"There was significant advocacy work, including volunteer-run festival-based drug checking services by Pill Testing Australia, in the years leading up to the ACT [Australian Capital Territory] Government 2021 commitment to fund a fixed-site pilot. Upon the ACT Government announcement, a consortium of organisations (Pill Testing Australia, Directions Health Services and Canberra Alliance for Harm Minimisation and Advocacy) submitted a proposal for consideration. Negotiation with the Government included assessment of costs, what services could be provided, staffing and potential locations (see Figure 1 below). The result is a drug checking service in the City Community Health Centre at 1 Moore Street in the Canberra civic area. During the pilot status the service was to operate at specified regular times each week and to be staffed by a variety of professionals. Staff at each shift include one alcohol and other drug counsellor, one primary health nurse, one peer educator, two analytical chemists and a medical practitioner on-call. A senior chemical analyst and medical toxicologist are available on-call to provide feedback on analytical results of clinical concern (novel products for which there may not be community familiarity, potentially hazardous doses, and dangerous mixtures) as well as to assess whether ACT Health should be alerted on any drugs of concern. Directions Director of Service Delivery or CEO provides management oversight."

" A small number of parents of young people who use drugs accessed the service with the aim of reducing the risks of harm that their children face in using drugs.

" Twelve percent of the primary service users resided outside the ACT, but note that this would include Queanbeyan, a city contiguous with Canberra. This proportion is not high enough to imply the existence of a ‘honeypot’ effect. Instead, it demonstrates the need for this type of service in other parts of the nation.

" A new ketamine-like substance was identified in the service in September 2022. The service understands that it is the first time globally that a new substance has been identified in a drug checking service. Its significance was highlighted by the fact that the service received enquiries about the substance nationally and across the globe. The service provided GC-MS analytical data to national forensic laboratories, providing timely information on the identity of a new psychoactive substance in the Australian drug market.

" The service found an unexpectedly high level of demand from people from diverse sectors wishing to do ‘walk-throughs’ of the service in which they are provided an understanding of the service user journey and demonstrations of the drug checking equipment. Senior policy makers and politicians, health professionals, researchers, advocates and media as well as people from interstate contemplating establishing drug checking services have completed walk-throughs. In this sense, the service provided a valuable information and an educational role in innovative drug harm reduction policies and practice in Australia.

" At least one interstate government health department requested the service data on an ongoing basis from ACTHD, presumably to inform their own policy work on drug checking.

" The evaluation team received requests from interstate colleagues for the sharing of the service and evaluation data collection tools. The interstate colleagues plan to use this information to support their own work in developing the evaluation of drug checking services when they become available in their own jurisdictions. This exchange of information creates the potential for a minimum dataset in the collection of data from drug checking services as they emerge across Australia.

" Establishment of the Australasian Drug Checking Information Group as a flow-on from the evaluation team’s presentation to, and network-building activity at, the 2022 Darwin APSAD conference. The group involves a consortium of individuals interested in best practices in drug checking across Australia and New Zealand."

"Both lifetime and recent use of cannabis increased between 2016 and 2019. In 2019, 36% had used it in their lifetime (up from 35% in 2016) and 11.6% had used it in the last 12 months (up from 10.4%). In addition, more people reported using it in the month before the survey (from 5.8% to 6.6%) but there was no change in the frequency of use—about half of those who used cannabis did so monthly or more often (tables 4.16 and 4.20).

"The increase in lifetime use was due mainly to an increase among people aged 60 and over (from 13.8% to 18.9%) (Table 4.41). This could be due to an ageing cohort of people who had used cannabis, an increase in people deciding to try it, or to more people being willing to report their use.

"Between 2016 and 2019, recent use of cannabis increased among older people (Table 4.43). Recent use among those aged 50–59 and 60 and over is at the highest level since 2001. These age groups were also the most likely to use cannabis regularly, with almost half using it once a week or more.

"Who is most likely to use cannabis?

"Males continue to be more likely to have recently used cannabis than females (14.7% compared with 8.6%), the greatest difference (almost twice as likely among males as females) occurring among those aged in their 30s and 40s (Table 4.43).

"Compared with those in other age groups, people in their 20s continued to be the most likely to use cannabis but this declined over the longer term—from 29% in 2001 to 24% in 2019."

"Most common substance use

"The most common substances used by secondary school students were analgesics and alcohol (Table 7.1). At least 93% of students in each age group had used analgesics in the past year (59% past month). Use of alcohol, tobacco and cannabis increased markedly with age. For the first time in the ASSAD survey series, the proportion of students who had used cannabis in the past month was greater than the proportion that had used tobacco cigarettes.

"Illicit substance use

"Inhalants and cannabis were the most common illicit substances used (Table 7.1). However, while cannabis use increases with age, inhalant use follows a unique pattern of lower reported use with older age.

"Ecstasy and hallucinogens were the next most commonly used illicit substances, with their use also greater at older ages.

"Experiences with amphetamines, opiates, cocaine, and performance enhancing drugs were rare at all ages.

"Use of illicit substances in the past month was low at all ages.

"Trends of illicit drug use over time

"Overall, the proportions of students that had used any of cannabis, hallucinogens, amphetamines, cocaine, opiates or ecstasy in their lifetime or in the past month were similar in 2011, 2014, and 2017 (Table 7.2). Among 16 and 17 year old females, the prevalence of past month use of any illicit substance was higher in 2017 than in 2014. For younger students, prevalence was similar to that reported in 2011 and 2014.

"When excluding cannabis, the proportions of students that had used any illicit substance were lower. There was no change in lifetime or past month use of any illicit substance other than cannabis between 2011 and 2017."

"Use of painkillers or analgesics (e.g., Disprin, Panadol, or Nurofen) is common among secondary students. Ninety-five per cent of students had ever used an analgesic, and around two-thirds of students had used them in the past month (Table 5.1).

"Use increased with age (e.g., past month use by 12 year olds: 55%; 17 year olds: 71%) and was higher among female than male students for lifetime, past year, past month, and past week.

"Among past year users, 52% of females and 42% of males had used analgesics 10 or more times in this period, while 16% of males and 11% of females had used analgesics only once or twice. Regular use (10 or more times) was higher among females than males at older ages.

"Of students who had used analgesics in the past week, 70% of males and 68% of females had used them once or twice.

"Reasons for use

"Students most commonly used analgesics to help ease headache (males: 53%; females: 44%, Table 5.3). Other common reasons for use included easing cold or ‘flu symptoms (males: 31%; females: 24%), menstrual pain (females: 25%), or dental pain (5%). Male students (14%) were more likely than female students (9%) to have used analgesics for sports injury pain.

"Changes in analgesic use

"Prevalence of lifetime analgesic use in 2017 was similar to 2014, while past month use was lower than in 2011 or 2014 (Table 5.4)."

"Meth/amphetamine use has been declining since it peaked at 3.4% in 2001 (Table 4.72), and stabilised in 2019 (1.4% in 2016 and 1.3% in 2019). While no statistically significant changes by age or sex were detected between 2016 and 2019, use has been declining among younger age groups since 2001 but increasing or remaining stable among older age groups (40 and over) (Figure 4.7).

"In 2001, people in their 20s were 11 times as likely to use meth/amphetamines in the previous 12 months as people in their 40s (11.2% compared with 1.0%) but meth/amphetamines no longer appears to be the drug of choice among this demographic. In 2019, people in their 20s were only 1.3 times as likely to use it as people in their 40s (2.4% compared with 1.9%)."

"The prevalence of alcohol consumption among Australian secondary students in 2017 is an indicator of the importance of drinking alcohol in contemporary adolescent cultures. Student reports of alcohol use reflect the degree of non-adherence to current NHMRC guidelines recommending people under the age of 18 do not use any alcohol.

"Of all students surveyed, 34% reported never having consumed alcohol (Table 4.1). Alcohol use was more common among older students, with 76% of 17 year olds having consumed alcohol in the past year, compared to 17% of 12 year olds (Table 4.1).

"Current drinking (in the past week) was more common among older than younger students. Overall, a greater proportion of male (16%) than female (14%) students were current drinkers.

"Risky drinking

"While any alcohol consumption is risky for teenagers, drinking five or more drinks on one occasion in the past week indicates risky levels of drinking for adults, according to the NHMRC guidelines. In 2017, risky drinking was more common among males (6%) than females (4%) overall (Table 4.1).

"Around 33% of all students surveyed reported risky drinking on at least one occasion in their lifetime (Table 4.2). Risky drinking in the last two weeks, past month, past year, and in their lifetime, was more common in older than younger students. Risky drinking in the last two weeks was more common among male than female older students, but there was no sex difference in students aged 12 to 15.

"Drinking five or more drinks on at least one occasion in the past seven days among current drinkers followed a similar pattern, with the proportion greater among male than female students, and among older than younger students (Table 4.3). Among current drinkers, male students reported a higher average number of drinks consumed (M = 8) than female students (M = 5), and older students drank more on average (M = 7) than younger students (M = 5)."

"The majority of drug deaths in an Australian study, conducted by the National Alcohol and Drug Research Centre, involved heroin in combination with either alcohol (40 percent) or tranquilizers (30 percent)."

"Between 1993 and 2007, the daily drinking rate for people aged 14 or older remained largely unchanged, at around 8% (Figure 4.1). However, in 2010, there was a significant fall compared to 2007, and in 2013, the proportion drinking daily again declined from 7.2% to 6.5%. In addition:
"• in the previous 12 months, around three-quarters (78%) of the population aged 14 or older had consumed a full serve of alcohol, and 22% had not consumed alcohol
"• the proportion of people aged 14 or older who had never had a full serve of alcohol has risen since 2004, with an increase between 2010 and 2013 (from 12.1% to 13.8%)."

"In 2010, 15.1% of people in Australia aged 14 years or older were daily smokers, declining from 16.6% in 2007. Between 1991 and 2010, the proportion of daily smokers declined by almost 40% to the lowest levels seen over the 19-year period (Table 3.1). The proportion of people who had never smoked increased. Also:
"• the number of people smoking daily in 2010 decreased by approximately 100,000 people (2.9 million in 2007 down to 2.8 million in 2010)
"• just under one-quarter of the population (24.1%) were estimated to be ex-smokers and more than half (57.8%) had never smoked in their life in 2010
"In 2010, those people who had never smoked (10.6 million) and those who were ex-smokers (4.4 million) far exceeded the number of smokers (3.3 million) aged 14 years or older."

"Morphine prescriptions declined from 38.3 to 30.7 per 1000 population between 2002–03 and 2007–08, representing a decrease of about 20%. Box 1A shows trends in morphine prescriptions by 10-year age group. Prescriptions were most common among older people (aged 70–79 and 80+ years), and much less common among younger people (aged 20–29 and 30–39 years). Significant linear declines over time were apparent in all age groups except the 50–59-year group."

"The results of this study are important for the child protection field. They show that, rather than severity of substance use being associated with mothers’ involvement with the child protection system, other factors are of greater importance. Of particular interest was the finding that having greater social support, particularly from parents, significantly reduced the likelihood of being involved with the child protection system."

"• In 2009–10, cannabis accounted for the highest number of drug-related arrests. There were 57,170 arrests involving cannabis in 2009–10, an increase of three percent from 2008–09, but an overall decrease of 17 percent from the number of arrests recorded in 1996–97.
"• The number of arrests for heroin peaked in 1998–99 with 14,341 arrests. This number fell considerably between 1999–2000 and 2001–02 before declining fairly consistently over the next 10 year period. In 2009–10, 2,767 arrests were made that involved heroin—an 81 percent decrease in arrests over that time.
"• In 1996–97, the number of arrests involving amphetamines was slightly below that of arrests involving ‘other’ drugs. Since then, however, arrests involving amphetamines have generally increased more than those involving other drugs, although this difference diminished in 2010, with only 3,893 more amphetamine arrests than arrests for other drugs. Overall, however, there has been a 258 percent increase in the number of amphetamine-related arrests since 1996–97.
"• In 2009–10, the number of cocaine arrests increased by 47 percent, rising from 848 in 2008–09 to 1,244. Despite this, the overall number of cocaine arrests remained lower than for any other drug type throughout the period.
"• Drug arrests involving a consumer were far more common across all drug types than those involving a provider. The highest proportion of those arrested (both consumers and providers) were for crimes involving cannabis (86%).
"• Providers accounted for 32 percent of cocaine-related arrests, 31 percent of heroin-related arrests and 28 and 24 percent of amphetamine and other drug-related offences, respectively."

"It is critical that Australia’s strategy enhances and maintains access to quality evidence-informed treatment. Integrated care is critical to Australia’s response and this includes approaches that allow individuals to connect to services which will address barriers to recovery, which might lead to issues such as physical and mental health needs, social, economic, legal or accommodation considerations. It is important that these services are accessible and tailored to the diverse needs of individuals affected by drug use.

"It is important to also ensure that there is investment in strategies that are critical to long term maintenance of recovery.

"Evidence indicates that maintenance of recovery is strongly associated with quality of life. Quality of life factors include issues such as family life, connection to community, employment and recreational opportunities. Therefore, investing in strategies to enhance social engagement, and where indicated, re-integration with community, is central to successful interventions that can reduce alcohol and drug demand and related problems, including dependence.

"Approaches that seek to build protective factors and address issues underpinning social determinants of health in order to prevent the initial uptake of drugs can also enhance community health and wellbeing and reduce health inequalities among population groups who experience disproportionate risk of harm from alcohol, tobacco and other drugs. This includes social services and community groups collaborating to improve access to housing, education, vocational and employment support, as well as developing and enhancing family and social connectedness, and strategies to reduce the availability, accessibility and demand for drugs."

"In 2012, IDRS participants were asked questions about BBVI [Blood-Borne Viral Infection] testing and vaccinations. Of those who commented, 93% reported testing for HBV in their lifetime compared to 96% for HCV and 94% for HIV.
"Of those who were tested for HBV, two-thirds (62%) had a test within the past year and one-third (30%) within the last three months. Six percent reported a positive result and 4% had been treated for HBV (anti-viral therapy only). Two-thirds (61%) had been vaccinated again HBV, with 87% having completed the course. The main reason for HBV vaccination was due to a history of injecting drug use (38%) (Table 81).
"Among those tested for HCV, two-thirds (65%) had a test within the past year and one-third (31%) within the last three months. Nearly half reported a positive result. Ten percent of those who commented had been treated for HCV (anti-viral therapy only), with 22% receiving HCV treatment (currently or in the last 12 months). The main reason for HCV testing on the last occasion was a ‘matter of routine’ (38%) and ‘it was a responsible thing to do’ (14%; Table 82)."

"In Australia it is estimated that about 13 per cent of people with HIV also have HCV. HIV shares major routes of transmission with both HCV and HBV. People who inject drugs are at particularly high risk for HCV and HIV co-infection.
"While HIV was not established in the Australian IDU population when NSPs were introduced, the prevalence of HCV was already high. HCV is a more robust virus than HIV and is transmitted more efficiently though blood-to-blood contact. Approximately 80 per cent of current HCV infections and 90 per cent of new infections are attributable to unsafe injecting practices (Commonwealth of Australia, 2005b). This explains IDUs being identified as a priority population within The Third National Hepatitis C Strategy."

"In 2010, there appeared to be a relationship between a person’s cocaine use and his or her mental health, psychological distress (see Glossary for definition of the Kessler Psychological Distress Scale) and body mass index (Table 9.7). In addition:
"• people who recently used cocaine were more likely to have been diagnosed with or treated for a mental illness (17.4% for recent users compared with 11.9%), and have high or very high levels of psychological distress (17.5% for recent users compared with 9.7%) than those who had not used cocaine in the previous 12 months
"• recent cocaine users were more likely to be underweight (5.0% for recent users compared with 2.3%), and considerably less likely to be obese (8.2% for recent users compared with 22.0%) than those who had not used cocaine in the previous 12 months."

"A striking finding from the toxicological data was the relatively small number of subjects in whom morphine only was detected. Most died with more drugs than heroin alone 'on board', with alcohol detected in 45% of subjects and benzodiazepines in just over a quarter. Both of these drugs act as central nervous system depressants and can enhance and prolong the depressant effects of heroin."

"Treatment episodes for problematic morphine use remained relatively stable during 2002–03 to 2007–08 (0.07 per 1000 population in 2007–08). Episodes for problematic oxycodone use doubled, from 0.01 per 1000 population in 2002–03 to 0.02 per 1000 population in 2007–08 (Box 2B)."

"Needle and syringe programs (NSP) were by far the most common source of needles and syringes in the preceding six months (95%), followed by chemists (16%). NSP vending machines were used by 33% of participants in TAS and 29% in NSW. Proportions reporting a friend, partner and/or dealer varied by jurisdiction. Hospitals and outreach/peer workers were also accessed (Table 75).

"In comparison, data from the 2010 National Drug Strategy Household survey reported that around 65% of recent injectors (used in the previous 12 months) obtained needles and syringes from a chemist, followed by 37% at NSP (Australian Institute of Health and Welfare, 2011)."

"Investment in NSPs (2000-2009) has resulted in:
"• An estimated 32,050 HIV infections and 96,667 HCV infections averted;
"• Substantial healthcare cost savings to government related to HCV and HIV;
"• Substantial gains in Disability Adjusted Life years.

"For every dollar currently spent on the activities of NSP, more than four dollars will be returned (in addition to the investment; i.e., five times the investment) and approximately 0.2 days of disability-adjusted life gained. Over a longer time horizon there is even greater return."

"In summary, the evidence available from this Evaluation indicates that:

"• operation of the MSIC in the King Cross area is feasible;

"• the MSIC made service contact with its target population, including many who had no prior treatment for drug dependence;

"• there was no detectable change in heroin overdoses at the community level;

"• a small number of opioid overdoses managed at the MSIC may have been fatal had they occurred elsewhere;

"• the MSIC made referrals for drug treatment, especially among frequent attenders;

"• there was no increase in risk of blod borne virus transmission;

"• there was no overall loss of public amenity;

"• there was no increase of crime;

"• the majority of the community accepted the MSIC initiative;

"• the MSIC has afforded an opportunity to improve knowledge that can guide public health responses to drug injecting and its harms."

"The only comprehensive evaluation of a medically supervised injecting centre was conducted during the 18 month trial of the Sydney centre. Staff intervened in 329 overdoses over one year with an estimate of at least four lives saved a year. There was no increase in reported hepatitis B or C infections in the area that the medically supervised injecting centre served despite an increase elsewhere in Sydney.

"The report described a decreased frequency of injecting related problems among clients. Half the centre's clients reported that their injecting practices had become less risky since using the centre. Furthermore, clients were more likely than other injectors to report that they had started treatment for their drug use; 11% of clients were referred to treatment for drug dependence. An economic evaluation of deaths averted by intervention of the medically supervised injecting centre showed that costs were comparable to those of other widely accepted public health measures.

"The centre also had benefits for the local community. Residents and business respondents reported fewer sightings of public injection and syringes discarded in public places, and syringe counts in the vicinity of the centre were lower after it opened than before. In addition, there was no evidence of an increased number of theft and robbery incidents in the area. Acceptance of the medically supervised injecting centre increased among both businesses and residents over the study period."