The role of alcohol and drug intoxication in fatal drowning and other deaths that occur on the Australian coast

Abstract

Introduction: Alcohol and drug (illicit or prescription) intoxication impairs motor skills, coordination, decision making abilities, hazard perception, and is known to increase the risk of death in coastal environments. Prior coastal safety research has focused largely on the impact of alcohol on drowning, with less research on the influence of drugs and leaving a significant number of other non-drowning fatalities largely excluded, despite being preventable with mitigation of injuries or medical factors. Method: This retrospective cross-sectional study explored the impact of alcohol and drugs on unintentional Australian drowning deaths and other coastal fatalities over a 16-year period to identify higher-risk populations and coastal activity groups for which alcohol/drug use is increased. Results: It was found that alcohol, benzodiazepines/sedatives, and amphetamine usage was prevalent in coastal deaths. Of the 2,884 coastal deaths, 80.6% of decedents had known toxicological data. Alcohol and/or drug intoxication contributed to 23% of coastal drowning deaths and 19% of fatalities. For drowning and other fatalities combined, 8.7% were due to alcohol, 8.7% due to drugs, and 4.1% due to both alcohol and drugs. Australian-born decedents were more likely to involve alcohol (RR = 1.7, 95%CI = 1.26–2.3, p < 0.001), drugs (RR = 2.62, 95%CI = 1.85–3.7, p < 0.001), or both alcohol and drugs (RR = 4.43, 95%CI = 2.51–7.82, p < 0.001) with an increased risk identified in Indigenous Australian populations (RR = 2.17, 95%CI = 1.12–4.24, p = 0.04). The impact of alcohol and drug intoxication varied by activity, with Personal Watercraft users more likely to die due to alcohol intoxication (RR = 2.67, 95%CI = 1.23–5.78, p = 0.035), while scuba divers (RR = 0, p < 0.001), snorkelers (RR = 0.14, 95%CI = 0.036–0.57, p < 0.001), and rock fishers (RR = 0.46, 95%CI = 0.22–0.96, p = 0.03) were less likely. Recreational jumping and fall-related coastal deaths were more likely to involve alcohol and alcohol/drugs combined. Practical Applications: This study identifies factors to further investigate or target with prevention strategies to decrease the holistic burden of mortality due to alcohol and/or drug usage on the Australian coast.