Mounting Burden of Substance Use on Health
Drug overdose deaths in Australia continue to cast a long shadow over the nation’s public health system, contributing significantly to the country’s disease burden and loss of life. According to the Australian Institute of Health and Welfare (AIHW), the combined use of tobacco, alcohol, and illicit drugs accounted for 14% of the total burden of disease in 2024. Drug overdose deaths are preventable, yet they remain a leading cause of premature death.
Burden of disease measures the impact of illness, injury, and early death through Disability-Adjusted Life Years (DALYs). Tobacco use alone contributed 7.6% of the national burden, causing cancers, respiratory and cardiovascular diseases. Alcohol was responsible for 4.1%, with particularly high risk among males aged 15–44. Illicit drug use added 2.9% to the disease burden, with opioids accounting for the largest share, followed by amphetamines, cocaine, and cannabis.
Drug overdose is a national crisis in Australia. [Credit: MART PRODUCTION/Pexels]
Alarming Death Toll
In 2023, 2,272 drug-induced deaths were recorded across Australia, marking the tenth consecutive year with more than 2,000 fatalities. “We’re losing the equivalent of a Boeing 737 full of Australians every month,” said John Ryan, CEO of the Penington Institute. “The overdose toll has long exceeded the road toll … it’s a huge problem that gets very little attention compared to other causes of death.”
John Ryan says Australia loses as many people to drug overdoses each month as would fill a Boeing 737. [Credit: ABC News/Andrew Altree-Williams]
More than three-quarters (77.8%) of these deaths were unintentional. Opioids, including heroin and prescription medicines, were the most common substances involved, contributing to 43.9% of deaths. Alarmingly, stimulant deaths rose by 2%, with methamphetamine now overtaking benzodiazepines as the second-most common drug involved in fatal overdoses.
For the tenth year in a row, there were more than 2,000 drug-related deaths in Australia in 2023, with 2,272 recorded. [Credit: MART PRODUCTION/Pexels]
First Nations Communities Disproportionately Affected
Data from 2018 showed that First Nations people bore a significantly higher burden, with tobacco and alcohol contributing to 12% and 10% of the total disease burden, respectively. Illicit drug use ranked fourth at 6.9%. The rate of drug-induced deaths among Aboriginal and Torres Strait Islander peoples in 2023 stood at 21.3 per 100,000, nearly four times higher than the rate among non-Indigenous Australians (5.7 per 100,000).
Alcohol use disorder and injuries cause the greatest burden of disease linked to substance use, especially among males. [Credit: Australian Institute of Health and Welfare]
Rising Injuries and Hospitalisations
Substance use is also fuelling injuries and hospitalisations across the country. From 2022–2023, 1.7% of Australians aged 14 and over required medical attention for alcohol-related injuries. Those who consumed more than 11 standard drinks in one sitting at least monthly reported significantly higher rates, with 10.2% needing treatment.
Illicit drugs also pose a substantial risk, with 2.6% of recent users reporting injury that required medical attention, and 1.3% needing hospitalisation. One percent reported overdose requiring medical attention, with 0.7% hospitalised. Though small in percentage, these figures reflect thousands of individuals and the immense strain on health services.
Between 2022 and 2023, 1.7% of Australians aged 14 and older needed medical care due to injuries linked to alcohol consumption. [Credit: Photo by Maurício Mascaro/Pexels]
Ambulance and Hospital Data Tell a Grim Story
Between January 2021 and March 2024, data from six jurisdictions (NSW, Victoria, Queensland, Tasmania, ACT and NT) showed alcohol consistently led to the highest rate of ambulance attendances. Hospital transports followed a similar pattern, with 86% to 92% of pharmaceutical-related ambulance attendances resulting in hospitalisation, compared to 71% to 83% for alcohol-related attendances.
Heroin-related attendances had the lowest transport rates, ranging from 49% to 76%. Attendance patterns also revealed that men accounted for most illicit drug-related cases, while women dominated pharmaceutical-related cases.
Police and Polydrug Use
Police were most likely to co-attend incidents involving GHB or amphetamines, with up to 45% of attendances in Victoria and NSW involving law enforcement. In contrast, pharmaceutical-related events had lower police presence.
Ambulance attendances involving multiple drugs were also concerning. Up to 79% of ecstasy-related incidents in Victoria and the ACT involved more than one substance. Pharmaceutical-related cases involved other drugs in over 50% of attendances, pointing to a complex and dangerous web of drug interactions.
The Crisis Behind Closed Doors
“Many of these deaths are occurring in private homes and often it’s lounge rooms in suburbia and regional and rural towns,” said John Ryan. Drug overdose deaths in Australia are not confined to stereotypical users. Increasingly, they involve people taking prescription medication, counterfeit pharmaceuticals, or mixing substances unknowingly.
Suzanne Nielsen of the Monash Addiction Research Centre warned about fake prescription drugs, which may contain potent synthetic opioids like fentanyl or nitazenes. “Even pharmacists wouldn’t necessarily be able to pick them apart immediately,” she noted. In Melbourne last year, four men died after consuming drugs laced with nitazenes.
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A Preventable Tragedy
Despite the scale of the crisis, advocates argue that the government’s approach focuses too much on law enforcement and too little on harm reduction. Mr Ryan stressed that more investment is needed in life-saving measures such as naloxone distribution, overdose education, and drug checking services.
“Overdose deaths are preventable,” he said. “We’ve got a real mismatch between what the evidence shows and what government is doing.”
Professor Nielsen echoed that call, urging stronger public education campaigns. “That … is often actually the sign of an overdose and there are many deaths that result from people not knowing how to respond,” she said.
Looking Forward
The federal government has invested $377 million over four years to subsidise opioid dependence treatment through the Pharmaceutical Benefits Scheme and has extended free naloxone access through the Take Home Naloxone program. Yet, experts argue these efforts must be scaled up.
As drug overdose deaths in Australia continue to claim thousands of lives each year, only a bold, evidence-based shift in policy and funding can turn the tide.
If you or someone you know needs help:
- Lifeline: 13 11 14
- National Alcohol and Other Drugs Hotline: 1800 250 015
- Family Drug Support: 1300 368 186
- Alcohol and Drug Foundation: 1800 250 015
- Medication Support and Recovery Service: 1800 931 101
