Why are stimulant deaths rising when opioid deaths are declining?

Opioid prescribing reforms, pain management changes, and improved naloxone access have had some measurable effect on opioid-related deaths since the 2017 peak. Stimulants — particularly methamphetamine — have no equivalent pharmacotherapy, making them harder to treat at the population level. Methamphetamine is also increasingly available, cheap, locally produced, and of higher purity than in past years. Cocaine deaths are rising in a distinct demographic: younger men in higher socioeconomic areas who may not self-identify as having a problematic relationship with a 'social' drug.

What does 'polydrug' mean and why does it matter for overdose risk?

73% of drug-induced deaths in 2024 involved two or more drug classes simultaneously. Polydrug use dramatically increases overdose risk because the drugs interact — for example, opioids combined with benzodiazepines produce synergistic respiratory depression. Stimulants combined with opioids raise heart rate and blood pressure while also masking sedation, which can delay recognition of overdose. 72% of overdose deaths occurred at home, where there may be no one present to recognise the emergency or administer naloxone.

Is there treatment available for stimulant use disorder?

Currently there are no TGA-approved pharmacotherapies specifically for stimulant use disorder in Australia — unlike opioid use disorder (buprenorphine, methadone) or alcohol use disorder (naltrexone, acamprosate). Psychosocial interventions and peer support are the primary evidence-based approaches. Research into pharmacotherapy options continues. In the meantime, general practice has a key role in early identification, harm-reduction conversation, and cardiovascular risk assessment for people who use stimulants.

Australia's drug overdose toll hits a 20-year high — stimulants are driving it

What just happened

The National Drug and Alcohol Research Centre has released its annual drug-induced death figures for 2024, and they represent a record: 2,005 Australians died from drug overdose — about 5.5 deaths every day — the highest count across NDARC’s 20-year monitoring program.

The headline is grim. But the details shift where you would look.

Opioids remain the most common single drug class in overdose deaths, involved in 56% of cases. Their share has been declining since the 2017 peak — which reflects, at least in part, the effect of prescribing reforms, pain management policy changes, and expanded naloxone access over the past decade.

What is going the other direction are stimulants. Amphetamine-type stimulant deaths reached their all-time high in 2024: 2.9 per 100,000, up 29% from 2.2 per 100,000 in 2023. Cocaine deaths rose 40% and also hit a record — driven almost entirely by men aged 25–35 in more advantaged socioeconomic areas. Seventy-three percent of all deaths involved two or more drug classes. Seventy-two percent happened at home.

Both-and

Who is dying — and it is not one group

The picture NDARC is describing does not fit the dominant stereotype about drug overdose death. Two-thirds of drug-induced deaths were men, but across the full data, the demographics are more varied than the typical framing suggests. People aged 65–74 had their highest death rates in the two-decade monitoring period. Among those 75 and older, disability limiting daily activities was the most common associated risk factor. This is the age group that general practice sees most intensively — and the group most likely to be on medications that interact dangerously with illicit drug use.

Among women, self-harm history appeared in 17% of drug-induced deaths — nearly twice the rate in men (9.1%). The intersection between drug use and suicidality is not a new finding, but the magnitude is worth sitting with. Twenty-two percent of all drug-induced deaths were classified as suicide-related.

What is driving the stimulant surge

Methamphetamine’s rise has a structural explanation. As Associate Professor Rachel Sutherland from NDARC noted, stimulants increase heart rate and blood pressure and can cause fatal cardiovascular complications in people with pre-existing cardiovascular disease. Dr Hester Wilson from the RACGP added the supply-side reality: “The rise in methamphetamine use is interesting. It’s because it’s easily available, cheap, produced locally, and it’s also had increased purity.”

Cocaine’s 40% rise is concentrated in younger, higher-income men — a demographic that historically has had less contact with drug treatment systems and may not self-identify as having a problematic relationship with a drug they experience as “recreational.”

Contaminated supply is also not marginal. Among 70 Australians who died from novel psychoactive substances over the study period, nearly one quarter appeared unaware they had taken anything other than MDMA, methamphetamine, or LSD — they died from substances they did not know they had ingested.

The pharmacotherapy gap

Here is the structural problem the data exposes. We have pharmacotherapy for opioid use disorder — buprenorphine, methadone — and the declining opioid death share may partly reflect this. We have pharmacotherapy for alcohol use disorder. We have no approved pharmacotherapy for stimulant use disorder.

As Associate Professor Sutherland put it directly: “We don’t have equivalent options for stimulants, and we do know there’s difficulties accessing treatment.”

This shifts the locus of what is possible toward harm reduction: conversations about polydrug risk, about cardiovascular risk in stimulant use with pre-existing disease, about fentanyl and novel psychoactive contamination in non-opioid supply.

The hospitalisation signal

Drug-related hospitalisations in 2023–2024 reached 56,797 — a 10.5% increase, growing at more than double the 4.1% rate of overall hospital admissions. Amphetamine-type stimulants accounted for 29% of drug-related admissions. This is the upstream indicator of the mortality data — and it is moving in the same direction.

My two cents

Dr Hester Wilson named something important in her response to the data: “Drugs have meaning, and people’s choice to use them is rational and has meaning for them. We need to ensure the care people can access is appropriate.”

That sentence matters because 2,005 deaths can produce a reflexive policy response that misses the mechanism. The people in these statistics are not irrational actors who need to be frightened into better choices. They are people whose drug use is serving a function — pain, stress, sleep, connection, pleasure — and who often encounter services oriented around abstinence, judgement, or specialist referral into waiting lists.

Dr Wilson again: “If we can have conversations with people early in their drug-taking career, we can help them have a better trajectory.” General practice is where those conversations can happen — because GPs see people across their life course, before the point of crisis, before specialist services are the appropriate next step.

What I take from this data is not despair but specificity. The opioid story shows that targeted intervention, sustained over time, can bend a curve. The stimulant story shows that we are at the beginning of that effort — and that the absence of pharmacotherapy means we are currently reliant on the harder, slower work of early detection, harm-reduction conversation, and cardiovascular risk assessment for the people who walk through the door.

Verdict: yes — 2,005 deaths in a year is a public health emergency that general practice sits squarely inside. The data on stimulants, polydrug use, older Australians, and the home as the primary site of death all point to things that can change in the clinical encounter, starting now.

Sources cited

Overdose deaths hit 20-year high. The Medical Republic, 4 August 2026. https://www.medicalrepublic.com.au/overdose-deaths-hit-20-year-high/127893