drugs for more than 21,000 Australians across 2022–23.

The RACGP is using the latest National Drug Strategy Household Survey 2022–23 report to reiterate calls that GPs treating people with problematic alcohol and other drug (AOD) use need more support.
‘We must ensure all people can get the help and support they need for AOD issues, including from their GP,’ Chair of RACGP Specific Interests Addiction Medicine Dr Hester Wilson said.
The Sydney GP, a longtime provider of care to patients experiencing AOD issues, welcomed the release of the Australian Institute of Health and Welfare (AIHW) report, which reveals the use of, and attitudes toward, alcohol, illicit drugs, tobacco, and e-cigarettes for more than 21,000 Australians.
Examining what has changed over the past 20 years, the report presents findings across a range of population groups, ages, gender and geographic areas.
Alcohol remains the most widely used and harmful drug, with around 31% of respondents (equivalent to 6.6 million people) drinking alcohol in ways that put their health at risk in 2022–‍23.
Dr Wilson said addressing alcohol-related harm must remain a priority for government and general practice teams.
‘Alcohol is the most destructive drug in Australia,’ she said.
‘The proportion of people drinking alcohol above guideline recommendations has fallen slightly from 33% in 2016, but we have a long way to go.’
Notably, the survey shows that while fewer males consumed alcohol at risky levels, more young females are drinking. While the reduction in risky alcohol consumption among males reflects a long-term downward trend, from 50% in 2007 to 39% in 2022–‍23, the decrease among females was relatively small in comparison, from 27% to 23%.
Dr Wilson is concerned about this ‘opposite trend’ among young females, which also mirrors increases in other risky behaviours, including illicit drug use.
‘I see a concerning number of women drinking alcohol before they are aware they are pregnant,’ she said.
‘It is vital that GPs keep having conversations with patients about alcohol consumption and how to have a healthier relationship with this drug or leave it behind altogether, especially young women.
‘The good news is that proportion of people drinking alcohol at risky levels is continuing to gradually decline over time. We are far from out of the woods yet, but I think more and more people, especially younger people, are waking up to the impact of alcohol on the health of themselves and their community.’
Illicit drugs
Cannabis remained the illicit drug of choice for most respondents, followed by cocaine. Among young people aged 18–24, cannabis use increased by 6% between 2019 and 2022–23, with cocaine use increasing by almost 4% over the same period. Recreational ketamine use also increased, with around 300,000 people having used the substance in the previous 12 months.
Dr Wilson again urged GPs to ‘be proactive and initiate discussions with patients about these harmful substances’, given some people may not be aware they are ‘putting themselves at extreme risk’.
Illicit drug use among women aged 18–24 is also on the rise, with more than one in three (35%) taking an illicit drug in the last 12 months, compared to 27% in 2019. The rate for usage among young men of the same age group has remained steady at 35%.
The survey highlights that 2022–23 marks the first time since AOD monitoring began that females aged 18–24 were as likely to use illicit drugs as males of the same age.
Non-medical opioids
Dr Wilson said the survey results relating to a decline in non-medical use of pain-relievers and opioids, such as codeine or oxycodone, is positive, particularly in light of recent changes to opioid dependency treatments.
Last year, the RACGP welcomed new PBS listings of opioid treatment medicines such as methadone and buprenorphine for eligible patients. The Federal Government then delayed a ban on GPs administering opioid dependence treatment medicines as a private script until 30 June this year – a temporary decision also backed by the college.
‘The Government heeded our calls and … we are continuing to engage productively with the Department of Health and Aged Care to ensure we can find a long-term solution that allows direct access to medicines, including long-acting buprenorphine,’ Dr Wilson said.
‘These treatments save lives, so let’s ensure GPs aren’t held back in helping patients at risk.’
According to the AIHW, non-medical use of pain-relievers and opioids declined from 2.7% in 2019 to 2.2% in 2022–23. This continues the downward trend since 2016, when 3.6% of the population had misused these drugs.
‘This is very welcome, so let’s harness this momentum to drive down harmful non-medical opioid use even further,’ Dr Wilson said.
Tobacco and vaping
For tobacco use, the survey reveals that between 2019 and 2022–23, the national smoking rate has dropped from 11% to 8.3%.
Despite Dr Wilson hailing this as positive news, it is now well-documented that use of e-cigarettes and nicotine vaping products is increasing substantially.
According to the AIHW, in 2022–‍23, almost half (49%) of people aged 18–24 reported having used an e‑cigarette at least once in their lifetime, the highest of all age groups. This compares to 26% of people who had done so in 2019.
Meanwhile, 9.6% of people aged 14–17 had ever used e‑cigarettes in 2019, but this percentage nearly tripled by 2022–‍23 to 28%.
Although the survey was conducted prior to recent vaping regulations coming into effect and Dr Wilson says there is ‘hope we can arrest this trend’, she echoes the RACGP President’s words that nicotine use and vaping must continue to be urgently addressed, especially among young people.
‘There is no “safe” or relatively “risk-free” level of smoking, or vaping – full stop,’ Dr Wilson said.
‘For anyone, particularly young people, considering taking up vaping my message is straightforward – don’t start, because you may well have a lot of difficulty stopping.
‘I’m seeing young people in my practice with severe nicotine dependence, and I strongly advise against taking up this habit to begin with. It is not a safe alternative, and we don’t fully know the long-term health consequences of vaping.’
AOD policies
With new AOD-related policies emerging, the AIHW survey also confirms that more Australians are supportive of harm-minimisation policies such as pill-testing and safe injecting rooms.
Between 2019 and 2022–‍23, support for almost all policy measures aimed at reducing drug-related harm increased, with the largest support for allowing drug testing at designated sites – now supported by 64% of survey respondents, and supervised drug consumption facilities now being supported by 53% of respondents. 
Dr Wilson, who is a long-time advocate of managing AOD use as a healthcare issue rather than a criminal matter, has previously said designated drug testing sites should be used as part of a range of harm-minimisation strategies and would ‘potentially change people’s behaviour to make it safer’.
‘People don’t use to come to harm and the reality is that substance-safety checking helps people make informed decisions,’ she said.
In March last year, the RACGP urged the Government to view AOD use through a health lens and end the ‘pointless war against drugs’ narrative. This came following the success of the college’s Alcohol and Other Drugs (AOD) GP Education Program designed to upskill GPs in providing holistic care to patients experiencing AOD issues.
The full National Drug Strategy Household Survey 2022–23 report is available on the AIHW website.
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