30/08/25 - Inquiry into the health impacts of alcohol and other drugs in Australia

Executive Summary

Alcohol and other drugs (AOD) continue to impose a heavy burden on Australia’s health, families and communities. Alcohol alone accounts for 5.1% of Australia’s total disease burden, contributing to more than 200 preventable conditions, including several cancers, cardiovascular disease, diabetes, stroke and injuries.^1,2 Annually, alcohol accounts for 60% of all AOD hospital admissions and 14% of all injury deaths.³ More than one in four Australians drink at levels that place their health at risk, and early exposure to alcohol continues to endanger young people – impairing neurological development, increasing the risk of injury, and alcohol dependence later in life.⁴ The total social cost of alcohol was estimated at $75b in 2022-23.⁵

Illicit drugs also represent a major public health challenge. Around one in five Australians used an illicit drug in the past year, and overdose deaths have exceeded 2,000 annually for the past decade.^6,7 Despite substantial investment in law enforcement, illicit drugs remain widely available, easily accessible and stable in price – demonstrating the importance of a balanced approach across the pillars of the National Drug Strategy.^6,8,9,10 The total social cost of illicit drug use is estimated at $30 billion per year.⁵

Australia’s current investment in responding to AOD harms is heavily imbalanced.

In 2021–22, 64.3% of government spending ($3 billion) was directed to law enforcement, compared with 27.4% for treatment, 6.7% for prevention, and just 1.6% for harm reduction.¹¹ This funding profile demonstrates significant relative underinvestment in approaches that are strongly supported by evidence and will contribute significantly to reductions in cost and harm. The result is growing rates of drug harm, an overburdened treatment system with uneven access across regions and ongoing pressure on the AOD workforce, which is affected by short-term funding, staff shortages and low remuneration.^12,13

The AOD sector’s integration with primary healthcare, mental health and other social services also remains limited, hindered by stigma that deters people from seeking help. The World Health Organization ranks illicit drug use as the most stigmatised health condition globally, with alcohol dependence ranked fourth.¹⁴ Stigma not only marginalises people who use drugs but also undermines prevention and early intervention efforts.

Looking ahead, Australia faces a rapidly changing AOD landscape.

Substances are becoming more potent, drug markets more dynamic, and alcohol more accessible through online sale and delivery. At the same time, the rise of misinformation – amplified by social media and artificial intelligence – poses new risks to public understanding of AOD risks and harms.

The commercial determinants of health continue to impede evidence-based reform. While the alcohol industry remains the most significant example of how commercial interests can undermine public health, emerging markets such as medicinal cannabis highlight the importance of proactive regulation to prevent similar patterns from developing.¹⁵

Australia stands at a crossroads. A comprehensive, systems-based approach is needed – one that values prevention, early intervention and harm reduction in supporting the treatment sector, and that is guided by evidence, coordination and transparency. This includes stronger investment in prevention and digital innovation, effective regulation of harmful products, robust governance and national coordination, and an approach to AOD that is well-funded, coordinated, evidence-based and free from stigma. With strategic leadership and sustained investment, Australia can protect public health, empower communities, and support all Australians to live healthier, safer lives.

Recommendations

1. Increases support for place-based, evidence-based primary prevention initiatives targeting AOD harm that facilitate community ownership of action.
2. Ensures the availability of targeted evidence-based prevention and early intervention initiatives for subgroups at higher risk of AOD harm that consider the unique circumstances of people who use AOD.
3. Updates the National Principles for school drug education (2004) and provides guidance on evidence-based AOD education programs
4. Funds the development of early intervention programs that support people who are at risk of experiencing AOD harm to seek support and information for early behaviour change. This should include tools and resources to self-manage behaviour change.
5. Explores and funds joined up digital AOD services as well as supporting links to digital navigation services.
6. Increases investment in initiatives that support family and friends of people who use AOD, and that encourage early help seeking.
7. Takes a leadership role in establishing a National Early Warning System and develops systems that ensure up to date evidence on effective, evidence-based responses to drug-related harm.
8. Works with States and Territories to re-establish an AOD specific intergovernmental coordination mechanism, like the Ministerial Drug and Alcohol Forum (MDAF).
9. Ensures the future National Drug Strategy
   a. has a commitment to its monitoring and evaluation, and that the appropriate coordination mechanisms are in place to facilitate this.
   b. Includes a stronger focus on regulation as form of managing supply of AOD
   c. Has the ability to respond to emerging issues of concern, that links with the re-established intergovernmental coordination mechanism.
   d. Includes an implementation plan and associated funding that rebalances investment across prevention, harm reduction, treatment and law enforcement.
   e. Has sub-strategies addressing AOD harm among First Nations people and AOD Workforce Development that are current and appropriately resourced.
10. Facilitates meaningful consultation with the AOD sector to enhance coordination and implements a strategic approach to planning and funding. This should include five year time frames for funding agreements that include indexation, renewal notices at least six months prior to the expiration of funding agreements and adequate funding and time allocation for meaningful evaluation.
11. Considers barriers to coordinated primary care for people who use AOD within the current primary care reforms and the role of PHNs in supporting prevention, early intervention and treatment to reduce AOD related harms.
12. Increases investment in evidence-based harm reduction services and ensures equitable access to these services.
13. Demonstrates leadership regarding decriminalisation of personal drug use, to aid jurisdictions in designing and implementing evidence-based drug policy. This should include:
    a. Consideration by the federal government of conflicts between its own laws and state and territory laws.
    b. Reviewing the threshold quantities set out in the Commonwealth Criminal Code Act 1995 that delineate between personal possession and trafficking
    c. Partnering with the State and territory Governments to undertake reform prioritising a health response to illicit drug possession for personal use.
14. Encourages states and territories to remove criminalisation of personal use and possession of cannabis and support the introduction of limited home-growing and gifting of cannabis.
15. Supports research into alternative and non-commercial models of cannabis legalisation and their outcomes.
16. Makes a clear statement regarding the purpose of alcohol taxation policy in Australia, which supports the role of alcohol taxation in reducing alcohol-related harms and offsetting their costs. This should include:
    a. Preservation of six-monthly CPI increases on the alcohol excise to ensure that real prices of alcohol do not crease over time, maintaining their public health effect.
    b. Reforming the alcohol taxation system in Australia to remove the WET and place wine products on the excise system.
    c. Hypothecation of a portion of the alcohol exercise to fund programs that prevent and treat alcohol-related harms in the community.
17. Introduce a regulatory framework with a legislative basis that effectively protects the community from exposure to alcohol marketing. This framework must include specific provisions which:
    a. Prohibit the collection, use and disclosure of personal information for commercial marketing purposes unless a person has provided active, informed, voluntary and non-incentivised opt-in consent.
    b. Prohibit the tracking, profiling, monitoring or targeting of children for commercial purposes, particularly for use by companies selling harmful products. This should be done as part of the proposed Children’s Online Privacy Code, which has been recently announced in response to the Privacy Act Review in 2023.
    c. Limit exposure of children to alcohol advertising on live TV and BVOD
    d. Establish mandatory compliance as well as effective administration, surveillance and deterrence systems for infringements.
18. Works with states and territories to introduce mandatory, standardised health warning labels on alcohol products.
19. Shows leadership and coordination with the jurisdictions in ensuring a comprehensive, evidence-based, and actionable approach to regulating alcohol availability.
20. Takes steps to reduce stigma of people who use alcohol and other drugs including: a. Investigate and implement opportunities to decrease structural stigma including the way in which government policies, campaigns and communication tools contribute to stigma.
    b. Influence and improve the way media reports on AOD issues by leveraging existing guidelines.
    c. Supports organisations representing people who use drugs in amplifying the voice of lived and living experience.
    d. Improve knowledge and understanding among the general public and dispel myths about AOD use and dependence.
21. Invest in and develop trusted, AI-powered digital prevention initiatives that counter AOD-related misinformation and expand public access to accurate, evidence-based information and support.
22. Invest in innovative, evidence-based digital early intervention models-of-care to expand the reach, accessibility and effectiveness of early intervention in Australia.