Health Needs Assessment Drug and Alcohol Treatment Central Queensland, Wide Bay, Sunshine Coast PHN

Transcription

1 Health Needs Assessment Drug and Alcohol Treatment Central Queensland, Wide Bay, Sunshine Coast PHN

2 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment: Drug and Alcohol Treatment Contents Executive Summary 4 Introduction 4 Outcomes of the health needs analysis 5 Outcomes of the service needs analysis: 12 Opportunities, priorities and options: Introduction Purpose Assessment framework Needs analysis (Section 2) Service analysis (Section 4) Prioritisation and options development (Section 5) PHN Catchment Health needs analysis PHN population Population distribution Projected growth Age distribution Self-rated health Alcohol and drug use trends Alcohol use and trends Tobacco smoking Drug use and trends Health and social determinants Demographic factors Social determinants Geographic factors Behavioural factors Related harms and injuries Health conditions and outcomes Associated burden of disease Mental illness Summary Stakeholder inputs Preliminary input from local experts Met and unmet population needs Identified service gaps and needs 69 Final Page 2

3 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment: Drug and Alcohol Treatment Effectiveness of service delivery models Broader consultation themes and key issues Service needs analysis Drug and alcohol treatment options Service distribution State-wide AOD services PHN Catchment Hospital and Health Services Profile Public hospital and health service data PHN Commissioned Services Non-Government services AOD workforce challenges Summary assessment Opportunities, priorities and options Service mapping Efficiency, effectiveness and coordination Performance evaluation 115 References 118 Appendix A 121 Appendix B 125 Final Page 3

4 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment: Drug and Alcohol Treatment Executive Summary Introduction This Initial Regional Drug and Alcohol Treatment has been prepared for the Central Queensland, Wide Bay, Sunshine Coast PHN (the PHN). The purpose of the report is to assist the PHN in determining the priorities for alcohol and drug treatment services to be considered as part of the PHN annual planning cycle. It will also serve to inform consultation with the Alcohol and Other Drug (AOD) sector during the PHN planning phase. At this developmental stage of the PHN s role in AOD service planning and commissioning, there are some gaps and inconsistencies in available data, and systematic engagement with the PHN s stakeholders is at early stages. This report presents the best available data on health needs, service needs and priorities for service development, as the basis for working with stakeholders during the planning phase. The following three tables summarise the assessment, and include: Table 1: Outcomes of the health needs analysis; Table 2: Outcomes of the service needs analysis; and Table 3: Opportunities, priorities and options. Final Page 4

5 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment: Drug and Alcohol Treatment Outcomes of the health needs analysis : Table 1 Outcomes of the health needs analysis Identified Need Key Issue Description of Evidence Social impacts and determinants of drug use Health inequalities are associated with various factors including social determinants of health such as education, occupation, income, employment status and rural location. There is a clear link between socioeconomic deprivation and risk of dependence on alcohol, nicotine and other drugs. The PHN catchment includes regions that differ largely on various socio-economic determinants of health. Queensland Government Statistician s Office data shows that: - There were higher than average proportions of people who are socioeconomically disadvantaged in Woorabinda (99.3%), North Burnett (65.6%) and Fraser Coast (60.7%) - In 2013, the PHN catchment had a higher percentage of people receiving unemployment benefits than Queensland with highest percentages in Wide Bay (9.7%), followed by Sunshine Coast (6.9%) and Central Queensland (4.5%). - The LGAs with the highest proportion of people receiving unemployment benefits were Woorabinda (35.3%) and Fraser Coast (10.3%). Queensland police data on crime offences indicate that the Central Queensland region (which most closely mirrors the PHN catchment) has had higher rates of breaches of domestic violence orders than Queensland over the past five years. A 12% increase in drug related offences between and was recorded in the Central Region. Highest rates of drug offences were in Woorabinda, Rockhampton and Central Highlands LGAs. Increased consumption of drugs and alcohol in rural and remote communities Rural and remote communities have geographical disadvantage that impacts their socio-economic environment as well as health. Burden of mental and physical illnesses, access to treatment services, and inappropriate use of alcohol and drugs are some of the issues that rural and remote communities face. The PHN catchment includes the regions that have very high proportions of populations living in outer regional, rural and remote areas. Australian Institute of Health and Welfare. (2014) National Drug Strategy Household Survey detailed report indicates that use of illicit drugs in the previous 12 months was more prevalent among people who were unemployed. Australian Institute of Health and Welfare. (2014) National Drug Strategy Household Survey detailed report indicates that people living in remote and very remote areas were twice as likely as people in major cities to smoke tobacco daily, drink alcohol in risky quantities, and use meth/amphetamines in the previous 12 months. According to Queensland Government Statistician s Office data, within the PHN catchment, LGAs in which there are greater proportions of outer regional and Page 5

6 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment: Drug and Alcohol Treatment Outcomes of the health needs analysis Comorbidities linked to alcohol and drug misuse Drug use including alcohol is a serious and complex problem, which contributes to thousands of deaths, substantial illness, disease and injury, social and family disruption, workplace concerns, violence, crime and community safety issues. The use and misuse of licit and illicit drugs is widely recognised in Australia as a major health problem, and one that has wider social and economic costs. Burden of disease associated with alcohol and drug misuse is large and potentially preventable. remote populations include Banana, with 89.4% classified as outer regional and 10.6% classified as remote; Central Highlands (69.2% outer regional and 30% remote); North Burnett (98% outer regional and 2% remote) and Woorabinda (100% remote.) Institute for Health Metrics and Evaluation Data indicates that in 2010, alcohol use was estimated to be responsible for 2.7% of the total burden of disease and injury in Australasia, while illicit drug use was estimated to be responsible for 2.6% of the burden of disease and 0.5% of deaths. Queensland Burden of Disease and Injury Report (2010) In Queensland, cancer was the leading broad cause of total burden (DALYs) (18.6%) in Queensland in 2007, and one-third of the total burden of cancer was due to preventable risk factors including tobacco, and alcohol consumption. Higher rates of risky alcohol consumption Indicators of increased pharmaceutical drug misuse Alcohol is responsible for a considerable burden of death, disease and injury in Australia. Drinking is a major factor in much of the injury resulting from road crashes and other accidents, and in social problems such as violence, family breakdown and child abuse and neglect. Alcohol-related harm is not limited to individual drinkers but impacts families, bystanders and the broader community. Specific regions within the PHN have higher rates of risky alcohol consumption. Illicit drug use has both short-term and long-term health effects, including poisoning, infective endocarditis, mental illness, selfharm, suicide and death. The social impacts of illicit drug use include stressed family relationships, family breakdown, domestic violence, child abuse, assaults and crime. It is estimated that illicit drug use costs the Australian economy $8 Population estimates released through the Public Health Information Development Unit for , indicate the PHN catchment had a higher agestandardised rate (ASR) of psychological distress compared to Queensland (ASR: 11.3 and ASR: 10.6 respectively). Queensland Department of Health. Queensland survey analytics system (QSAS), Regional detailed data. [Access date: 15 December 2015] - Data for shows that the PHN catchment had a higher prevalence of risky alcohol intake (22%) than Queensland (19.8%). This intake was higher in the LGAS of Central Highlands (33.5%), Livingstone (27%) and Banana (25.2%) National Drug Strategy Household Survey indicates that nationally, it is estimated that males in their late 20s and 40s were twice as likely to drink at risky levels than females. Young adult women (18-24 years) were also more likely to drink at risky levels. The 2013 National Drug Strategy Household Survey showed that - Australians who had misused a pharmaceutical increased from 4.2% in 2010 to 4.7% in Pharmaceutical drug users are likely to be more highly functioning and have higher socioeconomic status. Draft at 13/06/2016 2:19 PM Page 6

7 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment: Drug and Alcohol Treatment Outcomes of the health needs analysis Harms associated with regular cannabis use billion annually through crime, productivity losses and healthcare costs (National Rural Health Alliance, Illicit drug use in rural Australia. Fact sheet 33, June Canberra). In some regions of the PHN, there are concerns regarding pharmaceutical drugs misuse. Cannabis use is often correlated with use of alcohol, tobacco and other illicit drugs. Short term impact of cannabis depend on the dosage; regular and prolonged use may contribute to anxiety, insomnia and depression. Regular cannabis use may also create deficits in memory and attention, impair immunological competence of the respiratory system, and may also lead to the neglect of other important personal and social priorities. Cannabis is identified as the primary drug of concern in some of the PHN regions. HHS ATODS data for the Sunshine Coast Area identified the primary drug of concern in opioid pharmacotherapy in the Sunshine Coast Area was heroin (representing 39.80% of activity), followed by prescription opioids (37.7%) and codeine (15.2%). For context, in the Central Queensland area, service activity data for opioid treatment identifies cannabis as the primary drug of concern, followed by heroin and morphine. In the Wide Bay Area the primary drug of concern in the Fraser Coast AODS opioids pharmacotherapy service was heroin followed by morphine and oxycodone, and in the Bundaberg AODS opioids pharmacotherapy service was morphine followed by heroin then Methodone/Physeptone and Oxycodone. The 2013 National Drug Strategy Household Survey reported cannabis and meth/amphetamine users were more likely to use these drugs on a regular basis with most people using them at least every few months (64% and 52% respectively). The survey also identified a statistically significant increase in illicit drug use among the population aged over 50 years, which has been attributed to an increase in cannabis use. Summary reports produced by QNADA based on the AODTS-NMDS for the NGO AOD providers in the PHN catchment and for state-wide services identified the same top three principal drugs of concern (alcohol, amphetamines, and cannabis). Within the PHN catchment sample, cannabis was identified as the primary drug of concern for 28% of service activity, compared with a cumulative NMDS average of 23%. Psychological, health and social impacts of frequent methamphetamine use Ice is highly destructive for both users and their families. It is recognised as an extremely powerful stimulant that can trigger psychological disturbances or violent and aggressive behaviour. There is evidence of an increase in the number of people using ice. HHS ATODS data indicates the primary drug of concern in opioid treatment in the Central Queensland Area was cannabis (representing 70.94% of activity), followed by heroin and morphine (each representing 4.27% of AOD opioid treatment services). The 2013 National Drug Strategy Household Survey showed that while there was no rise in meth/amphetamine use in Australia in 2013 there was a change in the form used in that, among meth/amphetamine users, the use of ice (or crystal methamphetamine) more than doubled, from 22% in 2010 to 50% in 2013, and the frequency of meth/amphetamine drug use, with an increase in daily or weekly use (from 9.3% to 15.5%). Among ice users there was a doubling from 12.4% to 25%. Draft at 13/06/2016 2:19 PM Page 7

8 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment: Drug and Alcohol Treatment Outcomes of the health needs analysis HHS AODS data from 2015 indicates that: in 2015, methamphetamine use was the principal drug of concern for 14.2% of HHS AOD counselling and therapy services in Central Queensland Area. Amphetamine use was a primary drug of concern for an additional 9.84% of Central Queensland HHS AOD activity. Similar levels were observed in Wide Bay HHS - Bundaberg AODS data which showed 10.74% of clients identified methamphetamine as the principal drug of concern among counselling and therapy service clients. Harmful use of drugs and alcohol by young people Alcohol consumption in young adults is associated with physical injury, risky sexual behaviour, adverse behavioural patterns and academic failure as well as mental health problems including depression, self-harm and suicide. Similarly, age is one of the factors that determine how a drug will affect a user. As the brain continues to develop until a young person reaches approximately 18 years of age, they can be more vulnerable to the harmful effects of drugs. Stakeholder feedback indicated concern about lack of education services available to train staff in how to identify and manage people addicted to ice. Although National Drug Strategy Household Survey 2013 indicates - a delay in the age at which young people (aged 14 24) are having their first drink, rising from 14.4 years in 1998 to 15.7 years in 2013; and - a growing proportion of young people (12 17 years) choosing not to drink, increasing from 63.6% in 2010 to 72.3% in The summary of alcohol and drug information by the Australian Drug Foundation, 2014 indicates that - Alcohol continues to contribute to the three major causes of teen death nationally: injury, homicide and suicide, with 1 in 5 hospitalisations of people under 25 due to alcohol. - People aged were more likely to have used illicit drugs than other age groups, with more than a quarter (27%) reporting illicit use of drugs in the previous 12 months. Queensland Government Statisticians Office, 2014 data reports almost 100,000 people aged between 15 and 24 years in the PHN catchment, with 34.09% of the catchment s youth population in Sunshine Coast LGA. A further 16,550 people aged were estimated to be living in the Sunshine Coast LGA (representing 5% of the population). However, the largest proportion of the cohort lived in Central Highlands (representing 9.2% of the population or 2,879 people), followed by Woorabinda (8.5% or 85 people) and Gladstone (7.3% or 4,695 people). Draft at 13/06/2016 2:19 PM Page 8

9 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment: Drug and Alcohol Treatment Outcomes of the health needs analysis Significant health disparities for Aboriginal and Torres Strait Islander people relating to drug and alcohol use The PHN includes many regions with high proportions of Aboriginal and/or Torres Strait Islander people. Aboriginal and/or Torres Strait Islander Australians experience disproportionate harm from drug and alcohol use Stakeholder feedback indicated concern about misuse of drugs and alcohol by young people, particularly in the Gympie area. Australian Institute of Health and Welfare. (2014) National Drug Strategy Household Survey detailed report indicates that rates of cannabis use among Indigenous Australians remained relatively stable in 2013 and they were generally twice those in the non-indigenous population (19.0% compared to 10.0% for non-indigenous Australians). Higher rates of illicit drug use among the LGBTI community There is a growing body of evidence to suggest that people who identify as lesbian, gay, bisexual, transgender and intersex (LGBTI) may be at a higher risk of developing mental health and substance use problem. The LGBTI community is one of the National Aboriginal and Torres Strait Islander Peoples' Drug Strategy indicates that: - illicit drugs are estimated to cause 3.4% of the burden of disease and 2.8% of deaths compared to 2.0% and 1.3% among the non Indigenous population nationally - Aboriginal and/or Torres Strait Islander males are hospitalised for conditions to which alcohol makes a significant contribution at rates between 1.2 and 6.2 times those of non Indigenous males - Aboriginal and/or Torres Strait Islander females are hospitalised for conditions to which alcohol makes a significant contribution at rates between 1.3 and 33.0 times greater compared to non-indigenous females (including injuries related to assault) - Deaths from various alcohol related causes are 5 to 19 times greater than among non Indigenous Australians - In Queensland, from 1998 to 2006, two thirds of Aboriginal and Torres Strait Islander people who died by suicide had consumed alcohol, and more than one third had used drugs such as cannabis, amphetamines, inhalants or opiates at the time of their deaths Aboriginal people are overrepresented in the NGO AOD service episodes and HHS AODS activity statistics for each HHS region - Central Queensland, Sunshine Coast and Wide Bay, however compared with national trends there is potential for unmet demand for AOD services within this population group. Australian Institute of Health and Welfare. (2014) National Drug Strategy Household Survey detailed report indicates that - 35% of bisexual people had used cannabis in the previous 12 months compared with 23% of homosexual people Draft at 13/06/2016 2:19 PM Page 9

10 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment: Drug and Alcohol Treatment Outcomes of the health needs analysis High rates of alcohol and drug use in often hidden homeless population Increasing cannabis use by ageing population vulnerable populations in the PHN catchment and possibly have higher rates of drug use. People who are homeless are at significant risk of alcohol and drug misuse, and conversely this substance use decreases the personal resources which allow people to maintain secure and affordable housing. Homeless people are also noted as a hidden population group, not accurately captured in survey or AOD service data to understand the extent of need. The proportion of homeless people within the PHN catchment differs between the regions There is evidence of increased use of cannabis in older age groups. The PHN catchment currently has higher proportion of elderly (65 and above) and have been projected to have high proportions in the future. - Use of illicit drugs in the last 12 months was far more common among people who identified as being homosexual or bisexual than people who were heterosexual - Illicit drug use was more common than smoking and drinking alcohol among people who identified as being homosexual or bisexual - The largest differences in use among homosexual/bisexual people were in the use of ecstasy and meth/amphetamines; this was 5.8 times and 4.5 times more likely than heterosexual people. - Homosexual/bisexual people were also 2.9 times more likely to use cannabis and 2.8 times more likely to use cocaine in the previous 12 months. - Intake of alcohol in risky quantities and smoking tobacco daily were also more common but there was less of disparity in the use of licit drugs between homosexual/bisexual people and heterosexual people. Australian Bureau of Statistics, 2013 estimated that 3,142 people in the PHN catchment in 2011 were homeless, including 1,277 people in the Central Queensland Area, 938 people in Sunshine Coast Area and 927 in the Wide Bay Area. Headspace Centre Reports from within the PHN catchment for FY 2015/16 indicate 10.6% of young people accessing the Rockhampton centre were homeless or at risk of homelessness, which was above the national centre average of 10.4%. Australian Institute of Health and Welfare. (2014) National Drug Strategy Household Survey detailed report indicates that: While people aged 50 and over generally recorded the lowest rates of illicit drug use, there was a statistically significant increase in cannabis usage within the 50+ age group between 2010 and 2011 (increasing to represent from 8.8% of Australians aged years in 2010 to 11.1% in 2013). 21% of people between ages 60 and above reported to have ever used an illicit drug 6.4% of Australians aged 60+ years used illicit drugs in 2013 compared to 5.2% in This may reflect an increased uptake in the use of cannabis for self-medicated pain management. Draft at 13/06/2016 2:19 PM Page 10

11 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment: Drug and Alcohol Treatment Outcomes of the health needs analysis Queensland Government Statistician s office data, 2014 shows a large proportion of older and ageing population at up to 23.4% (Fraser Coast) followed by the Bundaberg and North Burnett LGAs. The Sunshine Coast and Wide Bay Areas were projected to have more than 20% of their population aged 65 years and over in Draft at 13/06/2016 2:19 PM Page 11

12 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment: Drug and Alcohol Treatment Outcomes of the service needs analysis: Table 2 Outcomes of the service needs analysis Identified Need Key Issue Description of Evidence AOD service provider engagement and coordination AOD treatment for rural and regional communities - equitable distribution of services Availability of after-hours and outreach services Service needs to address primary drugs of concern Comprehensive engagement with local AOD service providers was not possible in the timeframes of this needs assessment but is essential to prioritisation and strategy development. There are a few non-government organisations currently operating services in the catchment, in addition to those regionspecific services provided by HHSs. Equitable distribution of AOD services is necessary. There are potential gaps in follow-up, primary care and 24-hour crisis care in relation to drug and alcohol issues. Although alcohol stands out as a primary drug of concern, regions within the PHN catchment show difference in patterns of drug use and use of services differed in various regions. Feedback to QNADA from state-wide NGO AOD service providers identified the need to: - Improve coordination of AOD and related services between sectors - Coordinate with existing services to avoid overlap and expand capacity to accommodate all individuals in need of treatment - Co-locate mental health and AOD services as a strategy to improve coordination. There was also a strongly expressed need to reduce stigma around AOD use. As reported by QNADA, there are few non-government organisations currently operating services in the catchment, in addition to those region-specific services provided by HHSs. Preliminary service mapping indicates few non-government AOD provider listings in Wide Bay area, followed by Central Queensland area (relative to geographic spread) and Sunshine Coast area (relative to population size). QNADA service data are sourced from four out-client AOD treatment services in the PHN catchment area, noting two additional state-wide services located at Nambour and Rockhampton. This is particularly interesting, given clients from the PHN catchment represent 19% of the total service episodes of the cumulative NMDS sample, which indicates a high use of services and likely high demand. Patients from the PHN catchment also represented 10% of state-wide service episodes. Potential gaps in follow-up, primary care and 24-hour crisis care in relation to drug and alcohol issues (with the exception of hospital emergency departments) identified by local stakeholders as per reports by QNADA. QNADA reports outreach services represented 6% of service episodes by treatment setting in the PHN catchment, compared with 4% of state-wide service episodes by treatment setting, both well below the 29% of cumulative average of episodes by treatment setting. The principal drugs of concern from NGO AOD service data in the PHN catchment sample were alcohol (representing 35% of service episodes compared with a cumulative average of 42%), cannabis (28% compared with Page 12

13 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment: Drug and Alcohol Treatment Outcomes of the service needs analysis alcohol, cannabis and amphetamines 23%) and amphetamines (26% compared with 24%). State-wide services recorded a higher proportion of service episodes for alcohol (49%) and amphetamines (27%) and a lower proportion of service episodes for cannabis (12%). HHS ATODS data also confirms alcohol as a primary drug of concern in counselling and therapy AOD services representing 55.8% of counselling and therapy services in the Sunshine Coast Area, 40.06% (Fraser Coast) and 38.98% (Bundaberg) of counselling and therapy services in the Wide Bay Area and 34.2% of counselling and therapy services in the Central Queensland Area. After alcohol, cannabis was identified as the primary drug of concern in HHS counselling and therapy AOD services in the Sunshine Coast, Fraser Coast (within Wide Bay) and Central Queensland areas (9.3%, 15.41% and 21.3% respectively), followed by amphetamines in Sunshine Coast and Fraser Coast Areas (7.8% and 14.85%) and methamphetamine in the Central Queensland Area (14.2%). Bundaberg AODS data (within the Wide Bay area) indicates that after alcohol, morphine (16.78%) was identified as the primary drug of concern, followed by methamphetamine (10.74%). Local workforce and service resource assessments Changes in substance and patterns of substance use are likely to present challenges for the AOD workforce in responding to these changes, and associated health and social impacts. Challenges include responding to multiple comorbidities (e.g. mental illness, drug or alcohol addition, chronic disease), the implications of HHS ATODS data shows that: The primary drug of concern in opioid treatment in the Central Queensland Area was cannabis (representing 70.94% of activity), followed by heroin and morphine (each representing 4.27% of AOD opioid treatment services). By contrast, the primary drug of concern in opioid pharmacotherapy in Sunshine Coast Area was heroin, followed by prescription opioids, and codeine, and in the Wide Bay area morphine followed by heroin and prescription opioids for Bundaberg AODS clients; and heroin followed by morphine and oxycodone for Fraser Coast AODS clients. Referral data from NGO AOD services in the PHN catchment indicate 12% of referrals to AOD services came from mental health care services compared with 3% of referrals to state-wide services and a 4 % cumulative average. Preliminary survey results among local experts indicate potential reluctance among some service providers including clinical services to take up referrals Page 13

14 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment: Drug and Alcohol Treatment Outcomes of the service needs analysis Availability of brief intervention and screening data High demand for drug and alcohol counselling services Gaps in withdrawal management services Australia s ageing population, and particularly for Aboriginal and/or Torres Strait Islander Australians who have a shorter than average life expectancy and increased comorbidity rates. Challenges for the AOD workforce include regional variations in types of drug used along with other factors such as age, gender, chronic disease status, geographical area and socio-economic status. Brief intervention and screening data were not available at the time of this report to indicate the extent of demand for AOD services and should be explored with local AOD and associated health providers as part of further planning. There is high demand for counselling services in the PHN catchment. Available evidence reflects a potential gap in the availability of local withdrawal management services. with co-morbidity, noting also that some providers have restrictions due to service agreements. Local experts also indicate there are limited resources available for community workers to achieve the qualifications, training and development required to support AOD treatment. QNADA s report on NGO AOD services indicate state-wide service providers have suggested better AOD training in university medical and social service degrees. The main NGO AOD treatment type in the PHN catchment sample as reported by QNADA was counselling (representing 71% of service episodes compared with a cumulative average of 26%), followed by assessment only (12% compared with a cumulative average of 9%). The principal drugs of concern from NGO AOD service data in the PHN catchment sample were alcohol (representing 35% of service episodes), followed by cannabis and amphetamines. Average length of stay by treatment type indicate 95 days for counselling services within the PHN catchment sample compared with 116 days for statewide counselling services and 115 for the cumulative NMDS average. Aboriginal and Torres Strait Islander patients represented 15.46% of counselling and therapy episodes in the Central Queensland HHS, 10.06% in Bundaberg and 8.68% in Fraser Coast AODS services in Wide Bay, and 4.1% in the Sunshine Coast Area AODS activity data, which is an overrepresentation of this population group compared with the population average of each Area. Feedback from state-wide NGO AOD services identified access to counselling services as an area of need across the state, and with relevance to the PHN catchment. To improve access, providers suggested increased investment in the AOD sector and training for allied health and medical professionals. QNADA data indicates that withdrawal management accounted for 9% of NGO AOD service episodes in the PHN catchment sample, compared with a cumulative average of 20% and 41% of state-wide service episodes. Preliminary mapping identified only one home-based withdrawal program in the catchment. Only five of the 21 state-wide AOD services reported by QNADA Page 14

15 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment: Drug and Alcohol Treatment Outcomes of the service needs analysis Residential rehabilitation services Residential rehabilitation services was identified as a need were identified as providing withdrawal management services. Preliminary survey inputs from local stakeholders indicate there is a potential gap in inpatient AOD withdrawal beds and public withdrawal management services, however other local inputs suggest these services are sufficient to meet demand. Average length of stay by treatment type indicate 103 days for withdrawal management in the PHN catchment sample, compared with 36 days for withdrawal from the NMDS cumulative average. Inputs from local experts indicate there are barriers to accessing withdrawal management (detox) services beyond GP services, with no day detox program available in the catchment. The QNADA report notes the Royal Brisbane s Hospital Alcohol and Drug Service (HADS) provides a medical detoxification unit, however local experts note that this service is difficult to access for the PHN catchment population, both in terms of service competition and travel distance. The QNADA Report also notes in the context of withdrawal management there are a number of services with the capacity to provide AOD treatment in the catchment, if they were resourced to do so. Preliminary service mapping shows that 17 of 21 state-wide AOD services provide residential rehabilitation and two provide residential aftercare. We Help Ourselves is a state-wide service based in the PHN catchment (at Nambour) providing residential rehabilitation and The Gumbi Gumbi Aboriginal and Torres Strait Islander Corporation is a second state-wide residential rehabilitation service based in the PHN catchment area (Rockhampton), providing Indigenous specific AOD services. QNADA report indicates that the treatment delivery setting for the PHN catchment was primarily non-residential facilities (representing 72% compared with a cumulative average of 22%), which reflects the higher use of counselling services in the dataset. By contrast, 96% of state-wide service episodes were delivered in residential treatment facilities (compared with a cumulative average of 41%), which includes the state-wide service delivered in Nambour. Residential rehabilitation service episodes were not captured in the AOD service data for the PHN catchment sample as it has been reported as a state-wide service. Page 15

16 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment: Drug and Alcohol Treatment Outcomes of the service needs analysis Private pharmacotherapy service needs Preliminary survey inputs from local experts in the PHN catchment indicate the potential need for private opioid pharmacotherapy services where very limited places are known and/or prescribers available among existing private providers. Stakeholder inputs also identified geographic barriers to accessing AOD treatment services for those in need, who may benefit from access to more localised options. Residential rehabilitation services was identified as a need by local experts, with one or two stakeholders also noting a need for short, medium and long stay options. HHS AODS activity data shows that: HHS opioid treatment data varies significantly within the catchment, with heroin (39.80% of activity), prescription opioids (37.7%) and codeine representing the primary drugs of concern in Sunshine Coast Area, cannabis dominates Central Queensland HHS treatment data (at 70.99%), and in Wide Bay data the primary drugs of concern were heroin (35.93%), morphine (23.35%) and oxycodone (14.37%) within the Fraser Coast service, and morphine (39.91%) followed by heroin (15.02%) and methadone/physeptone (13.62%). 80% of opioid pharmacotherapy services in the Sunshine Coast HHS were delivered to patients aged over 35 years, compared with 65% - 75% in Wide Bay HHS (Fraser Coast and Bundaberg respectively) and 68% in the Central Queensland HHS. Levels of activity were highest among the patient cohort aged years (representing 33.5% of Sunshine Coast activity data, 27.4% of Central Queensland data and approximately 26% across Wide Bay HHS). Aboriginal and/or Torres Strait Islander patients represented 7.5% of Sunshine Coast HHS opioid pharmacotherapy services and 13.07% of Central Queensland HHS opioid treatment program activity from the Central Queensland HHS in Aboriginal and Torres Strait Islander AOD treatment services Preliminary survey inputs from local experts identified Aboriginal and/or Torres Strait Islander people as one population group with the most significant need for drug and alcohol treatment services in the PHN catchment. AOD client demographics from NGO providers and HHSs in the PHN catchment highlight an overrepresentation of Aboriginal and/or Torres Strait Islander people, however in the context of diverse, complex and high needs there remains potential for unmet AOD service needs among this priority population group. Some stakeholder feedback related to AOD services for Aboriginal and Torres Strait Islander peoples is summarised below: - There is a lack of culturally responsive service provision by other funded services in the area. Page 16

17 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment: Drug and Alcohol Treatment Outcomes of the service needs analysis Youth and young adult AOD education, prevention and treatment services Outcomes-focused performance evaluation Preliminary survey inputs from local experts identified young people as one population group with the most significant need for drug and alcohol treatment services in the PHN catchment. Patient experience and satisfaction to be documented as part of further engagement and consultation undertaken by the PHN. - There are treatment resistant clients, low socioeconomic and dually diagnosed client. - Clients requiring residential and detox services are also missing out due to no services. - There is a lack of brief intervention, withdrawal management, counselling, residential and non-residential rehabilitation for Aboriginal and Torres Strait Islander peoples. Reports from Maroochydore, Rockhampton and Hervey Bay Headspace Centres for the FY 2015/16 indicate that drug and/or alcohol interventions represent a very small portion of services provided to young people in the catchment (representing between 0.1% and 0.2% across the catchment centres, compared with the national centre average of 1.1%). In Central Queensland, stakeholders indicated concerns about insufficient services for young people whose homes were affected by drugs, alcohol misuse and domestic violence. In the Sunshine Coast area, lack of employment for young people was raised as an issue affecting mental health and wellbeing among young people. In recent consultations with Clinical and Community Advisory Councils in the PHN catchment identified similar concerns as stakeholders in the catchment. Client demographic data from four out-client AOD services reported by QNADA are consistent demographic indicators from the NDSHS, with clients predominantly aged in the year cohort (representing 32% of NGO AOD Service clients). Feedback from a number of service providers within the Gympie community identified mental health as a large issues leading to substance abuse (youth and adults) and self-harm among youths. Concerns were raised about emerging 3rd generation substance abuse in Gympie. State-wide NGO AOD providers identified better service coordination would also involve a measure of better experiences for individuals at enquiry point as they can be referred to any number of services as appropriate to their needs as matched to a service s target group. Need to capture data that helps understand the patient journey through AOD services across sectors, with a dual focus on good health and good social outcomes for consumer. Page 17

18 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment: Drug and Alcohol Treatment Outcomes of the service needs analysis Efficiency, effectiveness and coordination Sufficient data that will allow to measure impact of the service provision needs to be collected by the PHN. Need to capture data and information that helps the PHN understand: - The capacity of the AOD service system to adapt and sustain changes in workforce, infrastructure, policy and treatment needs - Expenditure on AOD services through different providers and sectors to evaluate technical efficiency of service options - Responsiveness and effectiveness of AOD services based on how well service outputs achieve their objectives, measuring service access, quality, cultural competency and appropriateness in meeting particular population group needs Page 18

19 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment: Drug and Alcohol Treatment Opportunities, priorities and options: Table 3 Opportunities, priorities and options Priority Possible Options Expected Outcome Sector Engagement and Strategy Development Increase local availability of withdrawal management and support services Work collaboratively with HHSs, QNADA, specialist drug and alcohol treatment providers in the region, Indigenous organisations and service providers, consumers, other government agencies and welfare organisations to further develop a comprehensive regional drug and alcohol treatment service needs assessment. Develop a comprehensive drug and alcohol treatment services plan for the region to guide future commissioning to meet local needs, enhance service coordination and integration. Engage further with local AOD service providers regarding opportunities and barriers to increasing local or home-based withdrawal management and support services. General consensus regarding priority population groups, localities of highest need, primary drugs of concern by Area, and priority treatment needs. Improved understanding of AOD service sector and treatment systems specialist, generalist and community and identification of agreed strategies required to increase service availability and integration within Increased delivery of withdrawal management services in the PHN catchment. Possible Performance Measurement General agreement with sector stakeholders regarding priorities and strategy. Decreased PHN patient representation in state-wide AOD service statistics for withdrawal management. Potential Lead PHN to lead planning in conjunction with a range of relevant stakeholders. PHN to lead further needs assessment and commission services. Commission appropriate withdrawal management and support services within the PHN region. Page 19

20 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment: Drug and Alcohol Treatment Opportunities, priorities and options Priority Possible Options Expected Outcome Increase availability of after hours counselling and crisis care services Guided by the region wide drug and alcohol treatment services plan, commission appropriate after hours drug and alcohol treatment services to address existing service gaps. Improved access to AOD services, especially in rural areas. Possible Performance Measurement Increased availability and utilisation of after hours drug and alcohol treatment services. Potential Lead PHN to lead further needs assessment and planning and commission services. Page 20

21 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment Drug and Alcohol Treatment 1. Introduction 1.1. Purpose This Needs Assessment on Regional Drug and Alcohol Treatment Needs Assessment has been prepared for the Central Queensland, Wide Bay, Sunshine Coast (CQWBSC) PHN. The purpose of the report is to assist the PHN in determining the needs, services gaps, options and priorities for Drug and Alcohol service options to be considered as part of the PHN annual planning cycle. It will also serve to inform consultation with the Alcohol and Other Drug sector during the PHN planning phase. At this developmental stage of the PHN s role in Drug and Alcohol service planning and commissioning, there are some gaps and inconsistencies in data, and systematic engagement with the PHN s stakeholders is at early stages. This report presents the best available data on health needs, service needs and priorities for service development, as the basis for working with stakeholders during the planning phase. Further work in assessing Drug and Alcohol Treatment needs in the catchment will be undertaken during in parallel with the development of a regional drug and alcohol treatment plan Assessment framework This report has had regard to the Needs Assessment Guidelines for PHNs and to the Guidance provided by the Department of Health with respect to AOD needs assessment. It includes summary information about: national, state and PHN catchment estimates of community and population group needs in relation to drug and alcohol treatment; social determinants and conversely, indicators of social and health outcomes including social impacts of drug and alcohol use, burden of disease and related harm; an overview of drug and alcohol treatment options; an overview of available AOD services at state and PHN catchment level; key stakeholder inputs regarding unmet population needs and service gaps in the PHN catchment; and priority areas and options for further assessment and consultation Needs analysis (Section 2) In order to identify geographic areas and population subgroups which are likely to have higher needs for drug and alcohol treatment, the assessment has used normative needs assessment techniques which consider: population distribution within the PHN; demographic features which signal vulnerabilities to drug and alcohol misuse; Page 21

22 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment Drug and Alcohol Treatment population groups with behaviours or attitudes which may pre-dispose them to drug and alcohol misuse; and comparative indicators which may indicate prevalence across the catchment. In order to understand the prevalence of drug and alcohol problems, the assessment has also considered expressed need through analysis of: alcohol and drug use trends, associated health outcomes, and at-risk population groups as identified by: o o o 2013 National Drug Strategy Household Survey; National Aboriginal and Torres Strait Islander Peoples Drug Strategy ; and PHN Catchment and LGA-level indicators from the Public Health Information Development Unit (PHIDU). patient demographics reported by the Queensland Network of Alcohol and Other Drug Agencies (QNADA), for state-wide and PHN catchment non-government AOD out-client service providers; patient demographics reported by the three Hospital and Health Services (HHSs) from public AOD treatment service activity in the PHN catchment in 2015; qualitative information from consumer groups for whom data was not readily available (e.g. LGBTI). Where localised data was not available, the assessment has relied on normative assessment and uses the most recent available benchmarks for National and State prevalence, extrapolated to the PHN population s cohorts. While there was insufficient time to consult specifically with the drug and alcohol sector on this needs assessment, targeted input from local experts has helped to refine the analysis and reporting. A summary of stakeholder inputs and the PHN s forward plan for engagement is presented in Section Service analysis (Section 4) The service needs analysis (Section 4) has relied on information available through the PHN and HHS, including: service provider listings developed by PiR consortiums, or as listed in online QFinder and NHSD directories; descriptions regarding the scope of HHS alcohol and other drug treatment services, as provided by each HHS team within the PHN catchment; Area-level data for HHS AOD treatment service activity in 2015, as provided by each HHS team within the PHN catchment; and Page 22

23 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment Drug and Alcohol Treatment state-wide and PHN catchment level reports on service activity, distribution and needs as reported by QNADA. This high level profiling of service distribution based on geographic location and general service descriptions has assisted with the preliminary identification of possible service gaps and areas of unmet need. The profile is supported by QNADA s report on NGO AOD service needs. A more detailed service needs analysis will be developed as part of the PHN s future planning activities with identified providers, to understand: service delivery and patient catchments; workforce capacity and skills gaps; service sub-categories (e.g. target population groups or specific treatments). Further analysis would also need to consider the PHN objectives of service efficiency, effectiveness and coordination Prioritisation and options development (Section 5) Synthesis and triangulation of the health needs, service needs and stakeholder inputs was undertaken using a matrix approach, to identify priority needs for service development and systemic change PHN Catchment The geographic catchment for the PHN is approximately 161,000 square kilometres. It includes the Central Queensland, Wide Bay and Sunshine Coast Areas, each of which were previously defined as Medicare Local regions, and align with the boundaries of their respective HHS regions. Figure 1 shows the PHN catchment area 1. 1 Public Health Information Development Unit Social Health Atlas of Australia. PHNs Single Maps Page 23

24 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment Drug and Alcohol Treatment Figure 1: PHN Catchment with CQ, WB and SC Area Boundaries, 2015 The PHN includes 12 Local Government Areas (LGAs) as shown in Table 4. Table 4: PHN Areas and LGAs Sunshine Coast Area and HHS Central Queensland Area and HHS Wide Bay Area and HHS Sunshine Coast Region LGA Banana Shire2 LGA Fraser Coast Region LGA Noosa Shire LGA Central Highlands Region LGA Bundaberg Region LGA Gympie Region LGA Livingstone Shire LGA North Burnett Region LGA Gladstone Region LGA 3 Rockhampton Region LGA Woorabinda Shire LGA 2 Banana Shire LGA has a concordance of 93.96% with the PHN region boundary. 3 Gladstone LGA is primarily apportioned to Central Queensland Area, but includes a small overlap with the Wide Bay Area boundaries. For the purpose of this assessment, Gladstone LGA is wholly represented as part of Central Queensland Area Page 24

25 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment Drug and Alcohol Treatment 2. Health needs analysis 2.1. PHN population Population distribution The PHN catchment s population in June 2014 was estimated at 823,985 people (see Table 5). Based on average annual projected growth of 1.8% (see Section 2.1.2), the population in 2016 would be approximately 853,915 people. The Sunshine Coast Area is the most southerly and geographically the smallest, but is the most populated area, with 46.6% of the catchment s population. It comprises the Sunshine Coast, Gympie and Noosa LGAs, which are predominantly coastal and hinterland communities. Approximately 25.0% of the catchment s population live in the Wide Bay (WB) Area, which comprises the Fraser Coast LGA (including the centres of Maryborough and Hervey Bay), and the more rural Bundaberg and North Burnett LGAs further north. The Central Queensland Area is geographically the largest and the most northerly. In 2014, the CQ Area was home to approximately 28.4% of the PHN catchment s population, distributed across five LGAs, including the Aboriginal community of Woorabinda, the rural Banana Shire, the Central Highlands, the regional centre of Rockhampton, and the Gladstone and Livingstone LGAs. The Estimated Resident Population (ERP) for the PHN catchment, Areas and LGAs in 2014 is shown in Table 5. As a whole, the PHN catchment was estimated to represent 17.44% of the Queensland population in The Public Health Information Development Unit (PHIDU) 4 PHN population estimates indicated that of the 98.5% people in the PHN region who stated their gender in the 2011 Census, 403,360 people (49.68%) were male and 408,941 people (50.31%) were female. On the basis that 20% of Australians may experience mental health issues in any one year 5, the PHN catchment as a whole would include approximately 164,797 people who had experienced mental health issues in the past year. 4 Public Health Information Development Unit Social Health Atlas of Australia. PHN Data Population Estimates 5 ABS (Australian Bureau of Statistics) National Survey of Mental Health and Wellbeing 2007 Page 25

26 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment Drug and Alcohol Treatment Table 5: Estimated resident population by age, 30 June 2014 Geography Age group 0 14 years years years years 65+ years TOTAL N % N % N % N % N % N Queensland 934, , ,323, ,159, , ,722,447 PHN Catchment 160, , , , , ,985 PHN Areas Sunshine Coast Central Queensland 71, , , , , ,338 51, , , , , ,747 Wide Bay 38, , , , , ,900 Local Government Areas Banana 3, , , , , ,236 Bundaberg 17, , , , , ,283 Central Highlands 7, , , , , ,595 Fraser Coast 18, , , , , ,306 Gladstone 14, , , , , ,097 Gympie 9, , , , , ,464 Livingstone 7, , , , , ,378 Noosa 9, , , , , ,052 North Burnett 1, , , , , ,311 Rockhampton 17, , , , , ,439 Sunshine Coast 52, , , , , ,822 Woorabinda ,002 Page 26

27 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment Drug and Alcohol Treatment Projected growth The PHN population is predicted to grow to approximately 1.2 million people by the year 2036, which is an average annual growth of 1.8% over 25 years (see Table 6). 6 By 30 June 2036: Sunshine Coast is projected to remain as the largest LGA with nearly 470,000 people; the Sunshine Coast Area will have the largest population at 469,873 persons, or 48.3% of the catchment s population (up from 46.6% in 2014); the Central Queensland Area s population is predicted to reach 359,257 people, or 29.1% of the catchment s population; and the Wide Bay area is expected to have a slower rate overall and reach a population of 278,127 people (or 22.6% of the catchment s total). LGAs expected to maintain highest annual average rates of growth include Gladstone at 2.9%, Livingstone at 2.5%, and the Sunshine Coast at 2.3%. Table 6: Projected population by LGA, Areas, the PHN region and Queensland Area Estimates as at 30 th of June each year % Av. ann. growth 2011(a) Queensland 4,476,778 4,946,319 5,477,082 6,007,578 6,548,220 7,095, PHN Catchment 782, , ,384 1,046,431 1,139,273 1,233, PHN Areas Sunshine Coast 365, , , , , , Central Queensland 217, , , , , , Wide Bay 200, , , , , , Local Government Areas Banana 14,812 15,068 15,101 15,021 14,917 14, Bundaberg 92, , , , , , Central Highlands 29,541 33,025 35,850 38,393 40,928 43, Fraser Coast 97, , , , , , Gladstone 59,461 70,098 83,424 96, , , Gympie 46,837 49,992 53,560 57,051 60,567 64, Queensland Government Population Projections, 2013 edition (medium series) Page 27

28 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment Drug and Alcohol Treatment Area Estimates as at 30 th of June each year % Av. ann. Livingstone 33,394 39,377 44,072 49,824 56,405 62, Noosa 51,038 55,419 58,539 59,605 61,033 61, North Burnett 10,374 10,331 10,314 10,320 10,325 10, Rockhampton 78,939 86,688 94, , , , Sunshine Coast 267, , , , , , Woorabinda 976 1,053 1,098 1,137 1,173 1, (a) 2011 data are estimated resident population (ERP). Source: Queensland Government Population Projections, 2013 edition (medium series) growth Table 7 indicates the SA2 geographical areas with the highest projected average annual population growth from 2016 to The Landsborough and Caloundra West SA2s will have very high rates of growth, reflecting the development of the new city of Aura, south of Caloundra. Table 7: Highest projected population growth , SA2s Statistical Area 2 Areas Average annual population growth Population Increase ( ) Landsborough Sunshine Coast 17.9% 40,270 Caloundra West Sunshine Coast 13.3% 49,750 Boyne Island - Tannum Sands Wide Bay 8.0% 19,754 Rockhampton City Central Queensland 4.9% 4,389 Torquay - Scarness - Kawungan Wide Bay 4.7% 14,529 Kin Kora - Sun Valley Wide Bay 4.3% 3,948 Parkhurst - Kawana Sunshine Coast 4.3% 6,645 Gracemere Central Queensland 4.2% 9,500 Gladstone Hinterland Central Queensland 4.2% 10,822 Source: QGSO, 2011 series ( Source: QGSO regional data profiles. Data from the Australian Bureau of Statistics: Population by Age and Sex, Regions of Australia. Released at 11.30am (Canberra time) 18 August Page 28

29 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment Drug and Alcohol Treatment Age distribution The PHN catchment had a median age of 41.3 years which was older than the Queensland median age of 36.8 years. 7 At 30 June 2014, the PHN catchment s population was estimated to include: 19.5% people aged 0-14 years, which was slightly lower than the Queensland average of 19.8%; 62.5% people aged years which was lower than the Queensland average of 66.23%; and 18.1% aged 65+ years, which was substantially higher than the Queensland average of 14%. Within the region: Woorabinda LGA had the largest percentage of persons aged 0 14 years (30.9%), followed by the Banana and Central Highlands LGAs; Central Highlands LGA had the largest percentage of persons aged years (70.0%); and Fraser Coast LGA had the largest percentage of persons aged 65 years and above (23.4%) followed by the Wide Bay and North Burnett LGAs. The SA2 areas with the highest proportion of people in specific age groups are shown in Table 8. Table 8: SA2 regions with the highest proportions of persons aged 0-4 years, years and 65 years and over All Population SA2 regions Corresponding LGA % of 0 to 4 years of age Central Highlands East (10.2%), Emerald (9.5%), Central Highlands Gracemere (10.0%) Clinton - New Auckland (9.4%), Telina Toolooa (9.4%) % of 15 to 24 year olds Sippy Downs (18.8%), Mooloolaba - Alexandra Headland (16.6%), Mountain Creek (15.0%) Emerald (15.1%) Bundaberg (16.5%) Rockhampton City (16.0%), The Range Allenstown (16.0%) Berserker (15.3%), Frenchville - Mount Archer (15.3%), Rockhampton Gladstone Sunshine Coast Central Highlands Bundaberg Rockhampton 7 QGSO Regional Profiles created using ABS , Population by Age and Sex, Regions of Australia, 2014 Page 29

30 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment Drug and Alcohol Treatment All Population SA2 regions Corresponding LGA % of 65 years and above Pialba - Eli Waters (27.8%), Fraser Coast Caloundra - Kings Beach (27.7%), Golden Beach - Pelican Waters (27.4%), Buderim North (25.4%), Tewantin (25.3%) Cooloola (26.8%) Millbank Avoca (25.8%) Sunshine Coast Gympie Bundaberg Self-rated health For the PHN catchment in , 82% (95% CI 79-84) of adults were modelled as self-reporting to be in excellent, very good or good health. The modelled population aged 15 years and over with fair or poor self-assessed health is summarised in Figure 2 as age standardised rates per 100 people for estimated population. Based on non-overlap of 95% CI for the rate per 100 population, six LGAs (Bundaberg, Fraser Coast, Gladstone, Gympie, North Burnett and Rockhampton) with higher rates of fair or poor self-assessed health compared to Queensland. Figure 2: standardised rate per 100 population for estimated population, aged 15+ years, with fair or poor selfassessed health Queensland 15.7 the PHN 17.1 Banana 15.0 Bundaberg 19.2 Central Highlands 14.8 Fraser Coast 20.0 Gladstone 16.3 Gympie 19.8 North Burnett 19.1 Rockhampton 17.2 Sunshine Coast 15.3 Woorabinda 16.6 Source: PHIDU Social Health Atlas of Australia, Australian Bureau of Statistics (ABS) Patient Experience Survey Page 30

31 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment Drug and Alcohol Treatment 2.2. Alcohol and drug use trends Alcohol use and trends The harmful use of alcohol is linked to both short-term and long-term health effects including: Short term effects such as impaired impair judgment and coordination, which can increase the risk of injury to the drinker or others, while also contributing to rates of crime, violence, anti-social behaviours and accidents (see Section 2.3.5); and Longer term effects, including alcohol dependence and chronic conditions such as high blood pressure, cardiovascular diseases, cirrhosis of the liver, types of dementia, mental health problems and various cancers (see section for associated health indicators in the PHN catchment) 9. The following subsections provide a brief discussion of national, state and PHN trends with respect to alcohol use. National trends Key findings from the 2013 National Drug Strategy Household Survey (NDSHS) in relation alcohol use indicate that: compared to 2010 figures, fewer people in Australia are consuming alcohol in quantities that exceeded the lifetime risk and single occasion risk guidelines (see Figure 3), however: o almost 1 in 5 (18.2%) people aged 14 or older consumed more than 2 standard drinks per day on average, which continues to exceed the lifetime risk guidelines 10 ; and o approximately 4 in 5 Australians aged 14 years or older still reported they had consumed alcohol in the past year with 6.5% drinking on a daily basis; males were twice as likely as females to exceed the lifetime risk guidelines (26% and 10%, respectively) and men in their 40s and late 20s were most likely to drink at risky levels (32%), while for women it was young adults aged (14.6%); and although 1 in 6 (15.6%) people in Australia had consumed 11 or more standard drinks on a single drinking occasion in the past 12 months, this was significantly lower than in 2010 (16.8%). 9 AIHW National Drug Strategy Household Survey: highlights and detailed report AIHW National Drug Strategy Household Survey: highlights and detailed report Page 31

32 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment Drug and Alcohol Treatment Figure 3: Alcohol drinking status, % people aged 14 years or older, 1991 to 2013 PHN and Queensland trends Rates of risky drinking are substantially higher in Queensland than national rates, and this produces greater impacts for Queensland, including the 34,000 alcohol related hospitalisations each year 11. Queensland and regional data released through Queensland Health for indicates that for the PHN catchment as a whole had a higher prevalence of persons with lifetime risk associated with alcohol intake (at 22%) than the Queensland population (at 19.8%) 12. Within the PHN catchment, areas with highest prevalence included: the Central Queensland Area (at 25.2%) and in particular the Central Highlands LGA (at 33.5%); and the Banana (25.2%), Gladstone (25%), Livingstone (27%) and Noosa LGAs (24.4%). 13 Activity data from NGO AODTS providers for the PHN catchment as reported by QNADA indicates alcohol as a primary drug of concern (representing 35% of service episode for the catchment sample, compared with a cumulative average of 42% and 55% state-wide service episodes). Activity data available through HHS AODTS for 11 Queensland Department of Health. Queensland survey analytics system (QSAS), Regional detailed data. Access date: 15 December Queensland Department of Health. Queensland survey analytics system (QSAS), Regional detailed data. Access date: 15 December Queensland Department of Health. Queensland survey analytics system (QSAS), Regional detailed data. Access date: 15 December 2015 Page 32

33 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment Drug and Alcohol Treatment the Sunshine Coast and Central Queensland Areas also identify alcohol as a primary drug of concern, particularly among counselling and therapy services representing 55.8% and 34.2% of service activity respectively. Service activity data is further discussed in Section Tobacco smoking National trends Key findings from the 2013 NDSHS in relation tobacco smoking trends include: Significantly declining rates of daily smoking, which have almost halved since 1991 (24.3% to 12.8% in 2013); Younger people are delaying the take up of smoking the age at which year-olds smoked their first full cigarette increased from 14.2 in 1995 to 15.9 years in 2013; and Smokers reduced the average number of cigarettes smoked per week; from 111 cigarettes in 2010 to 96 in According to the Australian Aboriginal and/or Torres Strait Islander Health Survey, daily smoking rates in tobacco use is of particular concern for the health of Aboriginal and/or Torres Strait Islander people, where there is a significantly higher smoking rate compared with the non-indigenous population 14. Daily smoking rates were also significantly higher among Aboriginal and/or Torres Strait Islander people aged 15 years and over living in remote areas than in non-remote areas (50% compared with 38%). This has primarily been attributed to significantly higher rates of smoking among young Aboriginal and/or Torres Strait Islander people in remote areas, when compared with the daily smoking rates for young people in non-remote areas 15. PHN and Queensland trends As noted by Table 36 of the PHN s Comprehensive Needs Assessment, the rate of daily smoking in the PHN catchment was marginally below the Queensland average (13.3% compared with 13.8%). Areas within the catchment with highest rates of daily smoking included the Wide Bay (at 15.5%) and Central Queensland Areas (at 15.1%); and in particular, the LGAs of Rockhampton (19.1%), Fraser Coast (16.8%), Bundaberg (14.9%) and Central Highlands (14.8%). While daily smoking indicators for the PHN catchment s Aboriginal and Torres Strait Islander population are not detailed, Section of this report identifies a higher representation of Aboriginal and Torres Strait Islanders in the PHN s Wide Bay and Central Queensland Areas, and particularly in the LGAs of Woorabinda (92.8%), 14 Australian Bureau of Statistics Australian Aboriginal and/or Torres Strait Islander Health Survey. 15 Australian Bureau of Statistics Australian Aboriginal and/or Torres Strait Islander Health Survey. Page 33

34 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment Drug and Alcohol Treatment Rockhampton (6.4%), North Burnett (6%) and Banana (4%). It is likely, on population numbers alone, that prevalence of daily smoking will be higher in these areas Drug use and trends The short and long term health effects of illicit and pharmaceutical drug misuse can be severe, including poisoning, heart valve infections, mental illness, self-harm, suicide and death 16. Use of inhalants may also lead to brain damage, disability or death, while the injection of illicit drugs can also allow the transmission of blood borne viruses, such as HIV/AIDS, Hepatitis C and Hepatitis B 17 The social impacts of drug abuse and illicit drug use are discussed further in section 2.3 and can include stressed family relationships, family breakdown, domestic violence, child abuse, assaults and crime 18. Health outcomes associated with drug and alcohol use, based on key indicators of the burden of disease and injury among Queenslanders are further discussed in Section 2.4. National trends The 2013 NDSHS found the proportion of Australians having used any illicit drug in the last 12 months has remained relatively stable over the past decade at around 1 in 7 Australians (18.1% of Australian males and 12.1% of females) 19. People aged years were most likely to have used an illicit drug in the previous 12 months, with over 1 in 4 reporting illicit drug us in the previous 12 months (27% of all people in that age group). The use of synthetic cannabinoids was slightly higher among those aged years. Overall, there was no change in recent use of most illicit drugs in The most common drug used both recently and over the lifetime was cannabis, used by 10.2% and 35% respectively of people aged 14 and over. Significant changes in use of specific drugs included: the proportion who had misused a pharmaceutical rose from 4.2% in 2010 to 4.7% in 2013; ecstasy use has been declining since 2007 and declined from 3.0% in 2010 to 2.5% in 2013; there were small but significant falls in recent use of heroin and people who had injected drugs. 16 AIHW National Drug Strategy Household Survey: highlights and detailed report AIHW National Drug Strategy Household Survey: highlights and detailed report AIHW National Drug Strategy Household Survey: highlights and detailed report AIHW National Drug Strategy Household Survey: highlights and detailed report 2013 Page 34

35 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment Drug and Alcohol Treatment Illicit drug use The 2013 NDSHS found the most common illicit drug used by Australians, both recently and over the lifetime, was cannabis. It also found cannabis and meth/amphetamines were more likely to be used by Australians on a regular basis, with most users of these drugs using them at least every few months (64% and 52% respectively). Cannabis use is often correlated with use of alcohol, tobacco and other illicit drugs. Short term effects of small does can result in euphoria, impaired information processing, decreased inhibitions and increased heart rate. Short term effects of large doses can include hallucinations, panic reactions, loss of consciousness, and confusion. Regular and prolonged use may contribute to anxiety, insomnia and depression, which are also identified as systems of withdrawal 20. Regular cannabis use may also create deficits in memory and attention, impair immunological competence of the respiratory system, and may also lead to the neglect of other important personal and social priorities 21. While rates of illicit drug use among the population aged 50 years and over was generally low, the NDSHS identified a statistically significant increase between 2010 and 2013 in illicit drug use among this population group (from 8.8% to 11.1% for those aged and from 5.2 to 6.4% for those aged 60 or older). This increase has been attributed to an increase in the use of cannabis. Also of note from the NDSHS, there was no rise in meth/amphetamine use between 2010 and 2013, however there was a change in the main form of meth/amphetamines used by Australians and the frequency of meth/amphetamine use, as follows: among meth/amphetamine users, the use of its powdered form fell from 51% in 2010 to 29% in 2013 while the use of ice (also known as crystal) more than doubled in the same period (from 22% to 50%); and among meth/amphetamine users, there was an increase in daily or weekly use (from 9.3% to 15.5%). Among ice users there was a doubling from 12.4% to 25% 22. The final report from the National Ice Taskforce 23 notes that: ice is an extremely powerful stimulant and can trigger psychological disturbances or violent and aggressive behaviour; long term use may damage the brain and cause impaired attention, memory and motor skills; and 20 Australian Medical Association Australian Medical Association AIHW National Drug Strategy Household Survey: highlights and detailed report Commonwealth of Australia, Department of the Prime Minister and Cabinet Final Report of the National Ice Taskforce Page 35

36 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment Drug and Alcohol Treatment The distress ice causes for individuals, families, communities and frontline workers is disproportionate to that caused by other drugs. Data collected by the Australian Institute of Criminology s Drug Use Monitoring in Australia programme (DUMA) shows a steady increase in the use of methamphetamine from 2009 to 2014 by people detained by police at a number of sites in Australian capital cities. The Institute suggests that the rise in use among police detainees could be an early warning of a potential rise in use among the general population, which may be reflected in the next NDSHS 24. Pharmaceutical drug misuse As indicated by the results of the NDSHS, pharmaceutical drug misuse in Australia is growing. While many prescription drugs are misused, including growth hormones and anabolic steroids, the most commonly misused, according to the survey are, opioids and benzodiazepines 25. As noted in a 2014 journal article for the Australian Prescriber 26, many people entering Australian alcohol and drug treatment describe unsanctioned use of prescription opioids and benzodiazepines in the preceding four weeks. It also notes an increasing number of calls received through a Victorian alcohol and drug counselling service regarding prescription opioids than heroin. Pharmaceutical drug misuse can due to consumers deliberately seeking hedonic drug effects, however vulnerable individuals may also use pharmaceutical drugs, including psychoactive prescription drugs as a means of self-medication 27. The characteristics of consumers likely to misuse pharmaceutical drugs vary from common drug user stereotypes. Consumers may be more highly functioning, have higher socioeconomic status, better education and more social support 28. Of note in relation to potential pharmaceutical misuse, findings from HHS AODTS data for the Sunshine Coast Areas highlights opioid pharmacotherapy services were primarily delivered for heroin, prescription opioids and codeine (representing 39.80%, 37.7% and 15.2% of service activity respectively). By contrast, opioid treatment programs in the Central Queensland Area focused on cannabis use (representing 70.99% of opioid treatment service activity data). AODTS data for the Sunshine Coast Area also indicates the percentage of services delivered for prescription opioid use was higher among new clients than its active client base, while the percentage of services delivered for heroin was higher for active clients compared with new. 24 Commonwealth of Australia, Department of the Prime Minister and Cabinet Final Report of the National Ice Taskforce 25 AIHW National Drug Strategy Household Survey: highlights and detailed report Dobbin, M. Monash University Pharmaceutical drug misuse in Australia. Australian Prescriber Independent Review. 27 Dobbin, M. Monash University Pharmaceutical drug misuse in Australia. Australian Prescriber Independent Review. 28 Dobbin, M. Monash University Pharmaceutical drug misuse in Australia. Australian Prescriber Independent Review. Page 36

37 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment Drug and Alcohol Treatment PHN and Queensland trends Summary reports produced by QNADA 29 based on AODTS National Minimum Data Set (NMDS) for the PHN catchment and for state-wide services found the same top three principal drugs of concern (alcohol, amphetamines and cannabis), with alcohol and amphetamines increasing as primary drugs of concern for statewide episodes. Data from these reports also indicate that clients in residential rehabilitation and withdrawal are seeking treatment for more than one drug of concern. Second to alcohol which represented 35% of NGO service episodes in the catchment sample, was cannabis accounting for 28% of service activity (compared with the cumulative NMDS average of 23%), followed by amphetamines (at 26% compared with the cumulative average of 24%). However, state-wide service data from QNADA indicates a corresponding decrease in cannabis as a principal drug of concern. Non-government AODTS clients are most likely be male, non-indigenous and aged 20-29, consistent with the cumulative average from the NMDS for AOD treatment services. 30 These demographic findings are also generally consistent with population group trends identified in the 2013 national survey. Figure 4 shows males represent 74% of episodes while females represent 25% in the PHN catchment. This is compared to cumulative NMDS data where males represent 66% of episodes and females 34%. 29 QNADA. March NGO AOD State-Wide Service Report and Central Queensland Sunshine Coast PHN Service Report 30 As part of the Commonwealth Government s efforts inform policy and planning for service delivery, the Alcohol and Other Drug Treatment Services National Minimum Data Set (AODTS-NMDS) was created. The National Minimum Data Set is a collection of closed treatment episodes provided by publicly funded AOD treatment services which provides demographic and other details including the type of service provided and the duration of the service episode. The collection of data initially is done by each agency individually and extracted through their client management system. The Queensland Network of Alcohol and Other Drug Agencies (QNADA) is contracted by Queensland Health to collect this data from all of the nongovernment agencies required to report the AODTS-NMDS in Queensland, clean and validate the data and submit to Queensland Health (cited in QNADA AOD Service Reports 2015). QNADA has produced reports summarising the data for all State-wide services, as well as reports on regional service data within each PHN catchment to provide an overview of met need. Page 37

38 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment Drug and Alcohol Treatment Figure 4: Service episodes by sex of client, PHN catchment sample Queensland and Sunshine Coast. Source: QNADA NGO AOD Services, Central Figure 5 shows 82% of clients identified as neither Aboriginal nor Torres Strait Islander origin represent, followed by Aboriginal but not Torres Strait Islander origin (13%) and both Aboriginal and Torres Strait Islander (2%). This is compared with cumulative data which shows neither Aboriginal Torres Strait Islander origin represent 77%, followed by Aboriginal but not Torres Strait Islander origin (17%) and not stated/ inadequately described (3%). Page 38

39 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment Drug and Alcohol Treatment Figure 5: Service episodes by Aboriginal and Torres Strait Islander origin, PHN catchment sample Section provides a breakdown of the PHN catchment s population characteristics by Aboriginal and/or Torres Strait Islander origin and indicates that, while the majority of AOD clients are non-indigenous, Aboriginal and/or Torres Strait Islander people remain overrepresented in the sample. Section also refers to data on hospital admissions and deaths that show higher levels of AOD use among Aboriginal and Torres Strait Islanders compared with non-indigenous Australians which suggests a likelihood of unmet demand for AOD services within the catchment s Aboriginal and/or Torres Strait Islander population. Page 39

40 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment Drug and Alcohol Treatment Figure 6 shows clients attending services within the PHN catchment sample are most likely to be aged (32%) followed by (26%) and (20%), at percentages above the cumulative average. Additional data from the report indicates that while the majority of clients (92%) were seeking treatment for their own drug use in the PHN catchment sample, 8% of the sample sought treatment for another s drug use compared with a cumulative average of 5%. Figure 6: Service episodes by age group, PHN catchment sample Further analysis of the PHN catchment sample is available in Section Client demographic data provided for HHS AODTS activity in the Sunshine Coast and Central Queensland Areas indicate the cohort is older than the average presenting through NGO AOD services. The highest percentage of patients accessing HHS AODTS services in the Sunshine Coast Area in 2015 was aged between 45 and 59 years (representing 32.3% of combined 31 AODTS service activity). Similarly this cohort represented the highest percentage of combined service activity in the Central Queensland Area (at 23.3%). For the Wide Bay Area, HHS data are available for the former Fraser Coast and Bundaberg Health Service Districts. The Fraser Coast District data shows a similar profile to the Sunshine Coast with the patient cohort aged years representing the highest percentage (27.2%) of service activity. However, in the Bundaberg District service activity data is highest for the two patient cohorts aged years (25.3%) and years (23.2%). 31 Combining AODTS counselling and therapy service activity data with opioid pharmacotherapy data. Page 40

41 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment Drug and Alcohol Treatment While comparable data on patient gender were not reported for Central Queensland Area, the HHS data received for the Sunshine Coast and Wide Bay Areas consistently indicate that males represent a larger proportion of the overall AODTS patient cohort. Non-government AODTS data presented in Table 9 show the percentage of poly drug use 32 represented in service episodes by primary drug of concern. It shows that poly drug use in the PHN catchment sample represented 48% of cannabis service episodes, followed by amphetamine (26%) and alcohol (22%). Poly drug use appears below the average in the PHN catchment sample compared with state-wide and cumulative service episodes. Table 9: Summary of Poly Drug use by Principal Drug of Concern for PHN catchment sample, state-wide episodes and cumulative episodes % Poly Drug Users (Central Qld & Sunshine % Poly Drug Users (State-wide) % Poly Drug Users (Cumulative) Coast) Amphetamines 26% 70% 59% Alcohol 22% 55% 43% Cannabis 48% 79% 47% Data presented in Table 10 indicate that 33% of episodes in the PHN catchment sample were for two or more drugs of concern, with 9% of episodes showing three or more drugs of concern. These are lower percentages than recorded from state-wide services and the cumulative average. Table 10: Summary of Poly Drug Use for PHN catchment sample, state-wide episodes and cumulative episodes Number of Drugs of Concern % Poly Drug Users (PHN catchment % Poly Drug Users (State-wide) % Poly Drug Users (Cumulative) sample) 2+ Drugs of Concern 33% 64% 50% 3+ Drugs of Concern 9% 25% 19% 4+ Drugs of Concern 1% 9% 8% Drug offences According to Queensland Police data, all five Queensland Police Services (QPS) regions within the PHN catchment reported increases in drug related offences between and A 12% increase in drug related offences between and was recorded in the Central Region (which matches most closely with the boundaries of the PHN Catchment, but includes Mackay to the north of Rockhampton) refers to the use of two or more psychoactive drugs in combination to achieve a particular effect. 33 Queensland Police Service, Queensland Government. Annual Statistical Review Page 41

42 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment Drug and Alcohol Treatment The number of drug offences in the PHN catchment over the year to 25 February 2016 is shown in Table 11. Comparing the number of offences to the population size, it is clear that Woorabinda had the highest ratio of drug offences to population size, followed by Rockhampton (at 2.6%) and the Central Highlands and Gympie (both at 2.1%). Most of Woorabinda s people have experienced significant historical, social and economic deprivations, and are likely to have higher rates of mental health issues as a result. Drug misuse is also a significant co-morbidity for people in Woorabinda. Table 11: Drug Offences by LGA 12 months to 25 Feb 2016 LGA No. Drug Offences (12 months to 25 Feb 2016) Rates per thousand Banana Woorabinda Rockhampton 2, Central Highlands Gympie 1, Fraser Coast 1, Gladstone 1, Sunshine Coast 3, North Burnett Bundaberg 1, Noosa Livingstone PHN 13, PHN excluding Woorabinda 12, Health and social determinants Demographic factors Australian research indicates that population groups that are more likely to participate in drug or alcohol misuse or have difficulty accessing mainstream services include: Men; Page 42

43 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment Drug and Alcohol Treatment Young people; Indigenous people; and Lesbian, Gay, Bisexual, Transgender and Intersex (LGBTI) people. The distribution of these population groups is discussed below. Men Population estimates for the PHN catchment at June 2014 indicate there were approximately 408,965 males (49.6%) and 415,029 females (50.4%) living in the catchment, a male to female distribution that was generally consistent with the Queensland average. Section 2.2 indicates that harmful use of alcohol and other drugs is more prevalent among males than females in Australia and as noted in a 2012 journal for the Australian Psychological Society, 34 the group of men who demonstrate the poorest health in Australia are those living in remote areas. This is reflected in both their shorter life expectancies and their poorer self-assessed health status 35. Alcohol consumption, smoking, drink driving accidents, depression and suicide were all noted as significantly higher among men in rural communities compared to those residing in urban locations 36. As shown in Table 12, males represent slightly higher proportions of the population in the Central Queensland Area (at 51.6%), with the highest representation identified in the LGAs of Central Highlands (53.8%), Gladstone (52.9%) and Banana (52%). Table 12: Population estimates by gender Males Females Persons Queensland 2,352, % 2,369, % 4,722,447 PHN Catchment 408, % 415, % 823,985 Sunshine Coast Area 187, % 197, % 384,338 Central Queensland Area 120, % 113, % 233,747 Wide Bay Area 101, % 104, % 205,900 Local Government Areas 34 Ricciardelli. L The quiet crisis: challenges for men s health in Australia. Australian Psychology Society. 35 Ricciardelli. L The quiet crisis: challenges for men s health in Australia. Australian Psychology Society. 36 Ricciardelli. L The quiet crisis: challenges for men s health in Australia. Australian Psychology Society. Page 43

44 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment Drug and Alcohol Treatment Males Females Persons Banana 7, % 7, % 15,236 Bundaberg 46, % 47, % 94,283 Central Highlands 17, % 14, % 31,595 Fraser Coast 49, % 51, % 101,306 Gladstone 34, % 31, % 66,097 Gympie 24, % 24, % 48,464 Livingstone 18, % 17, % 36,378 Noosa 25, % 27, % 53,052 North Burnett 5, % 4, % 10,311 Rockhampton 41, % 42, % 83,439 Sunshine Coast 137, % 145, % 282,822 Woorabinda % % 1002 Source: ABS Population by Age and Sex, Regions of Australia 2014 Young people At 30 June 2014, there were almost 100,000 people between 15 and 24 years in the PHN catchment (see Table 13). Approximately 44.7% of the PHN catchment's population aged years lived in the Sunshine Coast Area, 32.2% lived in the Central Queensland Area, and 23% lived in the Wide Bay Area. This reflects the distribution of the general population within the PHN catchment. The Sunshine Coast LGA had by far the highest share of the catchment s youth population at 34.09% (reflecting the larger Area population but also the higher percentage of young people in this LGA), followed by Rockhampton LGA at 12.6%, Bundaberg LGA at 11.12% and Fraser Coast LGA at 19.86%. The Banana and North Burnett LGAs within the Central Queensland Area had very small percentages of people aged years, reflecting the fact that young people in rural areas move to regional centres such as Rockhampton, Gladstone, Maroochydore or further afield to access training and employment. Table 13: Population years Number and Percentage of Catchment Area Population years % PHN Catchment Population PHN Catchment 97, % Sunshine Coast Area 43, % Central Queensland Area 31, % Page 44

45 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment Drug and Alcohol Treatment Area Population years % PHN Catchment Population Wide Bay Area 22, % Local Government Area Banana 1, % Bundaberg 10, % Central Highlands 4, % Fraser Coast 10, % Gladstone 8, % Gympie 5, % Livingstone 4, % Noosa 5, % North Burnett 1, % Rockhampton 12, % Sunshine Coast 33, % Woorabinda % Source: ABS Population by Age and Sex, Regions of Australia 2014 Young people are recognised as generally more inclined to experiment and take risks during their transition from childhood to adulthood and independence, which has the potential to impact on their individual health and wellbeing and have consequences for others 37. However, recent statistics from the NDSHS 2013 indicates some improvement in risk-taking behaviour primarily associated with alcohol consumption including: a delay in the age at which young people (aged 14 24) are having their first drink, rising from 14.4 years in 1998 to 15.7 years in 2013; and a growing proportion of young people (12 17 years) choosing not to drink, increasing from 63.6% in 2010 to 72.3% in While these are positive indicators of behaviour change, other evidence shows that alcohol continues to contribute to the three major causes of teen death: injury, homicide and suicide, with one in five hospitalisations of people under 25 due to alcohol Australian Bureau of Statistics Australian Social Trends. 38 Australian National Council on Drugs. 2013; Australian Drug Foundation Page 45

46 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment Drug and Alcohol Treatment In relation to illicit drug use, the NDSHS found young people aged were more likely to have used illicit drugs than other age groups, with more than a quarter (27%) reporting illicit use of drugs in the previous 12 months. Population estimates from PHIDU (2013) for the young adult cohort aged years indicate large numbers (16,550 people) live on the Sunshine Coast (representing 5% of the population), followed by Rockhampton (8,094 people representing 6.9% of the population). However, the largest proportion of this cohort lived in Central Highlands (representing 9.2% of the population or 2,879 people), followed by Woorabinda (8.5% or 85 people) and Gladstone (7.3% or 4,695 people). The larger representation of young adults in the communities of the Central Queensland Area may in part be attributed to employment arrangements in the resource industry or on rural and regional properties, and settlement of young families. In Woorabinda, the higher representation of young adults in the population is also reflective of the population s young median age generally 39. Aboriginal and/or Torres Strait Islander Australians The Aboriginal and/or Torres Strait Islander population data in Table 14 are based on the 2011 Census of Population and Housing (place of usual residence). In the PHN catchment, 23,415 persons (or 3.1%) were of Aboriginal and/or Torres Strait Islander origin (see Table 10), which represented 15% of Queensland s Indigenous population. The Central Queensland Area had the largest Indigenous population at 10,525 people, followed by Wide Bay with 7,006 people and Sunshine Coast with 5,844 people. However, Indigenous people were estimated to be undercounted in the 2011 Census by an average of 17.2% 40. Correcting for this, the Indigenous population in the PHN catchment may be closer to 27, 443 people. According to the 2011 Census, Woorabinda LGA had 877 Aboriginal and/or Torres Strait Islander people and the largest percentage of Aboriginal and/or Torres Strait Islander persons (92.8%). Other LGAs with populations of more than 2,000 Aboriginal and/or Torres Strait Islander people included: Sunshine Coast (4,082 people); Rockhampton (4,889 people); Fraser Coast (3,417 people); Bundaberg (2,981 people); and 39 At the 2011 Census, Woorabinda (S) had a median population age of 22 years, compared with a median age of 31 for the surrounding Central Highlands LGA, and a Queensland average of 36 years. 40 ABS Census Census of Population and Housing - Details of Undercount, 2011 Page 46

47 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment Drug and Alcohol Treatment Gladstone (2,049 people). Table 14: Proportion of Aboriginal and/or Torres Strait Islander population in the PHN catchment by LGA Aboriginal and/or Torres Strait Islander people Total population % of total population Queensland 155,824 4,332, PHN Catchment 23, , PHN Areas Sunshine Coast 5, , Central Queensland 10, , * Wide Bay 7, , Local Government Areas Banana , Bundaberg 2,981 89, Central Highlands 1,020 28, Fraser Coast 3,417 95, Gladstone 2,049 57, Gympie 1,281 45, Livingstone 1,109 32, Noosa , North Burnett , Rockhampton 4,889 76, Sunshine Coast 4, , Woorabinda * Central Queensland Area total excludes Woorabinda Source: QGSO, Regional Profiles created using ABS, Census of Population and Housing, 2011, Basic Community Profile - B09 (usual residence) Table 15 below summarises SA2 areas within the PHN catchment that have a higher proportion of Aboriginal and/or Torres Strait Islander people. The highest proportions of Aboriginal and/or Torres Strait Islander children were in the Sunshine Coast Area. Page 47

48 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment Drug and Alcohol Treatment Table 15: SA2s with higher proportion of Aboriginal and/or Torres Strait Islander populations in specific age groups Age groups % of 0 to 4 years of age % of 15 to 24 year olds % of 65 years and above SA2 regions (% of total population) Wurtulla Birtinya (21.3%), Noosa Heads (20.7%), Gympie North (20.0%), Aroona Currimundi (19.5%), Parrearra Warana (19.4%) Moffat Beach - Battery Hill (15.7%), Mooloolaba - Alexandra Headland (13.3%), Sunshine Beach (16.9%), Sippy Downs (15.0%), Glenlee Rockyview (14.9%), Palmwoods (12.4%), Noosaville (14.0%), Caloundra Hinterland (16.3%) Diddillibah Rosemount (9.7%), Caloundra Hinterland (9.1%), Cooloola (8.9%), Branyan Kensington (8.8%), Mount Morgan (8.5%), Gin Gin (8.5%), Glass House Mountains (8.4%) Source: QGSO, Regional Profiles created using ABS, Census of Population and Housing, 2011, Basic Community Profile - B09 (usual residence) - excludes Woorabinda Aboriginal and/or Torres Strait Islander Australians experience disproportionate harm from drug and alcohol use and drug related problems contribute significantly to disparities in health and life expectancy between Aboriginal and/or Torres Strait Islander and non Aboriginal and/or Torres Strait Islander Australians 41 As noted in the National Aboriginal and Torres Strait Islander Peoples Drug Strategy, illicit drug use has been estimated to cause 3.4% of the burden of disease and 2.8% of deaths among indigenous Australians, compared to 2.0% and 1.3% among the non Indigenous population 42. The strategy also notes that Aboriginal and/or Torres Strait Islander males are hospitalised for alcohol related conditions 43 rates between 1.2 and 6.2 times those of non Indigenous males. For Aboriginal and/or Torres Strait Islander females, alcohol-related hospitalisation rates are between 1.3 and 33.0 times greater (in the latter case for assault injuries) 44. Similarly, deaths from various alcohol related causes are five to 19 times greater than among non Indigenous Australians, with a strong association noted between harmful alcohol and drug use and suicide rates. Rates of suicide among Aboriginal and/or Torres Strait Islander peoples account for 4.2% of all Aboriginal and/or Torres Strait Islander deaths compared to the 1.6% national suicide rate 45. Queensland statistics from 1998 to 2006 indicate that two thirds of Aboriginal and/or Torres Strait Islander people who died by suicide had consumed alcohol, and more than one third had used drugs such as cannabis, amphetamines, inhalants or opiates at the time of their deaths. 41 Commonwealth Government National Aboriginal and Torres Strait Islander Peoples' Drug Strategy Commonwealth Government National Aboriginal and Torres Strait Islander Peoples' Drug Strategy Conditions to which alcohol makes a significant contribution 44 Commonwealth Government National Aboriginal and Torres Strait Islander Peoples' Drug Strategy Commonwealth Government National Aboriginal and Torres Strait Islander Peoples' Drug Strategy Page 48

49 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment Drug and Alcohol Treatment It is also noted that Aboriginal and/or Torres Strait Islander people, families and communities are most affected by acts of violence and trauma resulting from the harmful use of particular drugs, including alcohol, stimulants (including ice), inhalants and pharmaceuticals 46. Lesbian, Gay, Bisexual, Transgender, Intersex people People of diverse sexual orientation, sex or gender identity may account for up to 11% of the Australian population. 47 As the estimated PHN population in 2016 is approximately 853,915 people, the catchment could include up to 93,930 people who are lesbian, gay, bisexual, transgender or intersex. Latrobe University s Private Lives 2 48 study found that: rates of drug use were considerably higher among LGBT people than the general population and Illicit drug use was an indicator of poorer mental health (page 2); and gay, lesbian, bisexual, trans male and trans female people self-reported much higher rates of psychological distress and poorer general mental health than the national averages (p.10). Confirming the findings of the Private Lives study, findings from the 2013 NDSHS indicates that use of illicit drugs in the last 12 months was more common among homosexual or bisexual people than heterosexual people. Homosexual/bisexual people were nearly six times more likely to use ecstasy than heterosexual people and over four times more likely to use meth/amphetamines (including ice). Illicit drug use was slightly more common than smoking tobacco and drinking in the homosexual and bisexual population. However, there were no significant changes seen in the usage rates of alcohol and illicit drugs of this group between 2010 and Older people At 2011, the PHN catchment was estimated to include 130,884 people aged 65 years and above. By 2016, the population was projected to have risen to 162,202 (or 16.6% of the PHN population, up from 14.5% in 2011). The Sunshine Coast and Wide Bay Areas were projected to have more than 20% of their population aged 65 years and over in LGAs which were projected to have over 65 s representing more than 20% of the LGA population by 2016 include: Fraser Coast at 24.2%; 46 Commonwealth Government National Aboriginal and Torres Strait Islander Peoples' Drug Strategy Commonwealth Government. Department of Health National Lesbian, Gay, Bisexual, Transgender and Intersex (LGBTI) Ageing and Aged Care Strategy 48 Leonard, W., Lyons, A., & Bariola, E A closer look at Private Lives 2: Addressing the mental health and well-being of lesbian, gay, bisexual and transgender (LGBT) Australians. 49 Australian Drug Foundation Page 49

50 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment Drug and Alcohol Treatment North Burnett at 22.8%; Noosa at 22.1%; Bundaberg at 21.8%; and Gympie at 20.8%. Table 16: Projected increases in the population aged 65 and above from Total 65 + % 65 + Total 65 + % 65 + Total 65+ %65+ PHN Catchment 782, , , , , , PHN Areas Sunshine Coast 365,116 65, ,052 81, ,050 97, Central Queensland 217,123 24, ,309 31, ,589 39, Wide Bay 200,098 40, ,132 49, ,745 58, Local Government Areas Banana 14,812 1, ,068 2, ,101 2, Bundaberg 92,063 17, ,238 21, ,042 25, Central Highlands 29,541 1, ,025 2, ,850 3, Fraser Coast 97,661 20, ,563 25, ,389 30, Gladstone 59,461 5, ,098 7, ,424 9, Gympie 46,837 8, ,992 10, ,560 12, Livingstone 33,394 4, ,377 6, ,071 8, Noosa 51,038 9, ,419 12, ,539 14, North Burnett 10,374 2, ,331 2, ,314 2, Rockhampton 78,939 10, ,688 12, ,045 15, Sunshine Coast 267,241 47, ,641 58, ,951 70, Woorabinda , , Source: Projected population (medium series), by five-year age group (males, females and persons), by local government area, Queensland, 2011 to Queensland Government population projections, 2013 edition; Australian Bureau of Statistics, Population by Age and Sex, Regions of Australia, 2012 (Cat no ). While people aged 50 and over generally recorded the lowest rates of illicit drug use, there was a statistically significant increase in usage within the 50+ age group which has been attributed to attributed to an increase in Page 50

51 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment Drug and Alcohol Treatment use of cannabis 50 and may reflect an increased uptake in the use of cannabis for self-medicated pain management Social determinants This section discusses key social factors that can influence risky behaviour and drug and alcohol misuse. The Socio-economic Index for Areas (SEIFA) Index of Relative Socio-Economic Disadvantage identifies the geographic distribution of potential disadvantage based on factor including employment, educational attainment, income security, and access to social resources. Approximately 27.9% of the catchment s population are in the most disadvantaged quintile (see Table 17). Percentages in the most disadvantaged quintile were significantly higher in the Wide Bay area at 59.8%, and also high in the Central Queensland area at 30.1%. Within the catchment, the Central Highlands LGA had the largest percentage of persons in the least disadvantaged quintile (31.3%) while Woorabinda (99.3%), North Burnett (65.6%) and Fraser Coast (60.7%) had the largest percentage of persons in the most disadvantaged quintile (SEIFA scores 1 and 2). Table 17: Population by Index of Relative Socio-Economic Disadvantage quintiles, 2011 Geographic Area SEIFA (Index of Relative Socio-Economic Disadvantage), 2011 Quintile 1 (%Most disadvantaged) Queensland PHN Catchment PHN Areas Sunshine Coast Area Central Queensland Area Wide Bay Area Local Government Areas Banana Bundaberg Central Highlands Fraser Coast Gladstone Gympie Quintile 5 (%Least disadvantaged) 50 AIHW National Drug Strategy Household Survey: highlights and detailed report Page 51

52 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment Drug and Alcohol Treatment Geographic Area SEIFA (Index of Relative Socio-Economic Disadvantage), 2011 Quintile 1 (%Most disadvantaged) Quintile 5 (%Least disadvantaged) Livingstone Noosa North Burnett Rockhampton Sunshine Coast Woorabinda The 2013 NDSHS found people with the highest socioeconomic status (SES) were more likely to consume alcohol in risky quantities and to have used ecstasy and cocaine in the previous 12 months than people with the lowest SES. While, people with the lowest SES were twice as likely to abstain as people in the highest SES group. Unemployment Unemployment has direct effects on people s mental health and wellbeing, induced by feeling unproductive or isolated, which in turn can affect behavioural patterns of drug and alcohol misuse. Drug and alcohol misuse also has direct consequences both for employment access and sustained employment. As noted by the 2013 National Drug Strategy Household Survey, use of illicit drugs in the previous 12 months was more prevalent among people who were unemployed. This group was 1.6 times more likely to use cannabis, 2.4 times more likely to use meth/amphetamines and 1.8 times more likely to use ecstasy than employed people. In 2013, the PHN had a higher percentage of people receiving unemployment benefits (at 6.8%) than Queensland (5.6%) (see Table 18). The percentage was highest in the Central Queensland Area at 10.0%, followed by Wide Bay (at 8.8%) and Sunshine Coast (at 6.9%). Youth unemployment beneficiaries also represented a higher than average proportion of the population at 7.1%. The LGAs with the highest proportion of people receiving unemployment benefits were in Woorabinda (35.3%) followed by Fraser Coast (10.3%) Beneficiary patterns for long term (more than 6 months) unemployment benefits and young people (16 years to 24 years) receiving unemployment benefits showed a similar pattern. Page 52

53 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment Drug and Alcohol Treatment Table 18: People receiving an unemployment benefit, 2013 All People receiving an unemployment benefit People receiving an unemployment benefit longterm (>6months) Young people aged 16 to 24 receiving an unemployment benefit N Total % N Total % N Total % Queensland 169,211 3,036, ,623 3,036, , , The PHN 34, , , , ,032 85, Sub-regions Sunshine Coast 15, , , , ,664 37, Central Queensland 6, , , , ,183 27, Wide Bay 11, , , , ,185 19, Local Government Areas Banana 293 8, , , Bundaberg 5,237 55, ,256 55, , Central Highlands , , , Fraser Coast 5,896 57, ,726 57, ,131 9, Gladstone 1,563 42, ,078 42, , Gympie 2,688 28, ,122 28, , North Burnett 391 6, , Rockhampton# 4,121 74, ,070 74, , Sunshine Coast# 13, , , , ,121 33, Woorabinda Source: Data June 2013, PHIDU, Social Health Atlas of Australia Data by Primary Health Network Published 2014: November 2014 Release. # Rockhampton includes Livingstone LGA and Sunshine Coast includes Noosa LGA People who are homeless As noted in the Commonwealth Government s AOD Needs Assessment Toolkit, most treatment need exists in what are referred to as hidden populations, referring to at-risk population groups that are less to be counted accurately within health survey data, such as the NDSHS. People who are homeless are at significant risk of alcohol and drug misuse, and conversely this substance use decreases the personal resources which allow people to maintain secure and affordable housing. Page 53

54 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment Drug and Alcohol Treatment In 2011, it was estimated that 3,142 people in the PHN catchment were homeless, including 1,277 people in the Central Queensland Area, 938 people in Sunshine Coast Area and 927 in the Wide Bay Areas 51. The highest numbers of homeless people by SA2 located in the PHN catchment are summarised in Table 19 and indicate that: In the Central Queensland Area, the highest numbers of homeless were in Rockhampton (227 people), Gladstone (92 people) and Agnes Water - Miriam Vale (76 people) and Berserker at 74 people; In Sunshine Coast Area, the highest numbers were in the Noosa hinterland at 94 people and Maroochydore Kuluin at 70 people; and In the Wide Bay Area subregion the highest numbers were in Bundaberg (103 people), South Bundaberg (70) and Bundaberg North-Gooburrum) with 60 people. Additional indicators from Headspace youth mental health centres across the catchment found that 10.6% of young clients through Headspace Rockhampton were homeless or at-risk of homelessness above the national average of 10.4% and the averages through the Hervey Bay and Maroochydore centres (9.8% and 9.1% respectively). Table 19: SA2 Areas within the PHN with the highest numbers of homeless people Statistical Area 2 Rockhampton City 227 Nambour 127 Bundaberg 103 Noosa Hinterland 94 Gladstone 92 Bundaberg Region - South 77 Agnes Water - Miriam Vale 76 Berserker 74 Bundaberg East - Kalkie 71 Emerald 70 Maroochydore - Kuluin 70 Bundaberg North - Gooburrum 70 Gympie Region 69 Number of homeless people 51 Australian Bureau of Statistics, released on 20th Dec 2013: Census of Population and housing: Estimating homelessness, 2011 Page 54

55 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment Drug and Alcohol Treatment Statistical Area 2 Gladstone Hinterland 62 Maryborough 60 Number of homeless people Source: ABS Census of Population and housing: Estimating homelessness, Geographic factors The PHN catchment includes: the regional centres of Caloundra, Maroochydore, Hervey Bay, Bundaberg, Gladstone and Rockhampton; smaller centres such as Noosa, Maryborough, Emerald, Moranbah and Biloela; myriad smaller towns and villages across the coastal hinterlands and rural areas; and the Aboriginal community of Woorabinda. Based on the Accessibility/Remoteness Index of Australia (ARIA+) classification nearly 60% of the PHN s population live in areas classified as Inner Regional, 31% live in Major Cities, 8% live in Outer Regional areas and just under 2% live in Remote Areas 52. LGAs in which there are greater proportions of outer regional and remote populations include: Banana, with 89.4% classified as outer regional and 10.6% classified as remote; Central Highlands, with 69.2% classified as outer regional and 30% classified as remote; North Burnett, with 98% classified as outer regional and 2% classified as remote; and Woorabinda, which was classified as 100% remote. People in rural and remote areas within the PHN face socio-economic challenges such as unemployment and less access to education, extensive travel times to access services, and a lack of community awareness about mental health issues. Suicide is a critical issue in towns affected by drought, recent major floods and the mining downturn. 52 Population based on 2011 usual resident population. Based on the Australian Bureau of Statistics Remoteness Area (RA) classification using ARIA+ mean scores. Source: Australian Population and Migration Research Centre, University of Adelaide; ABS, Census of Population and Housing, 2011 Page 55

56 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment Drug and Alcohol Treatment They are generally served by smaller district centres such as Emerald, Moranbah and Biloela, and have insufficient populations to support tailored services for specific needs (e.g. LGBTI people and women with perinatal depression). With a catchment of 161,000 km2, including areas classified as remote or outer regional areas, the availability of transport is important to the accessibility of primary health care services. With the exception of Woorabinda where 47.8% of dwellings did not have a motor vehicle, the proportion of private dwellings in the PHN region with no motor vehicles was similar to or lower than Queensland in However, this was still a total of 17,270 dwellings without a motor vehicle. Public transport across the catchment is patchy at best. While coastal centres such as Rockhampton, Gladstone and Maroochydore have good local bus services and there is rail access (if infrequent) between all coastal centres, most of the rural areas are heavily dependent on private transport. Trips of three to four hours to access hospital and specialist mental health services are common, which is a significant impediment to treatment and support access Behavioural factors Behavioural factors which are commonly linked to harmful drug and alcohol use are described below. Motivations, knowledge and beliefs Over time alcohol consumption and episodes of heavy drinking have been normalised and generally accepted as part of Australian society and culture. Evidence also shows the number of Australians participating in any illicit drug use, including pharmaceutical misuse, is increasing 54. In the 2013 NDSHS, among people who had ever used an illicit drug, most people aged 14 or older reported trying them out of curiosity (66%) or because they wanted to do something exciting (19.2%). The motivations for continuing to use illicit drugs was most commonly to enhance experiences (30%), or because illicit drug use was exciting (17.5%). Recent investigations into party drug use by young people suggest that cost is also an influencing factor in the preferential use of amphetamines such as ecstasy, which is suggested to be more affordable than alcohol in achieving a desired experience 55. According to data from the Australian Crime Commission, the median price for 0.1 gram of heroin is $75, while the median price for 0.1 gram of cocaine is $ Nationally, the price of one MDMA tablet/capsule ranged between $15 and $50, consistent with prices reported in By contrast, the average price for a carton 53 PHIDU, Social Health Atlas of Australia Data by PHN Published 2014: November 2014 Release 54 AIHW National Drug Strategy Household Survey: highlights and detailed report Meldrum-Hanna, C. and Balendra, J. ABC Four Corners Australian Crime Commission Illicit Drug Data Report. 57 Australian Crime Commission Illicit Drug Data Report. Page 56

57 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment Drug and Alcohol Treatment of beer in 2011 was $40.55 and a nip of spirits worth $5.26 in the Brisbane metropolitan area price averages are likely to be higher in regional and remote areas of Queensland. The National Ice Taskforce reports anecdotal evidence that ice is relatively cheaper and more accessible than other illicit drugs in many parts of Australia 58. Based on the population and social characteristics and other health determinants described for the PHN catchment in Sections 2.1 and 2.2, additional knowledge and belief factors which are likely to impinge on drug and alcohol misuse in the PHN catchment involve a combination of factors including: geographic and social isolation experienced by regional and rural communities; potential stigma surrounding mental health in rural communities that may lead to private selfmedicating behaviours; lower levels of educational attainment and internet access than in major cities, leading to lower health literacy; higher rates of unemployment and underemployment, contributing to depression and alcohol or substance misuse; and limited knowledge of and access to resources and services for prevention, treatment, and recovery Related harms and injuries Family and partner violence In Australia, domestic and family violence is experienced by people of all cultures, ages and socio-economic groups, but the majority of those who experience these forms of violence are women. According to Lifeline, women represent two thirds of calls to the service 59 for support on a range of issues including domestic violence. Queensland police data on crime offences indicate that the Central Queensland region (which most closely mirrors the PHN catchment) has had higher rates of breaches of domestic violence orders than Queensland over the past five years, as shown in the sample for February in Figure 7. The rate of breaches has increased sharply in both Queensland and the Central Queensland region in the past twelve months. 58 Commonwealth of Australia, Department of the Prime Minister and Cabinet Lifeline Page 57

58 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment Drug and Alcohol Treatment Figure 7: Breach of Domestic Violence Orders Central Queensland Region and Queensland CQ QLD F E B 1 1 F E B 1 2 F E B 1 3 F E B 1 4 F E B 1 5 F E B 1 6 Source: QPS Region Reported Offence Rates Feb Health conditions and outcomes Associated burden of disease In 2010, alcohol use was estimated to be responsible for 2.7% of the total burden of disease and injury in Australasia (IHME 2014), while illicit drug use was estimated to be responsible for 2.6% of the burden of disease and 0.5% of deaths. Overall, however, illicit drug use accounts for an increasing proportion of the global burden of disease (moving from the 18th to 15th ranking risk factor between 1990 and 2010). It has been estimated that the cost to Australia from alcohol-related social problems was in the order of $15 billion in , and that illicit drug use cost the Australian economy $8 billion annually through crime, productivity losses and health-care costs 60. In Queensland, cancer was the leading broad cause of total burden (measured in Disability-Adjusted Life Years) (18.6%) in Queensland in 2007, followed by cardiovascular disease (15.9%) and mental disorders (14.0%), together accounting for nearly half the total burden. One-third of the total burden of cancer was due to preventable risk factors where tobacco, physical inactivity, high body mass and alcohol consumption were the largest causes. 60 AIHW National Drug Strategy Household Survey: highlights and detailed report 2013 Page 58

59 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment Drug and Alcohol Treatment Almost one-third of the total burden of disease and injury in Queensland in 2007 was due to the joint effect of modifiable risk factors. The three leading specific causes of disease burden in 2007 were coronary heart disease (9%), anxiety and depression (7.9%) and type 2 diabetes (5.2%) 61. The three largest specific causes of premature death (Years of Life Lost) in 2007 were coronary heart disease (14.7%), lung cancer (7.1%) and stroke (6.4%) Mental illness Excessive alcohol and drug use can lead to increased risk of mental health issues that range from a change in the transmission of serotonin, depression, to longer term effects such as drug-induced psychosis. Conversely, mental illnesses can lead to the abuse of drugs and/or alcohol, particularly as a means of self-medication. Population estimates released through the Public Health Information Development Unit for , indicate the PHN catchment had a higher age-standardised rate (ASR) of psychological distress compared to Queensland (ASR: 11.3 and ASR: 10.6 respectively) 63 The estimated population with mental and behavioural problems ( ) was also higher in the PHN catchment at ASR: 15.4 compared to ASR: 14.4 for Queensland. Bundaberg, Fraser Coast and Gympie LGAs all had higher scores for these factors than the PHN catchment as a whole Summary Table 20 summarises the key population health needs attributed to alcohol and drug use in the PHN catchment, accounting for: population distribution within the PHN; demographic features which signal vulnerabilities to drug and alcohol misuse; population groups with behaviours or attitudes which may pre-dispose them to drug and alcohol misuse; alcohol and drug use trends and associated health outcomes; AODTS patient demographics reported by QNADA and each HHS in the PHN catchment; comparative indicators which may indicate prevalence across the catchment; and qualitative information from consumer groups for whom data was not readily available (e.g. LGBTI). 61 Queensland Health. The health of Queenslanders Fifth report of the Chief Health Officer Queensland 62 Queensland Health. The health of Queenslanders Fifth report of the Chief Health Officer Queensland 63 Central Queensland, Wide Bay, Sunshine Coast PHN 2016 Mental Health and Suicide Prevention Needs Assessment, Page 59

60 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment Drug and Alcohol Treatment Table 20: Outcomes of the health needs analysis Outcomes of the health needs analysis Identified Need Key Issue Description of Evidence Social impacts and determinants of drug use Health inequalities are associated with various factors including social determinants of health such as education, occupation, income, employment status and rural location. There is a clear link between socioeconomic deprivation and risk of dependence on alcohol, nicotine and other drugs. The PHN catchment includes regions that differ largely on various socio-economic determinants of health. Queensland Government Statistician s Office data shows that: - There were higher than average proportions of people who are socioeconomically disadvantaged in Woorabinda (99.3%), North Burnett (65.6%) and Fraser Coast (60.7%) - In 2013, the PHN catchment had a higher percentage of people receiving unemployment benefits than Queensland with highest percentages in Wide Bay (9.7%), followed by Sunshine Coast (6.9%) and Central Queensland (4.5%). - The LGAs with the highest proportion of people receiving unemployment benefits were Woorabinda (35.3%) and Fraser Coast (10.3%). Queensland police data on crime offences indicate that the Central Queensland region (which most closely mirrors the PHN catchment) has had higher rates of breaches of domestic violence orders than Queensland over the past five years. A 12% increase in drug related offences between and was recorded in the Central Region. Highest rates of drug offences were in Woorabinda, Rockhampton and Central Highlands LGAs. Increased consumption of drugs and alcohol in rural and remote communities Rural and remote communities have geographical disadvantage that impacts their socio-economic environment as well as health. Burden of mental and physical illnesses, access to treatment services, and inappropriate use of alcohol and drugs are some of the issues that rural and remote communities face. The PHN catchment includes the regions that have very high Australian Institute of Health and Welfare. (2014) National Drug Strategy Household Survey detailed report indicates that use of illicit drugs in the previous 12 months was more prevalent among people who were unemployed. Australian Institute of Health and Welfare. (2014) National Drug Strategy Household Survey detailed report indicates that people living in remote and very remote areas were twice as likely as people in major cities to smoke tobacco daily, drink alcohol in risky quantities, and use meth/amphetamines in the previous 12 months. Page 60

61 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment Drug and Alcohol Treatment Outcomes of the health needs analysis Comorbidities linked to alcohol and drug misuse proportions of populations living in outer regional, rural and remote areas. Drug use including alcohol is a serious and complex problem, which contributes to thousands of deaths, substantial illness, disease and injury, social and family disruption, workplace concerns, violence, crime and community safety issues. The use and misuse of licit and illicit drugs is widely recognised in Australia as a major health problem, and one that has wider social and economic costs. Burden of disease associated with alcohol and drug misuse is large and potentially preventable. According to Queensland Government Statistician s Office data, within the PHN catchment, LGAs in which there are greater proportions of outer regional and remote populations include Banana, with 89.4% classified as outer regional and 10.6% classified as remote; Central Highlands (69.2% outer regional and 30% remote); North Burnett (98% outer regional and 2% remote) and Woorabinda (100% remote.) Institute for Health Metrics and Evaluation Data indicates that in 2010, alcohol use was estimated to be responsible for 2.7% of the total burden of disease and injury in Australasia, while illicit drug use was estimated to be responsible for 2.6% of the burden of disease and 0.5% of deaths. Queensland Burden of Disease and Injury Report (2010) In Queensland, cancer was the leading broad cause of total burden (DALYs) (18.6%) in Queensland in 2007, and one-third of the total burden of cancer was due to preventable risk factors including tobacco, and alcohol consumption. Higher rates of risky alcohol consumption Indicators of increased pharmaceutical drug misuse Alcohol is responsible for a considerable burden of death, disease and injury in Australia. Drinking is a major factor in much of the injury resulting from road crashes and other accidents, and in social problems such as violence, family breakdown and child abuse and neglect. Alcohol-related harm is not limited to individual drinkers but impacts families, bystanders and the broader community. Specific regions within the PHN have higher rates of risky alcohol consumption. Illicit drug use has both short-term and long-term health effects, including poisoning, infective endocarditis, mental illness, selfharm, suicide and death. The social impacts of illicit drug use Population estimates released through the Public Health Information Development Unit for , indicate the PHN catchment had a higher agestandardised rate (ASR) of psychological distress compared to Queensland (ASR: 11.3 and ASR: 10.6 respectively). Queensland Department of Health. Queensland survey analytics system (QSAS), Regional detailed data. [Access date: 15 December 2015] - Data for shows that the PHN catchment had a higher prevalence of risky alcohol intake (22%) than Queensland (19.8%). This intake was higher in the LGAS of Central Highlands (33.5%), Livingstone (27%) and Banana (25.2%) National Drug Strategy Household Survey indicates that nationally, it is estimated that males in their late 20s and 40s were twice as likely to drink at risky levels than females. Young adult women (18-24 years) were also more likely to drink at risky levels. The 2013 National Drug Strategy Household Survey showed that - Australians who had misused a pharmaceutical increased from 4.2% in 2010 to 4.7% in Page 61

62 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment Drug and Alcohol Treatment Outcomes of the health needs analysis Harms associated with regular cannabis use include stressed family relationships, family breakdown, domestic violence, child abuse, assaults and crime. It is estimated that illicit drug use costs the Australian economy $8 billion annually through crime, productivity losses and healthcare costs (National Rural Health Alliance, Illicit drug use in rural Australia. Fact sheet 33, June Canberra). In some regions of the PHN, there are concerns regarding pharmaceutical drugs misuse. Cannabis use is often correlated with use of alcohol, tobacco and other illicit drugs. Short term impact of cannabis depend on the dosage; regular and prolonged use may contribute to anxiety, insomnia and depression. Regular cannabis use may also create deficits in memory and attention, impair immunological competence of the respiratory system, and may also lead to the neglect of other important personal and social priorities. Cannabis is identified as the primary drug of concern in some of the PHN regions. - Pharmaceutical drug users are likely to be more highly functioning and have higher socioeconomic status. HHS ATODS data for the Sunshine Coast Area identified the primary drug of concern in opioid pharmacotherapy in the Sunshine Coast Area was heroin (representing 39.80% of activity), followed by prescription opioids (37.7%) and codeine (15.2%). For context, in the Central Queensland area, service activity data for opioid treatment identifies cannabis as the primary drug of concern, followed by heroin and morphine. In the Wide Bay Area the primary drug of concern in the Fraser Coast AODS opioids pharmacotherapy service was heroin followed by morphine and oxycodone, and in the Bundaberg AODS opioids pharmacotherapy service was morphine followed by heroin then Methodone/Physeptone and Oxycodone. The 2013 National Drug Strategy Household Survey reported cannabis and meth/amphetamine users were more likely to use these drugs on a regular basis with most people using them at least every few months (64% and 52% respectively). The survey also identified a statistically significant increase in illicit drug use among the population aged over 50 years, which has been attributed to an increase in cannabis use. Summary reports produced by QNADA based on the AODTS-NMDS for the NGO AOD providers in the PHN catchment and for state-wide services identified the same top three principal drugs of concern (alcohol, amphetamines, and cannabis). Within the PHN catchment sample, cannabis was identified as the primary drug of concern for 28% of service activity, compared with a cumulative NMDS average of 23%. Psychological, health and social impacts of frequent methamphetamine use Ice is highly destructive for both users and their families. It is recognised as an extremely powerful stimulant that can trigger psychological disturbances or violent and aggressive behaviour. HHS ATODS data indicates the primary drug of concern in opioid treatment in the Central Queensland Area was cannabis (representing 70.94% of activity), followed by heroin and morphine (each representing 4.27% of AOD opioid treatment services). The 2013 National Drug Strategy Household Survey showed that while there was no rise in meth/amphetamine use in Australia in 2013 there was a change in the form used in that, among meth/amphetamine users, the use of ice (or crystal methamphetamine) more than doubled, from 22% in 2010 to 50% in Page 62

63 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment Drug and Alcohol Treatment Outcomes of the health needs analysis There is evidence of an increase in the number of people using ice. 2013, and the frequency of meth/amphetamine drug use, with an increase in daily or weekly use (from 9.3% to 15.5%). Among ice users there was a doubling from 12.4% to 25%. HHS AODS data from 2015 indicates that: in 2015, methamphetamine use was the principal drug of concern for 14.2% of HHS AOD counselling and therapy services in Central Queensland Area. Amphetamine use was a primary drug of concern for an additional 9.84% of Central Queensland HHS AOD activity. Similar levels were observed in Wide Bay HHS - Bundaberg AODS data which showed 10.74% of clients identified methamphetamine as the principal drug of concern among counselling and therapy service clients. Harmful use of drugs and alcohol by young people Alcohol consumption in young adults is associated with physical injury, risky sexual behaviour, adverse behavioural patterns and academic failure as well as mental health problems including depression, self-harm and suicide. Similarly, age is one of the factors that determine how a drug will affect a user. As the brain continues to develop until a young person reaches approximately 18 years of age, they can be more vulnerable to the harmful effects of drugs. Stakeholder feedback indicated concern about lack of education services available to train staff in how to identify and manage people addicted to ice. Although National Drug Strategy Household Survey 2013 indicates - a delay in the age at which young people (aged 14 24) are having their first drink, rising from 14.4 years in 1998 to 15.7 years in 2013; and - a growing proportion of young people (12 17 years) choosing not to drink, increasing from 63.6% in 2010 to 72.3% in The summary of alcohol and drug information by the Australian Drug Foundation, 2014 indicates that - Alcohol continues to contribute to the three major causes of teen death nationally: injury, homicide and suicide, with 1 in 5 hospitalisations of people under 25 due to alcohol. - People aged were more likely to have used illicit drugs than other age groups, with more than a quarter (27%) reporting illicit use of drugs in the previous 12 months. Queensland Government Statisticians Office, 2014 data reports almost 100,000 people aged between 15 and 24 years in the PHN catchment, with 34.09% of the catchment s youth population in Sunshine Coast LGA. A further 16,550 people aged were estimated to be living in the Sunshine Coast LGA (representing 5% of the population). However, the largest proportion of Page 63

64 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment Drug and Alcohol Treatment Outcomes of the health needs analysis the cohort lived in Central Highlands (representing 9.2% of the population or 2,879 people), followed by Woorabinda (8.5% or 85 people) and Gladstone (7.3% or 4,695 people). Significant health disparities for Aboriginal and Torres Strait Islander people relating to drug and alcohol use The PHN includes many regions with high proportions of Aboriginal and/or Torres Strait Islander people. Aboriginal and/or Torres Strait Islander Australians experience disproportionate harm from drug and alcohol use Stakeholder feedback indicated concern about misuse of drugs and alcohol by young people, particularly in the Gympie area. Australian Institute of Health and Welfare. (2014) National Drug Strategy Household Survey detailed report indicates that rates of cannabis use among Indigenous Australians remained relatively stable in 2013 and they were generally twice those in the non-indigenous population (19.0% compared to 10.0% for non-indigenous Australians). National Aboriginal and Torres Strait Islander Peoples' Drug Strategy indicates that: - illicit drugs are estimated to cause 3.4% of the burden of disease and 2.8% of deaths compared to 2.0% and 1.3% among the non Indigenous population nationally - Aboriginal and/or Torres Strait Islander males are hospitalised for conditions to which alcohol makes a significant contribution at rates between 1.2 and 6.2 times those of non Indigenous males - Aboriginal and/or Torres Strait Islander females are hospitalised for conditions to which alcohol makes a significant contribution at rates between 1.3 and 33.0 times greater compared to non-indigenous females (including injuries related to assault) - Deaths from various alcohol related causes are 5 to 19 times greater than among non Indigenous Australians - In Queensland, from 1998 to 2006, two thirds of Aboriginal and Torres Strait Islander people who died by suicide had consumed alcohol, and more than one third had used drugs such as cannabis, amphetamines, inhalants or opiates at the time of their deaths Aboriginal people are overrepresented in the NGO AOD service episodes and HHS AODS activity statistics for each HHS region - Central Queensland, Sunshine Coast and Wide Bay, however compared with national trends there is potential for unmet demand for AOD services within this population group. Page 64

65 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment Drug and Alcohol Treatment Outcomes of the health needs analysis Higher rates of illicit drug use among the LGBTI community High rates of alcohol and drug use in often hidden homeless population Increasing cannabis use by ageing population There is a growing body of evidence to suggest that people who identify as lesbian, gay, bisexual, transgender and intersex (LGBTI) may be at a higher risk of developing mental health and substance use problem. The LGBTI community is one of the vulnerable populations in the PHN catchment and possibly have higher rates of drug use. People who are homeless are at significant risk of alcohol and drug misuse, and conversely this substance use decreases the personal resources which allow people to maintain secure and affordable housing. Homeless people are also noted as a hidden population group, not accurately captured in survey or AOD service data to understand the extent of need. The proportion of homeless people within the PHN catchment differs between the regions There is evidence of increased use of cannabis in older age groups. The PHN catchment currently has higher proportion of elderly (65 and above) and have been projected to have high proportions in the future. Australian Institute of Health and Welfare. (2014) National Drug Strategy Household Survey detailed report indicates that - 35% of bisexual people had used cannabis in the previous 12 months compared with 23% of homosexual people - Use of illicit drugs in the last 12 months was far more common among people who identified as being homosexual or bisexual than people who were heterosexual - Illicit drug use was more common than smoking and drinking alcohol among people who identified as being homosexual or bisexual - The largest differences in use among homosexual/bisexual people were in the use of ecstasy and meth/amphetamines; this was 5.8 times and 4.5 times more likely than heterosexual people. - Homosexual/bisexual people were also 2.9 times more likely to use cannabis and 2.8 times more likely to use cocaine in the previous 12 months. - Intake of alcohol in risky quantities and smoking tobacco daily were also more common but there was less of disparity in the use of licit drugs between homosexual/bisexual people and heterosexual people. Australian Bureau of Statistics, 2013 estimated that 3,142 people in the PHN catchment in 2011 were homeless, including 1,277 people in the Central Queensland Area, 938 people in Sunshine Coast Area and 927 in the Wide Bay Area. Headspace Centre Reports from within the PHN catchment for FY 2015/16 indicate 10.6% of young people accessing the Rockhampton centre were homeless or at risk of homelessness, which was above the national centre average of 10.4%. Australian Institute of Health and Welfare. (2014) National Drug Strategy Household Survey detailed report indicates that: While people aged 50 and over generally recorded the lowest rates of illicit drug use, there was a statistically significant increase in cannabis usage within the 50+ age group between 2010 and 2011 (increasing to represent from 8.8% of Australians aged years in 2010 to 11.1% in 2013). 21% of people between ages 60 and above reported to have ever used an illicit drug Page 65

66 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment Drug and Alcohol Treatment Outcomes of the health needs analysis 6.4% of Australians aged 60+ years used illicit drugs in 2013 compared to 5.2% in This may reflect an increased uptake in the use of cannabis for self-medicated pain management. Queensland Government Statistician s office data, 2014 shows a large proportion of older and ageing population at up to 23.4% (Fraser Coast) followed by the Bundaberg and North Burnett LGAs. The Sunshine Coast and Wide Bay Areas were projected to have more than 20% of their population aged 65 years and over in Page 66

67 Central Queensland, Wide Bay, Sunshine Coast PHN Initial Regional Needs Assessment Drug and Alcohol Treatment 3. Stakeholder inputs The Australian Department of Health s guidance on AOD needs assessment highlights that a comprehensive drug and alcohol treatment needs assessment requires stakeholder perspectives on three questions: 1. What is the level of treatment need in the region? 2. What treatment is provided, and to whom? 3. What are the gaps in treatment and the funding priorities given these gaps? While there was insufficient time to consult specifically with the drug and alcohol sector on this need assessment, targeted input from local experts has helped to refine the analysis and reporting. This section presents key stakeholder inputs specific to the AOD-related service needs of the PHN catchment. Inputs are derived from: local experts including PHN Area Managers, a sample of health service providers and Health and Hospital Service (HHS) representatives; consultation undertaken for the PHN s comprehensive needs assessment process; and previous Medicare Local needs assessments for each Area within the PHN catchment. Systematic engagement with the PHN s stakeholders is at early stages and this report will help to provide a basis for engaging with stakeholders in the PHN s planning phase. As part of the triangulation process for the AOD needs assessment (refer to Section 5), these inputs have also been analysed in conjunction with findings reported by QNADA from their recent consultation with state-wide non-government AOD providers Preliminary input from local experts During the week beginning 7 March 2016, a targeted group of stakeholders and service providers within the PHN catchment were invited to complete a brief qualitative survey. The survey aimed to gather some initial information about unmet needs and service gaps in the community in relation to AOD. Responses to the survey were received from: 11 Service Providers (4 from Central Queensland area, 2 from Wide Bay area, 4 from the Sunshine Coast area and 1 whose service relates to the whole PHN catchment) 9 Aboriginal and Torres Strait Islander Organisations (2 from the Central Queensland area, 3 from Wide Bay, and 4 from the Sunshine Coast area) 6 from Government Agencies (4 from the Wide Bay area, 1 from Sunshine Coast and 1 from Central Queensland area). Informed advice was also provided by Area Managers for each of the three Areas and PHN epidemiologists. Engagement with stakeholders during the planning process will ensure that gaps or inadequacies in this assessment s findings are reduced. Further consultation and elicitation of stakeholder feedback Page 67

68 Central Queensland, Wide Bay, Sunshine Coast PHN Regional Drug and Alcohol Treatment Needs Assessment will also be undertaken as part of the development of a Comprehensive Needs Assessment during the financial year Met and unmet population needs Survey participants were asked to nominate the specific population groups they believed are most in need of alcohol and drug treatment services across the PHN catchment, with flexibility to nominate more than one population group in their response (see Figure 8). The results indicate young people and Aboriginal and/or Torres Strait Islander residents of the PHN catchment have the most significant need for drug and alcohol treatment services, followed by rural communities generally, the LGBTI community and older people. Figure 8: Population group needs for AOD treatment services Page 68