Stimulants driving ‘concerning’ rise in harm

An increase in stimulant-related harms is shifting Australia’s overdose profile and driving the most pronounced changes, latest findings from the National Drug and Alcohol Research Centre (NDARC) indicate.
 
Rather than broad increases across all drug classes, stimulants are contributing more to drug-induced deaths and hospitalisations.
 
And while opioids remain the leading drug class identified in overdose deaths, this recent spike is attributed to a 40% increase from cocaine-related deaths and a 29% increase from amphetamine-type stimulants from 2023 to 2024 – the highest rate observed during the NDARC’s monitoring period.
 
These findings build on earlier released data showing that 2024 saw a record high of more than 2500 drug overdose deaths.
 
According to the UNSW Sydney’s NDARC report, in the same year there were 753 overdose deaths involving amphetamine-type stimulants (methamphetamine, amphetamine, MDMA) – representing the highest number recorded in Australia to date.
 
Associate Professor Marguerite Tracy sits on the RACGP Expert Committee – Quality Care and is Deputy Chair of the college’s Specific Interests Addiction Medicine group.
 
She told newsGP it is ‘always concerning’ to see increasing harms from substance use, but harm minimisation can be a key part of GP discussions with patients.
 
‘GPs see most of the population every year and we frequently have conversations about all substance use, including tobacco, alcohol, illicit substances and non-prescribed use of prescription medications – which can all cause significant harms,’ she said.
 
‘I frequently discuss with people using illicit substances to “start low and go slow” due to the wide variability in potency in the illicit market, ensuring they know where to access injecting equipment, safe disposal, screening and treatment for blood-borne viruses and using substances in the safest environment possible.’
 
Being safe includes having access to and knowing how to use take-home naloxone to reverse an opioid overdose, Associate Professor Tracy says.
 
‘I also stress this for those using amphetamine-type drugs due to the contamination with opioids which has been reported,’ she said.
 
Although not detailed in the latest NDARC report, harm from diversion of prescription medications is also on the rise, with other research suggesting more than one in five people report misuse of their prescribed ADHD stimulant medication, and one in six divert this medication.
 
The RACGP previously warned of non-prescribed pharmaceutical drug diversion into the black market after state governments expanded ADHD medication dispensing, bypassing GPs.
 
An earlier NDARC report based on survey findings reveals that 54% of respondents used non-prescribed pharmaceutical stimulants in 2024, up from 47% the previous year. Medication to treat ADHD was the most non-prescribed pharmaceutical stimulant used by those surveyed, with dexamphetamine the most widely taken, followed by Ritalin.
 
‘This is always an ongoing and challenging area,’ Associate Professor Tracy says.
 
‘The prescription medications which are diverted are varied and these medications all have a place in supporting people to manage pain, depression, ADHD and many other acute and chronic conditions.
 
‘We have regulations and processes for these medications such as scheduling controls and real-time prescription monitoring to support GPs and other prescribers in decision making if they have concerns about hazardous or harmful use of medications.’
 
The latest NDARC report also shows that close to 57,000 drug-related hospitalisations were recorded in 2023–24. This marks a 10.5% increase compared to the previous year, and more than double the 4.1% increase in all hospitalisations in the same period, with the NDARC team suggesting a rapid growth in drug-related hospitalisations compared to overall hospitalisations.
 
While opioid-related hospitalisations remained stable, amphetamine-type stimulants drove much of the overall increase in drug-related hospitalisations, increasing by 24% compared to the previous 2022–23 period, while cocaine-related hospitalisations also rose markedly by 29%. The largest proportion (29%) of drug-related hospitalisations was for amphetamine-type stimulants, with most involving methamphetamine.
 
NDARC Deputy Director and Drug Trends Program Lead Associate Professor Amy Peacock said these emerging trends present a ‘major public health concern’.
 
‘The sooner we respond to these changing patterns of drug-related harm, the greater our opportunity to prevent avoidable deaths and hospitalisations,’ she said.
 
Overall, polydrug use was a hallmark of overdose deaths, with 73% of cases involving two or more drug classes between 2020 and 2024.  Males accounted for 66% of all overdose deaths.
 
In 2024, 74% of drug overdose deaths were unintentional, with 22% classified as intentional. The most common psychosocial risk factor was a personal history of self-harm, noted in around one in eight deaths.
 
Through their harm-minimisation role, Associate Professor Tracy says GPs are also well placed to support patients experiencing mental health issues who may be at risk.
 
‘The report notes the proportion of those who had a personal history of self-harm, and I would recommend anyone who is or has had thoughts of self-harm seeks help from your GP for ongoing support’, she said.
 
‘We are ready to support anyone who is experiencing harms from substance use.’
 
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amphetamines drug overdose drug-induced deaths harm minimisation illicit drugs non-prescribed pharmaceuticals stimulants