NDARC Technical Report No. 217 (2005)
EXECUTIVE SUMMARY
Demographic characteristics of injecting drug users (IDU)
In 2004, one hundred IDU were interviewed for the IDRS in the ACT. The sample of IDU was very similar to those interviewed in 2003. Almost two thirds of the IDU sample was male (65%) and the mean age of respondents was 35 years. The majority (81%) of the IDU were unemployed. The mean age of formal school years completed was 11, and 32% reported they had trade or technical qualifications, while 17% reported that they had university or other tertiary qualifications. Almost half (48%) of the 2004 IDU respondents reported currently participating in some form of drug treatment. Forty five percent of IDU reported a previous prison history.
Patterns of drug use among IDU
In 2004, less than half the sample (41%) reported injecting once or more times a day (regardless of the drug injected). Younger IDU (<=25 years of age) were more likely to inject on a daily or more basis (55%) than users over 25 years of age (38%). The 2004 IDU sample injected less frequently than the 2003 IDU sample.
Similar to 2003, heroin was the drug of choice for the majority of respondents (68%), followed by methamphetamine (20%) and cannabis (7%). Seventy-four percent of the IDU sample reported heroin to be the drug they injected most often in the month prior to the interview. In 2004 the proportion of IDU reporting methamphetamine to be the drug they injected most often in the month prior to interview (24%) was similar to figures reported in 2003 (30%). Heroin was the most recent drug injected by almost three quarters of the 2004 IDU sample followed by methamphetamine (19%).
Polydrug use was universal amongst IDU, with respondents reporting an average of 12 drug classes used in their lives and 7 drug classes used in the six months preceding interview. In terms of the number of drug classes ever injected, respondents reported having ever injected an average of 6 drug classes and an average of 3 drug classes in the six months prior to interview. The most common drugs used on the day preceding the interview were heroin (53%), cannabis (51%), and alcohol (21%)
Heroin
Heroin use was universal among the 2004 IDU sample, as it was in 2003, with 91% reporting use in the six months prior to the interview. The median price of heroin remained relatively stable in 2004. From 2003 to 2004 the cost of a cap of heroin remained stable at $50, while the cost of a gram decreased slightly from $350 a gram in 2003 to $300 in 2004. Availability also remained stable, with heroin being reported as ‘easy’ (38%) or ‘very easy’ (53%) to obtain in the ACT. The reported purity of heroin in the ACT was perceived by IDU to have remained stable, with 19% believing heroin purity to be high and 42% medium. Key experts also reported the price of heroin to be stable and the purity medium. This is also supported by purity analysis of ACT police heroin seizures, where the median purity remained stable at approximately 32% during 2003-2004.
Despite the ease of access to heroin in the ACT in 2004 and the stability in price, there is a clear indication that the frequency of heroin use has decreased in 2004, with a decrease in the median days of use from 93 in 2003 to 73 in 2004. The proportion of IDU reporting daily heroin use also decreased from 32% in 2003 to 24% in 2004. Although these data indicate a trend towards a decrease in the frequency of heroin use in the ACT, it should be noted that differences were not statistically significant.
In 2004, there was an increase in the number of non-fatal heroin overdoses attended by the ACT Ambulance Service (from 159 in 2002-2003 to 248 in 2003-2004). The ABS (Degenhardt, Roxburgh & Baker, 2004) also reported an increase in the number of accidental deaths due to heroin overdose in the ACT from 8 in 2002 to 17 in 2003. However, the number of clients Alcohol and Drug Program clients withdrawing from heroin at Arcadia House in the ACT remained stable. The number of clients in opioid-related case management reached its lowest level in 2003-2004 since 1998-1999.
Methamphetamine
In 2004 81% of the IDU interviewed for the ACT IDRS study reported the use of some form of methamphetamine in the six months preceding the interview, a non-significant increase from 74% in 2003. In 2004 there was a decrease in the perceived availability of crystal methamphetamine by IDU in the ACT, with 32% of IDU reporting ice to be easy to obtain compared to 67% in 2003. This corresponded with an increase from 6% of IDU in 2003 to 24% of IDU in 2004 who believed ice to be difficult to very difficult to obtain. Despite this, crystal methamphetamine or ‘ice’ use remains high in the ACT in 2004 with crystal methamphetamine the form used most by 80% of recent methamphetamine users.
Of concern is a clear trend in the ACT toward the injection of methamphetamine. There was a statistically significant increase in the proportion of IDU who reported recent injection of ice (78% in 2004 compared to 64% in 2003) and base (26% in 2004 compared to 13% in 2003). The number of IDU reporting recent injection of methamphetamine powder remained stable from 2003 to 2004. In 2004, methamphetamine use in the ACT remains high in the context of a stable heroin market (rather than parallel to a decrease in heroin availability and use). This is a matter of some concern and was commented on by IDU and key experts. A considerable proportion of IDU commented on the widespread use of methamphetamine, even in the traditional heroin- or opioid-using population. Moreover key experts expressed a number of health concerns relating to ice use, particularly agitation, violent behaviour, drug induced psychosis as well as an increase in sexual risk taking and unsafe sexual practices.
Cocaine
As has been the case in the IDRS in previous years, cocaine does not appear to be a drug of choice for IDU in the ACT. Only 10% of IDU in 2004 had used cocaine in the six months prior to interview, and amongst those who had, patterns of use were infrequent. A small number of IDU commented on the price, purity and availability of cocaine, reporting that it was ‘difficult’ to ‘very difficult’ to obtain in the ACT, and that this had remained stable. The median price for cocaine was reported at $350 for a gram ($200 in 2003), representing an increase in price from the previous year. IDU reported cocaine purity in the ACT in 2004 to be low. The ACT police seized six cocaine samples in the ACT in 2003-2004, three of which were suitable for purity analysis. The median purity was reported to be 48%.
Cannabis
Cannabis use was widespread and frequent amongst the IDU sample in 2004. Cannabis had been used by 85% of the IDU sample in the six months prior to interview, with just over half of the sample (52%) reporting daily use. As anticipated, differences in price existed between outdoor-cultivated cannabis (‘bush) and indoor-cultivated cannabis (‘hydro’). The median price for an ounce of bush and hydroponic cannabis was $200 and $280 respectively. Consistent with key informant reports, the majority of IDU commenting on cannabis reported that it was ‘easy’ to ‘very easy’ to obtain, and that this had remained stable over the past six months. In support of the ease of availability of cannabis in the ACT, the weight of cannabis seized by ACT police has been increasing over the past four financial years. As has been the case in previous years, hydroponic cannabis remains the dominant form of cannabis on the market.
The number of Alcohol and Drug Program clients withdrawing from cannabis at Arcadia House in the ACT continues to rise, however the number of clients in cannabis related case management reached their lowest levels since 1998. In the ACT the majority of all drug related arrests are due to cannabis related offences.
Illicit use of methadone
In 2004, the level of use of diverted methadone among the ACT IDU sample was similar to that reported in 2003. Twenty-nine percent reported recent use of illicit methadone, compared to 26% in 2003. This indicates that the proportion of IDU reporting recent use of someone else’s methadone prescription has remained relatively stable. Twenty-five percent of the sample had injected illicitly obtained methadone (i.e. methadone that is prescribed to someone else) in the preceding six months, a slight decrease from the 34% reporting this in 2003. Of those IDU who had recently used methadone, 30% had used diverted methadone syrup.
Illicit use of buprenorphine
In 2004, 5% of IDU reported diverting licit buprenorphine via injection. This means that a small proportion of IDU reported recent injection of their buprenorphine prescription. Nine percent reported having ever used illicitly obtained buprenorphine, i.e. used buprenorphine prescribed to someone else, while 5% of IDU reported recent diversion via injection of illicit buprenorphine.
Morphine
Compared with 2003 (50%), in 2004, there was a small, but non-significant decrease in the proportion of IDU reporting the recent use of morphine in the ACT (40%). There was a corresponding decrease in the proportion of IDU reporting recent injection of morphine in the six months preceding interview (49% in 2003 to 40% in 2004). Of the IDU who had used morphine in the six months prior to interview, 80% had used illicitly obtained morphine at least once during this period, and a similar proportion (88%) reported that illicitly obtained morphine was the predominant form they had used. As in past years, MS Contin® was the preferred brand of morphine for majority (64%) recent morphine users.
Other opioids
The use of ‘other opioids’ remained relatively stable from 2003 to 2004, except in relation to injecting. In the six months prior to interview, almost one in five IDU (17%) reported the use of ‘other opiates’, with Panadeine Forte® being the most popular preparation used. However, there was a statistically significant decrease in the proportion of IDU that reporting recent injection of other opiates from 32% in 2003 to 17% in 2004.
There was a significant decrease in the use of homebake heroin among IDU in the 2004 ACT sample. In 2003, 16% of IDU interviewed reported use of homebake heroin in the six months prior to the interview, however in 2004 only 6% of IDU reported recent homebake use. All of those who had recently used homebake had injected it.
Benzodiazepines
Benzodiazepine use remained high among the IDU sample in 2004. Over half (59%) of the 2004 IDU sample reported using benzodiazepines in the six months preceding interview, though only a small proportion (7%) had injected benzodiazepines during this period. Forty one percent of the sample had used illicitly obtained benzodiazepines at least once during this period (a decrease albeit non-significant from 56% in 2003), while approximately one third (30%) reported that they mainly used benzodiazepines that were illicitly obtained. Valium® (65%) and Serepax® (9%) were the preferred forms of benzodiazepines used among IDU in 2004.
Associated harms
In 2004 the levels of injection-related risk-taking behaviour remains sufficiently high to warrant concern. The reported rate of ‘borrowing’ used needles among IDU increased slightly from 11% in 2003 to 14% in 2004. The proportion of IDU reporting that they had lent needles decreased slightly from 24% in 2003 to 17% in 2004. However, there was a statistically significant increase in the proportion of IDU who reported sharing injecting equipment from 35% in 2003 to 49% in 2004. This was due to an increase in the sharing of spoons and mixing containers among the 2004 IDU sample. Given the implication of this for the transmission of Hepatitis C Virus (HCV), this is of some concern. There was no change in the preferred locations of injection reported by IDU, with ‘private home’ again cited as the most common location of injection. However, in terms of the reported ‘last’ injection location, there was a significant increase in IDU reporting their last injection location as a public place, i.e. car, public toilet, street, from 2003 (21%) to 2004 (35%).
Approximately two thirds (69%) of the sample reported that they had experienced at least one injection-related problem in the month prior to interview (this figure is comparable to 65% reported in 2003), with almost one third (32%) of the sample reporting having experienced two or more problems during this period (36% in 2003). As in 2003, the most commonly reported difficulties were scarring/bruising and difficulty injecting.
Almost half (43%) of IDU surveys in 2004 reported experiencing mental health problems other than drug dependence in the six months preceding the interview. Despite this only 29% of IDU reported seeing a mental health professional in the same period. The IDU respondents most commonly sought help from mental health professionals for depression.
In 2004, 23% of respondents reported becoming verbally aggressive following drug use. IDU reported becoming verbally aggressive most often after using heroin, ice and alcohol. Eleven percent of IDU reported becoming physically aggressive, predominately following ice use. IDU attributed other peoples’ post-drug aggression mainly to ice and alcohol use.
There was a statistically significant decrease in the proportion of IDU who reporting engaging in at least one criminal activity in the month prior to the interview from 50% in 2003 to 34% in 2004. This was due to a decrease in property crime and a significant decrease in dealing crimes. However, the proportion of IDU who reported being arrested in the last year remained stable from 36% in 2003 to 38% in 2004.
Implications
The change in the methamphetamine market observed in the ACT IDRS 2003 study continues to remain of some concern in 2004. Methamphetamine use remains at high levels with a slightly higher proportion of IDU (81%) reporting the recent use of some form of methamphetamine compared to the previous year (74%). This is attributable to the continuing high levels of crystal or ice use by IDU in the ACT (73% in 2004 compared to 65% in the previous year). The ease of availability and increasing use of purer forms of methamphetamine is likely to translate to a concomitant increase in methamphetamine-related psychological, social and health problems in the future. This is supported by increasing numbers of ACT Alcohol and Drug Program clients undergoing withdrawal from methamphetamines in 2004. Key experts in both law enforcement and health-related contexts remarked that they were seeing an increase in agitation, aggression, drug-induced psychosis and sexual risk-taking behaviours in drug users who use ice. However, the number of clients in methamphetamine-related case management at the ACT Alcohol and Drug Program continues to remains low compared with the high rates seen in 2001. These data highlight the importance of monitoring these trends in the future.
In 2004 there is an emerging trend towards an increase in methamphetamine injection, with significant increases in the recent injection of crystal and base forms of methamphetamine observed. This increase is likely to result in an increase in injection-related health problems and of concern is the potential for increased risk of the transmission of blood born viruses. This concern is supported by a small increase in the proportion of IDU in 2004 who reported borrowing used needles, a significant increase in the sharing of injection related equipment, as well as a rise in the number of HCV cases in the ACT in 2003, with newly diagnosed HCV cases increasing from 7 in 2002 to 12 in 2003.
The increase in purity and availability of crystal methamphetamine has occurred in the context of a stable heroin market. There is no evidence to suggest that the recent rise in crystal methamphetamine use is the result of a shift in the ACT illicit drug market from heroin to methamphetamine. On contrary, the results of the 2004 IDU survey indicate that this has occurred in addition to continuing high rates of heroin use in the ACT.
Citation: Buckingham, K., Ward, J., Sparks, R. and Proudfoot, P. (2005) ACT Drug Trends 2004: Findings from the Illicit Drug Reporting System (IDRS), Sydney: National Drug and Alcohol Research Centre.