Wastewater testing makes headlines, but they ignore the one drug we really need to worry about

The latest National Wastewater Drug Monitoring Program Report contains some uncomfortable truths for West Australians.

As areas in regional WA have the highest overall methamphetamine consumption, Perth’s illicit usage continues to also rank high among Australia’s capital cities.

This report points to a sustained demand of illicit drug use, with an estimated 26.8 tonnes of methamphetamine, cocaine, heroin and MDMA consumed nationally between August 2024 and August 2025 – a 21 per cent increase on the previous year.

But for me, this isn’t a reason to overreact.

I keep asking myself: does this mean methamphetamine is the drug of most concern in WA right now? In my opinion, the short answer is no.

And if you read between the lines, this report tells us where we should be paying closer attention, too.

It’s a legal drug many Australians are still uncomfortable grappling with: alcohol.

The National Wastewater Drug Monitoring Program has been running for nine years and through the life of that program national consumption of nicotine and alcohol far exceeded consumption of all other substances being monitored.

In addition, cannabis consumption is on the rise, exceeding by some margin consumption of all other illicit drugs.

At Palmerston, while we are seeing more presentations where methamphetamine is part of the picture, this prevalence is second to alcohol, which remains the primary drug which people seek treatment and support for, with cannabis not far behind.

Our service data isn’t a perfect mirror of wastewater, but it reminds us of something important: alcohol and other drug use is so often a symptom of broader social and economic pressures.

This includes trauma, mental illness, housing stress, isolation, unemployment, family and domestic violence.

All things which are currently being exacerbated, especially with another round of interest rate hikes.

The most recent WA evidence base is sobering. Cancer Council WA’s “Alcohol fuels many harms” campaign points to a hidden crisis.

In WA, alcohol-caused cancers account for around three deaths a week and more than 1000 hospitalisations a year; and each week there are eight alcohol-related deaths, 402 hospitalisations and 180 family violence incidents.

WA also has one of the highest rates of alcohol-related emergency department presentations in the country, with around one in five ED patients on a Saturday night are there because of alcohol.

Harm from alcohol is preventable, and we have strong evidence about what works, but it requires resolve.

The WA Mental Health Commission’s new Mental Health and Alcohol and Other Drugs Strategy for 2026–2031 is timely.

I welcome the intent: move us away from waiting for crisis and toward earlier help, easier navigation and better connection to community supports.

The “no wrong door” approach matters because people don’t arrive neatly labelled “mental health” or “alcohol or drug use”.

The real work is making it tangible: stable funding, a workforce we can keep, and better local insight so we respond in the right place at the right time.

We can measure consumption more easily than we can measure complexity. The question is whether we’re curious enough to go looking for the missing pieces, before they become crises.

We also need the courage to talk about what’s still unfinished. Ideas like drug checking, exploring a supervised consumption facility, or needle and syringe programs in prisons remain contested.

But the underlying issue isn’t really the controversy, it’s whether we’re prepared to use evidence‑based harm reduction to prevent deaths, even when it challenges our comfort, and to talk about it with the same maturity we expect in every other area of public health.

So, what should WA do next?

Use wastewater as an early warning and fund rapid local responses when risk spikes, especially in regional WA.

Make treatment easier to reach: end‑to‑end pathways that include withdrawal support, rehab, step‑down and aftercare, with strong transitions back to community.

Strengthen harm reduction where people actually are: naloxone access, fast drug alerts, and mature, evidence‑led conversations about drug checking.

Do the steady work on alcohol: prevention and policy that reduces harm, alongside accessible treatment and family supports.

Back the system enablers: workforce, realistic indexation, and data/evaluation that tells us outcomes, not just activity.

Let’s use the latest wastewater testing results as one important input, then use all available evidence to guide policy, commissioning and local responses.

When the data tells us demand is strong, it should trigger a balanced approach across prevention, early intervention, treatment and harm reduction.

And when it reminds us alcohol is doing enormous damage, it should trigger the courage to act on the legal harms with the same seriousness we bring to the illegal ones.

If we can do that, these reports stop being a quarterly headline and become what they’re meant to be: a tool that helps us reduce harm and save lives.