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Providing the evidence base to reduce harmful AOD use in
Aboriginal and Torres Strait Islander communities
Drugs are chemical substances. Drugs that are taken recreationally are known as psychoactive drugs - they act on the brain to alter the way we think, feel or act. Psychoactive drugs include tobacco, alcohol, cannabis (gunja, weed, dope), amphetamines (speed, ice), ecstasy (E, eccy, Adam, XTC), cocaine (freebase, crack), opioids (such as heroin, morphine and methadone), and drugs prescribed for medical purposes such as analgesics (pain killers) and benzodiazepines (relaxants).
Illicit drugs are:
Use of drugs that are illegal is a big concern for Australia. The use of legal drugs such as alcohol and tobacco continues to be the biggest concern, but the use of illegal drugs is also adding to ill-health, family and community problems.
In Australia in 2005-06, 8,389 people attended hospital for reasons relating to illegal drug use. The main drugs involved were heroin, amphetamine, cannabis and cocaine. In 2005, there were 410 deaths involving illegal drugs; opioids (such as heroin) accounted for the largest number of deaths (374), followed by amphetamines (26) and cocaine (10).
The health costs associated with drug use in Australia are high. In 2004-05, the total cost of ill-health relating to drug use (legal and illegal) was around $56 billion dollars - $8 billion was in relation to illegal drug use.
There are also high costs in relation to law enforcement, prevention, treatment and harm reduction. In 2002-03, $3.2 billion was spent by governments in relation to illegal drugs. The largest amount was spent on law enforcement-related activity (mostly arrests of people using illegal drugs) (75%), prevention (10%), treatment (7%) and harm reduction (1%).
The higher level of drug use among Indigenous people needs to be understood in terms of their much greater level of disadvantage. This disadvantage began when Europeans took land for themselves and did not allow Indigenous people to live life the way they always had. Indigenous people were often separated from their country and their language groups and were forced to live in poor conditions in missions and settlements, where, except for the most basic roles, Indigenous people were largely excluded from colonial life.
Recent population surveys tell us that:
According to the 2004-2005 NATSIHS, 12% of Indigenous males and 7% of Indigenous females had used three or more illegal substances in the previous 12 months.
Figure 1 Proportions (percentages) of illicit drug use in the previous 12 months for the Indigenous and general Australian populations, by drug type, Australia, selected years
Sources: 2004-2005 NATSIHS; 2007 NDSHS
Note: Proportions are for: (1) Indigenous people aged 15 years or older living in non-remote areas; and (2) general Australian population aged 14 years or older
Figure 2 Changes in proportions of Indigenous people using illicit drugs, by drug type, Australia, 2002 and 2004-2005
Sources: AIHW (2007)
Note: 1 Proportions are for Indigenous people aged 15 years or older living in non-remote areas
2 Primary sources were: 2002 NATSISS and 2004-2005 NATSIHS
Recent research tells us that cannabis use is common among Indigenous people in remote communities:
This means that:
Information on when people first use illegal drugs is based mostly on small surveys. They suggest that the average age of first use among Indigenous people is up to 6 years younger than the non-Indigenous population:
There is no national data on deaths related to illegal drug use for Indigenous people. We know that ‘age-standardised’ death rates are similar for Indigenous people and non-Indigenous people who died as a result of illegal drug use (based on information from the health department of Western Australia in the 1990s).
Age-standardisation is a way of adjusting for differences in age make-up between populations so we can make comparisons between those populations (in this instance, the Indigenous population is made up of more young people than older people compared with the non-Indigenous Australian population).
In July 2002 to June 2004, hospitalisation rates for drug-related causes were generally higher for Indigenous people than non-Indigenous people living in Queensland, South Australia, Western Australia, and the Northern Territory (accounting for about 60% of the Indigenous population). The main reasons for hospitalisation were mental/behavioural disorders due to drug use.
Sharing needles is a risk for the spread of blood-borne viruses (viruses that live in the blood) such as Hepatitis C and HIV/AIDS. A report found that in the most recent five-year period (2002-2006):
In 2007, there were three times as many HIV notifications due to injecting drug use among the Indigenous population than in 2000 (18% compared with 6%), while the non-Indigenous rate remained unchanged at 3%.
Alcohol is the drug most often linked with thoughts of suicide, but a number of studies have shown that the influence of drugs other than alcohol also adds to the decision to commit suicide. In comparison with non-Indigenous males and females for the period 2001-2005, the Indigenous suicide rate was:
Illegal drug users are concerned about the impact of their drug use on family relationships, and cite family tensions about finding money for drug use.
Family violence is a common concern of community members in remote areas, with heavy use of cannabis believed to add to the harms arising from the use of alcohol, kava or inhalant use. The majority of police in remote areas (76%) also believed cannabis use added to domestic/family violence.
Communities in remote areas also expressed concern for child neglect and the sexual abuse of young people in relation to drug use. This concern was also expressed by police who linked cannabis use with disruption to schooling and with children trading sexual favours for money or drugs.
A Western Australian survey found that children of parents who used drugs other than alcohol or tobacco were:
Based on age-standardised rates, Indigenous people were 13 times more likely to be in prison than non-Indigenous people. The 2002 National Aboriginal and Torres Strait Islander Social Survey (NASTSISS) found that the two most important factors relating to Indigenous prosecution and imprisonment were high-risk alcohol use and illegal drug use.
Indigenous people experience disadvantage in all socioeconomic indicators (social and economic indicators including education, income, employment and housing). These indicators are also known as social determinants of health.
The relationship between social determinants of health and behaviours that damage health is strongest between disadvantage in the social determinants of health and legal and illegal drug use. The strength of this relationship is influenced by risk and protective factors (for example risk factors such as ‘absent parents’ and violence, and protective factors such as strong family relationships, recreational activities and community support). Disadvantage in the social determinants of health is evident in terms of:
According to available evidence, the use of illegal drugs among the Indigenous population is more than twice that of the non-Indigenous population, and the use among Indigenous people has increased in recent years for all types of illegal drugs. The use of cannabis among Indigenous people living in remote areas is much greater than that of Indigenous people living in urban areas.
The use of illegal drugs has major impacts on Indigenous people, families and communities in terms of violence (including family violence), child neglect, sexual abuse, crime and imprisonment.
The much greater disadvantage experienced by Indigenous people in the areas of education, employment, income, and housing are important contributors to the use of illegal drugs.
As with many of the health and related problems experienced by Indigenous people, reducing illegal drug use and its impacts requires a holistic approach: programs addressing illegal drug use in combination with a range of general programs aimed at ‘closing the gap’ between Indigenous people and other Australians in the areas of education, employment, income and housing.
© Australian Indigenous HealthInfoNet 2014
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