New reports show changing patterns of drug-related harm in Australia

Methamphetamine- and cocaine-related deaths are at their highest levels since national monitoring began two decades ago, and stimulant-related hospitalisations continue to rise. 

These are the key findings from the latest annual reporting from the Drug Trends program at NDARC, UNSW Sydney, which provide a comprehensive picture of drug-related harms in Australia, excluding those attributed to alcohol and tobacco.

The national rate of drug-induced mortality increased from 6.8 to 7.3 deaths per 100,000 people from 2023 to 2024, driven primarily by stimulants. Deaths involving amphetamine-type stimulants such as methamphetamine increased by 29%, while cocaine-related deaths increased by 40%. 

The rate of hospitalisations also increased by 8.0% from 2022-23 to 2023-24, with amphetamine-type stimulants being the most commonly identified drugs. Hospitalisations involving amphetamine-type stimulants increased by 24%, while cocaine-related hospitalisations rose by 29%.

What’s behind this new pattern?

The changing profile of drug-related harm should not be interpreted as a shift away from opioid-related harms. Opioids remain the drug class most commonly involved in overdose deaths, and heroin-related mortality increased by 32% between 2023 and 2024, reaching 2.0 deaths per 100,000 people. Heroin-related hospitalisations also increased by 26% in 2023–24, although the rate remained below levels observed in earlier years.

However, the trend of rising stimulant-related harms points to important changes in national and international drug markets, as well as changes in patterns of use and the health profile of people experiencing harm.

For instance, record-high global cocaine manufacturing has contributed to increased availability in Australia. Wastewater analysis, surveys with people who use drugs and seizure data all indicate increased cocaine availability and use in recent years. Although cocaine-related harms remain lower than those associated with methamphetamine or opioids, the consistent increases in cocaine-related hospitalisations and deaths suggest that this is an emerging issue requiring close monitoring.

Similarly, methamphetamine production and supply have increased internationally. In Australia, record consumption was recorded in wastewater data in 2024-25, which suggests a continuation of the upward trend observed prior to COVID-19. These changes are occurring alongside evidence of more frequent methamphetamine use, increased use of the higher-purity crystal form and other indicators of rising methamphetamine-related harms. 

Importantly, the burden is no longer concentrated primarily among younger people. The age profile of amphetamine-type stimulant overdose deaths has shifted steadily towards older age groups: in 2005, people aged 15-24 years accounted for one in eight deaths, compared with just 5% in 2024.

At the same time, mortality rates increased among those aged 25-34 years (from 0.98 to 6.0 deaths per 100,000 people), 35-44 years (from 0.93 to 6.0 deaths per 100,000 people) and 45-54 years (from 0.40 to 6.4 deaths per 100,000 people).

This pattern is consistent with the age shift in overdose deaths observed in the national mortality data. Prior research using the National Coronial Information System has also demonstrated that clinically significant cardiovascular pathology is common among methamphetamine-related deaths, even where cardiovascular disease is not the immediate cause of death.

Amphetamine-type stimulants can increase heart rate and blood pressure and may contribute to fatal cardiovascular complications, particularly among people with pre-existing cardiovascular disease. As the population of people who use methamphetamine ages, cardiovascular and other chronic health conditions may become increasingly important considerations in prevention, treatment and clinical care.

Finally, widespread polydrug use continues to be a defining feature of overdose mortality and hospitalisations.

Between 2020 and 2024, among overdose deaths involving at least one selected drug class, almost three-quarters (73%) of overdose deaths involved two or more major drug classes.

Commonly observed drug pattern profiles include:

• opioids in combination with antiepileptic, sedative-hypnotic and anti-parkinsonism drugs (4.7%, 312 deaths);
• opioids combined with antiepileptic, sedative-hypnotic and anti-parkinsonism drugs and antidepressants (4.0%, 267 deaths); and
• heroin with amphetamine-type stimulants (3.4%, 223 deaths).

What does this mean for harm reduction?

The findings highlight the need for earlier and more effective responses to Australia’s changing pattern of drug-related harm. This includes strengthening harm reduction responses for stimulants, improving access to evidence-based treatment for people experiencing methamphetamine or cocaine dependence, and continuing research into effective treatment options. Services should also be equipped to respond to the complex needs identified, including polydrug use, mental health concerns and the cardiovascular and other chronic health conditions affecting an ageing population of people who use methamphetamine.

Opioid overdose prevention and treatment must also remain a priority. This includes maintaining access to opioid agonist treatment and take-home naloxone, while recognising that people who use stimulants may also be exposed to opioids through polydrug or unwitting use. Drug checking services and timely, targeted risk communication continue to be critical for identifying higher-risk substances, informing people about emerging risks and supporting safer decisions as drug markets change.

The reports also demonstrate the value of ongoing national monitoring given the complex and dynamic nature of the drug landscape and the substantial, preventable and rising burden from overdose and other drug-related harms.

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