JOINT STATEMENT OF A/PROF SARAH THACKWAY …...Page 1 of 30 JOINT STATEMENT OF A/PROF SARAH THACKWAY...

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JOINT STATEMENT OF A/PROF SARAH THACKWAY AND DR MICHELLE CRETIKOS

3 May 2019

Name Associate Professor Sarah Thackway

Address NSW Ministry of Health, LMB 961, North Sydney, NSW 2059

Occupation Executive Director, Centre for Epidemiology and Evidence

Name Dr Michelle Cretikos

Address NSW Ministry of Health, LMB 961, North Sydney, NSW 2059

Occupation Director of Clinical Quality and Safety, Centre for Population

Health

On 3 May 2019, we, Associate Professor Sarah Thackway and Dr Michelle Cretikos

state:

1. This statement made by us accurately sets out the evidence that we would be

prepared, if necessary, to give in court as a witness. The statement is true to the best

of our knowledge and belief and we make it knowing that, if it tendered in evidence,

we will be liable to prosecution if we have wilfully stated in it anything that we know to

be false, or do not believe to be true.

Questions

2. We have been asked to respond to questions raised in the document titled “Appendix

A – Topics for written response.” We attach a copy of that document.

3. We provide our response to those specific questions below.

Response to Question 1

4. Brief CVs of Conjoint Associate Professor Sarah Thackway and Dr Michelle Cretikos. Full

CVs are attached at Appendix B and Appendix C

Conjoint Associate Professor Sarah Thackway, MPH, B.Soc.Sci, Grad Dip Epi

5. Associate Professor Sarah Thackway is the Executive Director of the Centre for

Epidemiology and Evidence, NSW Ministry of Health and holds a conjoint Associate

Professor position at the School of Public Health, University of NSW.

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6. Sarah has over 25 years’ experience in population and public health; working across the

policy, front-line and research sectors. She has held Executive roles since 2000. Sarah’s

current responsibilities are:

a) Ensuring effective population-based risk factor surveillance and reporting across NSW;

b) Delivering rapid syndromic surveillance to detect outbreaks of disease and patterns of drug-related harms;

c) Leading the state-wide data linkage capability for NSW; d) Championing data sharing for research and cross-Agency evaluation; e) Transforming complex statistical concepts into timely reports on the health of the

population; f) Strengthening data driven policy through increased access to information; g) Building data literacy and capability; h) Driving the generation of high quality, policy relevant population health research; i) Providing specialist epidemiological advice and information; and j) Driving strategic directions for the NSW public health and biostatistics training

programs.

Dr Michelle Cretikos BSc, MBBS, MPH, PhD, FAFPHM

7. Dr Michelle Cretikos is a public health physician with a PhD in health services research.

She has a master of public health, and has extensive experience in population health

program delivery, health service evaluation, epidemiology and surveillance, and public

health policy as a medical advisor.

8. Michelle is currently Director, Clinical Safety and Quality within the Centre for Population

Health, NSW Ministry of Health. The Centre is responsible for NSW Health policy,

legislation, strategy and program funding to prevent and minimise harm from lifestyle-

related conditions such as tobacco, alcohol, drugs, nutrition and physical activity-related

issues.

9. Michelle’s team is responsible for improving the quality and safety of alcohol and other

drug service delivery, and identifying and responding to emerging trends in alcohol and

drug related use and harms for NSW. Michelle’s team prepares monitoring and

surveillance information in relation to alcohol and other drugs. Michelle’s team is also

responsible for responding to notification of serious cases suspected to be related to

drug use, and coordinating a clinical and public health response to these issues. This

includes liaising with the Poisons Information Centre, local clinicians and laboratories

(including drug and alcohol services), and the NSW Forensic and Analytical Science

Services (FASS), the state reference laboratory.

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10. Michelle chairs the NSW Quality in Treatment Committee for drug and alcohol services,

and presents regularly to the quarterly Program Council for LHD and NGO delivered drug

and alcohol services. Michelle is also closely involved in strengthening the performance

monitoring framework for drug and alcohol related services. Michelle has worked in

many parts of the NSW Health system, at both state and local level. Michelle has also

been involved in national processes for policy development, program monitoring and

surveillance.

11. Michelle is currently leading the establishment of the state Alcohol and Other Drugs

Outcomes Register (AoDOR), which will be a first of its kind statewide linked dataset for

the whole treatment service sector in NSW. This register will allow population level,

system level, as well as treatment and setting specific outcomes monitoring for people

who access treatment for alcohol and other drug issues in NSW.

Summary and context

12. NSW Health monitors alcohol and other drug use and harms, including for amphetamine

type substances (ATS), using a range of behavioural survey, clinical and health system

data sources.

13. The information provides timely intelligence for policy and program responses and drives

service delivery improvement and service planning.

14. Significant harms are experienced by people using methamphetamine and other ATS,

however other substances, in particular alcohol and opioids are associated with more

deaths in the NSW community.

15. Many people who use ATS also use other substances, and many have other significant

comorbidities, including mental health conditions. These other substance use disorders,

or comorbidities may be the presenting problem or principal health concern when people

attend a health service.

16. Methamphetamine use and related harms also occur within a context of broader social

issues.

17. The prevalence of recent use (in the last 12 months) of methamphetamine in the

general community is low, and declined in NSW from 1.6% in 2010 to 0.7% in 2016.

18. Despite this decline in general community use, there is evidence in emergency

department, hospital and death data of a rapid increase in harms, with a peak in 2016.

The level of methamphetamine related harm appeared to stabilise in 2017-18.

19. Methamphetamine use is higher in disadvantaged populations and harms are higher in

males, Aboriginal people and people aged 25-44 years.

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20. The data sources and surveillance systems used to monitor alcohol and other drug use

and harms have different strengths and limitations. For example, emergency department

data is very timely, but less specific, while hospital admission and death data can be

more specific, complete and detailed, but less timely.

21. The different data sources are able to provide different insights into aspects of

substance use behaviours, health harms and treatment service provision, depending on

data characteristics such as completeness, population examined, service type and

setting.

22. People who use ATS may also experience harm from other substance use, have

comorbidities and struggle with complex social problems. In recognition of this

complexity, it is important to continue to strengthen NSW Health information systems

and reporting and feedback processes so that the health system response is

comprehensive and well integrated, and focused on delivering improved patient

outcomes.

23. NSW Health is undertaking a program of work to enhance the existing information

systems and reporting processes in relation to substance use surveillance, harms, health

service delivery and patient outcomes. This program of work includes:

a) Establishing a statewide, linked data register (AoDOR) that will facilitate a better

understanding of patient outcomes;

b) Enhancing access to clinical information, and the process of feedback of this

information to relevant clinicians to support improvements to the system of service

delivery and the clinical processes of care;

c) Enhancing the coverage of the system of surveillance (PHREDSS) for emergency

departments located in regional areas of NSW;

d) Strengthening the surveillance for acute, severe drug-related toxicity in emergency

departments and intensive care units;

e) Strengthening relationships with clinical and toxicological networks to enhance

identification and communication of emerging drug issues and an appropriate

statewide response.

Background

24. People use and may experience harms from a variety of amphetamine type substances

(ATS). The ATS group includes methamphetamine and methylenedioxy

methamphetamine (MDMA). The crystal form of methamphetamine is known as ‘ice’,

and MDMA is also known as ‘ecstasy’.

25. Harms from ATS are dependent on the type of amphetamine, dose, and the method and

frequency of use. For example, injected use is associated with greater harm than oral

ingestion. Although methylenedioxy methamphetamine (MDMA) use in the general

community is higher, methamphetamine related harms are greater.

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Purpose

26. NSW Health collects information on ATS use and harms from a range of sources for two

main purposes:

a. To inform short and long term policy responses by:

i. monitoring changes in patterns of use, harms and populations at risk;

ii. providing rapid intelligence to respond to alcohol and other drug-

related incidents.

b. To improve service delivery and patient outcomes.

Data sources and information systems

27. NSW Health uses a range of data sources and information systems to monitor alcohol

and other drug use and harms. The following data sources have been the main source of

information presented in this statement.

28. Health system data:

a) Hospitalisations sourced from the Combined Admitted Patient Epidemiology Data

(CAPED), NSW Ministry of Health

b) Emergency department presentations sourced from the NSW Public Health Rapid,

Emergency, Disease and Syndromic Surveillance (PHREDSS) system, NSW

Ministry of Health. NSW is the only jurisdiction in Australia that has the capacity

to report this data in a rapid way.

c) NSW Alcohol and Other Drug Treatment Services Minimum Data Set, NSW

Ministry of Health

29. Behavioural surveys:

a) National Drug Strategy Household Survey (NDSHS), Australian Institute of Health

Welfare (National and NSW estimates where available)

b) Illicit Drug Reporting System, National Centre for Drug and Alcohol Research

(NDARC)

Other data sources

30. Further information may be obtained from clinical information systems such as the

electronic medical records (eMR), as well NSW Ambulance data, toxicology data, and

other information service and treatment service data. NSW Health also draws on data

from other NSW Government agencies, and national administrative and research data to

assist in understanding the extent and impact of ATS harms.

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Current information and reporting enhancements

31. NSW Health is currently establishing a statewide, linked Alcohol and Other Drug

Outcomes Register (AoDOR) that will facilitate improved planning, delivery and

evaluation of AOD services across government and non-government services statewide.

By linking data from across the system, NSW Health will gain a better understanding of

patient characteristics and patterns of service utilisation, and importantly, longer-term

health and social outcomes. Appendix D lists the data sources that will be linked within

the AoDOR. In 2018, NSW Health obtained approval to create the AoDOR under the

Public Health Act and is currently working on creating the linked data set for use. It is

anticipated the first component of the linked dataset would be available for use in 2020.

32. By also enhancing the level of clinical information that can be routinely linked to the

existing administrative data, we will be able to develop a better understanding of the

quality of service delivery and impact of clinical services on patient outcomes statewide.

33. NSW Health proposes to enhance surveillance for serious drug related illness through

emergency departments and intensive care units, to inform clinical management and

complement existing surveillance systems for acute, severe toxicity. This process is

already being piloted in NSW in relation to serious, acute drug related toxicity in the

music festival setting.

34. NSW Health is currently updating the NSW methamphetamine use and related harms

surveillance report. This updated report will be published by 30 June 2019 following a

peer review process.

Response to Question 2(a)

Poly substance use

Australian Institute of Health and Wellbeing, National Drug Strategy Household Survey in

2016

35. The National Drug Strategy Household Survey (NDSHS) is the leading survey of licit and

illicit drug use in Australia.

36. Among recent Australian methamphetamine users, 75% reported using alcohol and 71%

reported using at least one other substance at the same time (excluding tobacco and

alcohol).

National Drug and Alcohol Research Centre (NDARC), Illicit Drug Reporting System, NSW

2016

37. The Illicit Drug Reporting System (IDRS) is a national illicit drug monitoring system

intended to identify emerging trends of local and national concern in illicit drug markets.

38. In 2018 in NSW, among people who inject drugs, 76% recently (in the last 6 months)

used crystal methamphetamine; and 83% recently used heroin (IDRS NSW 2018).

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Methamphetamine use

Australian Institute of Health and Wellbeing, National Drug Strategy Household Survey, 2016

39. The prevalence of recent (within the last 12 months) methamphetamine or

amphetamine use in the NSW population aged 14 years and above has significantly

decreased from 1.6% (2010) to 0.7% (2016) and is much lower than single occasion

high risk alcohol consumption (within the last 12 months) of 35%, in 2016.

40. Although methamphetamine use in the general community is decreasing, among current

users, the proportion reporting daily use is increasing, particularly among males.

41. In 2016, the NSW prevalence of recent methamphetamine use varied by age group:

a) 1% for people aged 14-35 years (confidence interval 0.4-1.5%, standard error

0.28%)

b) 1% for people aged 35-54 years (confidence interval 0.5-1.5%, standard error

0.24%)

c) Use in people aged 55 years and above was too low to produce an estimate.

42. In 2016, metropolitan and rural estimates of general community use across NSW were

not reliable because of low prevalence resulting in small numbers.

Methylenedioxy methamphetamine (MDMA) use

Australian Institute of Health and Wellbeing, National Drug Strategy Household Survey in

2016

43. The prevalence of recent (within the last 12 months) MDMA use in the NSW population

aged 14 years and over was relatively stable in NSW (2.9% in 2010, 1.9% in 2016).

44. In people aged 14 years and over, more males (2.3%) than females (1.5%) reported

recent use of MDMA.

45. In 2016, the NSW prevalence of recent methamphetamine use varied by age group:

a. 4.3% for people aged 14-35 years (confidence interval 3.2-5.5, standard

error 0.14)

b. 1% for people aged 35-54 years (confidence interval 0.6-1.5, standard error

0.24)

c. Use in people aged 55 years and above was too low to produce an estimate.

46. In 2016, metropolitan and rural estimates of general community use across NSW were

not reliable because of low prevalence resulting in small numbers.

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47. Geographic trends in patterns of use in those who use drugs across NSW are not able to

be derived from the Illicit Drug Reporting System behavioural survey performed by

NDARC, as this survey uses a metropolitan-based population only. For NSW in 2018, the

survey population was restricted to Sydney residents.

Response to Question 2(b)

48. NSW Health receives ambulance triple zero (000) call data on a four hourly basis for

public health surveillance purposes. This information is included in the PHREDSS system,

however is not specific enough to use for ATS monitoring as it does not systematically

record drug type. The ambulance call problem ‘overdose, poisoning and ingestion of

substances’ is used to support ED based alcohol and other drug surveillance.

49. NSW Ambulance also hold clinical data, collected during the patient care episode by

paramedics, in either the electronic medical record (eMR) or the paper based Patient

Health Care Record. Information available includes; demographics, clinical assessment

including vital signs and injury/illness characterisation, treatment provided and

outcomes. The Ambulance clinical information is not used for routine ATS related

surveillance at this time, but will be included for use in the statewide, linked Alcohol and

Other Drugs Outcomes Register (AoDOR).

Response to Question 2(c)

50. NSW Health routinely collects data on people who access health services. This data can

be used to identify particular groups presenting with greater ATS harms. Hospital

admissions and emergency department (ED) presentations may be analysed by: gender,

age, Aboriginal status and geographic region.

Hospitalisations

51. NSW hospitalisation data is sourced from the Combined Admitted Patient Epidemiology

Data (CAPED), NSW Ministry of Health. For this analysis data up to 30 June 2018 from

both public and private hospitalisations were included. Please see the response to

Question 4 below in relation to geographic trends for ATS related hospitalisations.

All ATS

52. The rate of all ATS related hospital admissions increased from 80 per 100,000 population

in 2011-12 to 169 per 100,000 population in 2017-18, with a peak of 193 per 100,000

population in 2016-17.

53. Of all ATS hospitalisation episodes of care for the financial years 2016-17 and 2017-18:

a) Methamphetamine accounted for 70% of hospitalisations

b) MDMA accounted for 6% of hospitalisations

c) Other and unspecified ATS accounted for the remaining 24% ATS

hospitalisations. This unspecified ATS use may include methamphetamine or

MDMA use.

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Methamphetamine

54. The rate of methamphetamine related hospital admissions increased rapidly from 22 per

100,000 population in 2011-12 to 118 per 100,000 population in 2017-18, with a peak of

134 per 100,000 population in 2016-17.

55. In 2017-18 rates of methamphetamine related hospitalisation were substantially higher

in males (161 per 100,000 population) compared to females (76 per 100,000 population)

and among Aboriginal people (740 per 100,000 population) compared to non-Aboriginal

people (102 per 100,000 population).

56. Rates of methamphetamine related hospitalisation were higher in all but the least

disadvantaged quintile.

MDMA

57. The rate of MDMA related hospital admissions was well below the rate of

methamphetamine related hospitalisations.

58. The rate of MDMA related hospitalisation increased slightly from around 4 per 100,000

population in 2011-12 to 11 per 100,000 population in 2017-18, with a peak of 12 per

100,000 population in 2016-17.

59. In 2017-18 rates of MDMA related hospitalisation were substantially higher in males (13

per 100,000 population) compared to females (8 per 100,000 population) and among

Aboriginal people (25 per 100,000 population) compared to non-Aboriginal people (10

per 100,000 population).

Other substances

60. The impact of other substances in relation to hospitalisation is substantial.

Opioids

61. The rate of opioid related hospitalisations in NSW for the period 2015-16 to 2017-18 was

very similar to the rate of ATS related hospitalisations (Figure 1).

62. The rate of opioid related hospital admissions increased from 147 per 100,000

population in 2011-12 to 171 per 100,000 population in 2017-18, with a peak in opioid

related hospitalisations of 183 per 100,000 population in 2016-17.

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Figure 1. Rate of ATS and opioid hospitalisations per 100,000 population, by

substance, NSW, 2011-12 to 2017-18

Alcohol

63. The impact of other substances in relation to hospitalisation is substantial, in particular

for alcohol.

64. In 2016-17 in NSW, the rate of alcohol-attributable hospitalisations were 610 per 100

000 population. Rates of Alcohol-attributable hospitalisation rates are not directly

comparable to the ATS hospitalisation rates as attributable fractions, developed by the

Australian Institute of Health and Welfare (AIHW) from the Australian Burden of Disease

Study 2011 (Australian Institute of Health and Welfare 2016. Australian Burden of

Disease Study: Impact and causes of illness and death in Australia 2011—summary

report. Australian Burden of Disease Study series no. 4. BOD 5. Canberra: AIHW) are

used. However this is the best way to measure alcohol related hospitalisations as alcohol

is commonly associated with both acute and chronic illness.

0

50

100

150

200

250

2011-12 2012-13 2013-14 2014-15 2015-16 2016-17 2017-18

MDMA MethamphetamineOther/unspecified amphetamine-type stimulants All amphetamine-type stimulantsOpioids

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National Alcohol and Drug related hospitalisations: AIHW, December 2018.

https://www.aihw.gov.au/reports/alcohol-other-drug-treatment-services/drug-related-

hospitalisations/contents/content

65. According to the Australian Institute for Health and Welfare (AIHW) across Australia in

2016-17 there were 137,000 hospital separations with a drug or alcohol related principal

diagnosis reported. This represented 1.2% of all hospital separations. Alcohol accounted

for 51% of the drug related separations.

66. The 137,000 hospital separations with a drug or alcohol related principal diagnosis

comprised:

a) 70,011 hospital separations with an alcohol related principal diagnosis;

b) 8,652 separations with a methamphetamine related principal diagnosis;

c) 8,615 total separations with an opioid related principal diagnosis;

d) 6,302 separations with a cannabinoids related principal diagnosis; and

e) 5,654 separations with other amphetamines related principal diagnosis.

Emergency department presentations

67. Emergency department presentations related to ATS were sourced from the NSW Public

Health Rapid, Emergency, Disease and Syndromic Surveillance (PHREDSS) system, NSW

Ministry of Health.

68. Emergency department surveillance is conducted across 64 NSW EDs using PHREDSS.

Diagnoses are coded by clinicians rather than clinical coders and usually do not identify

the drug type, for example ‘drug intoxication’. To conduct drug specific surveillance for

methamphetamine and MDMA, relevant ED presentations are identified using a keyword

search for relevant terms such as ‘ice’, ‘meth’, ‘MDMA’, ‘ecstasy’ across diagnosis and

triage text fields. Methamphetamine ED presentations are restricted to drug, alcohol and

mental health surveillance syndromes to minimise the large number of false detections

associated with the term ‘ice’, particularly for injuries, whereas MDMA presentations are

not restricted.

69. In 2017-18 there were over 1.85 million unplanned ED presentations to 64 NSW

hospitals:

a) Of these 5.6% were within the ‘mental health problems’, ‘alcohol problems’,

‘selected illicit drugs’ or ‘poisoning and overdose’ PHREDSS surveillance

syndromes.

b) Methamphetamine related ED presentations accounted for 0.24% of all

unplanned ED presentations.

c) Methamphetamine related ED presentations accounted for 4.32% of the ‘mental

health problems’, ‘alcohol problems’, ‘selected illicit drugs’ or ‘poisoning and

overdose’ PHREDSS surveillance syndromes.

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Methamphetamine

70. Methamphetamine related ED presentations were restricted to the alcohol, mental health

issues, some illicit drugs and poisoning and overdose surveillance syndromes leading to

an underestimate of approximately 40%, as determined by a validation study.

71. The number of methamphetamine related emergency department (ED) presentations in

NSW increased from 1,278 in 2011-12 to 4,525 in 2017-18, with a peak of 5,144

methamphetamine related emergency department presentations in 2015-16.

72. The majority of methamphetamine-related ED presentations were in the 25-34 and 35-

44 year age groups.

73. Males accounted for 70% of methamphetamine-related ED presentations in 2017-18.

74. To adjust for increasing activity over time at the 64 PHREDSS reporting hospitals a rate

per 1,000 ED presentations was used. The rate of methamphetamine-related ED

presentations in NSW increased from 0.8 per 1,000 presentation in 2011-12 to 2.4 per

1,000 presentations in 2017-18. The rate was at 3.0 per 1,000 presentations in 2015-16.

75. This trend over time was evident among both men and women, and all age groups.

76. Although the count of methamphetamine-related ED presentations in 2017-18 remained

higher (2,931) in metropolitan Sydney Local Health Districts (LHDs) compared to rural

and regional LHDs (1,594), when adjusted for activity the rates per 1,000 ED

presentations were similar (2.46 per 1,000 ED presentations in metropolitan LHDs

compared to 2.36 per 1,000 ED presentations in rural and regional LHDs).

77. In 2017-18, 30.2% of methamphetamine related ED presentations were admitted, lower

than 2016-17 (33.9%).

78. Of those admitted in 2017-18, 5.5% were admitted directly from ED to a critical care

ward, higher than in 2016-17 (2.2%).

MDMA

79. MDMA related ED presentations were not restricted to any PHREDSS surveillance

syndromes, which minimised the underestimation of MDMA related ED presentations.

80. The number of MDMA related emergency department (ED) presentations in NSW

increased from 861 in 2011-12 to 1,454 in 2017-18, with a peak of 1,663 presentations

in 2015-16.

81. The majority (70%) of MDMA related ED presentations were in 16-24 year olds.

82. Males accounted for 66% of MDMA related ED presentations in 2017-18.

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83. To adjust for increasing activity over time at the 64 PHREDSS reporting hospitals a rate

per 1,000 ED presentations was calculated. The rate of MDMA related ED presentations

in NSW increased from around 0.6 per 1,000 presentations in 2011-12 to 0.8 per 1,000

presentations in 2017-18, with a peak of 1.0 per 1,000 presentations in 2015-16.

84. This trend over time was evident among both men and women, and all age groups.

85. The months of December and January had the highest counts of MDMA related ED

presentations each year.

86. MDMA related ED presentations occurred more frequently on weekends and public

holidays, especially over the new year period.

87. The rate of MDMA related ED presentations per 1,000 presentations in rural and regional

LHDs (0.6 per 1,000 ED presentations) was half of that seen in metropolitan Sydney

LHDs (1.2 per 1,000 ED presentations).

88. In 2017-18, 20% of MDMA related ED presentations were admitted, similar to 2016-17

(21%).

89. Of those admitted in 2017-18, 12.3% were admitted directly from ED to a critical care

ward, higher than in 2016-17 (9.9%).

Response to Question 2(d)

90. For hospitalisations the data are sourced from NSW Combined Admitted Patient

Epidemiology Data (CAPED) and ABS population estimates. NSW Health uses the

International Statistical Classification of Diseases and Related Health Problems, Tenth

Revision, Australian Modification (ICD-10-AM). It consists of a tabular list of diseases and

accompanying index. For case selection in methamphetamine hospitalisations the

following codes are used if found in either the primary or secondary diagnosis fields, and

are across two main sections (F codes: mental and behavioural disorders, and T codes:

injury, poisoning and certain other consequences of external poisonings).

91. For example, for methamphetamine related hospitalisations, the following codes are

used:

a) poisoning by methylamphetamine: T43.61 or

b) mental and behavioural disorders due to use of methylamphetamine: F15.01,

F15.11, F15.21, F15.31, F15.41, F15.51, F15.61, F15.71, F15.81 or F15.91

92. For emergency department presentations, NSW Health’s data is aggregated using the

Rapid Emergency Department Data for Surveillance (REDDS). The case selection is

based on key word searches within the nursing assessment text – specifically “ice”,

“meth”, or “metham”. Selection is also based on provisional diagnosis within one of the

alcohol and other drugs syndromes.

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93. Further information on the pattern of clinical diagnoses associated with ATS is provided

below in relation to comorbidities.

Response to Question 2(e)

94. Methamphetamine related emergency department presentations and hospitalisations are

commonly associated with other substance use issues, a range of mental health

conditions, and psychosocial circumstances.

95. In 2017-18:

a) 50% of methamphetamine related ED presentations were assigned a mental

health-related provisional diagnosis, included in the ‘mental health problems’

surveillance syndrome (PHREDSS, NSW Health).

b) 42% (2,897) of methamphetamine related hospitalisations had a

methamphetamine related code in the primary diagnosis field.

96. In 2017-18, of the hospitalisations where a methamphetamine code was recorded in the

primary diagnosis field, the top 10 primary diagnoses were

a) substance use related (1,770 hospitalisations for dependence, harmful use,

withdrawal, and acute intoxication) and

b) mental health conditions (1,006 hospitalisations for psychotic disorder),

including:

i. F15.21: Mental and behavioural disorders due to use of

methylamphetamine- Dependence syndrome (1034 hospitalisations)

ii. F15.51: Mental and behavioural disorders due to use of

methylamphetamine - Psychotic disorder (1006)

iii. F15.11: Mental and behavioural disorders due to use of

methylamphetamine - Harmful use (291)

iv. F15.31: Mental and behavioural disorders due to use of

methylamphetamine - Withdrawal state (271)

v. F15.01: Mental and behavioural disorders due to use of

methylamphetamine - Acute intoxication (174)

vi. T43.61: Psychostimulants with abuse potential, methylamphetamine (89)

vii. F15.81: Mental and behavioural disorders due to use of

methylamphetamine - Other mental and behavioural disorders (19)

viii. F15.91: Mental and behavioural disorders due to use of

methylamphetamine - Unspecified mental and behavioural disorder (10)

ix. F15.61: Mental and behavioural disorders due to use of

methylamphetamine - Amnesic syndrome (2), and

x. F15.41: Mental and behavioural disorders due to use of

methylamphetamine - Withdrawal state with delirium (1 hospitalisation).

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97. In order to further understand patient comorbidity in methamphetamine related

hospitalisations with a primary methamphetamine related diagnosis, the first five other

diagnosis fields were examined.

98. For the 2,897 primary methamphetamine related hospitalisations in 2017-18, 5,414

other diagnoses were identified in the first five recorded secondary diagnosis fields.

These were principally related to:

a) other substance use related diagnoses – 2,424 diagnoses due to use of

cannabinoids, other stimulants, alcohol, opioids, tobacco, sedatives/hypnotics,

cocaine;

b) mental health conditions - 880 diagnoses due to chronic mental and behavioural

disorders, personality disorders, schizophrenia, anxiety, severe stress and

adjustment disorders, depression, bipolar affective and schizoaffective disorders;

c) psychosocial related diagnoses – 559 diagnoses due to housing and economic

circumstances, problems with primary support group including family, other

psychosocial circumstances; and

d) chronic viral hepatitis – 248 diagnoses.

99. In 2017-18, of 3,961 hospitalisations where a methamphetamine code was recorded in

any diagnosis field other than the primary diagnosis field, the top 10 primary diagnoses

were predominantly:

a) mental health related (1,363 diagnoses) and

b) other substance use related (831 diagnoses for alcohol, cannabinoids and

opioids) including:

i. F20: Schizophrenia (531 hospitalisations)

ii. F10: Mental and behavioural disorders due to use of alcohol (368)

iii. F12: Mental and behavioural disorders due to use of cannabinoids (263)

iv. F43: Reaction to severe stress, and adjustment disorders (231)

v. F25: Schizoaffective disorders (203)

vi. F11: Mental and behavioural disorders due to use of opioids (200)

vii. F31: Bipolar affective disorder (155)

viii. F60: Specific personality disorders (143)

ix. R45: Symptoms and signs involving emotional state (113), and

x. F32: Depressive episode (100 hospitalisations).

Response to Question 2(f)

100. Many drug related deaths occur in community settings, not in the hospital setting.

Therefore the NSW Ministry of Health uses the Cause of Death Unit Record File

produced by the ABS to monitor drug related deaths in NSW. Psychostimulant-induced

deaths (excluding cocaine) increased from 51 deaths in 2010 to 197 deaths in 2016 in

NSW. This is consistent with the increase in methamphetamine related harms seen in

other data sources. In NSW in 2016, 121 of the 197 psychostimulant induced deaths

(61%) included other classes of drugs as the underlying or associated cause of death.

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101. Drug related and drug induced deaths demonstrate a much higher burden for opioids

than ATS. The ABS and NDARC both report on drug deaths, and though different

methods are used, both report a significantly higher number of opioid deaths. For

Australia in 2016, NDARC reports higher rates of drug induced deaths for opioids

compared with amphetamines (4.58 vs. 0.45 deaths per 100,000 population). For

Australia in 2016, the ABS reports that there were 1,353 opioid related deaths and 363

psychostimulant related deaths (including MDMA, and meth/amphetamine).

102. The Alcohol and Other Drug Outcomes Register (AoDOR) will allow further more

detailed analyses in relation to ATS related deaths in future. In 2018, NSW Health

obtained approval to create the AoDOR under the Public Health Act and is currently

working on creating the linked data set for use. The new Register will contain 12

datasets (Appendix D) and will be used to:

a) facilitate measurement and monitoring of the impact of alcohol and other drug

treatments and services provided to patients;

b) identify, measure and monitor of health outcomes of patients who experience

alcohol and other drug related harm, and

c) plan and evaluate services, treatment and programs for people who experience

alcohol and other drug related harm across government and non-government

service settings.

Response to Question 2(g)

Kirby Institute, Australian Needle and Syringe Program Survey, 2016

103. Of those attending Needle and Syringe Program services in NSW, an increasing

proportion reported injecting drugs at least daily in the past month, and a decreasing

proportion reported no drug injection in the past month.

NDARC, Illicit Drug Reporting System, 2018

104. Showed that 76% of survey participants recently used methamphetamine, all of whom

used the crystal form.

105. NSW-based surveys show an increasing proportion of people who inject drugs report

methamphetamine as the drug injected most often, and as the drug last injected.

106. Between 2011 and 2018 there appears to be little change in perceived availability over

time of crystal methamphetamine amongst surveyed people in NSW who inject drugs,

with around 90% reporting access as ‘easy’ or ‘very easy’ in 2018.

107. In NSW the median price per gram of crystal methamphetamine reported by people

who inject drugs has decreased, falling from $400 per gram in 2016 to $250 per gram

in 2018.

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108. Variation in the general community use of methamphetamine and other ATS has been

described above.

NSW Alcohol and Other Drug Treatment Services Minimum Data Set, NSW

Ministry of Health

109. This data set is able to provide information on the principal versus other drugs of

concern in people who are accessing alcohol and other drug treatment services across

NSW.

110. For unique patients seen at NSW funded alcohol and other drug treatment services

(which includes services delivered by both NSW government and NSW funded non-

government services), methamphetamine was reported as a drug of concern for 7,903

people in 2015-16 and 6,781 in 2017-18 (Table 1). This excludes people who reported

other ATS as the principal or other drug of concern.

Table 1. Methamphetamine reported as the principal, or secondary or other drug

of concern, NSW funded alcohol and other drug treatment services, 2015-16 to

2017-18

Methamphetamine reported as 2015-16 2016-17 2017-18

Principal drug of concern 5479 5708 5150

Secondary or other drug of concern 2424 1891 1631

Total 7903 7599 6781

111. For the period 2015-16 to 2017-18, where methamphetamine was reported as the

principal drug of concern, the most commonly reported secondary or other drugs of

concern were cannabis (43%), alcohol (23%), opioids (15%) and other ATS (11%).

112. For the period 2015-16 to 2017-18, where methamphetamine was reported as the

secondary or other drug of concern, the most commonly reported primary drugs of

concern were opioids (39%), cannabis (31%), and alcohol (25%).

113. By comparison, for unique patients seen at NSW funded alcohol and other drug

treatment services, opioids were reported as a drug of concern for 9,422 people in

2015-16 and 8,317 people in 2017-18 (Table 2).

Table 2. Opioids reported as the principal, or secondary or other drug of concern,

NSW funded alcohol and other drug treatment services, 2015-16 to 2017-18

Opioids reported as 2015-16 2016-17 2017-18

Principal drug of concern 6874 6804 6504

Secondary or other drug of concern 2548 2029 1813

Total 9422 8833 8317

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114. Demographic and geographic trends as related to health services

115. Analysis of remoteness areas uses the ABS Accessibility/Remoteness Index of Australia Plus (ARIA plus). This is an index value based on road distance to major service centres e.g. health, education, or retail (GISCA). In the report, remoteness areas are classified as Major cities; Inner regional; Outer regional and remote areas. The term rural and remote is used when referring generally to areas outside Major Cities.

ATS

116. In order to examine the geographic trends in hospital admissions related to ATS, the

hospital data for NSW public hospitals only was used.

117. For NSW public hospitals, the rate of ATS related hospitalisations was higher for those

living in inner regional areas than for those living in major cities or outer regional or

remote areas for the period 2010-11 to 2017-18 (Figure 3).

118. In 2017-18, the rate of ATS related hospitalisation in public hospitals was 122 per

100,000 population in major cities, 153 per 100,000 population in inner regional and

125 per 100,000 population in outer regional and remote areas (Figure 3).

Figure 3: Rate of amphetamine type substance related hospital separations per

100,000 population by remoteness, public hospitals, NSW, 2010-11 to 2017-18

Source: CAPED, NSW Ministry of Health

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Methamphetamine

119. In 2017-18 the rate of methamphetamine related hospitalisation in public hospitals

was 87 per 100,000 population in major cities, 106 per 100,000 population in inner

regional and 97 per 100,000 population in outer regional and remote areas (Figure 4).

Figure 4: Rate of methamphetamine related hospital separations per 100,000

population by remoteness, public hospitals, NSW, 2010-11 to 2017-18

Source: CAPED, NSW Ministry of Health


120. The quality, completeness, reliability, usefulness, and limitations of NSW Health data

121. The data sources and surveillance systems used to monitor alcohol and other drug use

and harms have different strengths and limitations. For example, emergency

department data is very timely, but less specific, while hospital admission and death

data can be more specific, complete and detailed, but less timely.

122. The different data sources are able to provide different insights into aspects of

substance use behaviours, health harms and treatment service provision, depending

on the data characteristics such as completeness, population examined, service type

and setting.

123. For all clinical data sources, the reliability of the information in relation to ATS is

dependent on whether methamphetamine or other ATS were recorded as a feature in

the patient’s presentation. The other strengths and limitations of the two principal

NSW Health principal data sources used in this statement are as follows:

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Hospitalisations using CAPED

124. CAPED is a complete census of all NSW public and private hospital separations. It does

not have the coverage issues of ED data.

125. CAPED contains multiple diagnoses coded systematically by clinical coders using

internationally standardised diagnoses codes.

126. Hospitalisation data is not timely and is usually available 6 months after the end of the

financial year.

Emergence Department data using PHREDSS

127. PHREDSS is very timely, can report on unusual increases from yesterday and provides

stable trends over time.

128. PHREDSS reporting includes presentations to the 65 EDs captured accounted for 86%

of total NSW public emergency department activity in 2016/17.

129. The number of PHREDSS reporting hospitals have increased over time, although

coverage remains lower in rural locations. Coverage is higher in metropolitan Sydney

areas (97%) compared with the rest of NSW (73%) and can be reported from January

2011.

130. ED data only include one diagnosis code and coding of diagnoses are conducted by

clinicians at the completion of the presentation, not clinical coders. Non-specific codes

are used most frequently making the identification of drug types challenging.

131. Methamphetamine ED presentations are restricted to drug, alcohol and mental health

surveillance syndromes to minimise the large number of false detections associated

with the term ‘ice’, particularly across injuries.

132. MDMA presentations are not restricted to the drug, alcohol and mental health

surveillance syndromes.

133. The keyword search approach, used for ATS and other drug surveillance like opioids

may undercount presentations of interest, however the purpose of surveillance is to

identify trends over time rather than estimate burden.

134. While underestimation of presentations is one of the limitations, the trend analyses are

stable over time.

135. Rural hospitals are gradually being added to the PHREDSS system with the aim of

including all hospitals with electronic reporting capability within the next two years.

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136. NSW is the only jurisdiction in Australia that has the capacity to report this data in a

rapid way.

137. Further information about the data sources used in this statement is provided in

Appendix B. A full list of data sources that may be used to monitor ATS use and

related harms was provided in NSW Health’s previous submission to the Special

Commission of Inquiry dated 12 March 2019 (ref H19/16827).

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Appendix A:

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Appendix B: Curriculum Vitae of Sarah Thackway Brief Bio

Associate Professor Sarah Thackway is the Executive Director of the Centre for Epidemiology and

Evidence, NSW Ministry of Health and holds a conjoint position at the University of NSW. Sarah has

30 years’ experience in population and public health working across the policy, front-line and

research sectors. Sarah’s current responsibilities are:

• Leading the strategic, population health research agenda for NSW;

• Implementing state-wide data linkage for research and cross-Agency evaluation;

• Transforming complex statistical concepts into timely reports on the health of the

population;

• Operating syndromic surveillance to detect outbreaks in near-real time, and

• Providing strategic directions for the NSW public health and biostatistics training programs.

Recently Sarah led the NSW Health and Medical Research Strategic Review and the development of

the inaugural NSW Translational Research Grant Scheme. Currently she is establishing the NSW

Health China Desk within the Ministry of Health.

Select Executive Capabilities and Key Career Highlights

Leadership and strategic thinking

� Held Executive roles since 2000. These roles have cultivated productive working relationships

across sectors in Government (International, Federal and jurisdictional), NGOs and

Universities.

� Strong networks across Health and other Agencies have enabled the delivery of key projects.

� Led the NSW Health team for the state-wide NSW Health and Medical Research Strategic

Review.

� Australian and New Zealand School of Government Alumni.

Change management

� Reformed the Centre for Epidemiology and Evidence into a client-focused team with strategic

goals.

� Implemented a client services model to deliver evaluation and data services.

� Led multiple, large-scale transitions of teams including the amalgamation of population health

services (>120 people) across two Area Health Services, the transfer of the Office of Medical

Research (Department of Trade and Investment), the integration of the Centre for Health

Record Linkage (Cancer Institute) into NSW Health and the outsourcing of the Population

Health Survey.

Crisis management

� Extensive experience of working with multiple stakeholders on complex problems.

� Significant understanding and experience in managing and responding to public health

incidents applying ‘command-and-control’ approaches.

� Media spokesperson for public health concerns.

� Delivered novel, real-time surveillance for the Sydney Olympic Games and subsequently

invited to participate on international expert panels (Greece, Italy, Spain and China).

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Analytics, research and innovation

� Re-defined data linkage in NSW to accelerate access to data, realise cross-Agency linkage and

develop a new approach to linking bio-specimens to administrative datasets.

� Implemented a national first, dual-frame sampling for the NSW Health Survey to include

mobiles.

� Developed and led the NSW inaugural translational research grants program.

� Delivered transformational state-wide information management systems, including the

Population Health Information Management System and SAPHaRI

� Steered the development of the open data portal, Health Statistics NSW.

� Re-focused the flagship Report of the Chief Health Officer into a ‘narrative-driven’ data report.

� Understand the nexus between data/research evidence and policy and practice and regularly

act as a knowledge broker across a range of cross-sector, wicked problems.

Career profile

2006– present EXECUTIVE DIRECTOR, EPIDEMIOLOGY AND EVIDENCE, NSW Ministry of Health

� Lead a team of 120 people with a $20m budget.

� Develop, implement and evaluate strategies for the comprehensive surveillance and reporting

of health status, health risks, health outcomes and the performance of population health

programs.

� Lead the State-wide data linkage capability for NSW.

� Devise, implement and evaluate an integrated strategy to improve the uptake of research into

policy and practice and foster a knowledge-based approach to health policymaking in NSW.

� Drive the generation of high quality, policy relevant population health research.

� Develop, implement and evaluate strategies to build the skills and capacity of the NSW

population health workforce and to prepare future leaders and managers of the NSW health

system.

� Provide specialist epidemiological advice and information.

� Build capability and develop statistical information infrastructure to support population

health.

2005-2006 DIRECTOR, POPULATION HEALTH, South Eastern Sydney and Illawarra Health

� Led the Division of Population Health; Public Health, Health Promotion, HIV/AIDS and Related

Diseases, Women’s Health, Multicultural Health, Homelessness and Youth Health (140 FTE).

2000-2005 DIRECTOR, PUBLIC HEALTH, POPULATION HEALTH, Illawarra Health

� Led the strategic planning and response to communicable disease control, health protection

and health promotion.

�

1999-2000 MANAGER, OLYMPIC EPIDEMIOLOGICAL SURVEILLANCE, NSW Health

� Developed an integrated on-line Olympic Surveillance System to detect unusual patterns of

illness and injury in near ‘real-time’.

1997-1999 PUBLIC HEALTH OFFICER, NSW Health

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Recent Significant Committees

2018 NSW Health Analytics Framework: Implementation Committee

2018 NSW Strategic Analytics and Streamlined Information (Chair)

2017-18 NSW Cross-Agency Data Sharing Reference Group

2014 - 18 NHMRC Partnership Centre on Systems Perspectives on Preventing Lifestyle-Related

Chronic Health Problems: Executive Leadership Team

2017 NSW Prevention Research Support Program

2011-17 Australian Population Health Research Network Council

2015 - 17 NSW Premier’s Priority: Childhood Obesity: Expert Panel

2014 NHMRC Reference Group for Health and Health Services Research Data

2011-2012 NSW Health and Medical Strategic Research Review Advisory Committee

Academic profile

2016 Executive Fellow, Australian and New Zealand School of Government

Tertiary qualifications

1997-1999 Graduate Diploma of Applied Epidemiology, VETAB

1993-1995 Master of Public Health (Research), University of New South Wales

1990-1992 Bachelor of Social Science (Human Geography), University of New South Wales

Conjoint Academic positions

2010-2021 Associate Professor, University of NSW

2006-2010 Visiting Principal Fellow, University of Wollongong

2001-2006 Honorary Senior Fellow, University of Wollongong

Peer-review grant recipient

2013 – 2018 Principal Investigator, Partnership Centre on Systems Perspectives on Preventing

Lifestyle Related Chronic Health Problems. 2013 - 2018. $21m, including $11m from

the NHMRC.

2011- 2016 Associate Investigator, Centre for Informing Policy in Health with Evidence from

Research (CIPHER), NHMRC Centre for Research Excellence: $2,496,375

Peer reviewer

20 years’ experience with 10 journals (national and International)

Peer Review Publications = 49

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Appendix C: Curriculum Vitae of Dr Michelle Cretikos

Qualifications BSc MBBS

Master of Public Health

PhD in Health Services Research

Fellow of the Australasian Faculty of Public Health Medicine

Michelle Cretikos is a public health physician with extensive experience in public health

policy, epidemiology, population health program delivery and evaluation.

Current position

Director, Clinical Quality and Safety, Population Health, NSW Ministry of Health

• Improving the quality and safety of alcohol and other drug service delivery in NSW

• Strengthening the performance monitoring framework for NSW drug and alcohol related

services, including NSW funded non-government organisations.

• Identifying and responding to emerging trends in alcohol and drug related harms.

• Coordinating the public health response to notification of serious cases suspected to be

related to drug use. This includes liaising with the Poisons Information Centre, local

clinicians and laboratories (including drug and alcohol services), and the NSW Forensic

and Analytical Science Services (FASS), the state reference laboratory.

• Chairing the NSW Quality in Treatment Committee for drug and alcohol services

• Contributing to the quarterly Program Council for NSW drug and alcohol services.

Previous projects

• Leading the clinical engagement for routine identification and clinical service delivery for

children above a healthy weight and their families, in support of the Premier's Priority on

childhood overweight and obesity.

• Participation as an expert reviewer for the first two rounds of the NSW Translation

Research Grants Scheme in 2016 and 2017. This involved detailed review, provision of

written and verbal feedback on over 160 expressions of interest, a further review of full

applications, and recommendations to the selection panel.

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• Leading the coordination, content development, and cross-jurisdictional data linkage

project for the Better Cardiac Care Forum for Aboriginal and Torres Strait Islander People,

held in 2014. This was a national Forum which engaged all Australian jurisdictional

governments, along with relevant academic and non-government organisations in

identifying priority areas and high-impact clinical initiatives for recommendation to the

Australian Health Ministers’ Advisory Committee (AHMAC), to improve cardiac outcomes

for Aboriginal people.

• Leading the implementation and performance monitoring of the recent National

Partnership Agreement on Treating More Public Dental Patients (the Dental NPA). This

involved consultation with Local Health District Chief Executives on behalf of the Chief

Health Officer, communication to the Chief Executives regarding funding allocations and

service targets for the 2012-13, 2013-14 and 2014-15 financial years, and advice about

performance issues as required.

• Review of the funding model and exploration of a new state funding allocation model for

public dental services in NSW for 2014-15 and 2015-16. This involved consultation with

Local Health District Chief Executives, Deputy Secretaries of the NSW Ministry of Health

and the State Oral Health Executive. The model allocated approximately $180 million to

public dental services in 2014-15, and accommodated the existing Dental NPA, the

proposed adult dental NPA, and the new Medicare-funded dental initiative for children.

Previous positions

2013-2017 Medical Advisor, Office of the Chief Health Officer, NSW Ministry of Health.

2010-2013 Associate Director, Public Health Intelligence Branch, Centre for Epidemiology

and Evidence, NSW Ministry of Health.

2008-2010 Medical epidemiologist, Public Health Unit, Sydney South West Area Health

Service.

2009 State Planning Manager, Pandemic influenza response, NSW Department of

Health.

2008 Executive Officer, Office of the Chief Health Officer, NSW Department of

Health.

2005-2008 Public health officer, NSW Department of Health.

2002-2005 PhD, Health services research, Medical Emergency Team (MET) systems. 2002 Anaesthetics and Intensive Care Registrar, Royal Darwin Hospital, with

participation in the Aerial Medical Retrieval Service to remote Aboriginal communities.

2000-2001 Anaesthetics and Critical Care Registrar, Liverpool Hospital, Sydney. 1998-1999 Intern and Resident, St George Hospital, Sydney.

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Appendix D: NSW data sources that will be linked within the Alcohol and Other

Drug Outcomes Register (AoDOR)

1. Alcohol and other Drugs Treatment Services Minimum Data Set

2. Electronic Recording and Reporting of Controlled Drugs (ERRCD)

3. Non-admitted Patient Data Collection (NAP)

4. Mental Health Ambulatory Data Collection

5. Admitted Patient Data Collection

6. Emergency Department Data Collection

7. Register of Births, Deaths and Marriages

8. Cause of Death Unit Record File

9. NSW Ambulance Data Collections

10. Perinatal Data Collection

11. Notifiable Conditions Information Management System

12. HIV Database.

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Appendix E: NSW Data sources used to prepare this statement

National Drug Strategy Household Survey

The National Drug Strategy Household Survey (NDSH) is the leading survey of licit and illicit

drug use in Australia. The 2016 survey was the 12th survey conducted. Previous surveys

were conducted between 1985 and 2013. The data collected through these surveys have

contributed to the development of policies for Australia’s response to drug-related issues. In

2016, 23,772 people aged 12 or older gave information on their drug use patterns, attitudes

and behaviours. The sample was based on households, so people who were homeless or

institutionalised were not included (consistent with the approach in previous years).

The Illicit Drug Reporting System (IDRS)

The Illicit Drug Reporting System (IDRS) is a national illicit drug monitoring system intended

to identify emerging trends of local and national concern in illicit drug markets. The IDRS

consists of annual interviews across all Australian capital cities with people who inject drugs

(PWID), as well as analysis and examination of indicator data sources related to illicit drugs.

The IDRS is designed to be sensitive to trends, providing timely rather than detailed data.

Combined Admitted Patient Epidemiology Data (CAPED)

NSW hospitalisation data is sourced from the Combined Admitted Patient Epidemiology Data

(CAPED). CAPED records all inpatient separations from all public, private, psychiatric and

repatriation hospitals in NSW, as well as public multi-purpose services, private day

procedure centres and public nursing homes.

Emergency department presentations

Emergency department presentations for ATS are source from NSW Public Health Rapid,

Emergency, Disease and Syndromic Surveillance (PHREDSS) system. The PHREDSS system

provides daily monitoring, 7 days a week, of most unplanned presentations to NSW public

hospital emergency departments and all emergency Triple Zero (000) calls to NSW

Ambulance. PHREDSS monitors surveillance syndromes (groupings of similar diagnoses)

over time. Four syndromes are useful for alcohol and other drug surveillance: alcohol;

mental health issues; some illicit drugs and poisoning and overdose. Methamphetamine and

MDMA ED presentations are identified using a keyword search of diagnosis and triage fields.

Methamphetamine ED presentations are restricted to drug, alcohol and mental health

surveillance syndromes to minimise the large number of false detections associated with the

term ‘ice’, particularly across injuries. MDMA presentations are not restricted to the drug,

alcohol and mental health surveillance syndromes.

NSW Alcohol and other drug treatment services minimum data set

This dataset includes NSW Government and NSW funded non-government service providers,

and information on treatment provided in the community (outpatient) and residential

settings. It also includes information from specialist inpatient treatment services. The data

relates only to people who are accessing treatment related to use of alcohol and other

drugs. The data collection makes it possible to compare and aggregate information across

NSW on drug problems, service utilisation and treatment programs for a variety of clients,

communities and service settings. It also provides agencies with access to basic data

relating to particular types of clients, their drug problems and treatment responses. The

information provided in this report relates only to the main service provided.

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