Does this data mean more Australians are using heroin and cocaine overall?

The IDRS and EDRS surveys track people who are already using these substances — they are sentinel surveillance systems that measure patterns among active users, not population-level prevalence surveys. The finding that heroin is being used more frequently (daily on average among people who inject drugs surveyed) means use is intensifying among that group, which is associated with higher overdose and hospitalisation risk. The rise in cocaine use within the stimulant-using group (84% reporting recent use) reflects a sustained shift in the drug market rather than a sudden surge from a standing start — the threefold increase has been tracked since 2007.

What does this mean for how my GP might approach an appointment about alcohol or drug use?

GPs use routine enquiry about substance use as part of comprehensive health assessments, particularly for people with chronic health conditions, mental health concerns, or presentations where substance use may be relevant. The AUDIT-C for alcohol and the ASSIST tool for other substances are validated brief screening tools used in Australian general practice. This is not about surveillance — it is about opening a conversation that may be relevant to care. If you are concerned about your own substance use or that of someone you care about, your GP is a safe and non-judgemental starting point. ADIS (Alcohol and Drug Information Services) also provides state-based telephone support across Australia.

Australian drug use in 2026: heroin daily, cocaine at record highs

Every year, two national sentinel surveillance programs quietly collect some of the most clinically important drug use data in Australia. The 2026 results from the Illicit Drug Reporting System (IDRS) and the Ecstasy and Related Drugs Reporting System (EDRS) are out, and the pattern they show is one GPs, emergency departments, and mental health services need to understand.

Heroin frequency has reached its highest level since monitoring began in 2000 — daily use on average among the people who inject drugs surveyed. Cocaine is now reported by 84% of stimulant users surveyed — the highest proportion in 20 years. And heroin-related hospitalisations rose 26% between 2022–23 and 2023–24.

These are leading indicators. They tell us what the health system will be dealing with increasingly over the next two to three years.

What the data actually shows — and what it does not

It is important to read sentinel surveillance data accurately, because the media coverage often conflates it with population estimates.

The IDRS surveys people who inject drugs, recruited through needle and syringe programs, peer groups, and snowball sampling. The EDRS surveys people who use ecstasy and related stimulants, similarly recruited. Both programs are run by the National Drug and Alcohol Research Centre (NDARC) at UNSW Sydney in collaboration with Curtin University and state partners.

What the data shows is change within these groups — more frequent use, shifting preferences, new drug forms. What it does not directly show is the number of Australians using these substances overall. For that, you need population surveys like the National Drug Strategy Household Survey, which runs on a different cycle.

That distinction matters for AHPRA-appropriate clinical reasoning: these findings don’t tell us that your average 45-year-old patient is using heroin. They tell us that, among people who do inject drugs, the pattern has intensified significantly — which is a strong signal about overdose risk, hospital presentations, and the burden on treatment services.

The heroin picture

Fifty-one per cent of IDRS participants reported heroin use in the previous six months in 2026 — down from 79% in 2000. So fewer people in this group are using heroin. But among those who do, the frequency has increased to daily use on average — the highest frequency since the monitoring began.

This pattern — declining prevalence but increasing intensity — is consistent with a more dependent cohort remaining in the market as casual use declines. The clinical implication is higher overdose risk per person and higher hospitalisation rates. The 26% rise in heroin-related hospitalisations in one year is consistent with this interpretation.

Wastewater drug monitoring data — a population-level signal — broadly supports the IDRS finding, showing opioid presence in wastewater systems consistent with increased activity.

The cocaine picture

The cocaine finding is different in character. This is not a story about a shrinking but intensifying user group — it is about a sustained market expansion. The proportion of stimulant users reporting cocaine use has risen threefold since 2007, driven by increased supply and reduced price. At 84%, cocaine is now the dominant stimulant in this group.

The clinical concern here is cardiovascular. Cocaine carries well-documented cardiac risk — arrhythmia, coronary artery spasm, acute myocardial infarction — particularly in combination with other stimulants or in people with pre-existing cardiovascular disease. For GPs seeing patients who use stimulants, cocaine’s dominance in the current market is clinically relevant to cardiovascular risk assessment.

Methamphetamine and nitrous oxide

Methamphetamine remained prevalent at 80% of surveyed injecting drug users in 2026, with use occurring roughly every second day. This is consistent with patterns from previous years — meth has maintained its dominance in this group.

A notable shift in the nitrous oxide market: there has been a move away from 8-gram catering canisters toward larger cylinders of up to 2kg. This is relevant because larger cylinders are associated with higher-volume use and greater risk of the spinal cord complications that come from nitrous oxide’s effect on vitamin B12. Several states have moved to restrict the larger cylinders. GPs in states where this has not yet happened should be aware that the risk profile for patients who use nitrous oxide has changed.

What this means for general practice

For most GPs, these data points are background context rather than immediate clinical action items. They inform how to read a presentation — why a younger patient’s cardiovascular risk profile might be more complicated than it looks, why B12 should be on the differential for unexpected neurological findings, why the opioid overdose risk counselling conversation is worth having with patients on the periphery of these networks.

The RACGP Position Statement on Drug Use recommends a harm-reduction approach as the clinical default. That means meeting patients where they are: asking about substance use as part of routine comprehensive care, providing take-home naloxone information to patients who may be at overdose risk or who know someone who is, and ensuring that referral pathways to alcohol and other drug services are genuinely accessible rather than theoretical.

ADIS (Alcohol and Drug Information Services) provides state-based telephone support, available to patients and practitioners alike. The National Alcohol and Other Drug Hotline — 1800 250 015 — is the national entry point.

Verdict: yes — relevant clinical background for GPs managing patients with substance use concerns.

Sources cited

Heroin used more often, cocaine use up — The Conversation, 24 September 2026: https://theconversation.com/heroin-used-more-often-cocaine-use-up-what-new-data-says-about-drug-use-today-292125
Illicit Drug Reporting System — NDARC, UNSW: https://ndarc.med.unsw.edu.au/project/illicit-drug-reporting-system-idrs
Ecstasy and Related Drugs Reporting System — NDARC, UNSW: https://ndarc.med.unsw.edu.au/project/ecstasy-and-related-drugs-reporting-system-edrs