1 Drug-related hspital stays in Australia Prepared by Amanda Rxburgh and Luisa Degenhardt, Natinal Drug and Alchl Research Centre Funded by the Australian Gvernment Department f Health and Ageing Recmmended citatin: Rxburgh, A. & Degenhardt, L. (2006). Drug-related hspital stays in Australia, Sydney: Natinal Drug and Alchl Research Centre This bulletin presents data n drug-related hspital separatins in Australia fr the perid fr the fllwing drug types: piids, ccaine, amphetamines and cannabis. A hspital separatin is defined as an episde f care fr an admitted patient, which may refer t a ttal hspital stay (frm admissin t discharge), r a prtin f a hspital stay beginning r ending in a change f type f care, r transfer t anther hspital. The data presented in this bulletin include hspital separatins where the abve-mentined drugs were determined t be the principal reasn fr the hspital stay. Hspital separatins are cded accrding t the Wrld Health Organizatin s (WHO) Internatinal Statistical Classificatin f Diseases (ICD) and Related Prblems. The ICD 10th revisin (ICD 10 AM) (Natinal Centre fr Classificatin in Health, 1998) was used t cde data dating frm 1999 t the present in Suth Australia (SA), Western Australia (WA), and Queensland (QLD). The remaining jurisdictins cmmenced using ICD 10 AM cdes in Prir t this, the ICD 9th revisin (ICD 9 CM) (Natinal Cding Centre, 1996) was used t cde hspital separatins. Rates per millin persns f hspital separatins are als presented, and these are calculated using the Australian Bureau f Statistics estimated resident ppulatin figures as at 30 June each year. The data refer t persns aged between 15 and 54. Figure 1 shws rates per millin persns f hspital separatins fr all fur drug types. Rates f separatins were highest fr piids cmpared t the ther drug types. Rates fr ccaine, amphetamine and cannabis separatins were all relatively lwer during the twelve-year perid. Figure 1: Rates per millin persns f principal drug-related hspital separatins in Australia amng persns aged 15-54, by drug type,
2 Opiid-related hspital separatins Opiid-related hspital separatins declined dramatically in 2001/02 (Figure 2), cinciding with the herin shrtage reprted at this time. These separatins have remained lwer since this time. Rates f piidrelated hspital separatins were highest in New Suth Wales (NSW). Separatins fr piid dependence accunted fr apprximately tw-thirds f all principal piid-related separatins. Bth withdrawal and dependence separatins declined dramatically in 2001/02. Research examining the impact f the herin shrtage n patterns f drug use (Degenhardt and Day, 2004) and n presentatins fr treatment f herin use in NSW (Degenhardt, Cnry, Day et al., 2005) suggests several reasns fr the decline in piid dependence presentatins. First, there may be lwer levels f physical dependence amng users as a cnsequence f lwer herin purity at street level being reprted during the shrtage (Degenhardt et al., 2005). Secnd, the number f regular herin users in NSW mst likely declined fllwing the shrtage (Degenhardt and Day, 2004), resulting in fewer presentatins fr dependence. Likewise, with lwer purity in herin being reprted, many users may have been able t manage withdrawal withut presenting t hspital. While there was a dramatic decline in piid-related separatins, they remain the highest acrss the drug types, and given that they are primarily funded by Australian health care agreements, they are likely t place a cntinuing burden n the public health system. Figure 2: Rates per millin persns f principal piid-related hspital separatins in Australia amng persns aged 15-54,
3 Amphetamine-related hspital separatins Numbers f amphetamine-related hspital separatins were the next highest amng the drug types examined (Figure 3 shws the rates per millin persns), and these separatins have steadily increased ver the twelve-year perid. Rates were highest in QLD until 2000/01, when WA surpassed this figure. Rates in QLD increased steadily during the perid, and this is cnsistent with increases in plice detectins f clandestine labratries manufacturing methamphetamine (Kinner, Fischer and Llyd, 2006). QLD recrded the highest number f detectins f labratries in Australia between 1997/98 and 2001/02 (McKetin, McLaren and Kelly, 2005). WA als had relatively high rates f amphetamine-related separatins, and sharp increases were evident in 2000/01, the majrity f which was due t increases in separatins fr amphetamine dependence. This increase cincides with the herin shrtage and reprts f increased use f methamphetamine amng injecting drug users in Australia at this time (Staffrd, Degenhardt, Black et al., 2006). At their peak hwever, amphetamine-related separatins nly represented ne-quarter f the highest number f piid-related separatins recrded during the twelve-year perid. Amphetamine dependence separatins accunted fr apprximately ne-third f all principal amphetamine-related separatins. Numbers f amphetamine dependence separatins remain lwer than fr piid dependence. This is indicative that fewer methamphetamine users than piid users present fr treatment fr prblems assciated with their methamphetamine use, and that they are mre likely t present t health services when they are in crisis. This is cnsistent with findings f a study cnducted in Sydney n the utilisatin f health services by regular methamphetamine users (Kelly, McKetin and McLaren, 2005), with nly 10% f thse interviewed reprting receiving treatment fr their methamphetamine use in the past 12 mnths. Althugh amphetamine-related separatins nly accunted fr small numbers f hspital separatins, given that they are primarily funded by Australian health care agreements, that they are increasing, and that methamphetamine users tend t present when they are in crisis, these separatins are likely t present nging challenges t the public health care system. Figure 3: Rates per millin persns f principal amphetamine-related hspital separatins in Australia amng persns aged 15-54,
4 Cannabis-related hspital separatins Cannabis-related separatins were the third highest in number acrss the fur drug types during the perid, and have remained relatively stable ver the past few years fllwing an increasing trend between 1993 and Rates per millin persns were highest in NSW fllwed by VIC (Figure 4). The percentage f cannabis-related separatins that were due t dependence has cntinued t increase frm 1993/94 when they accunted fr 42% f principal cannabis-related separatins, t accunting fr mre than tw-thirds (70%) f these separatins in 2004/05. While cannabis dependence separatins have cntinued t increase since 1998, numbers are still cmparatively smaller than thse fr piid dependence This, tgether with a declining trend in cannabis use being reprted amng the general ppulatin in Australia (Australian Institute f Health and Welfare, 1999, Australian Institute f Health and Welfare, 2002, Australian Institute f Health and Welfare, 2005), indicates that nly a small prprtin f cannabis users in Australia g n t develp dependence and t experience prblems assciated with their cannabis use. Figure 4: Rates per millin persns f principal cannabis-related hspital separatins in Australia amng persns aged 15-54,
5 Ccaine-related hspital separatins Ccaine-related separatins were the lwest acrss the fur drug types and did nt exceed 300 per year during the twelve-year perid (Figure 5). Rates were highest in NSW, which accunted fr the majrity f the natinal ttal f ccaine-related separatins during this perid. Increases in ccaine-related separatins were recrded in 1998/99 and 2001/02, with the latter cinciding with the herin shrtage and increased reprts amng injecting drug users abut prblems assciated with ccaine use (Rxburgh, Degenhardt and Breen, 2004, Staffrd et al., 2006). A further increase was evident in 2004/05 in NSW, which was predminantly due t an increase in ccaine dependence separatins. This increase is cnsistent with reprts f increases in daily use and greater availability f ccaine amng injecting drug users in Sydney (Black, Degenhardt and Staffrd, 2006). Ccaine dependence separatins have remained belw 200 per year during the twelve-year perid, and accunted fr the majrity (85% in 1996/97) f all principal ccaine-related separatins in the earlier part f the perid. Figure 5: Rates per millin persns f principal ccaine-related hspital separatins in Australia amng persns aged 15-54,
6 Implicatins Opiid-related hspital separatins remain the highest acrss the fur drug types, and while they have declined dramatically since 2001/02, cntinued fcus n the develpment f effective treatment prgrams fr piids, as well as enhancement f existing (such as methadne) treatment prgrams shuld remain a pririty. Amphetamine-related hspital separatins have cntinued t increase during the twelveyear perid, and develpment f effective treatment prgrams fr methamphetamine users, as well as strategies t engage this grup, are crucial, as research suggests that few f these users are accessing health services except when they are in crisis. Cannabis-related hspital separatins were cmparatively fewer in number, suggesting that nly a small prprtin f cannabis users g n t develp dependence and prblems assciated with their use. Educatin at a preventative level, targeting yung peple, shuld address the lnger term prblems (such as dependence) that may develp, particularly with nging daily cannabis use. Infrmatin abut available treatment prgrams fr prblematic cannabis use shuld als be circulated mre bradly within the cmmunity in rder t target new users, as well as lnger term cannabis users. Ccaine-related hspital separatins were the lwest acrss the drug types, at less than 300 per year. This is indicative that the ccaine market in Australia, particularly utside f the metrplitan Sydney area, is relatively small. Nevertheless, given the dramatic increases in ccaine-related harms recrded during the time f the herin shrtage, and again mre recently, mnitring f this market (i.e. thrugh the Illicit Drug Reprting System) remains a pririty. The Natinal Hspital Mrbidity Database is a useful data surce fr mnitring illicit drugrelated harms in Australia. Cntinued mnitring f this dataset wuld prvide invaluable infrmatin abut trends in drug-related harms in Australia, as well as the cntext within which emerging trends can be understd. Finally, analysis f this dataset, in cnjunctin with ther available data surces wuld prvide a reliable framewrk within which t infrm evidence-based drug plicy in Australia. Fr mre detailed analyses f this data, please refer t: Rxburgh, A. and Degenhardt, L. (2006). Hspital stays related t illicit drugs in Australia, Natinal Drug and Alchl Research Centre Technical Reprt Number 261. Sydney: University f New Suth Wales. Acknwledgements We wuld like t acknwledge the Australian Institute f Health and Welfare, in particular Katrina Burgess, fr prviding us with the Natinal Hspital Mrbidity Database. Related links: Fr mre infrmatin n NDARC research, g t: Fr mre infrmatin abut the AIHW, g t: Fr mre infrmatin n ICD-10, g t: The Natinal Drug and Alchl Research Centre University f New Suth Wales Sydney NSW 2052 Ph: Fax: ISSN Recmmended citatin: Rxburgh, A. & Degenhardt, L. (2006). Drug-related hspital stays in Australia, Sydney: Natinal Drug and Alchl Research Centre
7 References Australian Institute f Health and Welfare (1999) 1998 Natinal Drug Strategy Husehld Survey: First results. Canberra: Australian Institute f Health and Welfare. Australian Institute f Health and Welfare (2002) 2001 Natinal Drug Strategy Husehld Survey: Detailed findings. Canberra: Australian Institute f Health and Welfare. Australian Institute f Health and Welfare (2005) 2004 Natinal Drug Strategy Husehld Survey: Detailed findings. Canberra: Australian Institute f Health and Welfare. Black, E., Degenhardt, L. and Staffrd, J. (2006) New Suth Wales Drug Trends 2005: Findings frm the Illicit Drug Reprting System (IDRS). NDARC Technical Reprt N Sydney: Natinal Drug and Alchl Research Centre, University f New Suth Wales. Degenhardt, L., Cnry, E., Day, C., Gilmur, S. and Hall, W. (2005) The impact f the Australian herin shrtage n demand fr and cmpliance with treatment fr drug dependence, Drug and Alchl Dependence, 79, Degenhardt, L. and Day, C. (Eds.) (2004) The curse and cnsequences f the herin shrtage in New Suth Wales. Australasian Centre fr Plicing Research, Adelaide. Kelly, E., McKetin, R. and McLaren, J. (2005) Health service utilisatin amng regular methamphetamine users. NDARC Technical Reprt N Sydney: Natinal Drug and Alchl Research Centre, University f New Suth Wales. Kinner, S., Fischer, J. and Llyd, B. (2006) Queensland Drug Trends 2005: Findings frm the Illicit Drug Reprting System (IDRS). NDARC Technical Reprt N Sydney: Natinal Drug and Alchl Research Centre, University f New Suth Wales. McKetin, R., McLaren, J. and Kelly, E. (2005) The Sydney methamphetamine market: patterns f supply, use, persnal harms and scial cnsequences. NDLERF Mngraph N. 13. Sydney: Natinal Drug and Alchl Research Centre, University f New Suth Wales. Natinal Centre fr Classificatin in Health (1998) The Internatinal Statistical Classificatin f Diseases and Related Health Prblems, 10th Revisin, Australian Mdificatin Natinal Centre fr Classificatin in Health, Sydney. Natinal Cding Centre (1996) Australian Versin f the Internatinal Classificatin f Diseases, 9th Revisin, Clinical Mdificatin (ICD-9-CM) Natinal Cding Centre, Sydney. Rxburgh, A., Degenhardt, L. and Breen, C. (2004) Changes in patterns f drug use amng injecting drug users fllwing a reductin in the availability f herin in New Suth Wales, Australia, Drug and Alchl Review, 23, (3) Staffrd, J., Degenhardt, L., Black, E., Brun, R., Buckingham, K., Fetherstn, J., Jenkinsn, R., Kinner, S., Newman, J. and Weekley, J. (2006) Australian Drug Trends 2005: Findings frm the Illicit Drug Reprting System (IDRS). NDARC Mngraph N. 59. Sydney: Natinal Drug and Alchl Research Centre, University f New Suth Wales.