ABSTRACT
Introduction
Australia's illicit tobacco trade poses major challenges, with evidence of increasing use. We examined: (i) use of illicitly traded tobacco (ITT) and reasons for use among two populations of people who use drugs in Australia; and (ii) factors associated with ITT use, versus exclusive licit tobacco use, in 2024 and 2025.
Methods
Cross‐sectional samples of people who regularly (i.e., ≥monthly) used illicit stimulants (Ecstasy and Related Drugs Reporting System (EDRS); n = 1430) or injected drugs (Illicit Drug Reporting System (IDRS); n = 1749) were recruited April–July in 2024 and 2025. Multivariable logistic regression identified factors associated with past 6‐month ITT use.
Results
In both samples of people who use drugs, the proportion using ITT among those who had recently used tobacco increased between 2024 and 2025: from 38% to 65% (p < 0.001) among EDRS participants and from 54% to 73% (p < 0.001) among IDRS participants. In both years and populations, ITT was most commonly obtained from tobacconists, with price the primary reason for use. Among EDRS participants, males had higher odds of ITT use in both years; older age and recent e‐cigarette and nicotine‐pouch use were associated with ITT use in 2024 only. Among IDRS participants, age was associated with ITT use in both years, while psychological distress was associated with ITT use in 2024 only. Capital city of residence was associated with ITT use across both populations and years; in 2025, lower odds were observed in Perth, Adelaide, Hobart and Canberra versus Sydney.
Discussion and Conclusions
Increases in ITT use among these two populations of people who use illicit drugs are concerning. Efforts to restrict availability should prioritise supply‐side controls, alongside treatment and demand‐reduction strategies.
Keywords: illegal tobacco products, illicitly traded tobacco, people who inject drugs, people who use drugs, tobacco
Key Points
In 2025, most Ecstasy and Related Drugs Reporting System (EDRS) (people who regularly used illicit stimulants) and Illicit Drug Reporting System (IDRS) (people who regularly injected drugs) participants who reported recent tobacco use were using illicitly traded tobacco (ITT).
ITT was most commonly obtained from tobacconists, with price as the primary reason for use.
Few factors were consistently associated with ITT use across years and across EDRS and IDRS samples.
Capital city of residence was only the factor associated with ITT use among both populations and in both years.
Efforts to restrict ITT availability should prioritise supply‐side controls, alongside treatment and demand‐reduction strategies.
1. Introduction
The World Bank defines illicitly traded tobacco (ITT) as ‘… any practice related to distributing, selling, or buying tobacco products that is prohibited by law’, covering a range of activities including counterfeiting, smuggling and tax evasion [1]. ITT products include unbranded loose‐leaf tobacco (also known as ‘chop‐chop’ [2]), unbranded cigarettes and smuggled branded cigarettes imported without paying excise and duties. As a result, ITT products are typically available at a lower price than tobacco products on which all taxes have been paid [3]. It is estimated that the illegal tobacco market alone results in 164,000 premature deaths a year around the world [4]. In Australia, ITT contributes to the tobacco‐related health burden, tax revenue losses (estimated at $3.2 billion in 2023–2024 [5]) and security implications stemming from crime syndicates profiteering through the ITT market [3, 6, 7].
Attempts to estimate the scale of the ITT market in Australia have produced varied results. Tobacco industry‐funded research reported in 2023 that ITT accounted for 28.6% of the tobacco market [8], while the Australian Taxation Office similarly estimated that 25% of all tobacco sales were illicit in 2023–2024 [5]. More recently, the Illicit Tobacco and E‐cigarette Commissioner estimated the ITT market to be worth $4.1 billion, with 50%–60% of the tobacco market considered to be illicit. Notwithstanding these differences, available data suggest a marked increase over the past decade in the proportion of the Australian tobacco market that is illicit [5, 8]. While the prevalence of tobacco smoking has declined overall, data from Australia's National Drug Strategy Household Survey suggest the proportion of the Australian population who smoke tobacco who used or purchased ITT products rose significantly from 8.6% in 2016 to 16.5% in 2022–2023 [9, 10]. Moreover, a survey conducted in November 2024 among a nationally representative sample of Australians found that one in five participants reported current daily or weekly use of ITT products [11]. These data are echoed by marked increases in both border seizures of ITT products [12] and ITT‐related crimes [13] in Australia over the last decade.
ITT products pose additional threats to wellbeing beyond the inherent health risks associated with smoking. Many ITT products lack the required plain packaging and health warnings, which are important deterrents to smoking, particularly for youth [14, 15]. An earlier study identified fungal spores and mould in samples of ‘chop‐chop’ stored in moist plastic bags [2, 16], though it remains unclear how widespread this issue is, whether it confers additional health risks beyond those related to tobacco use or whether it remains relevant given the current dominance of ITT ‘cigarette stick’ seizures in Australia (i.e., seizures of individual cigarettes) [17]. Moreover, the relative inexpensiveness of ITT removes a key motivation for quitting smoking [18] and may facilitate the uptake or continuation of smoking. These effects are likely to be most pronounced among people from lower socioeconomic areas, who are overrepresented in Australia's smoking population [9] and are most financially impacted by Australia's progressively increasing taxation on licit tobacco [18].
Although rates of tobacco use in Australia have declined substantially since the mid‐1990s [9], certain sub‐populations, such as people who use illicit drugs, still report high levels of tobacco use. For example, in two Australian populations of people who regularly use illicit drugs, tobacco use has remained at above 70% for over two decades [19, 20]. These samples encompass populations with characteristics which may be associated with increased price sensitivity, including younger, student‐dominated groups as well as groups with high unemployment and economic marginalisation. Yet, despite their likely high vulnerability to purchasing ITT products, to date, no examination of ITT use in these populations has been reported. Accordingly, this study explores: (i) patterns of and motivations for ITT use among two populations of people who use illicit drugs in Australia; and (ii) the sociodemographic, substance use and health factors associated with ITT use among these populations, compared to use of legally traded tobacco products only, in 2024 and 2025.
2. Methods
2.1. Study Design and Procedure
Data were drawn from annual interviews conducted with two sentinel cross‐sectional populations: (i) people who regularly inject drugs as part of the Illicit Drug Reporting System (IDRS); and (ii) people who regularly use ecstasy and/or other illicit stimulants as part of the Ecstasy and Related Drugs Reporting System (EDRS). Participants were recruited from each capital city of Australia (Brisbane/Gold Coast in Queensland), with a target of 100 participants per capital city per project. IDRS participants were recruited through needle‐syringe programs and treatment agencies and via word‐of‐mouth; EDRS participants were recruited via social media and word‐of‐mouth. To be eligible for the IDRS, people had to be ≥ 18 years of age; report injecting illicit/non‐prescribed drugs ≥ 6 days in the past 6 months; and have resided in the capital city of interview for ≥ 10 of the previous 12 months. The same criteria were applied to recruitment for the EDRS except that people had to report having used ecstasy and/or other illicit stimulants ≥ 6 days in the past 6 months. In 2024, 884 participants completed the IDRS interview between June and July and 740 participants completed the EDRS interview between April and July. In 2025, 865 participants completed the IDRS interview between May and July and 690 participants completed the EDRS interview between April and July. Informed consent was obtained and participants were reimbursed AUD$40.
Ethical approval for IDRS was granted by the South Eastern Sydney Local Health District Human Research Ethics Committee (HREC) and jurisdictional HRECs as required; approval for EDRS was granted by the University of New South Wales HREC and jurisdictional HRECs as required. Full methodological details can be found elsewhere [21, 22].
2.2. Measures
2.2.1. Illicitly Traded Tobacco
IDRS and EDRS participants have been asked about their tobacco use in the past 6 months since 2000 and 2003, respectively. In 2024, for the first time, those who reported any tobacco use were asked additional questions to ascertain if they had used any ITT. Specifically, they were asked what types of tobacco products they had used in the past 6 months (smoked tobacco products, non‐smoked tobacco products): those who reported use of smoked tobacco products were then asked if any of the smoked products they had used were illicit, with an explanation that ‘illicit tobacco refers to products sold illegally without the necessary taxes added to the price’. Any ITT use was computed by combining those who reported use of any non‐smoked tobacco products (which are illegal to sell in Australia, e.g., snus) and/or any illicit smoked tobacco products. Those who reported any ITT use were then asked additional questions about where they obtained ITT products from in the past 6 months, what product they purchased on their last occasion and the price they paid and reason/s for using ITT products instead of legally sold products. All relevant survey items are listed in Appendix A.
2.2.2. Sociodemographic, Substance Use and Health Factors Associated With ITT Use
Potential risk factors for ITT use, chosen a priori, comprised:
Sociodemographic factors: age group, current gender identity, stable housing (stable defined as own/rented/family home, public housing; unstable defined as boarding house/hostel, drug treatment residence, shelter/refuge, no fixed address, rough sleeping or squatting, couch surfing), identified as lesbian, gay, bisexual, queer or other (non‐heterosexual) (LGBQ+), median weekly income and city of recruitment.
Other nicotine products, cannabis and hazardous alcohol use: past 6‐month use of non‐prescribed cannabis, e‐cigarettes or nicotine pouches and past year hazardous alcohol use (as indicated by a score of ≥ 4 1 on the Alcohol Use Disorders Identification Test‐Concise (AUDIT‐C)) [23].
Participants were provided with the following explanation of nicotine pouches: ‘Nicotine pouches are small pouches (or bags) containing synthetic nicotine and sometimes other ingredients such as sweeteners and flavours. They are designed to be placed between the lip and gum. They differ from snuff as they do not contain tobacco’.
Participants were also asked about the frequency of use for non‐prescribed cannabis, e‐cigarettes, nicotine pouches and tobacco, reported as the number of days used in the past 6 months (range 1–180), where 180 days corresponds to daily use based on an assumption of 30 days per month.
Mental and physical health: past‐month high psychological distress (as indicated by a score of ≥ 22 on the Kessler Psychological Distress Scale; K10) [24], self‐reported health as good/very good/excellent (versus fair/poor) [25, 26] and self‐reported lifetime diagnosis of any chronic health condition, based on participant report of being diagnosed with one or more specified conditions (arthritis, asthma, diabetes, heart disease, kidney disease, cancer, lung condition, stroke or other cerebrovascular disease, chronic liver disease or other long‐term health condition; IDRS only).
2.3. Data Analysis
Sample characteristics and patterns of ITT use are summarised as proportions (categorical variables). Comparisons of categorical variables across 2024 and 2025 were analysed using a chi‐squared test, while comparisons of count data were analysed using the Mann–Whitney U test. Where cell sizes were less than 5 but greater than 0, counts were suppressed to avoid reporting unstable estimates and in line with standard practices to minimise potential disclosure risk.
To examine factors associated with ITT use, compared to licit use only, analyses were restricted to participants who reported recent use of any tobacco. The ITT use group included individuals who reported any use of illicitly traded tobacco, irrespective of concurrent licit tobacco use, whereas the reference group comprised participants who reported use of licit tobacco products only. Bivariate logistic regression was performed with each independent variable and the use of ITT outcome. Multivariable logistic regression was then conducted using variables with p < 0.05 in the bivariate analyses, with age group, gender identity and capital city included a priori as potential confounders given known age and gender differences in drug use and variation in drug markets across jurisdictions. Data from 2024 and 2025 were examined separately, with repeat participants excluded (in 2025, 53 EDRS participants and 173 IDRS participants reported participating in the 2024 survey). The full sample's flow chart can be found in Figure 1. A sensitivity analysis retaining repeat participants in the 2025 sample was conducted to assess robustness. Results of this analysis, along with ITT use by capital city breakdown, are included in Appendix B.
FIGURE 1.
Participant flow diagram for the Ecstasy and Related Drugs Reporting System (EDRS) and Illicit Drug Reporting System (IDRS) surveys, 2024–2025.
We report adjusted odds ratios with 95% confidence intervals. Model diagnostics showed no evidence of collinearity or influential outliers. Complete case analysis was used. Analyses were conducted using R, version 4.5.0. Results are reported according to the STROBE checklist for cross‐sectional studies [27] (Appendix C).
3. Results
3.1. Recent Use of Tobacco and Nicotine Products
In 2025, recent use of any tobacco product, regardless of whether purchased legally or illegally, was high among both the EDRS (72%) and IDRS sample (87%) and stable relative to 2024 (Table 1). There was a significant increase in the frequency of tobacco use among EDRS participants, from a median of 90 days in 2024 to 120 days in 2025, while frequency of use remained stable among the IDRS sample at a median of 180 days in the past 6 months indicating daily use throughout the reporting period.
TABLE 1.
Past 6‐month tobacco and nicotine use, among EDRS and IDRS participants, 2024–2025.
| EDRS sample | IDRS sample | |||||
|---|---|---|---|---|---|---|
| 2024 (n = 740) | 2025 (n = 690) | p value | 2024 (n = 884) | 2025 (n = 865) | p value | |
| Tobacco use | ||||||
| Any tobacco use, % | 72% | 72% | 0.855 | 87% | 87% | 0.946 |
| Median days of use c (IQR) | 90 (15–180) | 120 (24–180) | 0.041 | 180 (180–180) | 180 (180–180) | 0.410 |
| Any ITT use c , % | 38% | 65% | < 0.001 | 54% | 73% | < 0.001 |
| Illicit e‐cigarettes | ||||||
| Past 6‐month use, % | 69% | 65% | 0.135 | 27% | 25% | 0.280 |
| Median days of use c (IQR) | 90 (24–180) | 120 (24–180) | 0.307 | 90 (12–180) | 93 (24–180) | 0.140 |
| Nicotine pouches | ||||||
| Past 6‐month use, % | 19% | 20% | 1.00 | 3% | 2% | 0.766 |
| Median days of use c (IQR) | 4 (1–22) | 3 (1–20) | 0.381 | 4 (1–23) | 7 (4–30) | 0.224 |
| Any tobacco or nicotine use a , % | 87% | 87% | 0.787 | 91% | 90% | 0.948 |
| Use of all of the above products b , % | 16% | 14% | 0.440 | 1% | 1% | 1.00 |
Abbreviations: EDRS, Ecstasy and Related Drugs Reporting System; IDRS, Illicit Drug Reporting System; IQR, interquartile range; ITT, illicitly traded tobacco.
Reported past 6‐month use of tobacco or illicit e‐cigarettes or nicotine pouches.
Reported past 6‐month use of tobacco and illicit e‐cigarettes and nicotine pouches.
Among those who reported past 6‐month use.
Use of other nicotine products was also relatively common, particularly among EDRS participants, in which approximately two‐thirds reported recent use of illicit e‐cigarettes in both years and one in five reported use of nicotine pouches. Among IDRS participants, approximately one in four reported use of illicit e‐cigarettes in both years, with few reporting nicotine pouch use.
3.2. Aim 1: ITT Use Among EDRS and IDRS Participants, 2024–2025
In 2025, 46% of all EDRS participants reported ITT use (65% of those who had used tobacco), significantly increasing from 27% in 2024 (p < 0.001; 38% of those who had used tobacco) (Tables 1 and 2). Two‐thirds (63%) of the entire IDRS sample reported ITT use in 2025 (73% of those who had used tobacco), also a significant increase from 2024 (46%; p < 0.001; 54% of those who had used tobacco). Significant increases in ITT use were observed across most capital cities, except Adelaide, though Sydney, Perth and Hobart were the only capital cities that observed significant increases across both populations (see Table B3). Among both EDRS and IDRS participants, nationally and in both years, ITT use predominantly comprised smoked ITT use, with branded cigarettes the most commonly used ITT product (Table 2).
TABLE 2.
Patterns of ITT use among EDRS and IDRS participants, 2024–2025: type, source, price and motivation (excluding repeat participants from 2025).
| Among entire sample and who responded | EDRS | IDRS | ||
|---|---|---|---|---|
| 2024 | 2025 | 2024 | 2025 | |
| (N = 724) | (N = 672) | (N = 867) | (N = 842) | |
| Past 6‐month ITT use, % | 27% | 46% | 46% | 63% |
| Smoked products | 26% | 45% | 46% | 63% |
| Non‐smoked products | 3% | 4% | 2% | 1% |
| Among those who reported past 6‐month use of smoked ITT products and responded | N = 195 | N = 307 | N = 398 | N = 545 |
|---|---|---|---|---|
| ITT products used in past 6‐months | ||||
| Branded cigarette pack | 65% | 78% | 71% | 76% |
| Unbranded cigarette pack | 15% | 15% | 12% | 12% |
| Branded loose tobacco | 18% | 24% | 14% | 15% |
| Unbranded loose tobacco | 37% | 24% | 35% | 27% |
| Other smoked tobacco products | 7% | 3% | 2% | 4% |
| Among those who reported any past 6‐month ITT use and responded | N = 195 | N = 304 | N = 404 | N = 539 |
|---|---|---|---|---|
| Source of ITT products | ||||
| Online store | n ≤ 5 | 5% | n ≤ 5 | 1% |
| Physical (‘bricks and mortar’) vape store under the counter | 14% | NA | 5% | NA |
| Physical (‘bricks and mortar’) tobacconist | 53% | 63% | 76% | 80% |
| Physical (‘bricks and mortar’) convenience store, petrol station, supermarket, or other shop | 29% | 34% | 23% | 29% |
| Friend/relative/acquaintance | 29% | 22% | 11% | 9% |
| Dealer | 5% | 4% | 2% | 3% |
| Brought into Australia when coming back from overseas | n ≤ 5 | 5% | n ≤ 5 | n ≤ 5 |
| Other | n ≤ 5 | n ≤ 5 | 1% | n ≤ 5 |
| Median price last time purchased an ITT product: 1 Branded pack, 20 cigarettes (IQR; n) | n/a | $16 ($13–$20; n = 134) | n/a | $12 ($10–$15; n = 271) |
|---|---|---|---|---|
| Reason for using ITT instead of legal products | N = 195 | N = 299 | N = 404 | N = 541 |
| It's cheaper | 81% | 96% | 89% | 99% |
| It's healthier | n ≤ 5 | 2% | n ≤ 5 | 1% |
| It tastes better | 10% | 7% | 25% | 6% |
| It's easier to purchase | 7% | 7% | 7% | 4% |
| It's what my friends/colleagues smoke | 11% | 6% | n ≤ 5 | 2% |
| It's what the seller recommended/promoted | n ≤ 5 | n ≤ 5 | 0% | n ≤ 5 |
| I prefer to smoke cigarettes from another country | n ≤ 5 | 4% | 0% | n ≤ 5 |
| I don’t want to pay more taxes to the government | 4% | 9% | 3% | 6% |
| Other | 6% | 2% | 2% | n ≤ 5 |
Abbreviations: EDRS, Ecstasy and Related Drugs Reporting System; IDRS, Illicit Drug Reporting System; IQR, interquartile range; ITT, illicitly traded tobacco; n/a: In 2024, participants were not asked how many cigarettes were in the last pack they purchased.
Among those who reported recent ITT use, the majority of participants—in both populations and across both years—reported obtaining these products from a bricks and mortar tobacconist, followed by bricks and mortar convenience store and friends/acquaintances. The primary reason given for using ITT, instead of licit products, was because they were cheaper. Indeed, in 2025, participants who purchased ITT reported paying a median of $AUD12 (IDRS) and $AUD16 (EDRS) for a branded packet of 20 cigarettes.
3.3. Aim 2: Factors Associated With ITT Use, Compared to Use of Legally Purchased Products Only, Among EDRS and IDRS Participants, 2024–2025
3.3.1. Multivariable Model
Among EDRS participants, identifying as male was associated with increased odds of ITT use in both 2024 and 2025. Capital city of residence was also associated with ITT use in both years, although the nature of the association changed. Specifically, in 2024, participants residing in Brisbane/Gold Coast had higher odds of ITT use, compared to those residing in Sydney, while those residing in Perth had lower odds. In 2025, participants residing in Brisbane/Gold Coast, Perth, Adelaide, Hobart and Canberra all had lower odds of ITT use compared to those residing in Sydney. In 2024, being aged ≥ 40 years (compared to those aged < 20 years) and past 6‐month use of nicotine pouches and e‐cigarettes were associated with increased odds of ITT use; however, these were not significant in 2025 (Table 3).
TABLE 3.
Factors associated with ITT use, among EDRS participants who reported past 6‐month tobacco use, 2024 and 2025 (excluding repeat participants from 2025).
| Past 6‐month ITT use, 2024 | Past 6‐month ITT use, 2025 | |||||||
|---|---|---|---|---|---|---|---|---|
| Licit tobacco use only (n = 195) % | Any illicit tobacco use (n = 322) % | OR (95% CI) | AOR (95% CI) | Licit tobacco use only (n = 276) % | Any illicit tobacco use (n = 147) % | OR (95% CI) | AOR (95% CI) | |
| Demographics | ||||||||
| Age, years | ||||||||
| < 20 | 63 | 38 | Ref | Ref | 31 | 69 | Ref | Ref |
| 20–29 | 63 | 37 | 0.98 (0.64–1.51) | 1.07 (0.67–1.70) | 36 | 64 | 0.79 (0.48–1.31) | 0.87 (0.50–1.49) |
| 30–39 | 63 | 38 | 1.00 (0.57–1.74) | 1.23 (0.67–2.27) | 40 | 60 | 0.67 (0.37–1.23) | 0.56 (0.29–1.10) |
| ≥ 40 | 59 | 41 | 1.14 (0.62–2.07) | 2.16 (1.05–4.46) | 30 | 70 | 1.04 (0.51–2.20) | 1.02 (0.46–2.33) |
| Identify as male | ||||||||
| No | 70 | 30 | Ref | Ref | 44 | 56 | Ref | Ref |
| Yes | 56 | 44 | 1.78 (1.24–2.57) | 2.11 (1.41–3.20) | 28 | 72 | 2.10 (1.40–3.16) | 2.19 (1.42–3.40) |
| Capital city of residence | ||||||||
| Sydney | 64 | 36 | Ref | Ref | 14 | 86 | Ref | Ref |
| Melbourne | 54 | 46 | 1.49 (0.73–3.04) | 1.64 (0.78–3.47) | 24 | 76 | 0.51 (0.19–1.32) | 0.53 (0.19–1.39) |
| Brisbane/Gold Coast | 47 | 53 | 1.99 (0.99–4.05) | 2.40 (1.16–5.05) | 32 | 68 | 0.34 (0.13–0.84) | 0.30 (0.11–0.77) |
| Perth | 86 | 15 | 0.30 (0.12–0.69) | 0.32 (0.13–0.75) | 46 | 54 | 0.19 (0.07–0.45) | 0.17 (0.06–0.42) |
| Adelaide | 58 | 42 | 1.28 (0.64–2.58) | 1.51 (0.73–3.15) | 63 | 37 | 0.10 (0.04–0.23) | 0.09 (0.03–0.22) |
| Hobart | 67 | 33 | 0.87 (0.42–1.80) | 0.98 (0.46–2.09) | 38. | 62 | 0.26 (0.09–0.67) | 0.22 (0.08–0.59) |
| Darwin | 77 | 23 | 0.52 (0.18–1.35) | 0.62 (0.21–1.67) | 39 | 62 | 0.26 (0.07–1.02) | 0.30 (0.08–1.22) |
| Canberra | 55 | 46 | 1.48 (0.74–2.97) | 1.62 (0.79–3.37) | 30 | 70 | 0.37 (0.14–0.87) | 0.33 (0.13–0.81) |
| Sexual orientation | ||||||||
| Heterosexual | 62 | 38 | Ref | 34 | 66 | Ref | ||
| LGBTIQ+ | 62 | 38 | 1.00 (0.68–1.47) | 36 | 64 | 0.93 (0.60–1.45) | ||
| Median weekly income | ||||||||
| < 500 | 59 | 41 | Ref | 33 | 67 | Ref | ||
| 500–999 | 63 | 37 | 0.85 (0.55–1.30) | 31 | 69 | 1.06 (0.64–1.78) | ||
| 1000–1499 | 65 | 35 | 0.80 (0.46–1.39) | 40 | 60 | 0.74 (0.42–1.30) | ||
| ≥ 1500 | 65 | 35 | 0.80 (0.45–1.40) | 43 | 57 | 0.65 (0.35–1.22) | ||
| Housing | ||||||||
| Stable | 63 | 37 | ref | 34 | 66 | ref | ||
| Unstable | 53 | 47 | 1.48 (0.70–3.11) | 50 | 50 | 0.51 (0.21–1.22) | ||
| Other nicotine products, cannabis and alcohol use | ||||||||
| AUDIT‐C score (past year) | ||||||||
| < 4 | 60 | 40 | Ref | 41 | 59 | Ref | ||
| ≥ 4 | 63 | 37 | 0.88 (0.51‐1.53) | 33. | 66 | 1.40 (0.79–2.44) | ||
| Cannabis use (past 6‐month) | ||||||||
| No | 69 | 31 | Ref | 39 | 61 | Ref | ||
| Yes | 61 | 39 | 1.46 (0.89‐2.44) | 34 | 66 | 1.21 (0.67–2.14) | ||
| E‐cigarette use (past 6‐month) | ||||||||
| No | 70 | 30 | Ref | Ref | 35 | 65 | Ref | |
| Yes | 60 | 40 | 1.58 (1.03–2.43) | 1.67 (1.03–2.75) | 35 | 66 | 1.02 (0.65–1.60) | |
| Nicotine pouch use (past 6‐month) | ||||||||
| No | 65 | 35 | Ref | Ref | 37 | 63 | Ref | |
| Yes | 54 | 46 | 1.55 (1.03–2.33) | 1.78 (1.19–2.70) | 27 | 73 | 1.60 (0.97–2.71) | |
| Mental and physical health | ||||||||
| Psychological distress (K10 score) | ||||||||
| K10 < 22 | 67 | 33 | Ref | Ref | 32 | 687 | Ref | |
| K10 ≥ 22 | 59 | 41 | 1.42 (0.99–2.05) | 1.53 (0.97–2.42) | 36 | 64 | 0.83 (0.55–1.25) | |
| Self‐reported general health | ||||||||
| Poor/fair | 57 | 43 | Ref | 34 | 65 | Ref | ||
| Good/very good/excellent | 65 | 35 | 0.71 (0.48–1.04) | 34 | 65 | 1.00 (0.64–1.56) | ||
Note: Multivariable model controls for age, gender identity and capital city. Shaded cell indicates that the variable was not included in the multivariable model. Bolded OR/AOR (95% CI) indicates significance.
Abbreviations: AOR, adjusted odds ratio; AUDIT‐C, Alcohol Use Disorders Identification Test‐Concise; CI, confidence interval; EDRS, Ecstasy and Related Drugs Reporting System; ITT, illicitly traded tobacco; K10, Kessler Psychological Distress Scale; LGBQ+, lesbian, gay, bisexual, queer or other non‐heterosexual identity; OR, odds ratio.
Among IDRS participants, age and capital city of residence were associated with ITT use in both 2024 and 2025; however, the nature of the associations changed between the 2 years. In 2024, participants aged ≥ 40 years had higher odds of ITT use compared to those aged 20–29, while in 2025 those aged 30–39 years and ≥ 40 years had lower odds of ITT use. In 2024, participants residing in Melbourne had higher odds of ITT use compared to those living in Sydney; however, no significant difference was found in 2025. In both years, participants residing in Perth, Adelaide, Hobart, Darwin and Canberra all had lower odds of ITT use compared to those residing in Sydney. In 2024, reporting higher levels of psychological distress was associated with increased odds of ITT use in 2024 but not 2025 (Table 4).
TABLE 4.
Factors associated with ITT use, among IDRS participants who reported past 6‐month tobacco use, 2024 and 2025 (excluding repeat participants from 2025).
| Past 6‐month ITT use, 2024 | Past 6‐month ITT use, 2025 | |||||||
|---|---|---|---|---|---|---|---|---|
| Licit tobacco use only (n = 348) % | Any illicit tobacco use (n = 404) % | OR (95% CI) | AOR (95% CI) | Licit tobacco use only (n = 147) | Any illicit tobacco use (n = 434) | OR (95% CI) | AOR (95% CI) | |
| Demographics | ||||||||
| Age, years | ||||||||
| 20–29 | 68 | 32 | Ref | Ref | 18 | 83 | Ref | Ref |
| 30–39 | 45 | 55 | 2.52 (1.16–5.73) | 2.37 (0.95–6.07) | 32 | 68 | 0.45 (0.17–1.07) | 0.33 (0.11–0.86) |
| ≥ 40 | 45 | 55 | 2.53 (1.24–5.49) | 2.38 (1.04–5.71) | 24 | 76 | 0.66 (0.26–1.45) | 0.41 (0.15–0.98) |
| Identify as male | ||||||||
| No | 51 | 49 | Ref | Ref | Ref | Ref | ||
| Yes | 44 | 56 | 1.3 (0.95–1.78) | 1.19 (0.80–1.76) | 25 | 75 | 0.98 (0.66–1.43) | 0.96 (0.63–1.46) |
| Capital city of residence | 26 | 75 | ||||||
| Sydney | 29 | 71 | Ref | Ref | 11 | 89 | Ref | Ref |
| Melbourne | 10 | 90 | 3.48 (1.82–6.99) | 2.84 (1.46–5.79) | 11 | 89 | 0.94 (0.40–2.24) | 0.95 (0.40–2.26) |
| Brisbane/Gold Coast | 36 | 64 | 0.72 (0.40–1.29) | 0.60 (0.33–1.10) | 18 | 82 | 0.56 (0.24–1.30) | 0.57 (0.24–1.32) |
| Perth | 71 | 29 | 0.17 (0.09–0.30) | 0.15 (0.08–0.27) | 35 | 65 | 0.23 (0.10–0.47) | 0.20 (0.09–0.43) |
| Adelaide | 44 | 56 | 0.52 (0.30–0.89) | 0.47 (0.26–0.83) | 34 | 66 | 0.24 (0.11–0.49) | 0.23 (0.11–0.48) |
| Hobart | 81 | 19 | 0.10 (0.05–0.18) | 0.10 (0.05–0.18) | 35 | 65 | 0.22 (0.10–0.48) | 0.23 (0.10–0.50) |
| Darwin | 94 | 7 | 0.03 (0.01–0.07) | 0.02 (0.00–0.05) | 88 | 12 | 0.02 (0.00–0.06) | 0.01 (0.00–0.06) |
| Canberra | 46 | 54 | 0.48 (0.26–0.89) | 0.45 (0.24–0.86) | 37 | 64 | 0.21 (0.09–0.45) | 0.21 (0.09–0.45) |
| Sexual orientation | ||||||||
| Heterosexual | 46 | 54 | Ref | 26 | 75 | Ref | ||
| LGBQ+ | 46 | 54 | 1.02 (0.67–1.54) | 24 | 76 | 1.11 (0.69–1.85) | ||
| Median weekly income | ||||||||
| < 500 | 47 | 53 | Ref | 25 | 76 | Ref | ||
| 500–999 | 43 | 57 | 1.16 (0.85–1.60) | 27 | 73 | 0.89 (0.60–1.34) | ||
| 1000–1499 | 41 | 59 | 1.27 (0.48–3.54) | 22 | 78 | 1.14 (0.47–3.19) | ||
| ≥ 1500 | 43 | 57 | 1.18 (0.41–3.64) | 23 | 77 | 1.08 (0.32–4.92) | ||
| Housing | ||||||||
| Stable | 47 | 53 | Ref | 25 | 75 | Ref | ||
| Unstable | 46 | 55 | 1.05 (0.76–1.44) | 25 | 75 | 1.03 (0.69–1.56) | ||
| Other nicotine products, cannabis and alcohol use | ||||||||
| AUDIT‐C score (past year) | ||||||||
| < 4 | 47 | 53 | Ref | 26 | 74 | Ref | ||
| ≥ 4 | 46 | 55 | 1.30 (0.96–1.77) | 24 | 76 | 1.03 (0.69–1.56) | ||
| Cannabis use (past 6‐month) | ||||||||
| No | 48 | 52 | ref | 28 | 72 | ref | ||
| Yes | 46 | 54 | 1.08 (0.78–1.50) | 24 | 76 | 1.22 (0.80–1.84) | ||
| E‐cigarette use (past 6‐month) | ||||||||
| No | 49 | 52 | Ref | Ref | 26 | 74 | Ref | |
| Yes | 40 | 60 | 1.40 (1.01–1.94) | 1.21 (0.82–1.81) | 24 | 76 | 1.11 (0.73–1.72) | |
| Nicotine pouch use (past 6‐month) | ||||||||
| No | 46 | 54 | Ref | 25 | 75 | Ref | ||
| Yes | 50 | 50 | 0.86 (0.33–2.23) | 23 | 77 | 1.13 (0.34–5.11) | ||
| Mental and physical health | ||||||||
| Psychological distress (K10 score) | ||||||||
| K10 < 22 | 52 | 48 | Ref | Ref | 28 | 72 | Ref | |
| K10 ≥ 22 | 43 | 57 | 1.43 (1.06–1.94) | 1.49 (1.04–2.15) | 25 | 75 | 1.15 (0.77–1.72) | |
| Self‐reported general health | ||||||||
| Poor/fair | 43 | 57 | Ref | 23 | 78 | Ref | ||
| Good/very good/excellent | 49 | 51 | 0.79 (0.59–1.06) | 29 | 71 | 0.72 (0.49–1.05) | ||
| Self‐reported lifetime diagnoses of chronic health conditions (IDRS only) | ||||||||
| No | 48 | 52 | 27 | 73 | ref | |||
| Yes | 45 | 55 | 25 | 76 | 1.14 (0.78–1.67) | |||
Note: Multivariable model controls for age, gender identity and capital city. Shaded cell indicates that the variable was not included in the multivariable model. Bolded OR/AOR (95% CI) indicates significance.
Abbreviations: AOR, adjusted odds ratio; AUDIT‐C, Alcohol Use Disorders Identification Test‐Concise; CI, confidence interval; IDRS, Illicit Drug Reporting System; ITT, Illicitly traded tobacco; K10, Kessler Psychological Distress Scale; LGBQ+, lesbian, gay, bisexual, queer or other non‐heterosexual identity; OR, odds ratio.
Sensitivity analyses, containing the full 2025 sample (i.e., repeat participants not removed) found the above associations remained largely the same (see Table B4).
4. Discussion
This study examined patterns of ITT use among cross‐sectional samples of people who use drugs in Australia in 2024‐25, finding that ITT use significantly increased from 2024 to 2025 among people who regularly inject drugs and those who regularly use illicit stimulants. Cheaper price was the primary motivation for use across both populations, with participants paying less than half the legal retail price for ITT products. These findings highlight ongoing challenges facing tobacco control efforts in Australia, particularly among populations who may be vulnerable to financial stress and/or experiencing socioeconomic disadvantage and health inequities.
Tobacco use remains consistently high among people who use drugs in Australia. In 2025, 72% of EDRS participants and 87% of IDRS participants reported past 6‐month tobacco use—figures remarkably similar to those reported two decades ago (75% and 94% in 2005, respectively) [19, 20]. These percentages far exceed the 10.5% prevalence of current smoking observed in the general Australian population in 2022‐2023 [9], underscoring the concentration of tobacco‐related harm among people who use drugs and the limited reach of population‐level tobacco control measures within this group. These persistently high levels of use likely reflect complex interactions between shared neurobiological pathways, social contexts of co‐use and multiple forms of disadvantage—including poverty, mental health conditions and social marginalisation [28, 29, 30].
Against this backdrop of stable overall tobacco use, ITT use has increased substantially in both populations, consistent with broader evidence documenting growth in Australia's ITT market [3, 8]. Among EDRS participants, the frequency of tobacco use also increased in 2025 relative to 2024. Although days of use for ITT versus licit tobacco cannot be distinguished, precluding direct attribution to rising ITT use, this pattern raises concern that the availability of cheap tobacco may intensify consumption within a group already characterised by sustained high use. In both populations, the most common source was physical tobacconists, aligning with recent law enforcement investigations identifying retail outlets as primary distribution channels [12, 13]. The accessibility of ITT through conventional retail channels, albeit operating outside legal frameworks, likely lowers barriers to tobacco initiation and sustained use. This finding suggests that targeted enforcement efforts focusing on retail outlets may be effective in disrupting supply, though enforcement alone is unlikely to eliminate the illicit market while substantial price differentials and underlying demand persist [31].
Consistent with prior research [32, 33], price was the predominant reason for ITT use. The median price paid for a branded packet of 20 cigarettes (AUD$12–AUD$16 per pack) represents less than half the cost of legally purchased cigarettes in Australia, where retail prices range from AUD$36–AUD$69 per pack [34]. This substantial price differential creates powerful incentives for price‐sensitive consumers, particularly among populations experiencing financial stress or economic disadvantage. EDRS participants include high proportions of students and young adults with limited income, while IDRS participants experience high rates of unemployment and economic marginalisation [35, 36]. For individuals facing financial strain, cost savings associated with ITT may represent a significant proportion of tobacco expenditure, making these products attractive despite potential legal risks. Notably, there were a range of other motivations given for using ITT, including because ‘it tastes better’, suggesting that product characteristics beyond price may also influence use patterns [16].
The factors associated with ITT use, relative to exclusive licit tobacco use, differed across years and samples. In 2024, EDRS participants who identified as male, were aged ≥ 40 years and reported recent nicotine pouch and e‐cigarette use had higher odds of ITT use. The latter finding may reflect the nature of the sample, which comprises people engaged in illicit drug use and who may therefore be more likely to experiment with other illicit products. Alternatively, it may suggest overlap in the use of various nicotine‐containing products, potentially reflecting experimental use or the use of multiple products to manage nicotine dependence in contexts where smoking is restricted [37]. In contrast, in 2025, only gender remained significantly associated with ITT use. Among IDRS participants, higher psychological distress was associated with increased odds of ITT use in 2024—consistent with findings from general population samples [10]—but this association was not observed in 2025. Taken together, these findings suggest that growth in the ITT market may be accompanied by shifts in the characteristics of people accessing these products. The relative absence of associated factors in 2025 may indicate that ITT use is becoming ubiquitous among people who use tobacco, although this should be interpreted with caution given the small sample sizes.
Capital city of residence was the only factor consistently associated with ITT use across both populations and years, although the direction of the associations varied. In 2025, lower odds of ITT use were observed among participants residing in Perth, Adelaide, Hobart and Canberra, compared with Sydney, across both EDRS and IDRS participants. Lower odds were also observed among IDRS participants residing in Darwin and among EDRS participants residing in Brisbane, relative to Sydney. There is no clear explanation for the observed differences across years and populations. These variations may reflect sampling variability, differences in recruitment across the two populations or temporal and local fluctuations in market conditions (e.g., enforcement activity), although this cannot be determined with certainty.
Although jurisdiction‐specific data on the ITT trade are not publicly available, the absence of significant differences between Melbourne and Sydney is broadly consistent with media and law enforcement reports identifying New South Wales and Victoria as key sites of seizures and arson activity linked to organised crime [38, 39, 40]. Such conflict is typically associated with competition over distribution channels and point‐of‐sale control, which may reflect increased supply and retail and therefore availability. That said, significant increases in ITT use were observed in most capital city samples between 2024 and 2025, highlighting the breadth of uptake nationwide.
4.1. Practical Implications
These findings have important implications for tobacco control policy in Australia. Firstly, the increasing use of ITT undermines the effectiveness of high excise taxation as a primary control strategy. While excise increases remain an important and evidence‐based population‐level measure [1], their capacity to reduce tobacco use may be attenuated when inexpensive illicit alternatives are readily available to price‐sensitive populations. This is likely to be particularly salient among people already engaged in illicit substance use, who may face fewer barriers to accessing ITT and for whom price signals may prompt substitution rather than cessation. These findings highlight the limits of excise‐based approaches when supply‐side controls are weak and demand remains high. The identification of tobacconists as primary sources of ITT suggests that targeted enforcement and strengthened retail regulation may help disrupt supply chains.
Secondly, despite substantial population‐level declines in smoking, current strategies appear to have had limited impact among people who use drugs, indicating that universal approaches have not adequately addressed the needs of this group. As such, enforcement alone is unlikely to be sufficient without complementary interventions that reduce demand and address the structural factors sustaining high smoking rates. This should include accessible, integrated cessation support within existing services, with approaches tailored to the differing profiles of people who use drugs. For example, among samples of people who inject drugs, this might include integration of smoking cessation support within drug treatment services, using holistic harm‐reduction approaches that acknowledge the challenges of quitting multiple substances [41, 42]. In contrast, among samples of people who use stimulants, the association between ITT and e‐cigarette and nicotine pouch use in 2024 suggests that interventions should acknowledge and accommodate the range of nicotine products people may use concurrently. Across all groups, approaches should prioritise non‐stigmatising, accessible support that addresses the social and economic determinants of smoking [31, 43, 44, 45, 46].
4.2. Limitations
The population parameters of people who use or inject drugs are unknown and subsequently it is unclear whether the EDRS and IDRS samples are representative of these populations. In addition, the cross‐sectional design of the surveys precludes causal inference, while small sample sizes mean that findings should be interpreted with caution. The use of differing reference periods for key variables (past 6‐month substance use and past‐month psychological distress) may introduce some temporal misalignment and findings should therefore be interpreted with caution. Data were self‐reported and may be subject to bias, although previous studies point to sufficient validity and reliability of self‐report in studies assessing illicit substance use and associated behaviour [47]. Finally, it is possible that some participants were unable to accurately distinguish between licit and illicit tobacco products.
5. Conclusion
Tobacco use remains common among populations of people who use drugs in Australia and has shown little change over the past two decades. However, the use of ITT has increased substantially, driven primarily by their lower cost and mostly sourced from tobacconists, reflecting broader shifts in Australia's tobacco market. These findings underscore ongoing challenges for tobacco control, including the limited reach of existing strategies among people who use drugs and the risk that excise‐based approaches may be undermined by readily accessible illicit alternatives. Comprehensive responses combining targeted cessation support and effective supply‐side enforcement will be essential for reducing both licit and ITT use and associated harms among these populations.
Author Contributions
Each author certifies that their contribution to this work meets the standards of the International Committee of Medical Journal Editors.
Funding
A.P. (#1174630) is supported by a National Health and Medical Research Council Investigator Fellowship, C.P. is supported by an Australian Research Council Discovery Early Career Researcher Award Fellowship (DE230101131) and C.G. is supported by an Australian Research Council Future Fellowship (FT220100186). The work presented here was supported by funding from the Australian Government Department of Health, Disability and Ageing (RG231222‐A).
Conflicts of Interest
The Burnet Institute received travel funds from Navamedic for P.D. to attend a conference unrelated to this research. The other authors declare no conflicts of interest.
Acknowledgements
Open access publishing facilitated by University of New South Wales, as part of the Wiley ‐ University of New South Wales agreement via the Council of Australasian University Librarians.
Appendix A. Tobacco Questions Included in 2024 and 2025 EDRS and IDRS Surveys
Have you used tobacco in the last 6 months? Note: this include tobacco that has been mixed with cannabis.
No……………………………………………………………………………………………………………………………………0
Yes……………………………………………………………………………………………………………………………………1
-
2
How many days did you use tobacco in the last 6 months?
…………………………………………………………………………………………… (Min: 1, Max: 180)
-
3
What types of tobacco products have you used in the last 6 months? Read out all & mark all that apply
Smoked tobacco products (e.g., cigarettes, cigars, loose tobacco, cigarillos, molasses/shisha tobacco)……………………………………………………………….1
Non‐smoked tobacco products (e.g., chewing tobacco, snuff, heated tobacco products like iQOS that are devices that you insert a special cigarette into)…………………………………2
Other (specify)……………………………………………………………………………………….…3
-
4
Were any of the smoked tobacco products that you used in the past 6 months illicit? Note: illicit tobacco refers to products sold illegally without the necessary taxes added to the price
No……………………………………………………………………………………………………………………………………0
Yes……………………………………………………………………………………………………………………………………1
-
5
Which illicit smoked tobacco products have you used in the last 6 months? Read out all & mark all that apply
Branded cigarette pack(s) (including fake or real brands)…………………………………….1
Unbranded cigarette pack(s)……………………………………………………………………2
Branded loose tobacco (including fake or real brands)……………………………3
Unbranded loose tobacco (known as ‘chop chop’ in Australia)…………………………….4
Other smoked tobacco products (e.g., cigars, cigarillos, molasses/shisha tobacco) (specify) ..............................................………………………………………………….5
Non‐smoked tobacco products (e.g., chewing tobacco, snuff)………………6
-
6
Where have you obtained illicit tobacco products from in the past 6 months in Australia? Note: illicit tobacco products include all non‐smoked tobacco products (e.g., chewing tobacco, snuff), as well as illicit smoked tobacco products (cigarettes, cigars, loose tobacco). mark all that apply
Online store (surface or dark web)……………………………………………………………………………….1
Physical (‘bricks and mortar’) vape store under the counter^………………2
Physical (‘bricks and mortar’) tobacconist…………………………………………….3
Physical (‘bricks and mortar’) convenience store………………………………….4
Physical (‘bricks and mortar’) petrol station………………………………………….5
Physical (‘bricks and mortar’) supermarket…………………………………………….6
Other physical (‘bricks and mortar’) shop (specify)……………………………….7
Friend/relative/acquaintance…………………………………………………….……………8
Dealer…………………………………………………………………………………………………………………………….9
Brought into Australia when coming back from overseas…………………….10
Other (specify)…………………………………………………………………………………………11
-
7
The last time you purchased an illicit tobacco product, what product did you purchase? Note: illicit tobacco products includes all non‐smoked tobacco products (e.g., chewing tobacco, snuff), as well as illicit smoked tobacco products (e.g., ‘chop chop’, cigars, cigarillos, molasses/shisha tobacco). read out all
If participant reports that they have not purchased an illicit tobacco product (e.g., were give/gifted it), select 'skip question'.
Branded cigarette pack(s) (including fake or real brands)…………………….1
Unbranded cigarette pack(s)……………………………………………………………………2
Branded loose tobacco (including fake or real brands)……………………………3
Unbranded loose tobacco (known as ‘chop chop’ in Australia)…………………………….4
Other smoked tobacco products (e.g., cigars, cigarillos, molasses/shisha tobacco) (specify) ..............................................………………………………………………….5
Non‐smoked tobacco products (e.g., chewing tobacco, snuff)………………………………6
-
8
The last time you purchased an illicit tobacco product, how much did you purchase? Please specify measure
Pack(s)………………………………………………………………………………………………………………………….…1
Individual cigarette(s)…………………………………………………………………………….2
Gram(s)……………………………………………………………………………………………………………………………3
Kilogram(s)………………………………………………………………………………………………………………………4
Other (specify)…………………………………………………………………………………………5
-
9
Specify Quantity (e.g., 1 Pack, 0.5 g)
……………………………………………………………………………………………
-
10
The last time you purchased a pack, how many cigarettes were in a pack?^^
……………………………………………………………………………………………
-
11
The last time you purchased an illicit tobacco product how much did you pay? Note: Illicit tobacco products includes all non‐smoked tobacco products (e.g., chewing tobacco, snuff), as well as illicit smoked tobacco products (e.g., ‘chop chop’, cigars, cigarillos, molasses/shisha tobacco)
$……………………………………………………………………………………………………………………………………
-
12
Why do you use illicit tobacco products instead of legal products? Note: Illicit tobacco products includes all non‐smoked tobacco products (e.g., chewing tobacco, snuff), as well as illicit smoked tobacco products (e.g., ‘chop chop’, cigars, cigarillos, molasses/shisha tobacco). Mark all that apply
It's cheaper……………………………………………………………………………………………….1
It's healthier.……………………………………………………………………………………………..2
It tastes better…………………………………………………………………………………………….3
It's easier to purchase……………………………………………………………………………….4
It's what my friends/colleagues smoke………………………………………………………………………….5
It's what the seller recommended/promoted………………………………………….6
I prefer to smoke cigarettes from another country………………………………….7
I don’t want to pay more taxes to the government……………………………………….8
Other (specify).…………………………………………………………………………………………9
Note: ‘Don’t know’ and ‘Skip questions’ provided as response options for all questions. ^Not included as a response option in 2025 surveys, since legislative changes introduced 1 July 2024 (after 2024 EDRS/IDRS surveys were completed) meant that vape stores could no longer legally operate in 2025. ^^Not asked in 2024.
Appendix B. Supporting Information and Sensitivity Analyses Tables B1, B2, B3, B4
TABLE B1.
ITT use, among EDRS and IDRS participants who had recently used tobacco, 2024–2025: full sample (i.e., repeat participants not excluded).
| EDRS | IDRS | |||||
|---|---|---|---|---|---|---|
| 2024 (n = 533) | 2025 (n = 494) | Total (N = 1027) | 2024 (n = 769) | 2025 (n = 754) | Total (N = 1523) | |
| ITT use | ||||||
| No, n (%) | 322 (60%) | 167 (34%) | 489 (48%) | 348 (45%) | 206 (27.%) | 554 (36%) |
| Yes, n (%) | 195 (37%) | 309 (63%) | 504 (49%) | 404 (52%) | 548 (72.%) | 952 (63%) |
| Missing, n (%) | 16 (3%) | 18 (4%) | 34 (3%) | 17 (2%) | 0 (0%) | 17 (1%) |
Note: 2024 and 2025 figures do not match Table 1, since missing data has not been excluded.
Abbreviations: EDRS, Ecstasy and Related Drugs Reporting System; IDRS, Illicit Drug Reporting System; ITT, illicitly traded tobacco.
TABLE B2.
ITT use, among EDRS and IDRS participants who had recently used tobacco, 2024–2025: Repeat participants excluded from 2025 samples.
| EDRS | IDRS | |||||
|---|---|---|---|---|---|---|
| 2024 (n = 533) | 2025 (n = 441) | Total (N = 974) | 2024 (n = 769) | 2025 (n = 581) | Total (N = 1350) | |
| ITT use | ||||||
| No n (%) | 322 (60%) | 147 (33%) | 469 (48%) | 348 (45%) | 147 (25%) | 495 (37%) |
| Yes n (%) | 195 (37%) | 276 (63%) | 471 (48%) | 404 (53%) | 434 (75%) | 838 (62%) |
| Missing n (%) | 16 (3%) | 18 (4%) | 34 (4%) | 17 (2%) | 0 (0.0%) | 17 (1%) |
Abbreviations: EDRS, Ecstasy and Related Drugs Reporting System; IDRS, Illicit Drug Reporting System; ITT, illicitly traded tobacco.
TABLE B3.
Past 6‐month tobacco and ITT use, among EDRS and IDRS participants, 2024–2025: full sample (i.e., repeat participants excluded) by capital city.
| EDRS | IDRS | |||||
|---|---|---|---|---|---|---|
| 2024 | 2025 | p | 2024 | 2025 | p | |
| Sydney | ||||||
| Any tobacco use, % | 63 | 66 | 1.00 | 91 | 92 | 0.878 |
| Any ITT use*, % | 36 | 86 | < 0.001 | 71 | 89 | 0.001 |
| Melbourne | ||||||
| Any tobacco use, % | 70 | 69 | 1.00 | 89 | 86 | 0.720 |
| Any ITT use*, % | 46 | 76 | 0.002 | 90 | 89 | 0.990 |
| Brisbane/Gold Coast | ||||||
| Any tobacco use, % | 71 | 66 | 1.00 | 84 | 82 | 0.966 |
| Any ITT use*, % | 53 | 68 | 0.146 | 64 | 82 | 0.030 |
| Perth | ||||||
| Any tobacco use, % | 70 | 74 | 1.00 | 81 | 88 | 0.523 |
| Any ITT use*, % | 15 | 54 | < 0.001 | 29 | 65 | < 0.001 |
| Adelaide | ||||||
| Any tobacco use, % | 75 | 62 | 0.585 | 93 | 89 | 0.720 |
| Any ITT use*, % | 42 | 37 | 0.738 | 56 | 66 | 0.349 |
| Hobart | ||||||
| Any tobacco use, % | 77 | 76 | 1.00 | 93 | 86 | 0.523 |
| Any ITT use*, % | 33 | 62 | 0.008 | 19 | 65 | < 0.001 |
| Darwin | ||||||
| Any tobacco use, % | 65 | 68 | 1.00 | 89 | 71 | 0.436 |
| Any ITT use*, % | 23 | 62 | 0.020 | 7 | 12 | 0.690 |
| Canberra | ||||||
| Any tobacco use, % | 82 | 86 | 1.00 | 75 | 84 | 0.523 |
| Any ITT use*, % | 46 | 70 | 0.008 | 54 | 63 | 0.560 |
| National | ||||||
| Any tobacco use, % | 72 | 71 | 0.724 | 87 | 87 | 0.875 |
| Any ITT use*, % | 36.6 | 63 | < 0.001 | 53 | 75 | < 0.001 |
Abbreviations: EDRS, Ecstasy and Related Drugs Reporting System; IDRS, Illicit Drug Reporting System; ITT, illicitly traded tobacco.
Among those who reported past 6‐month tobacco use, p‐values were adjusted using the Benjamini–Hochberg false discovery rate procedure; few values were adjusted to p = 1.00.
TABLE B4.
Factors associated with ITT use, among EDRS and IDRS participants who reported past 6‐month tobacco use, 2025: sensitivity analyses with full sample (i.e., including repeat participants).
| Past 6‐month ITT use, EDRS 2025 | Past 6‐month ITT use, IDRS 2025 | |||||||
|---|---|---|---|---|---|---|---|---|
| Licit tobacco use only (n = 309) % | Any illicit tobacco use (n = 167) % | OR (95% CI) | AOR (95% CI) | Licit tobacco use only (n = 548) % | Any illicit tobacco use (n = 206) % | OR (95% CI) | AOR (95% CI) | |
| Demographics | ||||||||
| Age, years | ||||||||
| ≤ 20 | 31 | 69 | Ref | Ref | ||||
| 20–29 | 37 | 63 | 0.78 (0.48–1.26) | 0.90 (0.54–1.51) | 21 | 80 | Ref | Ref |
| 30–39 | 40 | 60.0 | 0.69 (0.39–1.22) | 0.67 (0.35–1.27) | 31 | 69 | 0.58 (0.24–1.29) | 2.55 (1.05–6.44) |
| ≥ 40 | 29 | 71 | 1.13 (0.57‐2.27) | 1.27 (0.60–2.80) | 27 | 73 | 0.69 (0.31–1.42) | 2.26 (1.00–5.30) |
| Identify as male | ||||||||
| No | 44 | 56 | Ref | Ref | 29 | 71 | Ref | Ref |
| Yes | 28 | 72.0 | 2.05 (1.40–3.01) | 1.97 (1.30–2.98) | 26 | 74 | 1.13 (0.81–1.57) | 1.15 (0.78–1.68) |
| Capital city of residence | ||||||||
| Sydney | 15 | 85 | Ref | Ref | 12 | 88 | Ref | Ref |
| Melbourne | 26 | 74 | 0.50 (0.20–1.19) | 0.55 (0.22–1.34) | 10 | 90 | 1.29 (0.61–2.79) | 3.28 (1.71–6.63) |
| Brisbane/Gold Coast | 35 | 65 | 0.44 (0.18–1.02) | 0.41 (0.16–0.98) | 17 | 83 | 0.67 (0.32–1.42) | 0.68 (0.38–1.23) |
| Perth | 48 | 52 | 0.19 (0.08–0.42) | 0.19 (0.08–0.44) | 32 | 69 | 0.31 (0.16–0.59) | 0.16 (0.09–0.30) |
| Adelaide | 61 | 39 | 0.11 (0.05–0.25) | 0.11 (0.04–0.26) | 37 | 63 | 0.24 (0.12–0.45) | 0.52 (0.30–0.92) |
| Hobart | 38 | 62 | 0.29 (0.12–0.69) | 0.28 (0.11–0.67) | 35 | 65 | 0.26 (0.13–0.50) | 0.10 (0.05–0.18) |
| Darwin | 43 | 57 | 0.24 (0.07–0.85) | 0.29 (0.08–1.07) | 84 | 16 | 0.03 (0.01–0.07) | 0.03 (0.01–0.08) |
| Canberra | 29 | 71 | 0.45 (0.19–0.99) | 0.44 (0.18–1.01) | 39 | 61 | 0.22 (0.11–0.42) | 0.49 (0.26–0.92) |
| Sexual orientation | ||||||||
| Heterosexual | 35 | 65 | Ref | 28 | 72 | Ref | ||
| LGBQ+ | 36 | 64 | 0.97 (0.64–1.47) | 25 | 75 | 1.14 (0.74–1.77) | ||
| Median weekly income | ||||||||
| < 500 | 32 | 68 | Ref | 27 | 73 | Ref | ||
| 500–999 | 33 | 67 | 0.94 (0.58–1.52) | 28 | 72 | 0.95 (0.68–1.35) | ||
| 1000–1499 | 38 | 62 | 0.75 (0.44–1.30) | 31 | 69 | 0.83 (0.40–1.82) | ||
| ≥ 1500 | 44 | 57 | 0.61 (0.34–1.09) | 28 | 72 | 0.95 (0.35–3.03) | ||
| Housing | ||||||||
| Stable | 34 | 66 | Ref | 27 | 73. | Ref | ||
| Unstable | 48 | 52 | 0.57 (0.24–1.34) | 27 | 73 | 1.00 (0.70–1.45) | ||
| Other nicotine products, cannabis and alcohol use | ||||||||
| AUDIT‐C score (past year) | ||||||||
| < 4 | 42 | 59 | Ref | 27 | 73 | Ref | ||
| ≥ 4 | 34 | 66 | 1.40 (0.81–2.39) | 29 | 71 | 0.88 (0.63–1.24) | ||
| Cannabis use (past 6‐month) | ||||||||
| No | 43 | 57 | Ref | 29 | 71 | Ref | ||
| Yes | 34 | 66 | 1.45 (0.86–2.45) | 27 | 73 | 1.09 (0.76–1.56) | ||
| E‐cigarette use (past 6 month) | ||||||||
| No | 36 | 64 | Ref | 28 | 72 | Ref | ||
| Yes | 35 | 65 | 1.07 (0.70–1.63) | 24 | 76 | 1.22 (0.84–1.79) | ||
| Nicotine pouch use (past 6‐month) | ||||||||
| No | 38 | 62 | Ref | Ref | 27 | 73 | Ref | |
| Yes | 27 | 73 | 1.65 (1.03–2.71) | 1.14 (0.62–2.07) | 26 | 74 | 1.06 (0.40–3.30) | |
| Mental and physical health | ||||||||
| Psychological distress (K10 score) | ||||||||
| K10 < 22 | 34 | 67 | Ref | 31 | 69 | Ref | Ref | |
| K10 ≥ 22 | 36 | 64 | 0.89 (0.61–1.3) | 26 | 74 | 1.43 (1.06–1.94) | 1.49 (1.04–2.15) | |
| Self‐reported general health | ||||||||
| Poor/fair | 34 | 66 | ref | 24 | 76 | ref | ref | |
| Good/very good/excellent | 35 | 65 | 0.96 (0.63–1.45) | 31 | 69 | 0.79 (0.59–1.06) | ||
| Self‐reported lifetime diagnoses of chronic health conditions, (IDRS only) | ||||||||
| No | 30 | 70 | Ref | |||||
| Yes | 26 | 74 | 1.26 (0.91–1.74) | |||||
Note: Multivariable model controls for age, gender identity and capital city. Shaded cell indicates that the variable was not included in the multivariable model. Bolded OR/AOR (95% CI) indicates significance.
Abbreviations: AOR, adjusted odds ratio; AUDIT‐C, Alcohol Use Disorders Identification Test‐Concise; CI, confidence interval; EDRS, Ecstasy and Related Drugs Reporting System; IDRS, Illicit Drug Reporting System; ITT, Illicitly traded tobacco; K10, Kessler Psychological Distress Scale; LGBQ+, lesbian, gay, bisexual, queer or other non‐heterosexual identity; OR, odds ratio.
Appendix C. Table C1
TABLE C1.
STROBE Statement—Checklist of Items That Should be Included in Reports of Cross‐Sectional Studies.
| Item no | Recommendation | Checked | |
|---|---|---|---|
| Title and abstract | 1 | (a) Indicate the study's design with a commonly used term in the title or the abstract | ✓ |
| (b) Provide in the abstract an informative and balanced summary of what was done and what was found | ✓ | ||
| Introduction | |||
| Background/rationale | 2 | Explain the scientific background and rationale for the investigation being reported | ✓ |
| Objectives | 3 | State specific objectives, including any prespecified hypotheses | ✓ |
| Methods | |||
| Study design | 4 | Present key elements of study design early in the paper | ✓ |
| Setting | 5 | Describe the setting, locations and relevant dates, including periods of recruitment, exposure, follow‐up and data collection | ✓ |
| Participants | 6 |
(a) Cohort study—Give the eligibility criteria and the sources and methods of selection of participants. Describe methods of follow‐up Case‐control study—Give the eligibility criteria and the sources and methods of case ascertainment and control selection. Give the rationale for the choice of cases and controls Cross‐sectional study—Give the eligibility criteria and the sources and methods of selection of participants |
✓ |
|
(b) Cohort study—For matched studies, give matching criteria and number of exposed and unexposed Case‐control study—For matched studies, give matching criteria and the number of controls per case |
N/A | ||
| Variables | 7 | Clearly define all outcomes, exposures, predictors, potential confounders and effect modifiers. Give diagnostic criteria, if applicable | ✓ |
| Data sources/measurement | 8 a | For each variable of interest, give sources of data and details of methods of assessment (measurement). Describe comparability of assessment methods if there is more than one group | ✓ |
| Bias | 9 | Describe any efforts to address potential sources of bias | ✓ |
| Study size | 10 | Explain how the study size was arrived at | ✓ |
| Quantitative variables | 11 | Explain how quantitative variables were handled in the analyses. If applicable, describe which groupings were chosen and why | ✓ |
| Statistical methods | 12 | (a) Describe all statistical methods, including those used to control for confounding | ✓ |
| (b) Describe any methods used to examine subgroups and interactions | ✓ | ||
| (c) Explain how missing data were addressed | ✓ | ||
|
(d) Cohort study—If applicable, explain how loss to follow‐up was addressed Case‐control study—If applicable, explain how matching of cases and controls was addressed Cross‐sectional study—If applicable, describe analytical methods taking account of sampling strategy |
✓ | ||
| (e) Describe any sensitivity analyses | ✓ | ||
| Participants | 13 a | (a) Report numbers of individuals at each stage of study—eg numbers potentially eligible, examined for eligibility, confirmed eligible, included in the study, completing follow‐up and analysed | ✓ |
| (b) Give reasons for non‐participation at each stage | ✓ | ||
| (c) Consider use of a flow diagram | ✓ | ||
| Descriptive data | 14 a | (a) Give characteristics of study participants (e.g., demographic, clinical, social) and information on exposures and potential confounders | ✓ |
| (b) Indicate number of participants with missing data for each variable of interest | ✓ | ||
| (c) Cohort study—Summarise follow‐up time (e.g., average and total amount) | N/A | ||
| Outcome data | 15 a | Cohort study—Report numbers of outcome events or summary measures over time | N/A |
| Case‐control study—Report numbers in each exposure category or summary measures of exposure | N/A | ||
| Cross‐sectional study—Report numbers of outcome events or summary measures | ✓ | ||
| Main results | 16 | (a) Give unadjusted estimates and, if applicable, confounder‐adjusted estimates and their precision (e.g., 95% confidence interval). Make clear which confounders were adjusted for and why they were included | ✓ |
| (b) Report category boundaries when continuous variables were categorised | ✓ | ||
| (c) If relevant, consider translating estimates of relative risk into absolute risk for a meaningful time period | N/A | ||
| Other analyses | 17 | Report other analyses done—eg analyses of subgroups and interactions and sensitivity analyses | ✓ |
| Discussion | |||
| Key results | 18 | Summarise key results with reference to study objectives | ✓ |
| Limitations | 19 | Discuss limitations of the study, taking into account sources of potential bias or imprecision. Discuss both direction and magnitude of any potential bias | ✓ |
| Interpretation | 20 | Give a cautious overall interpretation of results considering objectives, limitations, multiplicity of analyses, results from similar studies and other relevant evidence | ✓ |
| Generalisability | 21 | Discuss the generalisability (external validity) of the study results | ✓ |
| Other information | |||
| Funding | 22 | Give the source of funding and the role of the funders for the present study and, if applicable, for the original study on which the present article is based | ✓ |
Note: An Explanation and Elaboration article discusses each checklist item and gives methodological background and published examples of transparent reporting. The STROBE checklist is best used in conjunction with this article (freely available on the Web sites of PLoS Medicine at http://www.plosmedicine.org/, Annals of Internal Medicine at http://www.annals.org/ and Epidemiology at http://www.epidem.com/). Information on the STROBE Initiative is available at www.strobe‐statement.org.
Give information separately for cases and controls in case‐control studies and, if applicable, for exposed and unexposed groups in cohort and cross‐sectional studies.
Endnotes
Typically, AUDIT cut‐off scores are ≥ 3 for women and ≥ 4 for men. However, to facilitate ease of interpretation, we applied a cut‐off score of ≥ 4 regardless of gender. This may result in an underestimation of hazardous alcohol use among women.
Data Availability Statement
The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.