Skip to content

Key resources

  • Bibliography
    Bibliography
  • Health promotion
    Health promotion
  • Health practice
    Health practice
  • Yarning places
    Yarning places
  • Programs
    Programs
  • Organisations
    Organisations
  • Conferences
    Conferences
  • Courses
    Courses
  • Funding
    Funding
  • Jobs
    Jobs
Australian Indigenous HealthBulletin
 
Print this page Print

spacing1What do we know about injecting drug use among Indigenous people?

Many more Indigenous people than non-Indigenous people use injecting drugs. Disadvantage in areas such as education, employment and income contribute to the greater use of illicit drugs.

What is injecting drug use?

Injecting drug use refers to the use of a needle to administer a drug; the drug may be administered intravenously (via a vein), intramuscularly (directly into a muscle), or subcutaneously (just under the skin). Injecting drug use became possible in the late 19th century with the development of the hypodermic needle. The most commonly injected illicit drugs are opiates (heroin), amphetamines (speed) and cocaine [1].

What are the health problems related to injecting drug use?

In addition to bacterial diseases and tissue damage, injection carries with it an increased risk of addiction (drugs are absorbed rapidly when administered by injection and the more rapidly a drug is absorbed the greater the risk of addiction), an increased risk of contracting blood borne viruses (BBV), and the risk of overdose [1].

Deaths

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) [2] [3]. National data on mortality among Indigenous people are not available [4], but data collated by the Health Department of Western Australia found that the deaths of 26 Indigenous males and 14 Indigenous females in 1990-99 had been attributed to the use of drugs other than alcohol or tobacco (age-standardised rates were 11.1 and 5.9 per 100,000 population respectively) [5]. These death rates are similar to those for the total Australian population in 1999: 14 per 100,000 population for males and 5 per 100,000 for females [6].

Hospitalisation

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 [7].

The only detailed information about hospitalisation as a result of illicit drug use among Indigenous people was compiled as a part of reporting against the Aboriginal and Torres Strait Islander health performance framework [8]. Hospitalisation rates for drug-related causes were generally higher for Indigenous people than for non-Indigenous people living in Queensland, Western Australia, South Australia and the Northern Territory in July 2002 to June 2004 (comprising about 60% of the total Indigenous population), particularly for mental/behavioural disorders relating to use of cannabinoids (4.8 times the non-Indigenous rate), and multiple drugs and psychoactive substances (3.0 times the non-Indigenous rate).

Hepatitis C and HIV/AIDS

A concerning proportion of Indigenous users of amphetamines and opiates inject their drugs, with a high level of users sharing needles [9]. Findings from a South Australian study on Indigenous injecting drug users found that the people who regularly shared needles (12% of the surveyed participants) were more likely to be dependent, heavy polydrug users and frequent users of amphetamines [10]. These findings have implications for the spread of blood-borne viruses such as Hepatitis C and HIV/AIDS.

HEP C

Although poor reporting systems make it difficult to determine the rate of viral infection among Indigenous drug users [9], the ‘HIV/AIDS, viral hepatitis and sexually transmissible infections in Australia, Annual Surveillance Report 2007’ found that in the most recent five-year period (2002-2006), the rate of hepatitis C diagnosis increased in both the Indigenous and non-Indigenous population in the Northern Territory (in contrast with a decreasing trend nationally), but was lower in the Indigenous population. The rate of newly diagnosed hepatitis C infection in the Indigenous population of Western Australia and South Australia was between two and three times, and five and 10 times higher respectively than that in the non-Indigenous population [11]. This is likely to be a significant underestimation given that as recently as 2005 Indigenous status was not recorded for 65% of new Hepatitis C notifications [9].

HIV AIDS

Similarly, despite the equivalency in HIV infection rates between Indigenous and non-Indigenous Australians, Indigenous Australians are more likely than non-Indigenous Australians to contract HIV infection through the use of shared needles. In the most recent five-year period (2002-2006), the ‘HIV/AIDS, viral hepatitis and sexually transmissible infections in Australia, Annual Surveillance Report 2007’ reveals a three-fold increase in the proportion of HIV infections attributed to injecting drug use among Indigenous Australians since the 2000 report (18% compared with 6%), while the non-Indigenous rate has remained unchanged at 3% [11] [12].

Overdose

The National Drug and Alcohol Research Centre (NDARC), in their report ‘Findings from the Illicit Drug Reporting System’ (IDRS), found that 56% of participants using heroin and other opioids in 2007 had overdosed at some point in their lifetime. For participants who used amphetamines, 6% reported overdosing at some point in their lifetime [13]. In 2005, 46% of injecting drug users surveyed in Australia had overdosed at some point in their lifetime [14].

In 2001, a Western Australian study of 74 Indigenous people who inject drugs found that 24% of participants had overdosed at some time [15]. The authors note that these findings contrast with the findings of Larson (1996), where 52% of Indigenous heroin users had personally experienced overdose, however the lower overdose rate in the Western Australian study was attributed to a lesser use of heroin [15]. In 2002, a South Australian study of Indigenous injecting drug users found that 21% had overdosed after injecting, and in contrast to the Western Australian study, 97% of participants had used heroin in the last six months [10]. These figures suggest the overdose rate for Indigenous injecting drug users is variable; being less than or equal to that of the general Australian injecting drug user population. The concern for Indigenous injecting drug users relates to the stigma and shame of injecting drug use and the associated increased risks of overdose when injecting alone to conceal drug use from family and friends [16].

What strategies have been initiated to reduce the harm associated with injecting drug use?

The National Drug Strategy

The National Drug Strategy (developed by the Ministerial Council on Drug Strategy (MCDS)) is an umbrella framework which seeks to reduce the harmful effects of drugs and drug use through a series of national action plans addressing tobacco, alcohol, school-based drug education and illicit drugs [17].

Harm minimisation

Since 1985 Australia’s drug strategy has embraced the principle of harm minimisation to reduce drug-related harm. Harm minimisation refers to the policies and strategies of supply reduction, demand reduction and harm reduction which seek to reduce drug-related harm by improving the health, social, and economic outcomes for both the individual and the community [17].

Supply reduction strategies seek to reduce the production and supply of illicit drugs and to control and regulate licit drugs [18].

Research by Loxley and colleagues (2004) showed limited evidence for supply reduction strategies and highlighted the need for much more research into those strategies in use [4].

Those law enforcement strategies aimed at reducing demand among users which showed evidence for implementation included [4]:

Demand reduction strategies seek to reduce demand for substances and include strategies aimed at preventing the uptake of harmful drug use as well as strategies aimed at reducing drug use [18].

Strategies include addressing the broader social determinants of health as well as health sector specific strategies focussing on education and information on the risks associated with drug use [9].

Harm reduction strategies seek to reduce drug-related harm for individuals and communities while not necessarily reducing drug use [18].

Loxley and colleagues (2004) noted the programs with the strongest evidential support for harm reduction were needle and syringe distribution to reduce the spread of blood-borne viruses, the use of methadone for opiate dependence to reduce the risk of overdose and blood-borne viruses, and hepatitis B vaccinations [4].

In 2005-06, the Drug and Alcohol Service Reporting found that 27% of services used harm reduction interventions (such as information about safe using practices) in relation to substance use, and approximately 1,170 Indigenous clients received sobering up/residential respite involving 5,220 episodes of care [19]. In terms of injecting drug users, in 2003-04, 30 ACCHSs (22%) operated needle exchange programs [9].

What do we know about the prevalence of injecting drug use among Indigenous people?

According to recent population surveys (2004-2005 National Aboriginal and Torres Strait Islander Health Survey (NATSIHS); 2007 National Drug Strategy Household Survey (NDSHS)) the overall level of illicit drug use in the previous 12 months among the Indigenous population aged 15 years or older living in non-remote areas (28%) was more than twice the level of the general Australian population aged 14 years or older (13%) (Figure 1) [8] [20]. The higher level of drug use applied across all drug types. Amphetamines were the most commonly used drug after cannabis [8] [20].

Figure 1 Proportions of illicit drug use in the previous 12 months for the Indigenous and general Australian populations, by drug type, Australia, selected years

Proportions of illicit drug use

Sources: 2004-2005 NATSIHS 2007 NDSHS [20]

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

The overall level of illicit drug use in the previous 12 months by Indigenous people aged 15 years or older living in non-remote areas was 4.7% higher in 2004-2005 than in 2002 (Figure 2) [8]. This change reflects a 20% increase in the number of Indigenous people using illicit drugs in this 2-3 year period. The increase in cannabis use (18%) was around the same as the overall increase, but the increase in amphetamine use was much greater (46%) [8].

Figure 2 Changes in proportions of Indigenous people using illicit drugs, by drug type, Australia, 2002 and 2004-2005

Changes in proportions of Indigenous people using illicit drugs, by drug type, Australia, 2002 and 2004-2005

Sources: 2002 NATSISS ; 2004-2005 NATSIHS

Note: Proportions are for Indigenous people aged 15 years or older living in non-remote areas

Emerging evidence supports a preference among Indigenous injecting drug users for amphetamines over heroin; this is most likely a reflection of the longer lasting euphoric effects of amphetamine and its economic affordability in comparison to heroin . With evidence that amphetamine use is increasing among Indigenous people there are fears that non-Indigenous suppliers will use the existing, largely Indigenous, cannabis networks in rural and remote communities for the flow of amphetamines .

References

  1. Degenhardt L, Roxburgh A (2005) Accidental drug-induced deaths due to opioids in Australia, 2005. Sydney: National Drug and Alcohol Research Centre
  2. Degenhardt L, Roxburgh A (2007) Cocaine and methamphetamine related drug-induced deaths in Australia, 2005. Sydney: National Drug and Alcohol Research Centre
  3. Loxley W, Toumbourou JW, Stockwell T, Haines B, Scott K, Godfrey C, Waters E, Patton G, Fordham R, Gray D, Marshall J, Ryder D, Saggers S, Sanci L, Williams J (2004) The prevention of substance use, risk and harm in Australia: a review of the evidence. Canberra: Department of Health and Ageing
  4. Thomson N, ed. (2003) The health of Indigenous Australians. South Melbourne: Oxford University Press
  5. Australian Bureau of Statistics (2001) Australian social trends. Canberra: Australian Bureau of Statistics
  6. Australian Institute of Health and Welfare (2007) Australian hospital statistics 2005-06. Canberra: Australian Institute of Health and Welfare
  7. Australian Institute of Health and Welfare (2007) Aboriginal and Torres Strait Islander health performance framework, 2006 report: detailed analyses. Canberra: Australian Institute of Health and Welfare
  8. Couzos S, Murray R (2008) Aboriginal primary health care: an evidence-based approach. 3rd ed. South Melbourne: Oxford University Press
  9. National Centre in HIV Epidemiology and Clinical Research (2007) HIV/AIDS, viral hepatitis and sexually transmissible infections in Australia: Annual Surveillance Report 2007. Sydney: Australian Institute of Health and Welfare
  10. Black E, Roxburgh A, Degenhardt L, Bruno R, Campbell G, De Graaf B, Fetherston J, Kinner S, Moon C, Quinn b, Richardson M, Sindicich N, White N (2007) Australian drug trends 2007: findings from the Illicit Drug Reporting System (IDRS). Sydney: National Drug and Alcohol Research Centre
  11. Australian Institute of Health and Welfare (2007) Statistics on drug use in Australia 2006. Canberra: Australian Institute of Health and Welfare
  12. Gray D, Saggers S, Atkinson D, Carter M, Loxley W, Hayward D (2001) The harm reduction needs of Aboriginal people who inject drugs. Perth: National Drug Research Institute, Curtin University of Technology
  13. Coupland H, Ball K, Costello M, Harvey B, Maher L (2005) "Something is going to get us": a consultation and development project for a national campaign addressing injecting drug use in Indigenous communities: final report. Darlinghurst, NSW: Australian Federation of AIDS Organisations and the Australian Injecting and Illicit Drug Users League
  14. Ministerial Council on Drug Strategy (2006) National Drug Strategy: Aboriginal and Torres Strait Islander peoples complementary action plan 2003-2009: background paper. Canberra: Ministerial Council on Drug Strategy
  15. Ministerial Council on Drug Strategy (2004) National drug strategy: Australia's integrated framework 2004-2009. Canberra: Ministerial Council on Drug Strategy
  16. Office for Aboriginal and Torres Strait Islander Health (2007) Drug and alcohol service reporting: 2005-06 key results: a national profile of Australian Government funded Aboriginal and Torres Strait Islander substance use specific services. Canberra: Department of Health and Ageing
  17. Australian Bureau of Statistics (2006) National Aboriginal and Torres Strait Islander Health Survey: Australia, 2004-05. Canberra: Australian Bureau of Statistics
  18. Australian Bureau of Statistics (2004) National Aboriginal and Torres Strait Islander Social Survey, 2002. Canberra: Australian Bureau of Statistics
  19. Nicholas R (2004) Apprehension and custodial care of offenders affected by the use of amphetamine type stimulants. Marden, S.A.: Australasian Centre for Policing Research
  20. Putt J, Delahunty B (2006) Illicit drug use in rural and remote Indigenous communities. Canberra: Australian Institute of Criminology
 
Last updated: 19 January 2009
 
Return to top