NDARC Technical Report No. 257 (2006)
EXECUTIVE SUMMARY
Demographic characteristics of injecting drug users (IDU)
In 2005, one hundred and twenty-five IDU were interviewed for the IDRS in the ACT. The demographic characteristics of the 2005 IDU sample were very similar to those interviewed in 2004. The majority of IDU interviewed for the IDRS study were male (65%). On average respondents were aged 35 years, ranging from 18 to 59 years. In terms of education, IDU had completed an average of 10 formal school years, 39% of respondents had trade or technical qualifications, and 13% reported having university or other tertiary qualifications. Thirty-eight percent had a previous prison history. Over half (57%) of the 2005 IDU respondents reported currently participating in some form of drug treatment. The most common form of drug treatment among IDU in the 2005 ACT sample was opioid maintenance treatment with 75% of those in treatment engaged in methadone maintenance treatment and 19% in buprenorphine maintenance treatment.
Patterns of drug use among IDU
In terms of the injection history of IDU respondents, the mean age of first injection was 18 years. Heroin or methamphetamine were the drugs first injected by the majority of the 2005 IDU sample. Heroin was the drug of choice for the majority of respondents (67%), followed by methamphetamine (16%) and cannabis (11%). The drugs injected most often by IDU in the month preceding the interview were heroin (65%) and methamphetamine (28%). Heroin was the most recent drug injected by 61% of the 2005 IDU sample followed by methamphetamine (27%).
IDU reporting daily or more frequent drug injection in the month preceding the IDRS survey decreased from 41% in 2004 to 29% in 2005. This finding suggests that the frequency of drug injection among IDU in the ACT may be declining. However, younger IDU respondents aged 25 years or less were more likely to inject on a daily or more basis (40%) than IDU respondents aged over 25 (26%).
Polydrug use was universal amongst the 2005 IDU sample. Respondents reported an average of twelve drug classes ever used and an average of seven drug classes used in the six months preceding the interview. In terms of the number of drug classes injected, IDU respondents in 2005 reported having ever injected an average of six drug classes and having injected an average of three drug classes in the six months prior to the interview.
Heroin
The proportion of IDU reporting use of heroin in the six months preceding the interview remained approximately stable (91% in 2004 to 86% in 2005). In terms of the frequency of use, heroin use patterns varied from less than monthly to daily use. In the six months preceding the interview, the median days of heroin use was 60 (range 1-180). In terms of the frequency of heroin injection, 14% of recent heroin users had injected on a monthly or less basis, 19% had injected heroin on a more than monthly to a weekly basis, 44% had injected heroin weekly to less than daily, and 23% injected on a daily basis.
The median price of heroin remained stable in 2005. The reported price for a cap of heroin remained stable from 2004 to 2005 at $50; the reported price for a gram of heroin also remained stable from 2004 to 2005 at $300. IDU respondents reported heroin to be very easy (40%) to easy (48%) to obtain in the ACT. In 2005, IDU perceived the purity of heroin to be currently low (39%) to medium (43%).
Methamphetamine
The IDRS IDU survey collects data on three different forms of methamphetamine: methamphetamine powder ('speed'), methamphetamine base ('base') and crystal methamphetamine ('ice'). In 2005, 71% of the ACT IDU sample reported the recent use of some form of methamphetamine. A summary of findings for each form of methamphetamine is presented below.
Over half (59%) of the sample reported the recent use of speed, a significant increase when compared to the proportion of IDU reporting the recent use of speed in 2004 (41%). The majority of recent speed users used this substance infrequently in the six months prior to the interview, with a median of seven days of use reported during this period. Injection was the most common route of administration, with 56% of IDU having injected speed in the six months preceding the interview. The reported price for a point of speed remained stable from 2004 to 2005 at $50 and the reported price for a gram of speed was cheaper at $125 per gram (compared to $200 in 2004). IDU respondents reported speed to be easy (41%) to very easy (46%) to obtain in the ACT. In 2005, IDU perceived the purity of speed to be currently low (41%) to medium (24%).
Methamphetamine base was the form of methamphetamine used least by the 2005 IDU sample, with only 28% of IDU reporting recent use. Base users used this substance infrequently, with a median of five days of use in the six months preceding the interview. As was the case with speed, injection was the most common form of administration, with 27% of the IDU sample reporting recent base injection. The reported price for a point of base remained stable from 2004 to 2005 at $50 and the reported price for a gram of base was higher at $280 (compared to $220 in 2004). IDU respondents were divided in their perception of the current availability of base in the ACT with 23% of recent users reporting it to be very easy to obtain, 41% easy and 32% difficult. In 2005, IDU perceived the purity of base to be currently low (41%) to medium (27%).
Almost two-thirds (62%) of the sample reported the recent use of ice, a non-significant decrease from 73% of IDU reporting recent use in 2004. In 2005, recent ice users reported a median of nine days of use in the six months prior to the interview. There was a significant decrease in the proportion of the IDU sample reporting recent ice injection from 78% in 2004 to 62% in 2005. However, the median price of ice remained stable in 2005. The reported price for a point of ice remained stable from 2004 to 2005 at $50 and the price for a gram also remained stable at $300. IDU respondents reported ice to be very easy (39%) to easy (50%) to obtain in the ACT. In 2005, IDU perceived the purity of ice to be currently medium (26%) to high (53%).
Cocaine
Cocaine was used by 20% of the IDU sample in the six months preceding the interview, a significant increase from the 10% in 2004. Among those who had recently used cocaine in the ACT, the frequency of cocaine use was low, with a median of two days of use in the six months prior to the interview. Among the IDU who reported recent cocaine use, the most common form of administration was injection. There was an increase in the proportion of IDU who reported recent cocaine injection from 8% in 2004 to 17% in 2005; however, it should be noted that this difference was not statistically significant. A small number of IDU commented on the price, purity and availability of cocaine in the ACT in 2005, with the majority reporting that cocaine is 'difficult' (29%) to 'very difficult' (29%) to obtain in the ACT. The median price for cocaine in 2005 was reported to be $250 for a gram and $50 for a cap. Purity of cocaine in the ACT was perceived by IDU to be medium (43%) to high (36%).
Cannabis
Cannabis use was widespread and frequent amongst the IDU sample in 2005. One hundred percent of the IDU sample had ever tried cannabis and ninety percent had used cannabis in the six months prior to the interview. The majority of the IDU sample used cannabis frequently in the six months preceding the interview with a median of 180 days of use. IDU commented on the price, purity and availability of two different forms of cannabis: outdoor-cultivated cannabis ('bush') and indoor-cultivated cannabis (hydroponic). The median reported price of a gram of bush and hydroponic cannabis remained stable from 2004 to 2005 at $20. The median price of an ounce of bush cannabis in 2005 was reported by IDU to be $250, while the median price for an ounce of hydroponic cannabis was $290. The majority of IDU perceived both bush and hydroponic cannabis to be 'easy' to 'very easy' to obtain, and that availability had remained stable in the six months preceding the interview. IDU commenting on the potency of bush cannabis believed it to be low to medium and hydroponic cannabis to be medium to high. As has been the case in previous years, hydroponic cannabis remains the dominant form of cannabis on the market in the ACT.
Use of illicit methadone
The use of diverted methadone among the ACT IDU sample was similar to that reported in the previous year. Illicit methadone use refers to the diversion of methadone that is prescribed to someone else. Almost two-thirds (62%) of the IDU sample reported ever having tried diverted methadone and approximately one-third (30%) reported its recent use. Among those who had recently used in the ACT, the frequency of illicit methadone use was low with a median of two days of use in the previous six months. Injecting (18%), followed by swallowing, (16%) were the most common routes of illicit methadone administration.
In 2005, a small proportion of the IDU sample (13%) reported diverting licit methadone via injection (i.e. their own prescribed oral methadone preparation). In the six months preceding the interview, the median number of days IDU diverted methadone that was prescribed to them via injection was twenty-two.
Use of illicit buprenorphine
The use of diverted buprenorphine among the ACT IDU sample increased compared to the previous year. Use of illicit buprenorphine refers to the use of buprenorphine that is prescribed to someone else. There was an increase in the proportion of IDU reporting they had ever used illicit buprenorphine, from 9% in 2004 to 23% in 2005. There was also a corresponding increase in the proportion of IDU who had used illicit buprenorphine in the six months prior to the interview, from 5% in 2004 to 15% in 2005. The majority of IDU used illicit buprenorphine infrequently, with a median of two days of use in the six months prior to the interview. Injection (10%), followed by swallowing (6%), were the most common routes of diverted illicit buprenorphine use among the 2005 sample. In 2005, a small proportion of the IDU sample (5%) reported diverting their licit oral buprenorphine via injection. In the six months preceding the interview, the median number of days IDU diverted buprenorphine that was prescribed to them via injection was three.
Morphine
Over three-quarters of the IDU sample (79%) reported having ever tried morphine and approximately one-third (37%) reported the recent use of morphine. The majority of recent morphine users used morphine infrequently in the six months preceding the interview, with a median of 5 days of use. Among those who had recently used morphine, the main form of administration was injection, with 30% of the IDU sample reporting recent morphine injection. 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. The reports of IDU about the current availability of illicit morphine in the ACT were inconsistent, ranging from difficult to easy.
Other opioids
The use of 'other opioids' such as codeine by IDU in the ACT remained relatively stable from 2004 to 2005. Over one-third (41%) of the IDU sample reported the lifetime use of 'other opioids' and fourteen percent reported the recent use of 'other opioids'. IDU used 'other opioids' infrequently, with a median of five days of use in the six months preceding interview. Swallowing, followed by injecting, were the most common modes of 'other opioid' administration.
Over one-third of IDU (41%) reported ever having used homebake heroin and a minority (7%) reported the recent use of homebake heroin. Among the IDU who had recently used homebake heroin, the frequency of use was low, with a median of five days of use in the six months prior to the interview. All of those who had recently used homebake had injected it.
Patterns of other drug use
Benzodiazepine use remained high among the IDU sample in 2005. Approximately two-thirds (62%) reported using benzodiazepines in the six months preceding interview. The frequency of benzodiazepine use increased from a median of 13 days of use in 2004 to a median of 31 days of use in 2005. Recent benzodiazepine users reported swallowing as the primary route of administration; however, experimenting with injecting and smoking were also reported. Sixty-eight percent of the sample had used licit (prescribed) benzodiazepines in the six months prior to the interview, while 52 percent reported the use of benzodiazepines that are illicitly obtained.
IDU were asked to comment about their use of pharmaceutical stimulants (or prescription amphetamines). This included drugs such as dexamphetamine and methylphenidate, which are medications most commonly prescribed for Attention Deficit Hyperactivity Disorder (ADHD) and flu symptoms. Approximately one-quarter (22%) of the IDU sample reported the recent use of pharmaceutical stimulants, with injection followed by swallowing being the main routes of administration. Pharmaceutical stimulants were used infrequently by IDU in the six months preceding the interview, with a median of five days of use during this period. Eighty-two percent of those who used pharmaceutical stimulants had used licitly obtained prescription amphetamines in the six months prior to the interview. A smaller proportion (14%) of this group reported having recently used licitly obtained prescription amphetamines. Therefore, the majority of recent
pharmaceutical stimulant users are using pharmaceutical stimulants that are prescribed to someone else.
Alcohol was used by almost three-quarters (74%) of the IDU sample in the ACT in 2005, a significant increase from the fifty-eight percent of IDU who reported recent alcohol use in 2004. Recent alcohol users reported a median of thirteen days of use in the six months prior to the interview. The majority of IDU (96%) reported the recent use of tobacco, with 94% of those who reported use of tobacco in the six months prior to the interview being daily smokers.
Associated harms
In 2005, levels of injection-related risk-taking behaviour remained sufficiently high to warrant concern. The reported rate of borrowing used needles among IDU decreased slightly from 14% in 2004 to 9% in 2005; however, this difference was not statistically significant. The proportion of IDU reporting that they had lent needles remained relatively stable from 17% in 2004 to 19% in 2005. There was a non-significant decrease in the proportion of IDU who reported sharing injecting equipment (e.g. spoons, mixing containers, water and swabs) from 49% in 2004 to 38% in 2005. Given the implication of this for the transmission of hepatitis C virus (HCV), the sharing of injecting equipment remains a concern.
Almost two-thirds (61%) of the sample reported that they had experienced at least one injectionrelated problem in the month prior to interview. This figure is comparable to 69% of the sample in 2004. In 2005, the most commonly reported difficulties were scarring/bruising and difficulty injecting.
In the 2005 IDRS IDU sample there was a non-significant decrease in the proportion of IDU who reported recently experiencing mental health problems other than drug dependence in the six months preceding the interview, down from 43% in 2004 to 37% in 2005. Despite this, only 22% of IDU in the 2005 sample reported seeing a mental health professional during this period. IDU respondents most commonly sought help from health professionals for depression and anxiety. IDU were most likely to attend a GP or a psychiatrist for help with mental health problems.
In 2005, for the first time, IDU were asked about driving while under the influence of drugs. Approximately one-third (38%) of the sample reported that they had driven under the influence (within one hour of consuming drugs in the six months prior to the interview). IDU most commonly reported driving while under the influence of heroin, cannabis, methamphetamine powder, crystal methamphetamine, methadone and benzodiazepines.
In 2005, there was an increase in the proportion of IDU who reported engaging in at least one criminal activity in the month prior to the interview, up from 34% in 2004 to 41% in 2005. However, it should be noted that this difference was not statistically significant. This increase is attributable to small increases in the proportion of IDU in the 2005 sample reporting recent involvement in property crime, as well as drug dealing. However, the proportion of IDU who reported being arrested in the last year remained stable from 2004 (38%) to 2005 (36%). The majority of the sample perceived police activity towards IDU in the ACT was stable to increasing. However, the majority of IDU reported that recent police activity had not made it more difficult for them to score drugs in the six months preceding the interview.
Implications
- The heroin market in the ACT appears to have stabilised over the past three years, with the price, purity and availability of heroin remaining relatively stable. However, the frequency of heroin use has been steadily decreasing during this period. This trend needs to be monitored to see if it is indicative of a permanent change in the patterns of heroin use by IDU in the ACT. However, is important to note that recent heroin use among the 2005 IDU sample is almost universal, and, with the ease of access to heroin in the ACT, the demand for treatment for opioid dependence (i.e. methadone or buprenorphine maintenance) is expected to continue.
- The continuing high levels of ice and speed use by IDU in the ACT is expected to be associated with a corresponding rise in problems associated with the use of methamphetamine, such as psychosis, methamphetamine dependence, paranoia, cardiac difficulties, and aggressive behaviour (Degenhardt & Topp, 2003). Consequently, health and law enforcement professionals who work regularly with drug-using populations may need to develop and implement strategies for dealing with individuals who are agitated and aggressive due to methamphetamine intoxication. Moreover, there is likely to be an increase in demand for treatment services as people seek help for problems associated with the consequences of methamphetamine use.
- For the first time, in 2005, IDU were asked about drug driving. Findings indicated that approximately one-third of the IDU sample had recently driven soon after (within one hour) of taking illicit drugs. The most common drugs taken by IDU before driving in the six months preceding the interview were heroin, cannabis, methamphetamine (specifically speed and ice), methadone and benzodiazepines. Use of drugs in combination with alcohol and polydrug use is associated with increased driving impairment and risk of driving accidents (Kelly, Darke & Ross, 2004). Increasing the awareness of risks associated with drug driving is important among IDU populations.
- Levels of injection-related risk-taking behaviour remain sufficiently high to warrant concern. Although the proportion of IDU in the ACT reporting lending and borrowing needles remains low, approximately one-third of the 2005 sample reporting sharing injecting equipment (e.g. spoons, mixing containers, water and swabs). Given the implication of this for the transmission of hepatitis C virus (HCV), the sharing of injecting equipment is of concern. Increasing awareness of the harms associated with sharing injecting equipment other than needles is important.
Citation: Buckingham, K., Ward, J., Staniforth, A., Proudfoot, P. (2006) Australian Capital Territory Drug Trends 2005: Findings from the Illicit Drug Reporting System (IDRS). Sydney: National Drug and Alcohol Research Centre.