Alcohol, tobacco & other drugs in Australia

Harm reduction focuses on identifying and targeting specific risks that arise from alcohol and other drug use. This may include risks to the individual, as well as their family and friends (Department of Health 2017).

Minimising risky behaviours

Examples of programs that aim to minimise risky behaviours include:

• Needle and syringe programs (NSPs) are designed to reduce the sharing of injecting equipment through the provision of sterile needles and syringes to people who inject drugs. NSPs are a cost-effective measure that have successfully prevented the spread of HIV and Hepatitis C infection. NSPs also provide counselling services and actively encourage clients into drug treatment programs (Wodak and Cooney. 2004).
• Supervised drug consumption facilities/rooms and medically supervised injecting centres (MSIC) are places where people can use and inject drugs under the supervision of registered nurses, counsellors and health education professionals. MSIC services aim to prevent injury and death by being present when someone injects in order to provide immediate medical assistance as required. Kings Cross in Sydney has been home to a MSIC since 2001 (Uniting 2017) and a second opened in Richmond, Victoria, in July 2018.
• Drug checking, also known as pill testing, is a harm reduction service that allows people who are thinking about using drugs to test their pills/drugs at designated sites. The test informs them of the purity of the drug, as well as the substances it contains (ACT Health 2023). The ACT is currently piloting a fixed-site health and drug checking service and Queensland has announced intentions to introduce mobile and fixed-site pill testing. 
• Data from the CanTEST Program Evaluation - Final report (July 2022 to January 2023) show that: 
  • Of the 498 service users visiting the site:
    • 80% were from the ACT
    • 70% identified as ‘man or male’
    • 39% were aged 24 or under.
  • 53% of test results contained the expected drug.
  • Upon receiving test results, 10% of drugs were discarded at the service.
  • 66% of service users accepted AOD and/or general health intervention.
  • The site facilitated access to naloxone for 61 service users (Olsent et al. 2023).
• Smoke-free laws exist in Australia to protect people from harmful second-hand tobacco smoke. This includes banning smoking in all enclosed public spaces and certain outdoor public areas, such as children’s play areas, sport grounds and transport hubs.
• The Australian Government and state and territory governments are taking action to reduce e-cigarette use through stronger legislation, enforcement, education and support. A prescription is required to access e-cigarettes containing nicotine to help in stopping tobacco smoking. The following changes are being implemented over the course of 2024, with the intention of prohibiting non-therapeutic e-cigarettes in Australia:
  • banning the importation of disposable single use e-cigarettes
  • stopping the personal importation of e-cigarettes
  • banning the importation of non-therapeutic e-cigarettes (that is, e-cigarettes not intended to help with quitting or reducing the use of regular cigarettes)
  • imposing requirements on therapeutic e-cigarette importers and manufacturers, including compliance with minimum product standards. 
  • Further reforms are likely to be introduced later in 2024, including the introduction of pharmaceutical style packaging and quality and safety standards for all therapeutic e-cigarettes.
• Drink and drug driving laws are enforced across Australia to deter people from operating a vehicle under the influence of alcohol and or drugs and prevent deaths and significant injuries on the road. It is a criminal offence for drivers with a learner or probationary licence to have a blood alcohol concentration above zero and for full licence holders to have a blood alcohol concentration above 0.05 grams of alcohol per 100 millilitres of blood. Any presence of an illicit substance is also a criminal offence for drivers, regardless of the type of licence held.
• Take-home naloxone programs enable those people at risk of opioid overdose or adverse reaction, and their friends and family members to access naloxone at community and hospital-based pharmacies, alcohol and drug treatment centres and needle and syringe programs. Given in a timely manner, naloxone can reverse the effects of opioid overdose (Department of Health 2021).
  • Opioid overdose represents a significant and ongoing problem for Australia’s public health. Naloxone is a medication that reverses the effects of opioids and is an important means of responding to the harms associated with opioid overdose (including death) (Penington Institute 2018).
  • The Illicit Drug Reporting System (IDRS) reported that, in 2023, 80% of participants had heard of naloxone. Almost three-quarters (73%) of participants had heard of take-home naloxone programs, and over half the sample (52%) had been trained in naloxone administration. In 2023, nearly 1 in 3 (29%) respondents who had heard of naloxone reported that they had used naloxone to resuscitate someone in their lifetime (Sutherland et al. 2023).
• Changes due to the impacts of COVID-19 resulted in IDRS interviews in 2020–2023 being delivered face-to-face as well as via telephone and videoconference. All interviews prior to 2020 were delivered face-to-face, this change in methodology should be considered when comparing data from the 2020–2023 samples relative to previous years.
  • The IDRS Trends in self-reported past year non-fatal overdose and responses to overdose found that:
    • In 2020, among those who reported overdosing on heroin in the past year, the most common treatment received on the occasion of the last overdose was the administration of Narcan/naloxone.
    • Between 2009 and 2020, Narcan/naloxone and ambulance attendance were the 2 most common forms of treatment for heroin overdose  (Thomas et al. 2021).

Community support for harm reduction measures

The 2022–2023 NDSHS included questions about support for allowing people to test their drugs/pills at designated sites (that is, drug checking) and supervised drug consumption facilities/rooms. These measures were generally well supported, with more people supporting drug checking than drug consumption rooms. Support for both measures was highest among younger people and people who had used drugs in the past 12 months (AIHW 2024, Table 11.12).

Drug checking

Almost 2 in 3 (64%) people in Australia aged 14 and over supported drug checking, an increase from 57% in 2019 (AIHW 2024, Table 11.13). Over 4 in 5 (83%) people who had recently used drugs supported drug checking, compared with 55% of those who had never used drugs. Additionally, support was highest: 

• among people aged 18–24 (74%), and decreased to 55% in those aged 70+
• in Major cities (66%) and decreased with increased remoteness (54% in Remote and very remote areas)
• in the most advantaged socioeconomic area (73%) and lowest in the most disadvantaged areas (59%) (AIHW 2024, Table 11.12).

Supervised drug consumption rooms

Just over half (53%) of people in Australia supported supervised drug consumption rooms, up from 47% in 2019 (AIHW 2024, Table 11.13). Nearly three-quarters (72%) of people who had recently used drugs supported this measure, compared with 45% of people who had never used drugs. Additionally, support was highest:

• among people aged 18–24 (64%) compared with those aged 70 and over (44%).
• in Major cities (56%) and decreased with increased remoteness (38% in Remote and very remote areas).
• Support was highest among people in the most advantaged socioeconomic area (63%) and lowest among people in the 2^nd most disadvantaged area (47%).
• Support was highest among people with a bachelor degree or higher (72%) and lowest among people who had completed year 11 or less (55%) (AIHW 2024, Table 11.12).