3321.0.55.001 - Drug Induced Deaths, Australia, 1991-2001
ARCHIVED ISSUE Released at 11:30 AM (CANBERRA TIME) 15/07/2003
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CONTENTS
4. The term 'drug' refers to substances classified as drugs, medicaments or biological substances under ICD-10 guidelines. These drugs may by used for medicinal or therapeutic purposes, or to produce a psychoactive effect. The term excludes alcohol, tobacco and volatile solvents (e.g. petrol)." 5. For ABS purposes, drug-induced deaths are defined by the following ICD-10 codes:
6. In addition, although not part of the ICD-10 itself, this paper classifies drug-induced deaths according to their intent. Accidental drug-induced deaths include ICD-10 codes X40-X44, F11-F16, F19 and F55. Suicide by drugs includes ICD-10 codes X60-X64. This paper also uses the term drug-induced deaths involving opioids to describe drug-induced deaths where opium (ICD-10 code T40.0), heroin (T40.1) other opiates, (such as morphine or codeine, T40.2), methadone (T40.3), other synthetic narcotics (such as pethidine, T40.4) or other and unspecified narcotics (T40.6) were mentioned on official records. See Explanatory Notes for further details on definitions of drug-induced deaths. Back to top 2. TRENDS IN DRUG-INDUCED DEATHS 7. In 2001 there were 1,038 drug-induced deaths registered, constituting 0.8% of all deaths in that year (see summary table no. 3). This represented a fall of more than one-third from 1999, when drug-induced deaths registered in Australia peaked at 1,739 (1.4% of all registered deaths). Between 1999 and 2001 the standardised drug-induced death rate decreased by over 40%, from 9.1 to 5.3 registered deaths per 100,000 persons. 8. The decrease in drug-induced deaths was primarily related to a fall in deaths due to heroin use, particularly amongst men. In 1999 the standardised rate of drug-induced deaths involving opioids was 6.5 per 100,000 persons (9.8 males, 3.2 females). By 2001 this had fallen to 2.6 per 100,000 population (3.8 males, 1.5 females). FIGURE 1 - DRUG-INDUCED DEATH RATES, Australia, 1991-2001 9. The reduction in the drug-induced death rate was not uniform across the states. Starting from a far higher level, the largest decreases were in New South Wales and Victoria. There were smaller decreases in Queensland, South Australia and Western Australia. As a result, the significant differences in the standardised drug-induced death rates between the larger states visible in 1999 have been substantially reduced. Rates for Tasmania, the Northern Territory or the Australian Capital Territory are not calculated and presented here for individual years, due to the small numbers of drug-induced deaths involved, and the unreliability of any comparisons that might be made.
Back to top 3. ACCIDENTAL DRUG-INDUCED DEATHS 10. Drug-induced deaths are usually the result of an unintentional overdose or the effects of prolonged misuse of drugs. This remained the case in 2001, despite a more substantial decrease in accidental deaths due to drugs than in the overall drug-induced death rate. Accidental drug-induced deaths fell from 7.3 per 100,000 persons in 1999 to 3.7 in 2001 (standardised figures). 11. The standardised accidental drug-induced death rate for males decreased from 10.9 deaths per 100,000 persons in 1999 to 5.0 in 2001. In comparison the corresponding rate for females fell from 3.8 to 2.3 deaths per 100,000 persons. Consequently, the large gap between the female and male rates observed in 1999 has narrowed considerably. The standardised male accidental drug-induced death rate is now around twice as high as the female rate. FIGURE 3 - ACCIDENTAL DRUG-INDUCED DEATH RATES, Australia, 1991-2001 12. The use of heroin (an opioid) has been a focus of public debate on drug use during the past decade. Increased heroin use was largely responsible for the increase in accidental drug-induced deaths during the 1980s and 1990s. In 1999 opioids were involved in 77% of accidental drug-induced deaths. However, in 2001 this had declined to 58%. This fall was less pronounced amongst males (from 80% to 63%) than females (from 68% to 47%). In 1999 there were 1,084 accidental drug-induced deaths involving opioids (840 male, 244 female), but this fell to 413 in 2001 (304 male, 109 female). As an age standardised rate, accidental drug-induced deaths involving opioids fell from 5.6 deaths per 100,000 persons in 1999 (8.7 males, 2.6 females) to 2.1 in 2001 (3.2 males, 1.1 females). A fall in accidental drug-induced deaths involving opioids thus constituted the major contributor to the fall in the absolute number of drug-induced deaths (see figure 4). 13. This fall in deaths involving opioids seems to have been due to a shortage of heroin supply in Australia, also known as a 'heroin drought'. Results from the Illicit Drug Reporting System, administered by the National Drug and Alcohol Research Centre, indicate that "there was a dramatic reduction in the availability of heroin observed in all jurisdictions in which heroin had for some years been freely available" which "began in late 2000/early 2001, and was sustained throughout the first half of 2001".4 Furthermore, the shortage in supply seems to have resulted in decreased heroin usage. These findings have been corroborated by a study conducted by the NSW Bureau of Crime Statistics and Research.5 Declining heroin use was also detected by the 2001 National Drug Strategy Household Survey, with the percentage of respondents reporting heroin use in the last 12 months falling from 0.8% in 1998 to 0.2% in 2001.6 While the results of these studies should to be treated with some caution, due to the relatively small sample size of the surveys involved, taken together they offer strong evidence of a decrease in heroin usage. This would largely account for the fall in accidental drug-induced deaths. FIGURE 4 - RATE OF ACCIDENTAL DRUG-INDUCED DEATHS INVOLVING OPIOIDS, Australia, 1997-2001 Back to top 4. SUICIDE BY DRUGS 14. In contrast to accidental drug-induced deaths, suicides involving drugs did not show any significant change between 1999 and 2001. The standardised death rate for suicides by drugs remained steady at 1.5 deaths per 100,000 persons. The relatively equal distribution of suicides by drugs between males and females also remained (see figure 5). 15. This stability in suicide rates by drugs was consistent with the overall suicide figures between 1999-2001. The standardised suicide rate for all methods for males fell slightly from 22 deaths per 100,000 persons in 1999 to 20 in 2001, while the corresponding rate for females remained steady at 5 deaths per 100,000 persons. Consequently, the proportion of all suicides using drugs increased only slightly for females between 1999-2001, from 24% to 26%, while remaining stable for males at 8%. 16. In 2001 there were 285 suicides by drugs, accounting for 12% of all suicides in that year. Drugs were used in 26% of the suicides of females, making it the second most common method after hanging and strangulation (38%). Drugs were used in 8% of suicides by males, making it the fourth most common method after hanging and strangulation (44%), exposure to gases (mostly carbon monoxide from motor vehicle exhaust) (21%) and firearms (13%). FIGURE 5 - RATES OF SUICIDE BY DRUGS, Australia, 1991-2001 Back to top 5. AGE-SPECIFIC RATES 17. The tendency of people to die from drug-induced causes varied according to age group. In addition, the age profile of people who died accidentally from drug-induced causes differed substantially from those who suicided using drugs. 18. In 2001, rates of accidental drug-induced deaths were highest among young adults, peaking at 8 deaths per 100,000 persons among both 25-29 and 30-34 year-olds. In 1999 the drug-induced deaths peaked amongst 25-29 year-olds alone. 19. Although there was some fluctuation in age-specific rates of suicide by drugs, they were relatively stable compared to accidental drug-induced deaths. In 2001 suicide by drugs peaked at 3.4 deaths per 100,000 persons amongst those aged 85 years and over. However, the rate was between 1 and 3 deaths per 100,000 persons for all ages between 20 and 84 years. The age profile of people committing suicide by drugs was also different to that of people using other methods. As a proportion of all suicides, drug suicides increased with age, with 15% of suicides of people aged over 50 years from drugs, compared with 7% for those aged less than thirty years. FIGURE 6 - AGE-SPECIFIC DRUG-INDUCED DEATH RATES, Australia, 2001 6. TYPES OF DRUGS 20. Because of the pharmacological interactions between different drugs, using a mixture of drugs is more likely to result in adverse health effects, including death, than use of a single type of drug. For example, alcohol increases the effects of some drugs, and was present in 18% of accidental drug-induced deaths as a contributing factor, rather than as the drug that ultimately caused the death. 21. In 2001, opium, heroin and other opioids were involved in 36% of accidental drug-induced deaths, benzodiazepines were involved in 23% and other narcotics and hallucinogens were involved in 18%. Opium, heroin and other opioids were involved in the highest proportions of accidental drug-induced deaths of both males and females (39% and 29% respectively). However, the accidental deaths of females were more likely to involve benzodiazepines (28%) and antidepressants (23%) than those of males (21% and 11% respectively). The accidental deaths of females were less likely than males to involve other narcotics and hallucinogens (14% and 20% respectively). Alcohol was also present in combination with other drugs in 18% of accidental drug-induced deaths, although it was not the underlying cause of death. 22. The drugs used most commonly in suicides were benzodiazepines, antidepressants and opium, heroin and other opioids, which were involved in 28%, 28% and 20% of all suicides by drugs respectively. 4-Aminophenol derivatives such as paracetemol were more likely to be used by females who suicided than by males (13% and 9% respectively), while females were less likely than males to use benzodiazepines (25% and 31% respectively). Alcohol was also used in combination with other drugs in 13% of suicides by drugs, although it was not the underlying cause of death. 23. Consistent with the changing pattern of underlying drug-induced deaths, there was a substantial decrease in the total proportion of drug-induced deaths involving opium, heroin and other opioids, from 58% in 1999 to 31% in 2001. This decrease could be seen amongst both males and females (63% to 35% and 46% to 25% respectively). However, there was an overall increase in the proportion of drug-induced deaths involving methadone, from 8% in 1999 to 10% in 2001. TABLE 1 - MAIN TYPES OF DRUGS CONTRIBUTING TO DRUG-INDUCED DEATHS (a), Australia, 2001, as a percentage of drug-induced deaths (b), by sex and intent
(b) Death may be caused by more than one drug and therefore component percentages do not add to one hundred. (c) Alcohol is not included in the scope of poisoning in this article. Therefore alcohol is not the underlying cause of death, but taken in conjunction with other drugs, has led to these deaths. (d) Deaths attributed to long-term organ damage are drug-induced deaths where no poisons were identified in the body of the deceased at the time of post-mortem. TABLE 2 - AVERAGE NUMBER OF DRUGS (a) PER DRUG-INDUCED DEATH, Australia, 2001, for main types of drugs (b), by sex and intent
(b) Average number of drugs amongst deaths where each type of drug was mentioned on death certificate. (c) Includes all drug-induced deaths, even if no poison code was mentioned on death certificate. Back to top 7. YEAR OF OCCURRENCE 24. Information contained in the preceding sections of this paper refers to deaths registered by the state and territory Registrars-General during the calendar years in question. The following graph compares drug-induced death rates by year of registration and year of occurrence (see Explanatory Notes). There is very little difference between year of registration and year of occurrence figures, as around 89% of drug-induced deaths occurring in a particular year are registered in that year. This compares to around 95% for all deaths. Delays in registration of drug-induced deaths are more likely due to coroner deliberations. FIGURE 7 - DRUG-INDUCED DEATHS, YEAR OF REGISTRATION AND YEAR OF OCCURRENCE (a), Australia, 1991-2001 8. YEARS OF POTENTIAL LIFE LOST (YPLL) 25. Years of potential life lost is a measure of premature mortality, and is calculated based on deaths between the ages of 1 and 75 years. There were 37,356 years of potential life lost due to drug-induced deaths for the 2001 registration year. Drug-induced deaths accounted for 0.8% of registered deaths of all ages, and 1.9% of deaths between the ages of 1 and 75 years. Because drug-induced deaths occur generally in younger age groups, they represented 4.5% of the total years of potential life lost from all causes. See Table 7 for more details. 9. SUMMARY TABLES TABLE 3 - ALL DRUG-INDUCED DEATHS (a), 1991-2001, by age and sex
(b) Total includes under 15 years and age not stated. Back to top TABLE 4 - ACCIDENTAL DRUG INDUCED DEATHS (a), 1991-2001, by age and sex
(b) Total includes under 15 years and age not stated. Back to top TABLE 5 - SUICIDES BY DRUGS (a), 1991-2001, by age and sex
(b) Total includes under 15 years and age not stated. Back to top TABLE 6 - AGE STANDARDISED DRUG-INDUCED DEATH RATES (a), 1991-2001, by sex and intent
(b) ICD-10 codes F11-F16, F19, F55 and X40-X44. (c) ICD-10 codes X60-X64. (d) ICD-10 codes F11-F16, F19, F55, X40-X44, X60-X64, X85 and Y10-Y14. Back to top TABLE 7 - YEARS OF POTENTIAL LIFE LOST (YPLL) (a), 1991-2001, drug-induced deaths and deaths due to all causes
(b) Deaths occurring between ages 1-75 years inclusive. (c) YPLL age-standardised to 2001 Australian population - see Technical Note in ABS publication 'Causes of Death, Australia 2001', cat. no. 3303.0.8 Back to top Document Selection These documents will be presented in a new window.
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