EXECUTIVE SUMMARY
Demographic characteristics of people who inject drugs (PWID)
In 2011, one hundred and fifty people participated in the IDRS survey. Sixty-five percent were male, eighty-four percent reported they were not currently working or were currently receiving income support (such as disability or sickness benefits or the New Start jobseeker’s allowance) at the time of interview. The average age of respondents was 40 years (range 21-58 years). Seventeen percent of the sample identified as Aboriginal and/or Torres Strait Islanders1. Eighty-nine percent of the sample identified English as the main language spoken at home. Seventy-four percent of the sample had completed year 10, and 17% had completed year 12 at high school. Forty-two percent had obtained a trade or technical qualification and 5% had completed a university or college qualification such as a degree. Fifty-two percent had not completed any further education after leaving school. The majority (71%) of participants reported previous prison history and the average age of first injection was 19 years (range 8-43).
Patterns of drug use among the PWID sample
Heroin
Following the trends of previous years, heroin was still the preferred drug of choice (70%), in 2011 and this remained stable with reports from last year (71% in 2010). Heroin was the drug most often injected in the month prior to interview (62%; 65% in 2010) and the drug people had injected most recently (61%; 62% in 2010). Eighty-seven percent of participants reported use on one or more occasions in the six months preceding interview (92% in 2010). The median days of recent heroin use also remained stable at 90 days i.e. every 2nd day (96 days in 2010). The proportion of participants reporting daily use also remained stable (28% versus 32% in 2010).
The median price for a gram ($300) decreased from the record price reported in 2010 ($345) but the price for a cap of heroin ($50) continued to remain stable. Prices continued to remain higher than those reported prior to the heroin shortage in 2001. Heroin remained accessible in 2011, with 82% (83% in 2010) of those who commented reporting that it was either ‘easy’ or ‘very easy’ to obtain. The majority of participants that commented (64%; 70% in 2010) on ease of availability reported it had remained stable.
Participant reports (among those who commented) on heroin purity continued to be mixed in 2011. Forty-two percent of the participants that commented reported current purity as low, which remained stable, just over one-third (37%; 31% in 2010) reported it as medium. Thirty-two percent (41% in 2010) of those commenting considered purity levels to have remained stable over the preceding six months, while just over one-third (37%; 36% in 2010) commented it had decreased.
Methamphetamine
The proportion reporting any recent methamphetamine use (speed powder, base, ice or liquid2,3) remained stable in 2011 (60%; 57% in 2010). Among those reporting any recent use (speed, base, ice, liquid) the median number of days of use was 19 days which remained stable with 2010. The majority of users had used each form weekly or less over the six months preceding interview and the proportion (3% in 2011) of people reporting daily use of any type of methamphetamine over the past four years remained low relative to the proportion of daily heroin users.
A ‘point’ (0.1 of a gram) remained the most popular purchase amount for all three main forms of methamphetamine, and the median price remained stable at $50 for speed powder, base and ice/crystal. Again in 2011, there were insufficient numbers of purchases of any form of methamphetamine to comment on price changes in amounts larger than points.
Speed and ice/crystal forms of methamphetamine were typically reported by the majority of users as ‘very easy’ or ‘easy’ to obtain, whereas the availability of base varied. Availability for all forms was typically reported to have remained stable over the six months preceding interview. In 2011 there was a significant (p<0.01) decrease in the number of participants reporting ice/crystal as ‘high’ purity compared with 2010.
Cocaine
Recent cocaine use among PWID remained comparable to 2011 with 47% of the sample reporting recent use in 2011 (57% reporting use in 2010). The median days of use among users, also remained stable in 2010 at a median of 10 days (approximately fortnightly use). Daily cocaine use remained stable with 3% of users reporting daily use (5% in 2010). Reports of crack cocaine were once again almost non-existent among the PWID sample, a finding reflected in KE reports. There was a significant decrease (p<0.05) in the number of PWID who could comment on cocaine from 2010. The majority (67%; also 67% in 2010) reported cocaine availability to be ‘easy’ or ‘very easy’. The median price per gram and per ‘cap’ of cocaine remained stable in 2011 at $300 and $50 respectively. Very low numbers of participants reported purchases of other amounts.
Thirty-two percent of PWID reported cocaine purity as ‘medium’, which remained stable with reports from last year (36% in 2010).
Cannabis
The cannabis market continued to remain relatively unchanged since the commencement of the NSW IDRS in 1996. The majority of participants (81%; 72% in 2010) in the 2011 participant sample reported having used cannabis in the six months prior to interview. The median frequency of use among PWID remained at 180 days (daily use), which has been stable for the past 9 years.
In line with previous years, a large proportion of participants reported use of both the hydroponic (‘hydro’) and outdoor-grown (‘bush’) forms of cannabis, with hydro appearing to dominate the market. The number of participants reporting purchase of resin (hashish) and oil (hash oil) continued to remain very rare and infrequent. The price of hydroponic cannabis remained stable at $20 per gram (the most popular purchase amount), and the majority of recent users (96%; 92% in 2010) reported that it was readily available, i.e. ‘easy’ or ‘very easy’ to obtain. The price per gram of bush cannabis was also $20, but, as in previous years, larger purchase quantities of bush were slightly cheaper than for the equivalent quantity of hydro. Bush continued to be reported as less easily available than hydro, with fewer participants able to complete survey items on bush market characteristics (price, potency and availability). Potency of hydroponic cannabis continued to be reported as ‘high’, and bush continued to be as reported ‘medium’.
Use of pharmaceuticals
The IDRS monitors the extra medical use patterns and market characteristics of opioid pharmaceutical medications including both those prescribed for opioid substitution treatment (OST; i.e. methadone, buprenorphine, buprenorphine-naloxone), and those prescribed for pain relief (i.e. morphine and oxycodone).
Non-prescribed methadone
Over one-quarter (23%) of participants reported use of illicitly obtained methadone syrup in the six months preceding interview, which is stable compared with 2010 (27%). Use remained stable and relatively infrequent (approximately monthly). Eighteen percent of participants reported injecting illicit methadone syrup in the preceding six months (20% in 2010), the frequency (median days) of injection also remained stable. The majority that could comment on the availability of non-prescribed methadone reported that it was ‘very easy’ or ‘easy’. The median price of 50 cents per ml remained stable.
Recent use and injection of Physeptone obtained without prescription continued to remain uncommon.
Non-prescribed buprenorphine and buprenorphine-naloxone
The recent use and injection of non-prescribed buprenorphine in the preceding six months remained stable in 2011. The frequency of injection of non-prescribed buprenorphine over this period continued to remain low and stable.
Buprenorphine-naloxone (Suboxone) has been investigated by the IDRS since it was listed on the Pharmaceutical Benefits Scheme (PBS) in April 2006. Seven percent of the sample reported the use of non-prescribed buprenorphine-naloxone in 2011 and only 5% also reported recent injection.
Morphine
An increase in prevalence of any recent morphine use among the NSW IDRS PWID sample had been observed since 2001; however, in 2011 it remained comparable with 2010 (28% versus 35% in 2010). Recent use of non-prescribed morphine also remained relatively stable (21% versus 31% in 2010), as did recent injection (20% versus 28% in 2010). The median number of days non-prescribed morphine was injected was 10.
MS Contin remained the most common brand of morphine used. The median price for 100mg MS Contin tablets (‘grey nurses’) increased by $10 in 2011 to median of $40 per tablet. These results should be interpreted with caution due to small numbers commenting. Participants typically reported that it was ‘very easy’ or ‘easy’ to obtain. Availability was generally considered to have remained stable.
Oxycodone
Since 2005, a distinction has been made between prescribed and non-prescribed and other opioids in an effort to monitor the non-prescribed use of, and problems associated with, the diversion of oxycodone. Until 2005, oxycodone was included under ‘other opioids’.
Thirty-eight percent of participants reported use of any (prescribed or non-prescribed) oxycodone in the six months preceding interview (36% in 2010) on a median of 6 days (i.e. monthly), the same frequency of use as 2010 and 2009 (also 6 days). Thirty-two of the sample reported injecting it in this time on a median of six days, which remained stable compared with 2010.
Twenty-two percent (33% in 2010) of the sample felt confident to comment on the price and/or availability of illicit oxycodone in 2011. As per previous years the most common purchase amounts were 80mg OxyContin tablets, bought for a median price of $35 (range: $30-$40) each. The majority (78%; 64% in 2010) of participants commenting reported that availability was considered ‘easy’ or ‘very easy’, with availability generally considered to have remained stable.
Over the counter codeine
Since 2009 survey specific questions were asked about over the counter (OTC) codeine use and it was subsequently removed from the ‘other opioids’ classification. In 2011, thirty-eight percent of the sample reported recent use of OTC codeine, on a median of 5 days and no participants reported recent injection. Recent injection of other opioids also remained low (1%).
Benzodiazepines
Prevalence of benzodiazepine use remained relatively stable with 63% (78% in 2010) reporting use in the six months preceding interview, the frequency of use increased from a median of 37 days in 2010 to 90 days in 2011. The injection of benzodiazepines remained low with 3% (6% in 2010) reporting any injection on a median on six days in the past six months.
Nine percent had recently used ‘licit’ alprazolam on a median of 180 days while 37% had recently used ‘illicit’ alprazolam on a median of twenty-four days. Thirty percent of the NSW sample reported having used ‘licitly’ obtained other benzodiazepines on a median of 90 days in the last six months. While, thirty-five percent reported using ‘illicitly’ obtained other benzodiazepines on a median of 13 days in the six months preceding interview Small proportions reported injecting alprazolam or other benzodiazepines in the last six months.
Excluding Alprazolam, the most commonly used brand of benzodiazepine was diazepam (including generic diazepam, Valium, Antenex) (67%), followed by oxazepam (Serepax) (8%), temazepam (6%) and alprazolam (Xanax) (5%).
Seroquel
Twenty-one percent of the sample had used Seroquel® in the last six months (9% licit, 13% illicit). ‘Licit’ Seroquel® has been used on a median of 180 days compared to four days for ‘illicit’ Seroquel®.
Other drugs
Hallucinogens, ecstasy and inhalant use were relatively low within this sample. No participants reported recent hallucinogen use in 2011. Although approximately one-half (53%) of the sample had tried ecstasy, recent use was reported by only 10% of the sample on a median of 2 days. Only four percent reported injecting it in the preceding six months on a median of one day. Prevalence of recent inhalant use (e.g. nitrous oxide, amyl nitrite) remained low at 3%.
Alcohol and tobacco
Sixty percent of participants had consumed alcohol in the preceding six months (58% in 2010) on a median of 24 days, i.e. approximately once per week. This remained stable with 2010. Eleven percent of participants reported daily use of alcohol.
Tobacco remained the most commonly used substance investigated by the IDRS, with virtually all participants (97%) reporting smoking tobacco in the six months preceding interview on a median of 180 days (i.e. daily); a finding that has remained consistent since 1996 when the project commenced. Unlike smoking prevalence in the general population (Australian Institute of Health and Welfare 2011) smoking among IDRS participants has not declined over time.
Health-related trends associated with drug use
One quarter of all participants reported non-fatal heroin overdose in the year prior to interview (22% in 2010). There were four reports of overdose in the last month (n=3 in 2010).
Participant reports of borrowing and lending of needles and syringes remained stable in 2011. There was a significant (p<0.05) decrease in the proportion of participants reporting having shared other injecting equipment.
The most commonly reported location for last injection remained a private home, this remained stable with 2010.
Again in 2011, participants were asked the site on their body for their last injection. The majority (72%) reported their arm and only small proportions reported neck, groin, leg or foot.
Just over one-half (56%) of PWID participants who had injected in the last month reported at least one injection-related problem during this time (50% in 2010). As per 2010, the most commonly reported problems were prominent scarring/bruising of injection sites (38%; 31% in 2010) and difficulty injecting (36%; 27% in 2010).
One-half (52%) of the sample reported experiencing a mental health problem, other than drug dependence, in the preceding six months (44% in 2010) and there was a significant (p<0.01) increase in the percentage (63%; 32% in 2010) who reported seeking advice from a mental health professional during this time. Depression continued to be the most commonly reported mental health problem (31%; 30% in 2010).
Again in 2010, the 10-item Kessler Psychological Distress Scale (K10) was administered. The K10 assesses recent levels of psychological distress (anxiety and depressive symptomatology). The majority of participants were found to be in the ‘very high distress’ level of psychological distress category, at a proportion higher than the Australian normative value.
Six percent of the entire sample had driven under the influence of any alcohol in 2011. One-fifth (21%) of the entire sample had driven ‘soon’ after taking (an) illicit drug(s), with heroin being the most common drug last taken before driving.
Law enforcement-related trends associated with drug use
The proportion of PWID participants that reported being arrested in the previous 12 months remained stable at 37% of the entire sample (44% in 2010). Self-reported crime trends continued to follow those reported in previous years with the two most commonly reported crimes in the month prior to interview being drug dealing (29%; 24% in 2010) and property crime (22%; 24% in 2010). The daily expenditure on drugs and alcohol (excluding tobacco and prescribed medication) remained stable at median of $100 per participant (range: $2.50-$600).