Publication - Research and analysis

Young people experiencing harms from alcohol and drugs: literature and evidence review

Published: 8 November 2021
From: Director-General Health and Social Care
Directorate: Population Health Directorate
Topic: Health and social care
ISBN: 9781802015584

This report presents the findings of a rapid evidence review of prevalence and harms relating to alcohol and drug use among children and young people.

Supporting documents

2. Alcohol and Drug Use Prevalence and Harms: Latest Data and Trends

2.1 Overview and Key Findings

This section provides the latest data on the prevalence of alcohol and drug use among children and younger people (<25 years) in Scotland, with a focus on problematic use as opposed to experimental or occasional use. It also provides the latest data on to health-related harms and wider harms experienced by this population group from alcohol and drugs.

The key findings are that;

The proportion of children (<16 years) drinking alcohol increased between 2015 and 2018 following a long period of decline.
Drug use among children has remained relatively unchanged since 2006, but has increased among boys since 2013.
Among children, alcohol-related hospital stay rates have decreased steadily over time, but drug-related hospital stay rates have trebled since 2010/11.
Alcohol consumption is at its lowest level among younger people (16-24 years) since records began. However, AUDIT scores suggest that hazardous drinking and possible alcohol dependence are higher among those aged 16-24 years than any other age group.
While alcohol-specific deaths remain very low among those under the age of 25 years, with 3 reported deaths in 2020, the wider measure of alcohol-attributable deaths shows that alcohol was implicated in nearly one in five deaths among those aged 15-24 years in 2015.
Having declined between 2007/08 and 2016/17, alcohol-related hospital stay rates have since increased among younger people (15-24 years) over three consecutive years.
Drug use (including experimental, occasional and recreational use) is more common among younger people than older age groups, decreasing with age. However, it is older (but still young) age groups – particularly 35-45 year-olds – who are experiencing the most harms, with considerably higher rates of both hospital stays and deaths.
Drug-related deaths among younger people (<25 years) have more than doubled since 2017, with 78 deaths recorded in 2020.
Recent years have seen the emergence of a trend towards increasing drug-related hospital admissions among younger people (15-24 years). While both sexes have seen increases in drug-related hospitalisations in recent years, these trends have been particularly driven by an increase among males
The profile of drugs implicated in drug-related hospital stays among this age-group is markedly different than those of older age groups, while the profile contributing to deaths is more in line with adult data.

2.2 Alcohol and Drug Use Prevalence

2.2.1 Alcohol and Drug Use among Children

The Scottish Schools Adolescent Lifestyle and Substance Use Survey (SALSUS) 2018^[14] provides the latest data on the prevalence of alcohol and drug use among 13 and 15 year old children across Scotland. This survey data is limited by potential response bias and underreporting, and does not allow for strong conclusions to be drawn regarding hazardous/harmful alcohol use and problem drug use (although any use among children risks both short- and longer term health and social harms).

Following a sustained decline, a greater proportion of children are consuming alcohol

The proportion reporting having ever had an alcoholic drink had been steadily decreasing since 2004, but increased considerably across all groups between 2015 and 2018 (Figure 2.1). For 13 year-olds, rates increased from 29% to 37% for boys and 26% to 35% for girls. For 15 year-olds, rates increased from 63% to 70% for boys and 68% to 73% for girls.
Drinking in last week was reported by 6% of 13 year olds and one-in-five (20%) 15 year olds (Figure 2.2). Having broadly declined since 2004, there has been an increase between 2015 and 2018 for boys of both ages (from 4% to 7% for 13 year-olds and from 16% to 20% for 15 year-olds), and for 13 year-old girls (from 4% to 6%).

The line graph shows the proportion of 13 year old boys, 13 year old girls, 15 year old boys and 15 year old girls who reported ever having had an alcoholic drink, spanning 1990 to 2018. In 1990, 54% of 13 year old boys, 45% of 13 year old girls, 86% of 15 year old boys and 82% of 15 year old girls reported ever having had an alcoholic drink. The rates decline between 2004 and 2015, after which they increase. In 2018 the figures stand at 37% of 13 year old boys, 35% of 13 year old girls, 70% of 15 year old boys and 73% of 15 year old girls. — Figure 2.1 – Proportion of Pupils who have Ever Drank an Alcohol Drink (1990-2018)

Source: SALSUS 2018

The line graph shows the proportion of 13 year old boys, 13 year old girls, 15 year old boys and 15 year old girls who reported having a drink in the last week, spanning 1990 to 2018. In 1990, 10% of 13 year old boys, 10% of 13 year old girls, 30% of 15 year old boys and 25% of 15 year old girls reported having a drink in the last week. The graph shows a broad decline between 2004 and 2015, after which it displays an increase between 2015 and 2018 for boys of both ages (from 4% to 7% for 13 year-olds and from 16% to 20% for 15 year-olds), and for 13 year-old girls (from 4% to 6%). — Figure 2.2 – Proportion of Pupils Drinking in Last Week (1990-2018)

Source: SALSUS 2018

More children are consuming alcohol in risky consumption patterns

Having declined slightly between 2002-2015, the proportion having been drunk at least once increased among all groups except 15 year-old boys between 2015 and 2018 (Figure 2.3). Just over half (53%) of 13 year-olds and around two-thirds (70%) of 15 year-olds had ever been drunk. Four percent of 13 year-olds and one-in-five (21%) 15 year-olds reported having been drunk more than 10 times. Among those drinking in the last week, over half (52%) of 13 year-olds and 57% of 15 year-olds had been drunk, with rates among 13 year-old boys having increased from 43% to 51%.
The long-term trend towards an increasing age of first getting drunk has halted. While the age at which children first tried alcohol increased by 2 months to 13 years and 4 months in 2018, following long-term trends, the age at which pupils first got drunk (13.8 years) has not changed since 2015 (Figure 2.4).

The line graph shows the proportion of 13 year old boys, 13 year old girls, 15 year old boys and 15 year old girls who have ever had an alcoholic drink who have ever been drunk, spanning 2002 to 2018. In 2002, 57% of 13 year old boys, 55% of 13 year old girls, 76% of 15 year old boys and 79% of 15 year old girls reported having been drunk. The graph shows a broad decline between 2002-2015, after which the proportion having been drunk at least once increased among all groups except 15 year-old boys. In 2018, the figures stand at 48% for 13 year old boys, 57% of 13 year old girls, 66% of 15 year old boys and 74% of 15 year old girls. — Figure 2.3 – Proportion of pupils who have ever had an alcohol drink who have ever been drunk (2002-2018)

Source: SALSUS 2018

The line graph shows the mean age at which 15 year old pupils first had an alcohol drink and first got drunk, spanning 2008 to 2018. In 2008, the mean ages at which 15 year olds reporting first having a drink and first being drunk were 12.7 and 13.4 years, respectively. The graph shows the rates for first having an alcoholic drink increased steadily between 2010 and 2015, while the rates for first getting drunk have been increasing since 2010 until 2018, although the increase slowed after 2015. In 2018, 15 year olds reported first having a drink at a mean age of 13.3 years and first getting drunk at a mean age of 13.8 years. — Figure 2.4 – Mean age at which 15 year-old pupils who have ever had an alcoholic drink first had an alcoholic drink and first got drunk (2008-2018)

Source: SALSUS 2018

Drug use among children has remained relatively steady over time

While having remained steady since 2006, drug use among boys has been increasing since 2013^[15].

In 2018, 6% of 13 year-olds and 21% of 15 year-olds reported having ever used drugs. While drug use in the last month has remained relatively steady since 2006 (Figure 2.5), prevalence rates have increased among boys since 2013 (from 2%-4% of 13 year-old boys and from 11%-15% of 15 year-old boys between 2013 and 2018).

The line graphs shows the proportion of 13 year old boys, 13 year old girls, 15 year old boys and 15 year old girls who have used drugs in the last month, spanning 1998 to 2018. In 1990, 5% of 13 year old boys, 5% of 13 year old girls, 23% of 15 year old boys and 22% of 15 year old girls reported having used drugs in the last month. Figures have remained relatively steady between 2006 and 2018, although rates have increased among boys of both ages since 2013. In 2018, the figures stand at 4% of 13 year old boys, 3% of 13 year old girls, 15% of 15 year old boys and 9% of 15 year old girls. — Figure 2.5 – Proportion of Pupils who Used Drugs in the Last Month (1998-2018)

Source: SALSUS 2018

Drug Use Profile – Cannabis was the most widely used drug among 15 year old children (19% ever, and 11% in the last month), followed by ecstasy (6% ever and 3% in last month) cocaine (5% and 3%), MDMA powder (5% and 2%) and Novel Psychoactive Substances (NPS) (5% and 3%). There have been no statistically significant changes in these rates since 2015 (Figure 2.6).

The horizontal bar chart shows what percentage of 15 year olds in 2018 had used cannabis, ecstasy, cocaine, Novel Psychoactive Substances (NPS) and MDMA powder in the last month and what percentage had ever used these drugs.
Cannabis has the highest rates for having been used in the last month (11% of 15 year olds) and having ever been used (19%). Following cannabis, the drugs used in the last month were ecstasy (3%), cocaine (3%), NPS (3%) and MDMA powder (2%). Following cannabis, ecstasy had the highest rates for having ever been used (6% of 15 year olds), followed by cocaine (5%), NPS (5%) and MDMA powder (5%). — Figure 2.6 – Drugs used in last month and ever (15 year-olds) (2018)

Source: SALSUS 2018

Poly-Drug Use – Among those who had ever used drugs, 16% of 13 year-olds and 15% of 15 year-olds had used more than one drug the last time they used drugs. Rates have remained steady across both ages between 2015 and 2018.
Consumption with Alcohol – Thirty-one percent of 13 year-olds and 42% of 15 year-olds who had ever used drugs were drinking alcohol the last time they used drugs. Rates had notably decreased between 2010 and 2013, but has since risen among 15 year old boys. Rates were higher in girls than boys.
Problem Drug-Use Indicators – Of those who had ever used drugs, one in ten (10%) 13 year-olds and 7% of 15 year-olds reported feeling like they needed help due to their drug use. These proportions have remained stable over time, with no significant differences between boys and girls.

2.2.2 Alcohol and Drug Use Prevalence (15-24 Years)

Younger People: Alcohol Use

The Scottish Health Survey (SHeS) 2019^[16] provides the latest data on alcohol consumption among those aged 16 and over in Scotland. Again, this survey data is somewhat limited by underreporting and response bias.

The data showed;

In 2019, self-reported alcohol consumption among younger people (16-24 years) reached its lowest level since recording began in 2008. The reported average consumption of 10.0 units per week (drinkers only) was less than half of that in 2008 (21.6 units).
An increasing proportion are abstinent. Sixteen percent are non-drinkers; more than double that in 2008 (7%).
Younger people continue to consume less alcohol than other adult groups. The average per-week consumption was lower than the average seen across all ages (12.0 units). Of other adult groups, only those over 75 consume less.
Younger people drink less frequently than older age groups – Zero percent of respondents stated that they drank on five or more days in the previous week; lower than all older age-groups.
The proportion binge drinking has declined across the past decade but remains high – In 2019, the proportion drinking more than 4 units (males) or 3 units (females) on their heaviest drinking day was 32%, far lower than the 52% in 2009. Twenty-two percent reported drinking over 8 units (males) or 6 units (females) on their heaviest drinking day, again considerably lower than in 2008 (35%). However, the proportion drinking over 8 or 6 units was the joint highest figure across all ages, with greater prevalence among males (25%) than females (18%).

SHeS also reports on hazardous, harmful and dependent drinking. Defining hazardous/harmful drinking as the consumption of more than 14 units per week, the survey found that;

Fewer younger people are engaging in hazardous or harmful alcohol consumption than previously – Having peaked at 45% in 2009, hazardous/harmful alcohol consumption among those aged 16-24 has declined over the past decade to 20% in 2019 (Figure 2.7). This was lower than the average of 24% across all ages. Rates were twice as high among males (28% in comparison to 13% among females).

The line graph shows the percentages of 16-24 year olds and all ages who engaged in hazardous/harmful alcohol consumption by year, spanning 2008 to 2019. The graph shows an overall long-term decline. In 2019, the average for 16-24 year olds was 20%, while the average for all ages was 24%.

Source: Scottish Public Health Survey 2019

Using the Alcohol Use Disorders Identification Test (AUDIT) in order to determine the levels of hazardous, harmful or dependent alcohol use^[17], the survey reports;

Hazardous drinking is most common among younger people - 16-24 year-olds exhibited the highest rates of hazardous drinking (21%); greater than the average across all ages (14%) (Figure 2.8). Hazardous drinking was slightly greater among males (22%) than females (21%), with this gap considerably smaller than other age groups (Figure 2.9).
Harmful drinking is relatively rare among younger people – Comparable with the low rates seen across all ages, 1% of those aged 16-24 years engaged in harmful drinking.
Dependant drinking is more common among younger people – Those aged 16-24 years (4%) were more than twice as likely to exhibit drinking patterns suggestive of alcohol dependence than any other age-category. Rates of possible alcohol dependence were similar among males and females.

This bar chart shows the percentage scores for the Alcohol Use Disorders Identification Test (AUDIT) by age group in 2019. It shows that hazardous drinking is most common among 16-24 year olds and least common among 75+.

Source: Scottish Public Health Survey (SHeS) 2019

A recent study by Public Health Scotland^[18] triangulated self-reported data from SHeS 2015 with alcohol sales data to adjust alcohol consumption estimates to a more realistic level. This analysis suggested that;

the 21.61 grams per day reported by males aged 16-24 was around half of their estimated actual consumption of 37.39 grams, and;
the 12.29 grams reported by females aged 16-24 was considerably smaller than the adjusted estimate of 21.27 grams per day^[19].

While the 9.9 litres of pure alcohol sold per adult in Scotland in 2019 was lower than in 2015 (10.8 litres), similar adjustment would result in considerably higher estimates for consumption in 2019.

Younger People: Drug Use

The Scottish Crime and Justice Survey (SCJS) 2018/20^[20] provides the most recent prevalence data for drug use among those aged 15-24 years. Given the criminal justice orientation of the survey, it is likely to be even more limited by underreporting.

Drug use is far more common among younger people – Nearly one in ten (23.5%) of those aged 16-24 had taken drugs in the 12 months prior to survey. This was the highest proportion of any age group, and over ten times higher than among those aged 60 and over (1.6%).
Cannabis is by far the most commonly used drug – Cannabis was the most frequently used in the previous 12 months (21.4%), followed by cocaine (7.9%), ecstasy (5.6%), ketamine and LSD (both 3.6%). Drug use was higher among males (30.4%) than females (25.1%). 4.9% of those aged 16-24 years reported having ever used ‘legal highs’.
Most young people first try drugs in their teens – Most of those aged 16-24 years first used drugs aged 16-19 years (54.3%), followed by 10-15 years (12.7%) and 20-24 years (8.7%). 0.9% used drugs when less than 10 years old.^[21]

2.3 Alcohol and Drug Harms

2.3.1 Alcohol-Related Health-Harms

Alcohol-Related Hospital Admissions

Information Services Division’s Alcohol-Related Hospital Statistics Scotland 2019/20^[22] provides the latest data on alcohol-related hospital statistics for Scotland.

For those aged 15-24 years, the data shows that;

Alcohol-related hospital stay rates are increasing again – After a sustained decline between 2007/08 and 2016/17, the past three years have seen an increase in stay rates. In 2019/20, the hospital stay-rate was 351.7 per 100,000 (Figure 2.9). While far lower than in 2007/08, this is a 15.4% increase on the rates in 2016/17.
Hospital admissions remain lower than any older age group – They are around a third of the stay-rates among those aged 55-64 years, and around half of the Scottish average across all ages.
Rates are considerably higher among males – Across the time series, males have had far higher hospital stay rates than females; 385.2 and 318.2 per 100,000 in 2019/20, respectively.

This line graph shows the general acute hospital stay rates per 100,000 for all alcohol conditions, for 15-24 year olds, spanning 1997/98 to 2019/20. It shows a long term increase from 1997/98 until 2007/08, after which rates begin to decrease until 2016/17. Between 2016/17 and 2019/20 rates begin to increase again, reaching 351.7 per 100,000 in 2019/20. — Figure 2.9 – General acute hospital stay rates (per 100,000) for all alcohol conditions (15-24 years) (2019/20)

Source: ISD Hospital Admissions 2019/20 Data Visualisation Tool

Hospital stay rates among those under 15 years are considerably lower than all other age groups. Alcohol-related hospital stays have declined among those aged under 15 years since the time series began in 1997/98. Having peaked in 1997/98, hospitalisation rates are now at 21.2 per 100,000, with the previous year having seen a reversal of the general trend towards decline seen across recent years (Figure 2.10). In 2019/20, the stay rate was 20.7 and 21.7 per 100,000 for boys and girls, respectively.

The line graph shows the general acute hospital stay rates per 100,000 for all alcohol conditions, for 0-14 year olds, spanning 1997/98 to 2019/20. In 1997/98 there were 60 acute hospital stays per 100,000, following which there was an overall long-term decline until 2018/19, after which there was a slight increase from 20 per 100,000 to 21.2 in 2019/20. — Figure 2.10 – General Acute Hospital stay rates (per 100,000) for all alcohol conditions (0-14 years) (2019/20)

Source: ISD Hospital Admissions 2019/20 Data Visualisation Tool

Alcohol-Attributable Hospital Admissions

ScotPHO^[23] adopted the wider measure of ‘alcohol-attributable’ hospital admissions, which include an appropriate proportion of deaths from 30 chronic and acute conditions. Their most recent analysis of 2015 data showed that;

Around one in fourteen hospital patients aged 16-24 years were hospitalised due to an alcohol-attributable condition. Among those aged 16-24 years, 2,969 patients were admitted with an alcohol-attributable condition; 6.7% of all 16-24 year olds hospitalised that year.
Around one in ten of all male patients aged 16-24 years were admitted due to an alcohol-attributable condition. Ten percent (n=1,790) of male patients aged 16-24 were admitted to hospital due to an alcohol-attributable condition; the highest proportion across any age and sex category. This compared to 4.5% (n=1,179) of female patients aged 16-24 years.
Mental and behavioural disorders were the main causes of alcohol-attributable hospitalisation admissions for males aged 16-24. These accounted for 2.4% of all hospital admissions (n=244), followed by other unintentional injuries (1.7%, n=298), and all injuries (1.1%, n=196).
Intentional self-harm and ethanol poisoning were the main causes of alcohol-attributable hospitalisation admissions for females aged 16-24 years. These contributed 0.8% (n=221) and 0.8% (n=220), respectively, followed by mental and behavioural disorders (0.7%, n=187).

Alcohol-Specific and Alcohol-Attributable Deaths

Alcohol-specific deaths among those under 25 remain very low, with most deaths seen in people in their fifties and sixties. In 2020, there were 3 alcohol-specific deaths in those under 25 years; 0.25% of the total of 1,190 across all ages^[24]. Both of these deaths were in individuals aged 20-24 years; one male, one female.

In line with their reporting on hospital admissions, ScotPHO^[25] used the wider measure of ‘alcohol-attributable deaths’ as part of their reporting of 2015 data on mortality. Among individuals aged 16-24, there were 38 alcohol-attributable deaths; 18.0% of the total deaths for this age group in 2015. Deaths were five times as high among males (n=32) than females (n=6), and accounted for around twice the proportion of total deaths (20.6% and 10.7%). The three leading causes of death among males aged 16-24 in 2015 were intentional self-harm (n=12, 7.7% of total deaths), road/pedestrian traffic accidents (n=9, 5.8%), and poisoning (n=7, 4.5%). Deaths among females were led by intentional self-harm (n=2, 3.6%), road/pedestrian traffic accidents (n=2, 3.6%, n=2), poisoning (n=1, 1.8%), and epilepsy and status epilepticus (n=1, 1.8%).

2.3.2 Drugs-Related Health Harms

Problem Drug Use Prevalence

Public Health Scotland’s Prevalence of Problem Drug Use in Scotland: 2015/16 Estimates^[26] defines problem drug use as the problematic use of opioids (including methadone) and/or the illicit use of benzodiazepines, and implies routine and prolonged use. This data doesn’t capture the different profile of drugs causing harms among younger people, and predates the recent increase in harms noted in the following section.

Both the number of young people with problem drug use and their proportion of the total across all ages has declined over time. In 2015/16, around one in ten (9.21%, n=5,900) of the estimated total of problem drug users were aged 15-24 (Figure 2.11); in 2009/10, compared to around one in five (19%, n=7,900) of the total of 57,300 in 2009/10^[27]. This was the lowest prevalence across the three age-categories for which data was available (between 15 and 64 years). Rates were four times higher in males (1.42% of the total population compared to 0.33%), with this gender divide the greatest of any age group.

The pie chart shows the estimated proportion of the total population with problem drug use in 2015/16 by age. The highest proportion were 35-64 year olds, followed by 25-34 year olds, with 15-24 year olds being the lowest at 9.21%. — Figure 2.11 – Proportion of Total Population with Problem Drug Use 2015/16 by age (n=57,300)

Source: Problem Drug Use in Scotland: 2015/16 Estimates

Drug-Related Hospital Admissions

Public Health Scotland present data on hospital activity relating to illicit drug use in Scotland between 1996/97 and 2019/20^[28]. A trend has emerged towards increasing drug-related hospitalisations among younger people. Having declined between 2002/03 and 2012/13, rates among 15-24 year-olds have seen a sustained increase in the years since. In 2019/20, there were 1,716 drug-related hospitalisations among 15-24 year olds in Scotland (268.5 per 100,000); an 80% increase on the rate in 2012/13 (Figure 2.12). While both sexes have seen increases in drug-related hospitalisations in recent years, these trends have been particularly driven by an increase among males. Rates remain lower than older groups; less than half of those among aged 34-44, having been around three times as high as this age-category in 1996/97.

Source: ISD Scotland Interactive Dashboard, Drug-Related Hospital Statistics (PHS, 2021)

The profile of drugs causing harms among young people includes emerging trends and is markedly different from those of older ages. Among those aged 15-24, recent years have seen particularly sharp increases in hospital stays from sedatives/hypnotics, cocaine and cannabinoids. While opioids provide the greatest contribution to hospital stays across all ages they provide a far smaller contribution among young people. However, having followed a trend of general decline for two decades, they have risen for two consecutive years until 2019/20.

For those aged 15-24, the 2019/20 drug-related hospitalisations data^[29] shows;

Sedatives/Hypnotics^[30] (including benzodiazepines) - Rates have nearly trebled in three years to 36.5 per 100,000 in 2019/20; their highest since recording began in 1996/97 (figure 2.13). While they contributed only 7.0% of hospitalisations in 2016/17, they now contribute nearly double that (13.6%) in 2019/20. Rates among males are double that of females.
Cocaine – In 2019/20, cocaine hospitalisation rates were the highest since recording began for the fifth consecutive year (Figure 2.14). Rates have increased year-on-year from 2011/12. The rate in 2019/20 (72.1 per 100,000) is more than three times higher than in 2011/12, and more than twenty times higher than in 1996/97. Having only contributed 1.4% of all drug-related hospitalisations among those 15-24 years in the three years between 1996/99 it now contributes more than a quarter (27.1%) of hospitalisations. Rates are more than double that of all ages, with rates among young males around twice as high as females.
Cannabinoids – Hospital stays for cannabinoid use rose to their highest ever level for the fifth consecutive year, with 2018/19 to 2019/20 having seen the sharpest increase (59.3%) (Figure 2.15). The rate of 80.48 per 100,000 is nearly around two and a half times that of 2012/13, and four times higher than in 1996/97. While having contributed only 8.5% of drug-related hospitalisations in 1999/00, they now account for 29.9%. Rates are more than double the rate seen across all ages, and are more than twice as high among males than females.
Opioids – Opioid hospitalisations rates peaked in 2001/02, and declined every year between 2007/08 and 2017/18 (Figure 2.16). 2019/20 has seen the first consecutive two-year increase in the hospitalisation rate from opioids since the late 1990s (from 27.20 in 2017/18 to 39.53 per 100,000 in 2019/20). They made up 14.9% of hospitalisations in 2019/20; four times lower than the 45.3% in 2009/10, but having risen slightly for two consecutive years. Of adult groups, rates are lowest rate among those aged 16-24. Rates are higher among females (19.44 per 100,000) than males (12.53 per 100,000).
‘Other Stimulants’^[31] – Rates have remained considerably higher than across other age categories since recording began (Figure 2.17). While having declined steadily since peaking in 2015/16, the rate of 26.43 per 100,000 in 2018/19 remains around three times the rate across all ages. They contribute around one in ten (9.6%) of drug-related hospitalisations among those aged 15-24 years; nearly four times higher than across all age groups, although having steadily declined since 2014/15. While rates were nearly three times as high among males in 2018/20, this has narrowed considerably in 2019/20 due to a sharp fall among males and an increase among females.
Multiple/other drug use^[32] – While remaining lower than half of their peak of 124.66 per 100,000 in 1999/00, hospitalisation rates from multiple/other drugs have risen annually since 2011/12 to 40 per 100,000 in 2019/20, and contribute over one in four (25.2%) of drug-related hospitalisations (Figure 2.18). Rates are three times higher in males than females (103.73 and 31.55 per 100,000). Rates are slightly higher than across all ages, and are nearly three times higher in males than in females.