TRENDS IN ALCOHOL AND DRUG RELATED AMBULANCE ATTENDANCES IN VICTORIA 2012/13

Transcription

1 Ambo Project: Alcohol and Drug Related Ambulance Attendances TRENDS IN ALCOHOL AND DRUG RELATED AMBULANCE ATTENDANCES IN VICTORIA 2012/13 Belinda Lloyd Sharon Matthews Caroline X.Gao December 2013

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3 Ambo Project: Alcohol and Drug Related Ambulance Attendances TRENDS IN ALCOHOL AND DRUG RELATED AMBULANCE ATTENDANCES IN VICTORIA 2012/13 Belinda Lloyd Sharon Matthews Caroline X.Gao May 2014 Ambo Project: Alcohol and Drug Related Ambulance Attendances is a collaboration between Turning Point and Ambulance Victoria, and is funded by the Victorian Department of Health

4 Trends in alcohol and drug related ambulance attendances in Victoria: 2012/13. Copyright 2014 State of Victoria. Produced with permission from the Victorian Minister for Mental Health. Unauthorised reproduction and other uses comprised in the copyright are prohibited without permission. This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced by any process without permission. Copyright enquiries can be made to the Communications and Publications Unit, Turning Point, Gertrude Street, Fitzroy, Victoria 3065, Australia. Ambo project: alcohol and drug related ambulance attendances is funded by the Mental Health, Drugs and Regions Division of the Department of Health. Published by Turning Point May 2014 ISBN: (ebook) The correct citation for this publication is: Lloyd B., Matthews S., Gao X.C. (2014). Trends in alcohol and drug related ambulance attendances in Victoria: 2012/13. Fitzroy, Victoria: Turning Point

5 Contents Contents... v List of Tables... ix List of Figures... xi List of Maps... xiii Preface... xiv Acknowledgements... xv Acronyms... xvi Summary... 1 Chapter 1: Introduction... 6 Non-fatal versus fatal heroin overdose... 6 Ambulance service records... 6 The current report... 7 Chapter 2: Methods... 8 Data generated from VACIS... 8 Data auditing and quality control... 8 Definition of drug involvement/overdose used in this report... 9 Mapping of alcohol- and drug-related ambulance attendances Population estimates Chapter 3: Alcohol-Related Attendances (Alcohol Only) Characteristics of alcohol-related attendances Day of week and time of day of alcohol-related attendances Alcohol-related attendances in local government areas Trends over time in alcohol-related attendances Chapter 4: Cannabis-Related Attendances Characteristics of cannabis-related attendances Day of week and time of day of cannabis-related attendances Cannabis-related attendances in local government areas Trends over time in cannabis-related attendances Chapter 5: Ecstasy-Related Attendances Characteristics of ecstasy-related attendances Day of week and time of day of ecstasy-related attendances Ecstasy-related attendances in local government areas Trends over time in ecstasy-related attendances Ambo Project: Alcohol and Drug related Ambulance Attendances 2012/13 Annual Report Page v

6 Chapter 6 All Amphetamine-Related Attendances Characteristics of all amphetamine-related attendances Day of week and time of day of all amphetamine-related attendances All amphetamine-related attendances in local government areas Trends over time in all amphetamine-related attendances Chapter 7 Crystal Methamphetamine-Related Attendances Characteristics of crystal methamphetamine-related attendances Day of week and time of day of crystal methamphetamine-related attendances Crystal methamphetamine-related attendances in local government areas Trends over time in crystal methamphetamine-related attendances Chapter 8: Other Amphetamine-Related Attendances Characteristics of other amphetamine-related attendances Day of week and time of day of other amphetamine-related attendances Other amphetamine-related attendances in local government areas Trends over time in other amphetamine-related attendances Chapter 9: Benzodiazepine-Related Attendances Characteristics of benzodiazepine-related attendances Day of week and time of day of benzodiazepine-related attendances Benzodiazepine-related attendances in local government areas Trends over time in benzodiazepine-related attendances Chapter 10: Inhalant-Related Attendances Characteristics of inhalant-related attendances Day of week and time of day of inhalant-related attendances Inhalant-related attendances in local government areas Trends over time in inhalant-related attendances Chapter 11: All Heroin-Related Attendances Characteristics of all heroin-related attendances Day of week and time of day of all heroin-related attendances All heroin-related attendances in local government areas Trends over time in all heroin-related attendances Chapter 12: Heroin Overdose (Responding to Naloxone) Attendances Characteristics of heroin overdose attendances (responding to naloxone) Day of week and time of day of heroin overdose attendances (responding to naloxone) Heroin overdose attendances (responding to naloxone) in local government areas Trends over time in heroin overdose attendances (responding to naloxone) Ambo Project: Alcohol and Drug related Ambulance Attendances 2012/13 Annual Report Page vi

7 Chapter 13: Other Heroin-Related Attendances Characteristics of other heroin-related attendances Day of week and time of day of other heroin-related attendances Other heroin-related attendances in local government areas Trends over time in other heroin-related attendances Chapter 14: GHB-Related Attendances Characteristics of GHB-related attendances Day of week and time of day of GHB-related attendances GHB-related attendances in local government areas Trends over time in GHB-related attendances Chapter 15: Anticonvulsant-Related Attendances Characteristics of anticonvulsant-related attendances Day of week and time of day of anticonvulsant-related attendances Anticonvulsant-related attendances in local government areas Trends over time in anticonvulsant-related attendances Chapter 16: Antidepressant-Related Attendances Characteristics of antidepressant-related attendances Day of week and time of day of antidepressant-related attendances Antidepressant-related attendances in local government areas Trends over time in antidepressant-related attendances Chapter 17 Antipsychotic-Related Attendances Characteristics of antipsychotic-related attendances Day of week and time of day of antipsychotic-related attendances Antipsychotic-related attendances in local government areas Trends over time in antipsychotic-related attendances Chapter 18 Opioid Analgesic-Related Attendances Characteristics of opioid analgesic-related attendances Day of week and time of day of opioid analgesic-related attendances Opioid analgesic-related attendances in local government areas Trends over time in opioid analgesic-related attendances Chapter 19: Other Analgesic-Related Attendances Characteristics of other analgesic-related attendances Day of week and time of day of other analgesic-related attendances Other analgesic-related attendances in local government areas Trends over time in other analgesic-related attendances Ambo Project: Alcohol and Drug related Ambulance Attendances 2012/13 Annual Report Page vii

8 Chapter 20: Cocaine-Related Attendances Characteristics of cocaine-related attendances Day of week and time of day of cocaine-related attendances Cocaine-related attendances in local government areas Trends over time in cocaine-related attendances Chapter 21: Summary of findings References Appendix Ambo Project: Alcohol and Drug related Ambulance Attendances 2012/13 Annual Report Page viii

9 List of Tables Table 1: Alcohol- and drug-related attendances in metropolitan Melbourne, regional Victoria, and Victoria / Table 2: Numbers of metropolitan Melbourne and regional Victoria attendances by drug /13 compared with 2011/ Table 3: Characteristics of alcohol-related attendances /12 and 2012/ Table 4: Numbers of alcohol-related attendances by local government area in metropolitan Melbourne /12 and 2012/ Table 5: Numbers of alcohol-related attendances by local government area in regional Victoria /12 and 2012/ Table 6: Characteristics of cannabis-related attendances /12 and 2012/ Table 7: Numbers of cannabis-related attendances by local government area in metropolitan Melbourne /12 and 2012/ Table 8: Numbers of cannabis-related attendances by local government area in regional Victoria /12 and 2012/ Table 9: Characteristics of ecstasy-related attendances /12 and 2012/ Table 10: Numbers of ecstasy-related attendances by local government area in metropolitan Melbourne /12 and 2012/ Table 11: Numbers of ecstasy-related attendances by local government area in regional Victoria /12 and 2012/ Table 12: Characteristics of all amphetamine-related attendances /12 and 2012/ Table 13: Numbers of all amphetamine-related attendances by local government area in metropolitan Melbourne /12 and 2012/ Table 14: Numbers of all amphetamine-related attendances by local government area in regional Victoria /12 and 2012/ Table 15: Characteristics of crystal methamphetamine-related attendances /12 and 2012/ Table 16: Numbers of crystal methamphetamine-related attendances by local government area in metropolitan Melbourne /12 and 2012/ Table 17: Numbers of crystal methamphetamine-related attendances by local government area in regional Victoria /12 and 2012/ Table 18: Characteristics of other amphetamine attendances /12 and 2012/ Table 19: Numbers of other amphetamine-related attendances by local government area in metropolitan Melbourne /12 and 2012/ Table 20: Numbers of other amphetamine-related attendances by local government area in regional Victoria /12 and 2012/ Table 21: Characteristics of benzodiazepine-related attendances /12 and 2012/ Table 22: Numbers of benzodiazepine-related attendances by local government area in metropolitan Melbourne /12 and 2012/ Table 23: Numbers of benzodiazepine-related attendances by local government area in regional Victoria /12 and 2012/ Table 24: Characteristics of inhalant-related attendances /12 and 2012/ Table 25: Numbers of inhalant-related attendances by local government area in metropolitan Melbourne /12 and 2012/ Table 26: Numbers of inhalant-related attendances by local government area in regional Victoria /12 and 2012/ Table 27: Characteristics of heroin-related attendances /12 and 2012/ Table 28: Numbers of all heroin-related attendances by local government area in metropolitan Melbourne /12 and 2012/ Table 29: Numbers of all heroin-related attendances by local government area in regional Victoria /12 and 2012/ Table 30: Characteristics of heroin overdose attendances (responding to naloxone) /12 and 2012/13 88 Table 31: Numbers of heroin overdose attendances (responding to naloxone) by local government area in metropolitan Melbourne /12 and 2012/ Table 32: Numbers of heroin overdose attendances (responding to naloxone) by local government area in Ambo Project: Alcohol and Drug related Ambulance Attendances 2012/13 Annual Report Page ix

10 regional Victoria /12 and 2012/ Table 33: Characteristics of other heroin-related attendances /12 and 2012/ Table 34: Numbers of other heroin-related attendances by local government area in metropolitan Melbourne /12 and 2012/ Table 35: Numbers of other heroin-related attendances by local government area in regional Victoria /12 and 2012/ Table 36: Characteristics of GHB-related attendances /12 and 2012/ Table 37: Numbers of GHB-related attendances by local government area in metropolitan Melbourne /12 and 2012/ Table 38: Numbers of GHB-related attendances by local government area in regional Victoria /12 and 2012/ Table 39: Characteristics of anticonvulsant-related attendances /12 and 2012/ Table 40: Numbers of anticonvulsant-related attendances by local government area in metropolitan Melbourne /12 and 2012/ Table 41: Numbers of anticonvulsant-related attendances by local government area in regional Victoria /12 and 2012/ Table 42: Characteristics of antidepressant-related attendances /12 and 2012/ Table 43: Numbers of antidepressant-related attendances by local government area in metropolitan Melbourne /12 and 2012/ Table 44: Numbers of antidepressant-related attendances by local government area in regional Victoria /12 and 2012/ Table 45: Characteristics of antipsychotic-related attendances /12 and 2012/ Table 46: Numbers of antipsychotic-related attendances by local government area in metropolitan Melbourne /12 and 2012/ Table 47: Numbers of antipsychotic-related attendances by local government area in regional Victoria /12 and 2012/ Table 48: Characteristics of opioid analgesic-related attendances /12 and 2012/ Table 49: Numbers of opioid analgesic-related attendances by local government area in metropolitan Melbourne /12 and 2012/13 up to here Table 50: Numbers of opioid analgesic-related attendances by local government area in regional Victoria /12 and 2012/ Table 51: Characteristics of other analgesic-related attendances /12 and 2012/ Table 52: Numbers of other analgesic-related attendances by local government area in metropolitan Melbourne /12 and 2012/ Table 53: Numbers of other analgesic-related attendances by local government area in regional Victoria /12 and 2012/ Table 54: Characteristics of cocaine-related attendances /12 and 2012/ Table 55: Numbers of cocaine-related attendances by local government area in metropolitan Melbourne /12 and 2012/ Ambo Project: Alcohol and Drug related Ambulance Attendances 2012/13 Annual Report Page x

11 List of Figures Figure 1: Proportion of alcohol-related attendances by time of day of week, metropolitan Melbourne /12 and 2012/ Figure 2: Proportion of alcohol-related attendances by time of day of week, regional Victoria /12 and 2012/ Figure 3: Alcohol-related attendances by month /12 and 2012/ Figure 4: Alcohol-related attendances by year /04 to 2012/ Figure 5: Proportion of cannabis-related attendances by time of day of week, metropolitan Melbourne /12 and 2012/ Figure 6: Proportion of cannabis-related attendances by time of day of week, regional Victoria /12 and 2012/ Figure 7: Cannabis-related attendances by month /12 and 2012/ Figure 8: Cannabis-related attendances by year /04 to 2012/ Figure 9: Proportion of ecstasy-related attendances by time of day of week, metropolitan Melbourne /12 and 2012/ Figure 10: Proportion of ecstasy-related attendances by time of day of week, regional Victoria /12 and 2012/ Figure 11: Ecstasy-related attendances by month /12 and 2012/ Figure 12: Ecstasy-related attendances by year /04 to 2012/ Figure 13: Proportion of all amphetamine-related attendances by time of day of week, metropolitan Melbourne /12 and 2012/ Figure 14: Proportion of all amphetamine-related attendances by time of day of week /12 and 2012/ Figure 15: All amphetamine-related attendances by month /12 and 2012/ Figure 16: All amphetamine-related attendances by year /04 and 2012/ Figure 17: Proportion of crystal methamphetamine-related attendances by time of day of week, metropolitan Melbourne /12 and 2012/ Figure 18: Proportion of crystal methamphetamine-related attendances by time of day of week, regional Victoria /12 and 2012/ Figure 19: Crystal methamphetamine-related attendances by month /12 and 2012/ Figure 20: Crystal methamphetamine-related attendances by year /04 and 2012/ Figure 21: Proportion of other amphetamine-related attendances by time of day of week, metropolitan Melbourne /12 and 2012/ Figure 22: Proportion of other amphetamine-related attendances by time of day of week, regional Victoria /12 and 2012/ Figure 23: Other amphetamine-related attendances by month /12 and 2012/ Figure 24: Other amphetamine-related attendances by year /04 to 2012/ Figure 25: Proportion of benzodiazepine-related attendances by time of day of week, metropolitan Melbourne /12 and 2012/ Figure 26: Proportion of benzodiazepine-related attendances by time of day of week, regional Victoria /12 and 2012/ Figure 27: Benzodiazepine-related attendances by month /12 and 2012/ Figure 28: Benzodiazepine-related attendances by year /04 and 2012/ Figure 29: Proportion of inhalant-related attendances by time of day of week, metropolitan Melbourne /12 and 2012/ Figure 30: Proportion of inhalant-related attendances by time of day of week, regional Victoria /12 and 2012/ Figure 31: Inhalant-related attendances by month /12 and 2012/ Figure 32: Inhalant-related attendances by year /04 to 2012/ Figure 33: Proportion of heroin-related attendances by time of day of week, metropolitan Melbourne /12 and 2012/ Figure 34: Proportion of heroin-related attendances by time of day of week, regional Victoria /12 and 2012/ Figure 35: Heroin-related attendances by month /12 and 2012/ Ambo Project: Alcohol and Drug related Ambulance Attendances 2012/13 Annual Report Page xi

12 Figure 36: Heroin-related attendances by year /04 to 2012/ Figure 37: Proportion of heroin overdose attendances (responding to naloxone) by time of day of week, metropolitan Melbourne /12 and 2012/ Figure 38: Proportion of heroin overdose attendances (responding to naloxone) by time of day of week, regional Victoria /12 and 2012/ Figure 39: Heroin overdose attendances (responding to naloxone) by month /12 and 2012/ Figure 40: Heroin overdose attendances (responding to naloxone) by year /04 and 2012/ Figure 41: Proportion of other heroin-related attendances by time of day of week, metropolitan Melbourne /12 and 2012/ Figure 42: Proportion of other heroin-related attendances by time of day of week, regional Victoria /12 and 2012/ Figure 43: Other heroin-related attendances by month /12 and 2012/ Figure 44: Other heroin-related attendances by year /04 to 2012/ Figure 45: Proportion of GHB-related attendances by time of day of week, metropolitan Melbourne /12 and 2012/ Figure 46: Proportion of GHB-related attendances by time of day of week, regional Victoria /12 and 2012/ Figure 47: GHB-related attendances by month /12 and 2012/ Figure 48: GHB-related attendances by year /04 to 2012/ Figure 49: Proportion of anticonvulsant-related attendances by time of day of week, metropolitan Melbourne /12 and 2012/ Figure 50: Proportion of anticonvulsant-related attendances by time of day of week, regional Victoria /12 and 2012/ Figure 51: Anticonvulsant-related attendances by month /12 and 2012/ Figure 52: Anticonvulsant-related attendances by year /04 to 2012/ Figure 53: Proportion of antidepressant-related attendances by time of day of week, metropolitan Melbourne /12 and 2012/ Figure 54: Proportion of antidepressant-related attendances by time of day of week, regional Victoria /12 and 2012/ Figure 55: Antidepressant-related attendances by month /12 and 2012/ Figure 56: Antidepressant-related attendances by year /04 to 2012/ Figure 57: Proportion of antipsychotic-related attendances by time of day of week, metropolitan Melbourne /12 and 2012/ Figure 58: Proportion of antipsychotic-related attendances by time of day of week, regional Victoria /12 and 2012/ Figure 59: Antipsychotic-related attendances by month /12 and 2012/ Figure 60: Antipsychotic-related attendances by year /04 to 2012/ Figure 61: Proportion of opioid analgesic-related attendances by time of day of week, metropolitan Melbourne /12 and 2012/ Figure 62: Proportion of opioid analgesic-related attendances by time of day of week, regional Victoria /12 and 2012/ Figure 63: Opioid analgesic-related attendances by month /12 and 2012/ Figure 64: Opioid analgesic-related attendances by year /04 to 2012/ Figure 65: Proportion of other analgesic-related attendances by time of day of week, metropolitan Melbourne /12 and 2012/ Figure 66: Proportion of other analgesic-related attendances by time of day of week, regional Victoria /12 and 2012/ Figure 67: Other analgesic-related attendances by month /12 and 2012/ Figure 68: Other analgesic-related attendances by year /04 to 2012/ Figure 69: Proportion of cocaine-related attendances by time of day of week, metropolitan Melbourne /12 and 2012/ Figure 70: Proportion of cocaine-related attendances by time of day of week /12 and 2012/ Figure 71: Cocaine-related attendances by month /12 and 2012/ Figure 72: Cocaine-related attendances by year /04 to 2012/ Ambo Project: Alcohol and Drug related Ambulance Attendances 2012/13 Annual Report Page xii

13 List of Maps Map 1: Alcohol-related attendances by Victorian LGA, numbers of attendances / Map 2: Alcohol-related attendances by Victorian LGA, rates per 100,000 ERP / Map 3: Alcohol-related attendances by Victorian postcode, numbers of attendances / Map 4: Cannabis-related attendances by Victorian LGA, numbers of attendances / Map 5: Cannabis-related attendances by Victorian LGA, rates per 100,000 ERP / Map 6: Cannabis-related attendances by Victorian postcodes, numbers of attendances / Map 7: Ecstasy -related attendances by Victorian LGA, numbers of attendances / Map 8: Ecstasy -related attendances by Victorian LGA, rates per 100,000 ERP / Map 9: Ecstasy -related attendances by Victorian postcode, numbers of attendances / Map 10: Amphetamine-related attendances by Victorian LGA, numbers of attendances / Map 11: Amphetamine-related attendances by Victorian LGA, rates per 100,000 ERP / Map 12: Amphetamine-related attendances by Victorian postcode, numbers of attendances / Map 13: Benzodiazepine-related attendances by Victorian LGA, numbers of attendances / Map 14: Benzodiazepine-related attendances by Victoria LGA, rates per 100,000 ERP / Map 15: Benzodiazepine-related attendances by Victorian postcode, numbers of attendances / Map 16: Inhalant-related attendances by Victorian LGA, numbers of attendances / Map 17: Inhalant-related attendances by Victorian LGA, rates per 100,000 ERP / Map 18: Inhalant-related attendances by Victorian postcode, numbers of attendances / Map 19: Heroin-related attendances by metropolitan Victorian LGA, numbers of attendances / Map 20: Heroin-related attendances by regional Victorian LGA, rates per 100,000 ERP / Map 21: Heroin-related attendances by Victorian postcode, numbers of attendances / Map 22: GHB-related attendances by Victorian LGA, numbers of attendances / Map 23: GHB-related attendances by Victorian LGA, rates per 100,000 ERP / Map 24: GHB-related attendances by Victorian postcode, numbers of attendances / Map 25: Anticonvulsant-related attendances by Victorian LGA, numbers of attendances / Map 26: Anticonvulsant-related attendances by Victorian LGA, rates per 100,000 ERP / Map 27: Anticonvulsant-related attendances by Victorian LGA, postcode, numbers of attendances / Map 28: Antidepressant-related attendances by Victorian LGA, numbers of attendances / Map 29: Antidepressant -related attendances by Victorian LGA, rates per 100,000 ERP / Map 30: Antidepressant-related attendances Victorian postcode, numbers of attendances / Map 31: Antipsychotic-related attendances by Victorian LGA, numbers of attendances / Map 32: Antipsychotic-related attendances by Victorian LGA, rates per 100,000 ERP / Map 33: Antipsychotic-related attendances by Victorian postcode, numbers of attendances / Map 34: Opioid analgesic-related attendances by Victorian LGA, numbers of attendances / Map 35: Opioid analgesic -related attendances by Victorian LGA, rates per 100,000 ERP / Map 36: Opioid analgesic-related attendances by Victorian postcode, numbers of attendances / Map 37: Other analgesic-related attendances by Victorian LGA, numbers of attendances / Map 38: Other analgesic-related attendances by Victorian LGA, rates per 100,000 ERP / Map 39: Other analgesic-related attendances by Victorian postcode, numbers of attendances / Map 40: Cocaine-related attendances by Victorian LGA, numbers of attendances / Map 41: Cocaine-related attendances by Victorian LGA, rates per 100,000 ERP / Map 42: Cocaine-related attendances by Victorian postcode, numbers of attendances / Map 43: LGAs of outer metropolitan Melbourne Map 44: LGAs of inner metropolitan Melbourne Map 45: LGAs of regional Victoria Ambo Project: Alcohol and Drug related Ambulance Attendances 2012/13 Annual Report Page xiii

14 Preface This examination of non-fatal drug related events attended by ambulance in Victoria is a collaborative project between Turning Point s Population Health Research Program and Ambulance Victoria, and is funded by the Victorian Department of Health. Turning Point strives to promote and maximise the health and wellbeing of individuals and communities living with and affected by alcohol and other drug-related harms. Our work is essential to understanding the complexities of alcohol and drug use in our community and in developing effective approaches to prevent and treat dependence and other related harms. Turning Point was opened in 1994 and operates from a unique organisational model that combines excellence in research with best practice approaches to education and training, alongside clinical service delivery. This model means we operate from within the alcohol and other drug (AOD) sector while benefiting from specialist skills and knowledge across research, education, and service delivery disciplines. The organisation amalgamated with public health provider Eastern Health in October 2009 and is formally affiliated with Monash University. Turning Point is part of the International Network of Drug Treatment and Rehabilitation Resource Centres for The United Nations Office of Drugs and Crime (UNODC) and is a member of the International Harm Reduction Association. The organization is unique among alcohol and drug agencies for its mission to combine clinical services with research and training, and brings together a broad base of expert, experienced professionals in each of these three areas. The staff at Turning Point have specialist expertise in the design, implementation and monitoring of alcohol and drug related research and evaluation, and have experience in the development of practice standards and guidelines which have been packaged for use by a range of services. Turning Point has established a number of innovative programs and plays a key role in influencing government policy. A range of clinical services are provided by the organization including a state-wide 24-hour telephone assessment and referral service (DirectLine), withdrawal, opioid pharmacotherapy, and counselling treatment programs. Among its achievements, Turning Point has provided key input to advisory bodies such as the Premier s Drug Advisory Council and the Premier s Drug Prevention Council. Current research projects include the examination of the patterns of alcohol and other drug use and related harm in the Victorian community, and the development and evaluation of a number of treatment programs. The Turning Point Population Health Research Program is responsible for investigating patterns of alcohol and drug use and related harm using population-based datasets available in Victoria. The staff in the Population Health Research team currently include: Belinda Lloyd, Mohajer Abbass Hameed, Cass Connor, Annie Haines, Caroline Gao, Cathie Garrard, Cherie Heilbronn, Jessica Killian, Liliana Laskaris, Heather Laurie, Elizabeth Le, Daniel Leung, Sharon Matthews, Lisa Meyenn, Elke Mitchell, Rowan Ogeil, Melissa Reed, Andrew Rodsted, Adam Scott, Kay van Namen and Merran Waterfall. The Population Health Research team aims is to examine patterns of drug use and harm in Victoria and provide this information to policy makers, alcohol and drug workers, as well as other interested groups and individuals. Current projects include the Victorian Alcohol and Drug Statistics Series. Ambo Project: Alcohol and Drug related Ambulance Attendances 2012/13 Annual Report Page xiv

15 Acknowledgements We would like to thank Cathie Garrard, Annie Haines, Alexa Hayley, Cherie Heilbronn, Liliana Laskaris, Heather Laurie, Elizabeth Le, Daniel Leung, Josephine Mascaro, Lisa Meyenn, Elke Mitchell, Melissa Reed, Andrew Rodsted, Lydia Soh, Julie Tennant, Qian Wang, Merran Waterfall and Julie Wood, for their valuable contribution. Ambo Project: Alcohol and Drug related Ambulance Attendances /13 Annual Report Page xv

16 Acronyms ABS AOD ERP GHB LGA PCR PWID Australian Bureau of Statistics Alcohol and Other Drug Estimated Resident Population Gamma-Hydroxy Butyrate Local Government Area Patient Care Record People Who Inject Drugs Ambo Project: Alcohol and Drug related Ambulance Attendances /13 Annual Report Page xvi

17 Summary Table 1 provides a summary of drug- and alcohol-related events attended by ambulance in Victoria in 2012/13. Alcohol-related attendances were most common in both metropolitan Melbourne and regional Victoria, with benzodiazepines the second most common drug category involved in ambulance attendances across metropolitan Melbourne and regional Victoria. Non-opioid analgesics also featured, with this category ranking third for regional Victorian alcohol- and drug-related ambulance attendances, and fourth for metropolitan Melbourne attendances (with all heroin-related attendances ranking third in metropolitan Melbourne). Attendances related to antidepressants, antipsychotics and cannabis were also common across Victoria in 2012/13. In 2012/13, population rates of attendances were higher for cannabis, anticonvulsants, antidepressants, antipsychotics, opioid analgesics and other analgesics in regional Victoria than in metropolitan Melbourne. Table 1: Alcohol- and drug-related attendances in metropolitan Melbourne, regional Victoria, and Victoria /13 Metropolitan Melbourne N (rate)** Regional Victoria N (rate)** All Victoria N* (rate)** Alcohol (2665.9) 3692 (2559.9) (2650.0) Cannabis 1416 (338.2) 554 (384.2) 1975 (351.2) Ecstasy 306 (73.1) 54 (37.4) 360 (64.0) All Amphetamines 1394 (333.1) 312 (216.6) 1708 (303.7) Crystal Methamphetamine 1112 (265.7) 231 (159.8) 1344 (239.0) Other Amphetamines 282 (67.4) 82 (56.8) 364 (64.7) Benzodiazepines 3159 (754.6) 808 (560.0) 3979 (707.6) Inhalants 122 (29.1) 31 (21.5) 153 (27.2) All Heroin 1901 (454) 102 (70.9) 2003 (356.2) Heroin (with response to naloxone) 960 (229.4) 38 (26.1) 998 (177.5) Other Heroin 940 (224.6) 65 (44.8) 1005 (178.7) GHB 578 (138.1) 42 (29.0) 620 (110.3) Anticonvulsants 230 (54.9) 104 (72.1) 334 (59.4) Antidepressants 1221 (291.6) 487 (337.6) 1710 (304.1) Antipsychotics 1145 (273.5) 425 (294.7) 1574 (279.9) Opioid Analgesics 711 (169.8) 350 (242.4) 1065 (189.4) Other Analgesics 1584 (378.5) 603 (418.1) 2193 (390.0) Cocaine 122 (29.1) 10 (6.9) 132 (23.5) *Total N for Victoria may equal more than the sum of metropolitan and regional cases as some attendances may not contain location information ** per 1,000,000 population Table 2 provides a summary of drug- and alcohol-related events attended by ambulance in metropolitan Melbourne and regional Victoria in 2011/12 and 2012/13, and the change between 2011/12 and 2012/13. In metropolitan Melbourne, large increases (greater than ten per cent) were noted in alcohol-, cannabis-, ecstasy-, all amphetamine-, crystal methamphetamine-, benzodiazepine-, GHB-, anticonvulsant-, antidepressant-, antipsychotic-, opioid analgesic-, non-opioid analgesic- and cocaine-related attendances. There was a smaller increase in other heroin-related attendances. A large decrease (greater than ten per cent) was noted in attendances for heroin (with response to naloxone). With the exception of inhalant- and GHB-related attendances, the change Ambo Project: Alcohol and Drug related Ambulance Attendances 2012/13 Annual Report Page 1

18 patterns in regional Victoria were broadly the same as in metropolitan Melbourne. Table 2: Numbers of metropolitan Melbourne and regional Victoria attendances by drug /13 compared with 2011/ /12 N Metropolitan Melbourne 2012/13 N % Change from 2011/ /12 N Regional Victoria 2012/13 N % Change from 2011/12 Alcohol % % Cannabis % % Ecstasy % % All Amphetamines % % Crystal Methamphetamine % % Other Amphetamines % % Benzodiazepines % % Inhalants % % All Heroin % % Heroin (with response to naloxone) % % Other Heroin % % GHB % % Anticonvulsants % % Antidepressants % % Antipsychotics % % Opioid Analgesics % % Other Analgesics % % Cocaine % % Note: Except where indicated, all figures in the proportions are weighted. Alcohol: Daily numbers of alcohol-related attendances were significantly higher in 2012/13 than in 2011/12 in both metropolitan Melbourne and regional Victoria. The mean age of patients attended increased in 2012/13 in metropolitan Melbourne and regional Victoria. In metropolitan Melbourne and regional Victoria, the proportion of cases occurring in public spaces decreased when compared with 2011/12. In both metropolitan Melbourne and regional Victoria, the proportion of alcohol-related attendances where the patient was transported to hospital increased significantly in 2012/13 when compared with the previous year. Melbourne retained its ranking as the LGA with the highest proportion of alcohol-related attendances in metropolitan Melbourne. In regional Victoria, Greater Geelong was the LGA with the highest proportion of alcohol-related ambulance attendances in 2012/13, followed by Latrobe and Ballarat, while Yarriambiack and Warnambool had the highest rates of attendances. Alcohol involvement in other drug-related attendances: In metropolitan Melbourne, there was a large decrease (ten percentage points or greater) in the proportion of ecstasy-related attendances where alcohol was also involved when compared with the preceding year. For all other drug categories, there were smaller decreases or increases in the proportions of attendances where alcohol was also involved. In regional Victoria, large decreases were seen in the proportions of cannabis-, ecstasy-, antidepressant- and cocaine-related attendances where alcohol was also involved when compared with the preceding year, while a large increase was noted in the proportion of inhalant-related attendances where alcohol was also involved. For all other drug categories, there Ambo Project: Alcohol and Drug related Ambulance Attendances 2012/13 Annual Report Page 2

19 were smaller decreases or increases in the proportions of attendances where alcohol was also involved. Cannabis: Across metropolitan Melbourne and regional Victoria, the daily number of cannabis-related attendances in 2012/13 increased significantly when compared with the preceding year. In both metropolitan Melbourne and regional Victoria, the proportions of cannabis-related attendances where alcohol was involved decreased while the proportion where the patient was transported to hospital increased in 2012/13 when compared with the previous year. In metropolitan Melbourne, the three LGAs with the highest rates for cannabis-related ambulance attendances in 2012/13 were Melbourne, Frankston and Port Phillip. In regional Victoria, Latrobe and Greater Shepparton had the highest population rates in 2012/13. Ecstasy: In both metropolitan Melbourne and regional Victoria, there were significant increases in the daily numbers of ecstasy-related attendances in 2012/13 when compared with 2011/12. The age of patients attended decreased in metropolitan Melbourne while the age increased in regional Victoria in 2012/13 compared with 2011/12. In metropolitan Melbourne, the proportion of attendances where alcohol was also involved decreased while the proportion of attendances where the patient was transported to hospital increased. In metropolitan Melbourne, the three LGAs with the highest rates for ecstasy-related ambulance attendances in 2012/13 were Melbourne, Stonnington and Port Phillip. In regional Victoria, Greater Bendigo and Greater Geelong had the highest population rates in 2012/13. All amphetamines: In both metropolitan Melbourne and regional Victoria, the daily number of all amphetamine-related attendances and the proportion of events co-attended by police in 2012/13 increased significantly when compared with the preceding year. In metropolitan Melbourne, there was a significant decrease in the proportion of cases where alcohol was also involved, while there was a significant increase in the proportion of cases where the patient was transported to hospital in 2012/13 when compared with 2011/12. In regional Victoria, the proportion of events occurring in public spaces increased significantly. In metropolitan Melbourne, the three LGAs with the highest rates for all amphetamine-related ambulance attendances in 2012/13 were Melbourne, Port Phillip and Yarra. In regional Victoria, Latrobe, Moorabool and Greater Shepparton had the highest population rates of all amphetamine-related ambulance attendances in 2012/13. Crystal methamphetamine: In 2012/13 across Victoria, the daily number of crystal methamphetamine-related attendances was significantly higher than in 2011/12. In metropolitan Melbourne, significant decreases were seen in the proportion of cases where alcohol was involved, and where events occurred in public spaces, while significant increases were noted in the proportion of events co-attended by police, and cases where the patient was transported to hospital. In regional Victoria, there was a significant increase in the proportion of events co-attended by police. In metropolitan Melbourne, the top three ranking LGAs in the proportion of crystal methamphetaminerelated ambulance attendances were Melbourne, Casey and Hume. In regional Victoria, Latrobe, Moorabool and Horsham had the highest population rates of crystal methamphetamine-related ambulance attendances in 2012/13. Other amphetamines: In metropolitan Melbourne, the proportion of cases where the patient was transported to hospital was significantly higher than in 2011/12. In metropolitan Melbourne, the three LGAs with the highest rates for other amphetamine-related ambulance attendances in 2012/13 were Melbourne, Port Phillip and Yarra. In regional Victoria, Greater Shepparton and Latrobe had the highest population rates of other amphetamine-related ambulance attendances in 2012/13. Ambo Project: Alcohol and Drug related Ambulance Attendances 2012/13 Annual Report Page 3

20 Benzodiazepines: Across metropolitan Melbourne and regional Victoria, the daily numbers of benzodiazepine-related attendances were higher in 2012/13 than in 2011/12. Significant decreases were seen in the proportions of events occurring in public spaces, while significant increases were evident in the proportions of events co-attended by police and in cases where the patient was transported to hospital. The mean age of patients increased significantly while the proportion of male patients decreased significantly in metropolitan Melbourne. The proportion of cases involving alcohol decreased significantly in regional Victoria In metropolitan Melbourne, the three LGAs with the highest rates for benzodiazepine-related ambulance attendances in 2012/13 were Yarra, Frankston and Melbourne. In regional Victoria, East Gippsland, Benalla and Bass Coast had the highest population rates of benzodiazepine-related ambulance attendances in 2012/13. Inhalants: The daily number of regional Victorian inhalant-related attendances in 2012/13 was significantly higher than in 2011/12. In metropolitan Melbourne, the three LGAs with the highest rates for inhalant-related ambulance attendances in 2012/13 were Maroondah, Melbourne and Greater Dandenong. In regional Victoria, Mildura, Ballarat and Greater Bendigo were the LGAs with the highest rates of inhalant-related ambulance attendances in 2012/13. All heroin: In metropolitan Melbourne, the mean age of patients and the proportion of cases where the patient was transported to hospital increased significantly in 2012/13 compared with the previous year In metropolitan Melbourne, the three LGAs with the highest rates for all heroin-related ambulance attendances in 2012/13 were Yarra, Melbourne and Maribyrnong. In regional Victoria, Greater Geelong was the LGA with the highest population rate of heroin-related ambulance attendances in 2012/13, followed by Ballarat. Heroin with response to naloxone: The daily number of heroin overdose attendances in 2012/13 was significantly lower than in 2011/12. There was a significant increase in the mean age of patients in 2012/13 when compared with 2011/12. In metropolitan Melbourne, the three LGAs with the highest rates of heroin overdose ambulance attendances in 2012/13 were Yarra, Melbourne and Maribyrnong. In regional Victoria, Greater Geelong was the LGA with the highest rate of heroin overdose ambulance attendances in 2012/13. Other heroin: Across metropolitan Melbourne and regional Victoria, the proportions of cases where the patient was transported to hospital increased significantly. In metropolitan Melbourne, the three LGAs with the highest rates of other heroin-related ambulance attendances in 2012/13 were Yarra, Melbourne and Maribyrnong. In regional Victoria, Wodonga and Baw Baw had the highest population rates of other heroin-related ambulance attendances in 2012/13. GHB: The daily number of GHB-related attendances in metropolitan Melbourne increased significantly when compared with the preceding year. Significant increases were seen in the proportions of events occurring in public and outdoor spaces, co-attended by police, and cases where the patient was transported to hospital. In regional Victoria, the mean age of patients attended decreased significantly. In metropolitan Melbourne, the three LGAs with the highest rates of GHB-related ambulance attendances in 2012/13 were Melbourne, Port Phillip and Stonnington. In regional Victoria, Moorabool, Wellington and Latrobe had the highest population rates of GHB-related ambulance attendances in 2012/13. Anticonvulsants: In regional Victoria, the proportion of cases where the patient was transported to hospital increased significantly when compared with the preceding year. In metropolitan Melbourne, Ambo Project: Alcohol and Drug related Ambulance Attendances 2012/13 Annual Report Page 4

21 the three LGAs with the highest rates of anticonvulsant-related ambulance attendances in 2012/13 were Mornington Peninsula, Port Phillip and Frankston. In regional Victoria, although Greater Geelong was the LGA with the highest proportion of anticonvulsant-related ambulance attendances in 2012/13, while South Gippsland, Mitchell and Bass Coast had the highest population rates. Antidepressants: In metropolitan Melbourne, the daily number of antidepressant-related attendances was significantly higher in 2012/13 than in 2011/12, while the mean age was lower in 2012/13 than in 2011/12. In regional Victoria, there was a significant decrease in the proportion of cases involving alcohol, while there was a significant increase in the proportion of cases where the patient was transported to hospital. In metropolitan Melbourne, the three LGAs with the highest rates of antidepressant-related ambulance attendances in 2012/13 were Frankston, Melbourne and Cardinia. In regional Victoria, Benalla, East Gippsland and Horsham had the highest population rates of antidepressant-related ambulance attendances in 2012/13. Antipsychotics: The daily numbers of antipsychotic-related attendances increased significantly in both metropolitan Melbourne and regional Victoria when compared with 2011/12. In regional Victoria, there was a significant decrease in the proportion of attendances where alcohol was also involved in 2012/13 when compared with 2011/12. In metropolitan Melbourne, the three LGAs with the highest rates of antipsychotic-related ambulance attendances in 2012/13 were Frankston, Port Phillip and Melbourne. In regional Victoria, East Gippsland, Northern Grampians and Greater Bendigo had the highest population rates of antipsychotic-related ambulance attendances in 2012/13. Opioid analgesics: When compared with 2011/12, the daily number of opioid analgesic-related attendances and the proportion of cases where the patient was transported to hospital increased significantly in metropolitan Melbourne. In regional Victoria, when compared with 2011/12, the proportion of attendances where alcohol was also involved decreased significantly, while the proportion of events co-attended by police, the daily number of the attendances, and the mean age of patients increased significantly. In metropolitan Melbourne, the three LGAs with the highest rates for opioid analgesic-related ambulance attendances in 2012/13 were Frankston, Port Phillip and Yarra Ranges. Horsham, East Gippsland and Mildura had the highest rates of opioid analgesic-related attendances in regional Victoria. Other analgesics: In 2012/13 the daily numbers of other analgesic-related attendances and the proportion of cases where the patient was transported to hospital increased in both metropolitan Melbourne and regional Victoria when compared with the preceding year. In metropolitan Melbourne, there were significant decreases in the proportion of attendances where alcohol was also involved and in the proportion of events occurring in public spaces. In metropolitan Melbourne, the three LGAs with the highest rates for other analgesic-related ambulance attendances in 2012/13 were Melbourne, Frankston and Moonee Valley. In regional Victoria, Benalla, East Gippsland and Campaspe had the highest population rates. Cocaine: There was a significant increase in the proportion of cases where the patient was transported to hospital in metropolitan Melbourne compared with 2011/12. When compared with 2011/12, the proportion of attendances where alcohol was also involved remained unchanged in metropolitan Melbourne. Due to the small number of cocaine-related attendances in regional Victoria, most characteristics had too few cases to be reported. Ambo Project: Alcohol and Drug related Ambulance Attendances 2012/13 Annual Report Page 5

22 Chapter 1: Introduction This report is part of an ongoing project undertaken by Turning Point, and which commenced in The rate of fatal heroin overdoses was increasing in Victoria in the late 1990s (Dietze, Fry, Rumbold, & Gerostamoulos, 2001), and in response to increasing concern about the prevalence of overdose, the current project was established to examine non-fatal heroin overdose in depth using ambulance service records (Dietze, Cvetkovski, Rumbold, & Miller, 1998). The project is funded by the Victorian Department of Health, formerly the Victorian Department of Human Services. Non-fatal versus fatal heroin overdose Surveys of people who inject drugs (PWID), along with anecdotal reports from users, suggest that the experience of overdose is common amongst heroin users both in Australia (e.g., Darke, Ross, & Hall, 1996a; Loxley, Carruthers, & Bevan, 1995) and overseas (e.g., Gossop, Griffiths, Powis, Williamson, & Strang, 1996). Darke et al. (1996a) found that 68% of respondents had experienced a heroin overdose. A survey conducted in Victoria as part of the Illicit Drug Reporting System found that 64% of regular heroin users reported having an experience of at least one overdose (Jenkinson & Quinn, 2007). Indeed, heroin users identify overdose as the heroin related harm with which they are most concerned. Most research on heroin related overdose has examined fatal overdoses (Dietze et al., 2001; Farrell, Neeleman, Griffiths, & Strang, 1996). However, the examination of non-fatal heroin overdoses is likely to be far more informative than the examination of fatal heroin overdoses. This is because fatal overdoses represent only a small fraction of the total number of heroin overdoses; the majority of heroin overdoses remain non-fatal. Recognition of this fact has seen an increase in the research effort that has been directed at the examination of non-fatal overdoses (Darke et al., 1996a; Darke, Ross, & Hall, 1996b). This research has been important in terms of identifying risk factors for overdose and informing the development of strategies for the prevention of fatal overdose (Darke et al., 1996b; Farrell et al., 1996; Gossop et al., 1996). Ambulance service records Examination of non-fatal overdose has been conducted through surveys of PWID (e.g., Darke et al., 1996a). However, another potential source of information regarding these overdoses is records of ambulance attendance (Bammer, Ostini, & Sengoz, 1995; Degenhardt, Hall, & Adelstein, 2001; Dietze, Cvetkovski, Rumbold, & Miller, 2000; Dietze, Jolley, & Cvetkovski, 2003). The rate of ambulance attendance at heroin overdose has been found to be as high as 56% of total overdoses (Darke et al., 1996a). Recognition of this fact has seen an increase in the use of ambulance service records to examine the nature and prevalence of heroin overdose (Bammer et al., 1995; Degenhardt et al., 2001; Dietze et al., 2003). In this regard ambulance service records can provide rich information on heroin related overdose and have significant advantages over one-off surveys of PWID. For example, ambulance service records are not subject to the same sampling biases inherent in surveys of PWID (see Hser, 1993). Moreover, in contrast to one-off surveys, ambulance records are routinely collected and are thus sensitive to potential changes in heroin market characteristics such as changes in drug purity, policing practices and user behaviour. In Victoria, ambulance paramedics are required to complete an electronic patient care record (epcr) for every incident that they attend and for which they provide a service. These electronic records are Ambo Project: Alcohol and Drug related Ambulance Attendances 2012/13 Annual Report Page 6

23 downloaded onto VACIS, which contains the details of incident location and incident result (hospital journey etc.) along with additional details about the incident, such as the patient s condition. This method of data collection superseded an earlier paper-based recording of incident and patient details (see previous periodic reports from this project). In early 1997 Turning Point commenced discussions with the Metropolitan Ambulance Service, now Ambulance Victoria, with a view to establishing whether their records could be used to examine non-fatal overdose in Melbourne. The resulting project was designed to examine non-fatal heroin overdose using ambulance service records through the establishment of a database of all ambulance attendances at overdose events in the Melbourne metropolitan area. With enhanced data collection available from June 1998, attendances involving drugs other than heroin can also be examined. The current report In this annual report, eighteen drug categories are examined: 1. Alcohol 2. Cannabis 3. Ecstasy 4. All amphetamine related attendances 5. Crystal methamphetamine 6. Other amphetamine 7. Benzodiazepines 8. Inhalants 9. All heroin related attendances 10. Heroin overdose (responding to naloxone) 11. Other heroin 12. GHB 13. Anticonvulsants 14. Antidepressants 15. Antipsychotics 16. Opioid analgesics 17. Other analgesics, and 18. Cocaine related attendances. The appendix includes key maps of the Victorian LGAs included in the report. Ambo Project: Alcohol and Drug related Ambulance Attendances 2012/13 Annual Report Page 7

24 Chapter 2: Methods Data generated from VACIS The results presented in this report are generated from an analysis of electronic data extracted from VACIS. This system is used by Ambulance Victoria paramedics to record the details of all emergency cases they attend, the endpoint being an electronic patient care record (epcr). The project team have developed a method for parsing the received VACIS electronic data to correctly identify relevant alcohol and drug related cases and extract the required information. However, due to the structure of the data model in the VACIS (point of care data collection), extracting alcohol- and drug-related attendance information requires additional programming, manual data entry and clerical validation so as to accurately extract the specific drugs or substances involved in the cases attended by ambulance. As a consequence, a separate database was developed for the current project that integrates and standardises information extracted from the VACIS data supplied with the existing Turning Point project database. Victorian regional data became available from the system in 2011, hence the VACIS data have now included both the metropolitan Melbourne area and the regional Victorian area. The current database contains information on: the drugs or substances involved geographic location type of location (e.g., indoors/outdoors, public building/private residence) time of day, day of week demographic details of patient (sex, approximate age) whether naloxone had been administered (yes/no) and response to naloxone administration (effective/not effective) outcome (e.g., taken to hospital/not transported) whether police co-attended other relevant clinical data (e.g., cyanisation, pupil size, respiratory rate). The database has in excess of 385,000 records that have been collected for the period of 01/06/1998 to 30/06/2013. Analysis of some of the data collected for this period forms the basis of this report. Data auditing and quality control The data are internally validated when parsed for import and conversion from the VACIS transfer files provided by Ambulance Victoria to Turning Point. Variables and coding used in the VACIS data are compared to the Turning Point database model and any discrepancies are flagged for investigation by project staff. When the VACIS data have been parsed, converted and appended to the Turning Point database, the electronic PCR records are collated for review by project staff in order to manually code the various project-specific data required for reporting, including correctly coding the drugs and substances involved in the event. After the set of electronic PCR records is manually coded, the dataset is reviewed by senior project staff and extracted for cleaning prior to analysis. Multiple electronic PCRs for the same patient are aggregated and a random selection of cases is reviewed to ensure the manual coding was accurate Ambo Project: Alcohol and Drug related Ambulance Attendances 2012/13 Annual Report Page 8

25 and consistent. Data are then converted to a format suitable for analysis and are merged with the Turning Point master project dataset. Preliminary analyses are performed to identify any anomalous trends in the data. Any unusual or unexpected results are then re-reviewed to ensure that data accurately reflect the case details. Ongoing review and cleaning of historical data are undertaken to maintain the quality of the core dataset. Accordingly, numbers may vary slightly between this report and previous publications. In addition to these formal quality control methods, throughout these processes, all project staff involved - the data entry personnel and the Research Fellows responsible for analysis - communicate to identify trends, anomalies or interesting patterns noticed in the current dataset. Definition of drug involvement/overdose used in this report The attribution of a drug or substance as being involved in the event is formed on the basis of ambulance paramedic mention of the involvement of these substances, established through paramedic clinical assessment, patient self-report or information provided by someone else at the scene, such as family, friends or associates. The drug categories reported indicate the involvement of these drugs however other drugs and alcohol may have also been ingested (with the exception of Alcohol which is an exclusive category in this report). The core criterion project staff use in determining the involvement of a drug or substance is: Is it reasonable to attribute the immediate or recent (not merely chronic) over- or inappropriate ingestion of the substance or medication as significantly contributing to the reason for the Ambulance Victoria attendance? Alcohol-related events Alcohol-related cases are defined as those cases attended by ambulance where assessment of causality is that only alcohol, as far as could be ascertained, was involved in causing the attendance. These cases usually relate to alcohol intoxication and poisoning, but may include alcohol-related injuries. All amphetamine-related attendances This category is an aggregation of the cases classified as either crystal methamphetamine- or other amphetamine-related events. Crystal methamphetamine-related attendances These cases are selected on the basis of ambulance paramedic mention of the involvement of Crystal meth(amphetamine), Ice, etc., established through patient self-report or information provided by someone else at the scene, such as family, friends or associates. Data on crystal methamphetamine/ice as the type of amphetamine involved in events have been collected from October Other amphetamine-related attendances These cases are selected on the basis of ambulance paramedic mention of the involvement of any form of amphetamine excluding crystal meth(amphetamine), ice, etc., established through patient self-report or information provided by someone else at the scene, such as family, friends or associates. It should be noted that crystal methamphetamine cases cannot be excluded from the Ambo Project: Alcohol and Drug related Ambulance Attendances 2012/13 Annual Report Page 9

26 other amphetamine category with certainty. Therefore, the other amphetamine category should be viewed as excluding crystal methamphetamine cases as far as could be ascertained. All heroin-related attendances This category is an aggregation of the cases classified as either heroin overdose or other heroin- related events. Heroin overdose It is difficult to define heroin overdose (Darke & Zador, 1996). For the data presented in this report, Heroin overdose refers to a positive response to the administration of naloxone (an opioid antagonist) for those people attended by an ambulance and where there was no indication that the overdose resulted from another opioid such as morphine or methadone. Other drugs and alcohol may also have been ingested. Other heroin-related attendances These are cases where evidence of heroin use is established through the clinical assessment of the ambulance paramedic and/or by the patient or his or her associates at the scene, but naloxone was not administered. In these cases too, other drugs and alcohol may have also been ingested. Ecstasy-, gamma-hydroxybutyrate (GHB)-, cannabis-, cocaine- and inhalant- related attendances These cases are selected on the basis of ambulance paramedic mention of the involvement of these substances, established through patient self-report or information provided by someone else at the scene, such as family, friends or associates. Data on GHB as the drug involved in events have been collected from March Benzodiazepine-related attendances This category includes drugs such as alprazolam, bromazepam, clobazam, clonazepam, diazepam, flunitrazepam, lorazepam, midazolam, nitrazepam, oxazepam, temazepam and triazolam. This category also includes the sedatives zolpidem and zopiclone. Anticonvulsant-related attendances Selected anticonvulsants include the drugs carbamazepine, gabapentin, lamotrigine, oxcarbazepine, pregabalin, sodium valproate, tiagabine and topiramate. For the Ambo Project, the only anticonvulsants coded are those that are used - on- or off-label - in treating psychiatric conditions, primarily bipolar disorder. Data pertaining to anticonvulsant-related attendances were collected from May Antidepressant-related attendances Included in this category are drugs such as amitriptyline, citalopram, clomipramine, desvenlafaxine, dothiepin, doxepin, duloxetine, escitalopram, fluoxetine, fluvoxamine, imipramine, mianserin, mirtazapine, moclobemide, nortriptyline, paroxetine, phenelzine, reboxetine, sertraline, tranylcypromine, trimipramine and venlafaxine. Antipsychotic-related attendances These include drugs such as amisulpride, aripiprazole, chlorpromazine, clozapine, droperidol, flupenthixol, fluphenazine, haloperidol, olanzapine, paliperidone, pericyazine, pimozide, quetiapine, Ambo Project: Alcohol and Drug related Ambulance Attendances 2012/13 Annual Report Page 10

27 risperidone, thioridazine, trifluoperazine, ziprasidone, zuclopenthixol. This category also includes lithium. Opioid analgesic-related attendances This category includes drugs such as dextropropoxyphene (with or without paracetamol), fentanyl, hydromorphone, morphine, oxycodone, pethidine and tramadol, but excludes methadone and buprenorphine. Other analgesic-related attendances Other analgesics includes drugs such as aspirin, ibuprofen and paracetamol, either alone or in combination with other drugs (excluding dextropropoxyphene but including codeine). Please note that for all categories, values of less than five cases are not reported. Mapping of alcohol- and drug-related ambulance attendances The ability to map ambulance attendances for alcohol- and drug-related harm provides unparalleled opportunities to explore clustering of harms in local areas at the micro level for populations and subpopulations of interest. The production of maps of patterns and clusters of alcohol- and other drugrelated harms requiring ambulance attendance addresses policy priorities and also the need to develop strategic and timely responses to alcohol and drug related harms. For each of the main drug groups included in this report, maps of concentrations of alcohol- and drug-related ambulance attendances are provided for 2012/13. These maps are presented at two levels of geographic specificity - by local government area (LGA) and by postcode of attendance for both metropolitan Melbourne, and for Victoria. Please note that postal area may not specify which part of Victoria is regional or Melbourne metropolitan area. Key maps of LGAs are provided in the Appendix. Population estimates This report uses Australian Bureau of Statistics Estimated Resident Population (ERP) data to calculate population rates. These figures are estimated at June 30 each year. For the 2011/12 financial year, ERP data from 2011 has been used as the denominator, whilst for the 2012/13 financial year, 2012 ERP data has been used as the denominator. Ambo Project: Alcohol and Drug related Ambulance Attendances 2012/13 Annual Report Page 11

28 Chapter 3: Alcohol-Related Attendances (Alcohol Only) Alcohol-related cases are defined as those cases attended by ambulance where assessment of causality is that only alcohol, as far as could be ascertained, was involved in causing the attendance. No other drugs or substances are known to be involved in these events. These cases usually relate to alcohol intoxication and poisoning, but may include alcohol-related injuries. Characteristics of alcohol-related attendances The data displayed in Table 3 shows characteristics of alcohol-related ambulance attendances in metropolitan Melbourne and regional Victoria for 2011/12 and 2012/13. The daily numbers of alcoholrelated attendances were significantly higher in 2012/13 than in 2011/12 (p<0.001) in both metropolitan Melbourne and regional Victoria. The mean age of patients attended increased in 2012/13 (p<0.001) in metropolitan Melbourne and regional Victoria. In metropolitan Melbourne and regional Victoria, the proportion of cases occurring in public spaces decreased (p<0.001) when compared with 2011/12. In both metropolitan Melbourne and regional Victoria, the proportion of alcohol-related attendances where the patient was transported to hospital increased significantly in 2012/13 when compared with the previous year (p<0.001). Table 3: Characteristics of alcohol-related attendances /12 and 2012/13 N attendances (per 1m population) Mean per day (SD) Metropolitan Melbourne Regional Victoria 2011/ /13 P 2011/ /13 P (2147.6) (2665.9) (1816.0) (2559.9) < <0.001 (11.10) (13.43) (4.23) (5.42) Daily range Alcohol involved < (100%) (100%) (100%) Age - Mean (SD) (17.89) (17.27) (18.48) Age - Median (range) < (<1-95) (<1-95) (<1-91) Male (65%) (66%) (63%) Public space < (52%) (49%) (42%) Outdoor space (50%) (49%) (83%) Police co-attendance (20%) (21%) (14%) Transported to < hospital (70%) (86%) (73%) Note: Except where indicated, all proportions are based on non-missing information (100%) 41 (17.58) 41 (<1-94) 2312 (63%) 1371 (38%) 1100 (82%) 603 (16%) 2544 (87%) Day of week and time of day of alcohol-related attendances <0.001 < <0.001 In both metropolitan Melbourne and regional Victoria, the distribution of alcohol-related ambulance attendances across the days of the week was consistent in both 2011/12 and 2012/13, with the highest proportion of attendances occurring on Saturdays and Sundays and lowest on Mondays. The peak time for alcohol-related attendances in 2012/13 was between 12pm and 6am on Saturday and Sunday. The distribution of alcohol-related attendances over times of day and days of week is Ambo Project: Alcohol and Drug related Ambulance Attendances 2012/13 Annual Report Page 12

29 presented in Figure 1 and Figure 2, and indicates that the trend in temporal variation in attendances was similar in 2011/12 and 2012/13. Figure 1: Proportion of alcohol-related attendances by time of day of week, metropolitan Melbourne /12 and 2012/13 Figure 2: Proportion of alcohol-related attendances by time of day of week, regional Victoria /12 and 2012/13 Ambo Project: Alcohol and Drug related Ambulance Attendances 2012/13 Annual Report Page 13

30 Alcohol-related attendances in local government areas Alcohol-related ambulance attendances are presented for 2012/13 (and 2011/12 for comparison) by local government area for metropolitan Melbourne in Table 4 and for regional Victoria in Table 5. In metropolitan Melbourne, the three LGAs with the highest rates for alcohol-related ambulance attendances in 2012/13 were Melbourne, Port Phillip and Yarra (Table 4). Rates of attendances increased across the majority of LGAs when compared with the previous year. The only exception was Boroondara. Melbourne retained its ranking as the LGA with the highest rate of alcohol-related attendances in metropolitan Melbourne. Nillumbik remained the LGA with the lowest rate of alcohol-related attendances in metropolitan Melbourne. In regional Victoria, although Greater Geelong was the LGA with the highest proportion of alcoholrelated ambulance attendances in 2012/13, Yarriambiack and Warnambool had the highest population rates, followed by Latrobe and Greater Shepparton (Table 5). Rates of attendances increased across the majority of LGAs when compared with the previous year. The exceptions were Murrindindi, Hepburn, Gannawarra and Buloke, showing decreases in population rates for alcoholrelated ambulance attendances. Mapped alcohol-related attendances for 2012/13 are presented at LGA level (Map 1 and Map 2) and postcode (Map 3) for metropolitan Melbourne and regional Victoria. Ambo Project: Alcohol and Drug related Ambulance Attendances 2012/13 Annual Report Page 14

31 Table 4: Numbers of alcohol-related attendances by local government area in metropolitan Melbourne /12 and 2012/13 LGA 2011/ /13 LGA N (%*) Rate** N (%*) Rate** Melbourne 1165 (13%) Melbourne 1418 (13%) Yarra 439 (5%) Port Phillip 614 (6%) Port Phillip 521 (6%) Yarra 458 (4%) Stonnington 342 (4%) Frankston 543 (5%) Frankston 400 (5%) Greater Dandenong 575 (5%) Greater Dandenong 435 (5%) Stonnington 399 (4%) Maribyrnong 219 (3%) Maribyrnong 276 (3%) Maroondah 262 (3%) Mornington Peninsula 435 (4%) Moreland 349 (4%) Maroondah 311 (3%) Kingston 332 (4%) Darebin 403 (4%) Darebin 311 (4%) Kingston 385 (4%) Hobsons Bay 186 (2%) Hobsons Bay 221 (2%) Mornington Peninsula 301 (3%) Moonee Valley 279 (3%) Moonee Valley 221 (3%) Moreland 382 (3%) Knox 250 (3%) Whitehorse 354 (3%) Boroondara 267 (3%) Brimbank 430 (4%) Banyule 190 (2%) Hume 372 (3%) Yarra Ranges 226 (3%) Knox 295 (3%) Brimbank 276 (3%) Casey 477 (4%) Melton 159 (2%) Yarra Ranges 264 (2%) Cardinia 107 (1%) Bayside 168 (2%) Bayside 134 (2%) Glen Eira 236 (2%) Hume 238 (3%) Melton 198 (2%) Whitehorse 207 (2%) Cardinia 130 (1%) Casey 335 (4%) Banyule 196 (2%) Glen Eira 174 (2%) Boroondara 264 (2%) Wyndham 208 (2%) Monash 281 (3%) Monash 211 (2%) Whittlesea 257 (2%) Whittlesea 180 (2%) Manningham 170 (2%) Manningham 124 (1%) Wyndham 250 (2%) Nillumbik 56 (1%) 89.3 Nillumbik 67 (1%) Rest of Melbourne 0 (0%) - Rest of Melbourne 0 (0%) - * % of metropolitan Melbourne ** per 100,000 population Ambo Project: Alcohol and Drug related Ambulance Attendances 2012/13 Annual Report Page 15

32 Table 5: Numbers of alcohol-related attendances by local government area in regional Victoria /12 and 2012/ / /13 LGA N (%*) Rate** LGA N (%*) Rate** Warrnambool 87 (3%) Yarriambiack 27 (1%) Central Goldfields 33 (1%) Warrnambool 125 (3%) Latrobe 190 (7%) Latrobe 280 (8%) Mildura 129 (5%) Greater Shepparton 229 (6%) Greater Shepparton 153 (6%) Wellington 146 (4%) East Gippsland 105 (4%) East Gippsland 148 (4%) Murrindindi 32 (1%) Mildura 169 (5%) Greater Geelong 497 (19%) Bass Coast 97 (3%) Wellington 93 (4%) Central Goldfields 38 (1%) Mansfield 17 (1%) Wangaratta 80 (2%) Bass Coast 61 (2%) Greater Geelong 640 (18%) Southern Grampians 31 (1%) Colac-Otway 56 (2%) Ballarat 178 (7%) Ballarat 242 (7%) Buloke 12 (1%) Horsham 49 (1%) Wodonga 65 (3%) Strathbogie 24 (1%) Moira 51 (2%) Glenelg 48 (1%) Glenelg 35 (1%) Mount Alexander 43 (1%) Mitchell 61 (2%) Wodonga 88 (2%) Surf Coast 46 (2%) Ararat 27 (1%) Campaspe 63 (2%) Campaspe 87 (2%) Wangaratta 46 (2%) Swan Hill 49 (1%) Benalla 23 (1%) Mansfield 18 (0.5%) Strathbogie 15 (1%) Greater Bendigo 228 (6%) Swan Hill 32 (1%) Surf Coast 57 (2%) Greater Bendigo 148 (6%) Pyrenees 14 (0.4%) Colac-Otway 30 (1%) Benalla 28 (1%) Hepburn 21 (1%) Corangamite 33 (1%) Baw Baw 60 (2%) Moira 57 (2%) Gannawarra 14 (1%) Mitchell 71 (2%) Horsham 26 (1%) Southern Grampians 32 (1%) Corangamite 21 (1%) Baw Baw 82 (2%) Moyne 20 (1%) Moorabool 54 (2%) Northern Grampians 14 (1%) Macedon Ranges 75 (2%) Mount Alexander 20 (1%) Alpine 19 (1%) Yarriambiack 8 (0.3%) Hindmarsh 9 (0.2%) Ararat 12 (1%) South Gippsland 40 (1%) South Gippsland 29 (1%) Murrindindi 19 (0.5%) Pyrenees 7 (0.3%) Buloke 9 (0.2%) Alpine 11 (0.4%) 91.2 Northern Grampians 16 (0.4%) Moorabool 26 (1%) 90.7 Loddon 10 (0.3%) Macedon Ranges 38 (2%) 88.6 Moyne 21 (1%) Hindmarsh 5 (0.2%) 85.4 Hepburn 18 (0.5%) Loddon 5 (0.2%) 66.3 Gannawarra 12 (0.3%) Golden Plains 10 (0.4%) 52.7 Indigo 14 (0.4%) 91.0 Indigo 8 (0.3%) 52.2 Golden Plains 16 (0.4%) 82.4 Rest of Regional Victoria 8 (0.4%) - Rest of Regional Victoria 8 (0.3%) - *% of regional Victoria ** per 100,000 population Ambo Project: Alcohol and Drug related Ambulance Attendances 2012/13 Annual Report Page 16

33 Map 1: Alcohol-related attendances by Victorian LGA, numbers of attendances /13 Ambo Project: Alcohol and Drug related Ambulance Attendances 2012/13 Annual Report Page 17

34 Map 2: Alcohol-related attendances by Victorian LGA, rates per 100,000 ERP /13 Ambo Project: Alcohol and Drug related Ambulance Attendances 2012/13 Annual Report Page 18

35 Map 3: Alcohol-related attendances by Victorian postcode, numbers of attendances /13 Ambo Project: Alcohol and Drug related Ambulance Attendances 2012/13 Annual Report Page 19