NDARC Technical Report No. 174 (2004)
EXECUTIVE SUMMARY
Demographic characteristics of injecting drug users (IDU)
One hundred and fifty four IDU participated in the 2003 IDRS. Sixty eight percent were male, 86% were unemployed and the average age of respondents was 33 years. Forty seven percent had not completed any further education after school and 6% had completed a university degree. Sixty eight percent had a previous prison history. The average age of first injection was 19.9 years.
Patterns of drug use among IDU
Proportions of IDU reporting cocaine as their drug of choice decreased markedly from 19% in 2002 to 4% in 2003, and a similar pattern was seen in proportions reporting cocaine as the drug they had injected most in the preceding month (17% in 2002 to 2% in 2003). The proportion of IDU reporting heroin as their preferred drug increased from 72% in 2002 to 84% in 2003, representing the highest figure since the commencement of the IDRS. This pattern was also reflected in proportions reporting heroin as the drug injected most in the preceding month (73% in 2002 to 83% in 2003).
The proportion of IDU reporting daily heroin use in the preceding six months decreased from 53% in 2002 to 47% in 2003, which is consistent with increasing numbers reporting current engagement in drug treatment (37% in 2002 to 47% in 2003). There were fewer IDU reporting daily use than prior to the heroin shortage in 2001. Indicator data analysed showed relatively stable rates of; recorded police incidents for heroin possession/use (NSW Bureau of Crime Statistics and Research); ambulance callouts to heroin overdoses and overdose presentations to emergency departments (NSW Department of Health) in the preceding twelve months. Numbers across these data collections remained substantially lower than figures recorded prior to 2001, suggesting that the market has not returned to pre-shortage levels.
Heroin
The median price for a gram of heroin ($300) and a cap of heroin ($50) remained stable in 2003. Prices remained higher than those reported in 2000.
Heroin availability appears to have returned to some extent, with the overwhelming majority (91%) of IDU reporting that heroin was ‘easy’ to ‘very easy’ to obtain (compared to 88% in 2002). Seventy percent thought that availability had remained stable (54% in 2002). Seven percent reported that heroin was ‘difficult’ to obtain (compared to 11% in 2002) and 20% (the same as 2002) thought it had become more difficult.
Eighty one percent of IDU thought that heroin was of ‘low’ to ‘medium’ purity. NSW police seizure data indicated that the median purity of heroin remains low (approximately 30%) and has not returned to levels reported prior to 2001.
Key informant comments on the price and availability of heroin were consistent with IDU reports.
Methamphetamine
Fifty three percent of IDU had used some form of methamphetamine (speed, base or ice) in the preceding six months, a proportion comparable to 2002 (48%). Thirty one percent reported using speed (representing a slight decrease from 39% in 2002), while there was an increase in proportions using the more potent forms of methamphetamine. Thirty two percent reported using base (23% did so in 2002) and 38% reported using ice (representing a marked increase from 25% in 2002).
A ‘point’, i.e. 0.1 of a gram, was a popular purchase amount for all three forms of methamphetamine, and the median price remained stable at $50 for speed, base and ice.
Speed remained readily available with 75% of IDU commenting reporting that it was ‘easy’ or ‘very easy’ to obtain, and that availability had remained stable (53%) or had become easier (18%). Base was also ‘easy’ or ‘very easy’ to obtain (75%), with availability remaining stable (60%). Availability of ice increased substantially in 2003, with 80% reporting that it was ‘easy’ to ‘very easy’ to obtain (compared to 59% in 2002). Only 14% of IDU commenting thought that ice was ‘difficult’ or ‘very difficult’ to obtain compared to over half of those commenting (59%) in 2002. Consistent with reports of increased availability, 41% of IDU commenting thought that ice had become easier to obtain.
Key informants predominantly reported on ice, and comments were consistent with those of IDU.
Cocaine
The prevalence and frequency of cocaine use dropped substantially in 2003. Fifty three percent of IDU reported cocaine use in the preceding six months (compared to 79% in 2002) and median number of days use declined from 24 days in 2002 to five days in 2003. Prevalence rates were the lowest reported since 1997, as were the median number of days used.
Thirty percent of IDU reported that cocaine was ‘difficult’ to ‘very difficult’ to obtain compared to 23% in 2002, while 64% thought it ‘easy’ to ‘very easy’ (74% thought so in 2002). Approximately half of those commenting (54%) thought availability had remained stable while nearly a third (28%) thought it had become more difficult.
Despite changes in availability and use patterns, cocaine prices remained remarkably stable. The median price for a gram of cocaine has been reported as $200 since 1996, while the price for a cap has remained stable at $50 since 1998.
Key informant comments were consistent with those of IDU.
Cannabis
The cannabis market has remained relatively unchanged since the commencement of the IDRS, and the majority of IDU (79%) continued to report cannabis use. Frequency of use increased substantially from 81 days in 2002 to 180 days (daily use) in 2003.
The price of cannabis remained stable at $20 per gram and the overwhelming majority (91%) of IDU reported that it was readily available.
Key informant reports on cannabis were consistent with those of IDU.
Use of illicit pharmaceuticals
More detailed data regarding the purchase, frequency of use and injection of illicit pharmaceuticals was collected in 2003 to provide further clarification regarding the diversion of these medicines. Licit use was defined as being from a prescription in the participant’s name.
Illicit Methadone
The proportions reporting use of illicit methadone syrup in the preceding six months remained relatively stable at 18% (compared to 20% in 2002). Approximately half of this group had been engaged in methadone treatment during this period, indicating that methadone was being diverted to IDU engaged in treatment, as well as to those who were not.
Eleven percent of IDU reported injecting illicit methadone syrup in the preceding six months, and just under half (47%) of this group were engaged in methadone treatment during this period.
Eight percent of IDU reported illicit methadone syrup as the form they had used most in the preceding six months, none of whom were engaged in treatment.
Illicit methadone was considered to be readily available with 69% reporting that it was ‘easy’ to ‘very easy’ to obtain. A third reported it was ‘difficult’. Sixteen percent of IDU reported buying illicit methadone in the past six months, primarily from street dealers and friends.
Smaller proportions of IDU reported using illicit physeptone tablets (5%) in the preceding six months, the majority (70%) of whom were engaged in methadone treatment.
Illicit Buprenorphine
Fewer IDU (5%) reported the use of illicit buprenorphine in the preceding six months, and as with illicit methadone, just under half of this group (43%) had been engaged in buprenorphine treatment during this period. Only three IDU reported injecting illicit buprenorphine in the preceding six months. Three percent of IDU reported illicit buprenorphine as the form they had used most in the preceding six months, none of whom were engaged in treatment.
Morphine
Prevalence of morphine use (23% compared to 22% in 2002) and injection (20% compared to 18% in 2002) in the preceding six months remained relatively stable. Frequency of morphine use also remained stable at a median of five days.
Morphine was predominantly from illicit sources. MS Contin was the most common brand of morphine used, with 100mg tablets reported at a median price of $20. A small proportion of IDU (9%) reported buying morphine, predominantly from friends and street dealers.
Morphine was not considered to be readily available, with 50% of those commenting reporting that it was ‘difficult’ to obtain.
Other opioids
There was a decrease in the prevalence of use (13% compared to 23% in 2002) and injection (2% compared to 6% in 2002) of other opioids such as Panadeine Forte and pethidine in the preceding six months, while frequency of use remained stable (median of five days). Panadeine Forte was the main form used and one third of those reporting other opioid use sourced them illicitly.
Benzodiazepines
Despite a restriction in the availability of benzodiazepine gel capsule preparations (Euhypnos, Nocturne, Normison & Temaze) being introduced on 1 May 2002, IDU continued to use and inject benzodiazepines. Sixty two percent of IDU reported benzodiazepine use (compared to 58% in 2002), and 19%, benzodiazepine injection (the same as in 2002) in the preceding six months. There was a slight increase in median days used (from 13 in 2002 to 18 in 2003), and in the proportion reporting daily benzodiazepine use (from 6% in 2002 to 10% in 2003). Among those reporting daily use, almost half (47%) reported injecting benzodiazepines in the preceding six months. Just under half (40%) of those using benzodiazepines reported sourcing them illicitly, and Valium and Normison were the more popular brands used.
Associated harms
The proportion of IDU sharing needles remained relatively stable, with 6% reporting that they had used a needle after someone else in the preceding month (7% in 2002). The proportion reporting that someone else used a needle after them decreased slightly from 17% in 2002 to 12% in 2003. The proportion reporting shared use of other injecting equipment such as filters and water remained high at 43% (compared to 38% in 2002).
Compared to 2002, there was very little change in location for injection, with just over half (56%) of the sample reporting private home as both their usual injection location and where they last injected. Approximately a third of the sample reported a public place as their usual location (34%) and the last location (33%). Eight percent reported that they usually injected at the medically supervised injecting centre in Kings Cross (12% did so in 2002).
Sixty percent of IDU reported injection related health problems in the past month (compared to 66% in 2002), with 30% reporting multiple problems (from 38% in 2002). Consistent with previous years, prominent scarring/bruising of injection sites (38%) and difficulty injecting (33%) were the most frequent problems reported. Half of the sample reported ever having overdosed. Two percent reported an overdose in the month preceding interview, while figures for overdose within the past twelve months were slightly higher at 12%.
There was little change in the proportion (80%) of IDU who reported spending money on drugs on the day prior to interview or the median amount of money spent ($100).
Approximately half (46%) of the sample had spent $100 or more on drugs that day while approximately a quarter (23%) had spent $200 or more.
Approximately a quarter (26%) of the sample reported seeking help from a mental health professional for a problem other than drug use, representing a slight increase from 19% in 2002. Depression continued to be the most commonly reported mental health problem (16% compared to 13% in 2002).
Proportions reporting involvement in criminal activity in the month preceding interview (55%) remained relatively stable, and the most commonly reported offences were drug dealing (36%) and property crime (31%). Forty nine percent of IDU had been arrested in the previous twelve months representing a slight increase from 41% in 2002. There was little change in IDU perception of police activity, with two thirds reporting that police activity had increased in the preceding six months, and two thirds reporting that this activity had no impact on their ability to obtain drugs
Implications
The findings of the 2003 NSW IDRS indicate that further attention is required in the following areas:
- Research into drug trends and associated harms of methamphetamine use studying a group of primary methamphetamine users.
- Close monitoring of the patterns and prevalence of ice use.
- Development of effective treatment programs for methamphetamine users along with the development of strategies to engage and retain users in these programs.
- More detailed research into the nature of the cocaine market (that supplies IDU) in Sydney.
- Careful consideration by medical practitioners of the clinical need for benzodiazepine gel capsule preparations and the possibility of removing them from the market.
- Increasing focus on the development of educational material regarding the dangers of sharing injecting equipment other than needles, as well as broader dissemination of this material.
Citation: Roxburgh, A., Breen, C. and Degenhardt, L. (2004) New South Wales Drug Trends 2003: Findings from the Illicit Drug Reporting System (IDRS), Sydney: National Drug and Alcohol Research Centre.