Trends in cannabis availability, use, and treatment in Australia, 2013–14 to 2021–22

This section uses survey data from the 2022–2023 National Drug Strategy Household Survey (NDSHS) to describe self-reported cannabis use amongst people aged 14 and over in Australia. This information is supplemented with data on cannabis use among adolescents from the Australian Secondary Students’ Alcohol and Drug (ASSAD) survey, and population-weighted average cannabis consumption estimates from the National Wastewater Drug Monitoring Program (NWDMP). The information in this section primarily relates to non-medical cannabis use (that is, cannabis obtained without a prescription from a doctor), but definitions of cannabis use vary by data source.

Medical cannabis in Australia

Prior to 2016, cannabis was classified as an illegal narcotic under Australian law. In February 2016, this legislation was amended to allow access to medical cannabis for specific patients under strict medical supervision. ‘Medical cannabis’ is generally used to refer to cannabis that is obtained via a prescription from a healthcare provider, but some people use cannabis for medical purposes without a prescription for self-determined medical purposes. Data sources on both kinds of medical cannabis use in Australia are relatively limited, and some methodologies (for example, wastewater analysis, urinalysis) are not able to distinguish between medical and non-medical use. However, available data on medical cannabis indicate a growing number of Australians are accessing medical cannabis via a prescription.

Data from the 2022–2023 NDSHS indicate that 3.0% of people aged 14 and over had used cannabis for medical reasons in the previous 12 months, either sometimes (2.0%) or always (1.0%) (AIHW 2024). Among those who exclusively used cannabis for medical purposes, 7 in 10 (70%) did so without a prescription. Access via medical pathways, however, is becoming more common. In 2019, just 1.8%* of people who used cannabis for medical purposes always had it prescribed by a doctor; in 2022–2023, this proportion increased to 22% (AIHW 2024).

* Estimate has a relative standard error between 25% and 50% and should be interpreted with caution.

Data on medical cannabis approvals are sourced from the Therapeutic Goods Administration (TGA), which is the regulatory body for medical cannabis access in Australia. The TGA does not record the number of cannabis prescriptions dispensed but does record approvals for access to medical cannabis via two different pathways: the Authorised Prescriber Scheme (AP) and the Special Access Scheme Category B (SAS-B) (TGA 2023). TGA data indicate a substantial rise in the number of medical cannabis approvals since 2016, with 963,000 approvals via the AP pathway and 458,000 via the SAS-B pathway from July 2016–December 2023. Of those 458,000 SAS-B approvals, 234,000 were for chronic pain and 117,000 were for anxiety (TGA 2023). More information is available on the TGA's Medicinal Cannabis Hub.

Cannabis use

Data from the most recent NDSHS showed that 2.5 million people (11% of the population aged 14 and over) had used cannabis in the previous 12 months in 2022–2023 (AIHW 2024). This was stable from 2019, but self-reported lifetime use increased across the same period (Figure 4; Tables 2.1–2.2). Most people who had recently used cannabis usually obtained it from a friend or a dealer (61% and 21%, respectively), and 9 in 10 usually used it in a private home (90%). Cannabis was commonly smoked on its own in a joint or from a bong (33% and 25%, respectively), or with tobacco in a joint (17%) (AIHW 2024). These methods of use are also commonly reported in surveys of people who regularly use stimulants or regularly inject drugs, and adolescents who use cannabis (Sutherland et al. 2023a; Sutherland et al. 2023b; Scully et al. 2023).

Who uses cannabis?

As in previous years, males were more likely than females to have recently used cannabis (13% compared with 9.8%). However, this gap has narrowed over time as fewer males and more females report using cannabis. This was particularly apparent among younger people, with a higher proportion of females than males aged 14–19 reporting recent cannabis use in 2022–2023 (18% compared with 13%) (Figure 3; Tables 2.1–2.2).

People aged under 30 were more likely to have recently used cannabis than those in older age groups in 2022–2023 (Figure 3). The mean age of people who had recently used cannabis increased from 29 years in 2001 to 36 in 2022–2023 (AIHW 2024).

Figure 3: Lifetime^a or recent^b use of cannabis, by age group and gender, people aged 14 and over, 2001 to 2022–2023

Data from the ASSAD survey indicate that use of cannabis among secondary school students is similar to that of the general population. In 2022–2023, 12% of students aged 12–17 had used cannabis in the past year and 6.6% had used it within the past month (Scully et al. 2023). Older students aged 16–17 were more likely than those aged 12–15 to have used cannabis in the past month (11% compared with 4.6%). Both lifetime and past month cannabis use declined for those aged 16–17 between 2017 and 2022–2023, while for younger students it has remained stable since the early 2000s.

Cannabis use by geographic and socioeconomic area

Wastewater data from the NWDMP show that the population-weighted average consumption of cannabis is typically higher in regional areas than in capital cities (ACIC 2023). Results from the NDSHS support this: in 2022–2023, people living in Remote and Very remote areas were more likely to have used cannabis recently (13%), compared with those in Major cities or Inner regional areas (12% and 10%, respectively) (Figure 4; Table 2.3). This pattern has remained relatively consistent over time, but the gap in recent cannabis use between remoteness areas has diminished over time. Cannabis use also varied by socioeconomic area, with people living in the most advantaged socioeconomic areas being the most likely to have used cannabis recently in 2022–2023 (13%).

Figure 4: Cannabis use, by remoteness area or socioeconomic area, people aged 14 and over, 2007 to 2022–2023

Health conditions among people who use cannabis

Most people who had used cannabis in the previous 12 months reported their health as ‘good’ (32%) or ‘very good’ (38%) in 2022–2023 (Figure 5; Table 2.4). Mental health conditions, however, were more commonly experienced among this cohort than for people who had not used cannabis, including both anxiety (24% compared with 11%) and depression (23% compared with 12%). 

People who had used cannabis in the previous 12 months were also more likely to report experiencing high or very high levels of psychological distress (31% compared with 15% for those who had not used cannabis). 

Concerningly, the proportion of people experiencing anxiety increased substantially between 2019 and 2022–2023 across all 3 cohorts (Figure 5). This increase disproportionately impacted people who use cannabis, who were more than twice as likely to experience anxiety and twice as likely to experience high or very high levels of psychological distress compared with people who do not use cannabis. This highlights a need for improved access to both mental health and alcohol and other drug support among people who use cannabis, in addition to other healthcare services (for example, GPs).

Figure 5: Self-assessed health status, health conditions or psychological distress, by cannabis use, people aged 18 and over, 2007 to 2022–2023

Existing evidence suggests that cannabis is often prescribed and/or used medically for the management of both chronic pain and mental health conditions. While the NDSHS does not include information about what conditions cannabis is prescribed for, it does include information about health conditions among people who use medical cannabis. In 2022–2023, a high proportion of people who had medical cannabis prescribed to them experienced anxiety (49% compared with 13% nationally), depression (47% compared with 13%), or chronic pain (43% compared with 11%) (AIHW 2024). Similarly, TGA data indicate that 234,000 of the total 458,000 SAS-B cannabis approvals between July 2016 and December 2023 were for chronic pain and a further 117,000 were for anxiety (TGA 2023).

Risk factors for cannabis-related harm

Cannabis use has been linked to various harms including dependence and overdose (Volkow et al. 2014; Whetton et al. 2020). Notably, 1 in 10 Australians (10%) who had recently used cannabis reported that they could not stop or cut down their cannabis use even if they wanted to in 2022–2023 (AIHW 2024). Additionally, people who had recently used cannabis were more likely than those who had not to access a range of alcohol, tobacco, and other drug treatment services including information and education (9.0% compared with 2.3%), counselling (8.2% compared with 1.7%), and medications to help quit smoking (5.7% compared with 2.6%) (Table 2.5). 

Certain psychosocial and drug use factors may increase the risk of a person experiencing harm from cannabis. For example, people who start using cannabis at a younger age or who use it more frequently are more likely to develop dependence. Using other drugs at the same time as cannabis can also increase the risk of overdose or other adverse events (National Academies of Sciences, Engineering and Medicine 2017; Volkow et al. 2014). This section focuses on key factors that may indicate a risk of harm, namely age of initiation, frequency of use, polydrug use (that is, using alcohol or other drugs at the same time as cannabis) and dependence risk scores. 

Age of initiation of cannabis use

The mean age of initiation of lifetime cannabis use was 19.1 years in 2022–2023, stable from 18.9 in 2019. This age is higher than in 2007 but remains younger than the age of initiation for any other illegal drug (Table 2.6). Age of initiation of cannabis use is typically lower in Remote and very remote areas compared with Major cities.

Daily cannabis use

In 2022–2023, 3 in 5 people (61%) who had recently used cannabis did so about once a month or less often. Almost 1 in 5 people (18%) who had recently used cannabis did so every day, up from 14% in 2019. Males were more likely than females to report daily use, and people in their 50s and over were more likely than younger people to use daily. People in Outer regional areas were the most likely to report daily use (27%) and those in Major cities were the least likely (16%) (Figure 6; Tables 2.7–2.9). 

Figure 6: Frequency of cannabis use, overall and by age group, gender or remoteness area, people aged 14 and over who have recentlyᵃ used cannabis, 2010 to 2022–2023

Use of other drugs at the same time as cannabis

Use of other drugs at the same time as cannabis is common but has declined since 2019. Between 2019 and 2022–2023, there were decreases in the proportion of people who used cannabis with alcohol (from 87% to 74%), tobacco (from 63% to 41%) or any illicit drug (from 35% to 23%) (Figure 7; Tables 2.10–2.12). Conversely, the proportion of people who did not use other drugs together with cannabis (‘none of the above’) rose from 3.4% to 19%. Use of other drugs varied among different population groups:

• Males were more likely than females to have used alcohol, tobacco, or any illicit drug at the same time as cannabis in 2022–23. 
• People in their 50s were more likely than those in other age groups to have used cannabis at the same time as alcohol or tobacco, while those in their 20s were the most likely to have used it with an illicit drug. 
• People in Remote or very remote areas were the most likely to use alcohol (79%) or tobacco (51%) at the same time as cannabis, while those in Major cities were the most likely to report using illicit drugs (24%) or not using other drugs (20%) with cannabis (Figure 7). 

Figure 7: Other drugs used at the same time as cannabis, overall and by gender, age group, or remoteness area, people aged 14 and over who have recentlyᵃ used cannabis, 2010 to 2022–2023

Who is at higher risk of cannabis dependence?

Around 1 in 5 people (18%) who had recently used cannabis in 2022–2023 were identified as having moderate or high risk cannabis use (Figure 8; Tables 2.13–2.16). This was consistent with 2019, but high risk use disproportionately affected certain groups:

• A higher proportion of females than males reported high risk cannabis use (4.8% compared with 3.7%), and this proportion more than doubled from 2019 (1.8%*). This is concerning given that females were less likely than males to report use of cannabis in the previous 12 months (9.8% compared with 13% in 2022–2023).
• People aged 14–19 were more likely than other age groups to have high risk cannabis use (11% compared with 4.1% for all people aged 14 and over). This group also had the highest proportion of people in the moderate risk use category (17% compared with 14.4% overall).
• High risk cannabis use was more common among people with a mental illness diagnosis or treated for a mental health condition (8.2%* compared with 3.6% who were not) and those experiencing high or very high levels of psychological distress (8.0% compared with 1.2% for people experiencing low distress).
• People in Inner regional areas were more likely than other groups to have high risk cannabis use (5.4%*), while those in Outer regional areas were the most likely to have moderate risk use (17%).

* Estimate has a Relative Standard Error of 25–50% and should be interpreted with caution.

Figure 8: Risk score for cannabis use, by age group or gender, mental health conditions, or psychological distress, or remoteness area, people aged 14 and over who have recentlyᵃ used cannabis, 2019 to 2022–2023

Conclusions

The findings described in this section indicate that certain groups of people who use cannabis may be at increased risk of experiencing harm. Women, younger people, and those living in regional or remote areas may benefit from targeted education and awareness to facilitate treatment seeking. 

These findings highlight the complex relationship between cannabis use and physical and mental health. People who use cannabis (with or without a prescription) are more likely than those who do not to experience conditions like chronic pain, depression, and anxiety. In describing these characteristics, it also represents an opportunity for healthcare providers to engage with people about additional types of support they may need (for example, alcohol and other drug (AOD) or mental health services).