NDARC Technical Report No. 249 (2006)
EXECUTIVE SUMMARY
This report presents the results of an ongoing study that monitors ecstasy and related drug markets in NSW. The 2005 sample provides data for the sixth year on trends in ecstasy and related drug markets. Data collected since 2000 are also included. Trends in the demographic characteristics and patterns of drug use among regular ecstasy users, their criminal behaviour, and harms perceived to be related to their ecstasy use are presented. The implications of the results and the nature and characteristics of ecstasy and related drug markets are discussed.
Demographic characteristics of regular ecstasy users
The 2005 results indicate that regular ecstasy users, a population defined in this study by at least monthly use of tablets sold as ecstasy, tend to be young, relatively well-educated, and likely to be employed or engaged in full-time study. Five participants were currently in treatment for a drug-related problem, and six participants had previously been incarcerated. Demographic characteristics of regular ecstasy users interviewed have changed little since 2000.
Patterns of drug use among REU
Participants could be characterised as extensive polydrug users, over one-third of whom nominated ecstasy as their favourite or preferred drug. On average, participants had used eleven drugs in their lifetime and had used seven in the preceding six months. Almost all reported lifetime use of alcohol, cannabis, methamphetamine powder (speed) and tobacco.
The prevalence and frequency of use of ecstasy and related drugs such as ketamine, GHB, MDA, and base, changed in 2005 which may suggest that while substantial minorities continue to report recent and lifetime use of these drugs, these may be influenced by such factors as price and availability. They may not be as widely or consistently available as ecstasy and therefore the use of these drugs may be opportunistic in nature. This is reflected in the relatively low frequency of use of these drugs, with most recent users reporting using less than monthly.
Ecstasy
Participants in the 2005 sample first used ecstasy at a mean age of 20 years. Forty percent of participants had used ecstasy weekly or more, 48% reported using ecstasy between monthly and fortnightly, 33% between fortnightly and weekly, and 20% reported using ecstasy more than weekly. Two-fifths (41%) of participants reported they had binged (used continuously for more than 48 hours without sleep) on ecstasy in the preceding six months. Most (77%) reported typically using more than one tablet per occasion of use. Consistent with previous years, participants primarily took ecstasy orally.
The use of other drugs in conjunction with ecstasy was commonly reported, including alcohol, tobacco, cannabis, speed and crystal methamphetamine or ice. Most participants also used a similar range of drugs to ease the come down or recovery period following acute ecstasy intoxication, including alcohol, tobacco and cannabis.
Price, purity and availability of ecstasy
The median price paid for a single ecstasy tablet was $30 in 2005 and most participants reported that this price has remained stable. Most participants paid for ecstasy or were given ecstasy as a gift. The majority reported obtaining from friends and known dealers and the most frequently reported purchase location was from friends homes or dealers homes.
There was variation regarding users subjective reports of the purity of ecstasy and KE reports reflect this inconsistency. The median purity of seizures of tablets containing MDMA/phenethylamines analysed by both AFP and NSW police have remained stable since 2002/03. Many tablets sold as ecstasy will not contain any MDMA. Users reports of purity are consistent with this.
Tablets sold as ecstasy have remained readily available in Sydney since 2000; the great majority of users have consistently described the drug as very easy to obtain across time.
Imported tablets are more likely to contain MDMA than locally manufactured imitation tablets that contain methamphetamine. The number and weight of customs seizures of ecstasy seized at the border has increased in recent years, suggesting either changes in customs activity, improvements in detection, or more ecstasy being imported into the country, or a combination of these factors. The supply of imported MDMA tablets is also supplemented by domestic production: NSW police reported that the ratio of methamphetamine tablets sold as ecstasy to ecstasy tablets containing MDMA decreased in 2001/02. This may indicate an increase in imported MDMA, some manufacture of local MDMA, or that tablets containing methamphetamine are being sold as such. Consistent with the possibility that local manufacture is occurring, there have been seizures of the precursors required to manufacture MDMA, and in 2002/03 NSW Police reported seven clandestine MDMA laboratories detected in NSW (Australian Crime Commission 2003). This suggests that there are local manufactures of ecstasy attempting to compete with importers of the drug.
Factors influencing the price and use of ecstasy
For the first time, in 2005, respondents were asked to comment on the factors they believed would influence the price of ecstasy as well and their use of ecstasy. While reports varied, the majority of the sample reported that knowing their ecstasy supplier (79%) and buying ecstasy in larger quantities (88%) would result in a decrease in the price of ecstasy. Factors which the majority of the sample believed would result in no change to their ecstasy use included a greater availability of ecstasy and other drugs; changes in the risk of being caught by police; or changes in the penalties relating to the use of ecstasy. The majority of respondents also indicated that a negative impact on physical health, mental health, occupation and relationships would result in a decrease in their use of ecstasy.
Methamphetamine
Virtually all (94%) participants in 2005 reported having used methamphetamine powder (speed) at some time and three-quarters (76%) reported using speed in the six months preceding interview. Recent users reported using speed at a median frequency of once a month, with snorting and swallowing being the most common routes of administration.
Approximately two-thirds (63%) of the 2005 sample reported lifetime base use and 43% had used base in the preceding six months. The majority of recent users reported using less than once a month and the most common route of administration was swallowing. Prevalence of base use has increased over time, although it has remained stable since 2002. The frequency and quantity of base use has fluctuated in recent years.
Two-thirds of the sample (62%) reported having used crystal methamphetamine at some time and two-fifths (40%) reported using in the preceding six months. Crystal use appears to have stabilised or decreased in 2005 relative to the 2004 sample. Quantity of crystal use seems to have remained relatively stable. Most crystal users used less than monthly while one-quarter used between monthly and fortnightly. In contrast to the other forms of methamphetamine, the most common route of crystal administration was smoking. Of those who reported using other drugs whilst using ecstasy, 21% reported using crystal with ecstasy, while 44% of those who binged reported doing so with crystal in 2005 (compared to 53% of those who had recently binged using crystal in 2004 and 37% in 2003).
The price of speed was commented on by over three-quarters (77%) of the sample, with $60 for one gram the most common purchase. Forty-six percent (35% of the entire sample) agreed the price of speed had remained stable. Nearly half (46%) of the sample reported on the current price of base. A point (0.1 of a gram) was the most commonly purchased amount, for which a median of $30 was paid. Forty-four percent (20% of the entire sample) reported the price of base had remained stable. Fifty-one respondents were able to comment on the current price of crystal, with a point of crystal the most frequently purchased amount for $50. Of those who commented, 28% (14% of the entire sample) reported that the price had remained stable while 24% (12% of the entire sample) reported that the price had increased in the preceding six months. Amongst those who commented, the current purity of speed was considered medium (36%) and the current purity of both base (52%) and crystal (43%) were considered to be high.
The majority of those who commented reported the availability of speed was easy to very easy to obtain. Conflicting reports were provided in regards to the availability of base, with responses ranging from easy to difficult. Conflicting reports in regards to the availability of crystal were also reported, with reports ranging from easy to difficult.
Cocaine
The prevalence of lifetime cocaine use has remained stable across sampling years, with the majority (76%) of participants reporting having used cocaine at some time in 2005. However, proportions of REU that reported recent cocaine use rose in 2005, with more than half (55%) of the respondents reporting having used cocaine in the previous six months. The median number of days used has fluctuated across the six year period; in 2005 the majority of recent cocaine users had used cocaine once a month or less. Snorting was the most common route of administration.
Thirty respondents commented on the price of cocaine, which was commonly purchased in grams for a median of $270. One-third of respondents reported that the price of cocaine had remained stable in the last six months. Conflicting reports were reported regarding the availability of cocaine. Reports of purity also varied. The majority did not know if the purity had changed in the past six months.
Ketamine
In 2005, 65% of the sample reported lifetime use of ketamine, while recent ketamine use remained stable at 39%. Frequency of ketamine use by the majority of recent users was less than once a month, which is comparable to previous years.
A gram of ketamine was purchased for a median of $100 (n=44). The majority (30%; 13% of the entire sample) reported the price as stable. Over half (55%) of those who commented reported that the purity was high. Conflicting reports were provided regarding the availability of ketamine, with reports ranging from easy to difficult. Of those who commented, most believed that the level of availability had remained stable in the preceding six months.
GHB
One-third of the 2005 sample (32%) reported lifetime use of GHB while 13% reported using GHB in the preceding six months. While the prevalence of GHB use has increased over time, with substantial increases in reports of both lifetime and recent use since 2000, there was a decrease in recent use of GHB in 2005. Three-fifths of those who had recently used GHB had done so less than monthly.
Only a small proportion of participants in 2005 were able to comment on price and availability so these data must be interpreted with caution. GHB was commonly purchased in a vial for a median of $25. Thirty-one percent (5% of the entire sample) reported the price was stable. Conflicting reports were obtained regarding the availability of GHB, with responses ranging from very easy to difficult.
LSD
Lifetime and recent use of LSD has increased in 2005, with 71% reporting lifetime use of LSD and 33% reporting recent use. Frequency of LSD use was a median of two days in 2005. Users typically used one tab per occasion of use and this has remained stable across sampling years.
Thirty-eight respondents were able to comment on the price of LSD, which was reported at a median price of $20 in 2005; this price was reported to have remained stable by over half of those who commented (22% of the entire sample). The price of LSD has increased steadily since 2000. Reports on the current availability of LSD were inconsistent. Fifty-seven percent (24% of the entire sample) reported that the availability of LSD had remained stable in the preceding six months.
MDA
Approximately one-third (32%) of participants in 2005 reported a lifetime prevalence of MDA use and one-fifth (19%) reported recent MDA use. Prevalence of lifetime and recent MDA use decreased in 2005. The median number of days for which MDA was used remained stable.
Eight participants were able to comment on the price of MDA, which was reported as a median of $37.50 per capsule. Three-fifths (59%; 10% of the entire sample) believed that MDA was currently easy to obtain. Of those who commented, 65% (11% of the entire sample) reported that the availability of MDA had remained stable in the preceding six months.
Patterns of other drug use
Comparable to previous years, almost all regular ecstasy users report consuming alcohol on a median of once per week. Similarly, most of the 2005 sample reported recent cannabis use, the majority of whom smoked on a median of two days per week. Tobacco use was common, with over half of those reporting recent use being daily cigarette smokers. Also comparable to previous years, half of the 2005 sample reported lifetime use of benzodiazepines. Those who reported recent benzodiazepine use did so at a median frequency of once a month. Nineteen participants reported lifetime use of antidepressants although only six participants reported recent use. The use of inhalants such as amyl nitrate and nitrous oxide appear to have remained stable across time. Small numbers reported the recent use of mushrooms and other drugs.
Drug information-seeking behaviour
Respondents in the 2005 PDI survey were asked for the first time to discuss their drug information-seeking behaviour. Nearly half (47%) of respondents always found out the content and purity of ecstasy, and nearly one-third (28%) indicated that they always found out the content and purity of other drugs (not including ecstasy). Friends were the most frequently cited source of information regarding content and purity of ecstasy. Nearly one-third (28%) indicated that they had used testing kits.
Risk behaviour
One in four (27%) respondents reported having injected a drug at some time in their lives and 17% reported injecting in the six months preceding interview. A median of 3.5 drugs (range 1-11) had ever been injected while those who reported injecting in the preceding six months had injected a median of two (range 1-7) drug types.
Two-fifths (42%) of lifetime injectors reported injecting for the first time while under the influence of drugs. Ecstasy, cannabis and alcohol were most often reported drugs used, followed by speed and MDA.
When lifetime injectors were asked to specify how they learned to inject, three-quarters (77%) reported that a friend or partner showed them how. Of those that reported having injected in the preceding six months, no respondents reported using a needle after someone else in the month preceding interview.
Twenty-four percent of the sample reported that they had never been vaccinated for hepatitis B. A further 59% reported that they had completed the vaccination schedule, 6% did not finish the vaccination schedule and 6% did not know if they had been vaccinated. Of the sample, 42% reported that they had never been tested for HCV, while 34% had been tested in the last year, 18% were tested more than a year ago and 4% either did not know or didnt get their result. Forty-one percent of the sample had been tested for HIV in the last year and a further 21% had been tested more than a year ago.
The majority (91%) of participants reported penetrative sex in the six months preceding interview. A large proportion (44%) reported one sex partner during the preceding six months although one-fifth (22%) of participants reported having penetrative sex with two partners and 17% reported having six or more partners. More than one-third (37%) of those who reported penetrative sex in the preceding six months had had anal sex. The majority (80%) of those reporting recent penetrative sex reported using drugs during sex in the previous six months. The drugs mainly reported were ecstasy, alcohol and methamphetamine.
Of the sample, 48% had driven within one hour of taking a drug. The drug most commonly taken was ecstasy (69%) followed by cannabis (55%) and speed (36%).
Health-related issues
Of the PDI sample 15% of the participants had overdosed on either ecstasy or other related drugs. Of those that had overdosed, the main drug used was GHB (33%) followed by alcohol (27%).
For the second time, in 2005, the severity of dependence scale (SDS) was used for ecstasy and methamphetamine. The median SDS score for ecstasy was 0.5 (range 0-8). Half (50%) of the respondents had obtained an SDS score of zero, 16% a score of one and 4% obtained a score of two. Seventeen percent of respondents who had used ecstasy in the last six months obtained an SDS score of four or more. Of those that had used methamphetamines the median SDS score was zero (range 0-11), with 15% scoring four or above, the level of dependence.
Participants in 2005 reported a range of other problems associated with their drug use. Participants were asked if they had experienced any occupational, social, financial or legal problems in the six months preceding interview that they would attribute to their drug use. Proportions reporting these harms predominantly attributed them to their use of ecstasy rather than other drugs.
Approximately two-fifths of the sample had experienced financial problems (39%), occupational/study problems (39%) and relationship/social problems (35%) in the preceding six months attributable to the use of ecstasy and related drugs; 7% reported legal problems.
Criminal activity, policing and market changes
Relatively few of the ecstasy users interviewed were involved in criminal activity apart from dealing drugs. Twenty-three percent reported dealing drugs in the month preceding interview and most of them reported dealing once a week or less.
There was a marked decrease in the proportion of ecstasy users sampled who perceived recent increases in police activity. However, of those who did report an increase, the majority reported an increase in police presence in nightclubs, dance parties and raves (including doofs and dance parties) and increased use in drug detection dogs.
The majority of all of ecstasy users reported that police activity had not made it more difficult for them to obtain drugs.
Conclusions
There is increasing evidence that the use of ecstasy is widespread and that the market has increased or stabilised in recent years. The results of general population surveys (showing an increased prevalence of use over time), increases in arrests for possession or dealing ecstasy, increases in calls to telephone help lines about ecstasy, and reports from regular users, suggest that, over time, this group is increasing in size and that ecstasy is being used more heavily. The PDI survey data show that regular ecstasy users score from a range of people and use in a wide variety of locations. All this information suggests that, despite Australia’s continued effort to reduce both the importation and local manufacture of ecstasy, it has remained readily available in Sydney since 2000. Continued monitoring of the market for ecstasy will ensure policymakers are well placed to respond to changes in the market or to the nature and extent of ecstasy-related harms in a timely fashion.
Implications
There is evidence to suggest that ecstasy (MDMA) may be neurotoxic to serotonergic neurons in the brain, which are involved in mood regulation and memory function (Hegadoren, Baker et al. 1999; Boot, McGregor et al. 2000). The long-term consequences of ecstasy use are not well understood. Results from the PDI suggest that there is the potential to reduce the harm associated with ecstasy and related drug use in this population. The challenge of harm reduction strategies is to incorporate messages that are credible and acceptable to the population.
The majority of ecstasy users reported a range of psychological, neurological and physical harms related to their use of the drug, yet they continue to use in ways that may be considered harmful. Substantial proportions reported recently bingeing on ecstasy and using large amounts of alcohol in conjunction with ecstasy. Both these patterns of behaviour are likely to increase the risks associated with ecstasy use and should perhaps be considered by health educators as harmful behaviour worth targeting.
Although many users were able to identify harms related to the use of ecstasy and related drugs, there were users that did not know the risks associated with use. As regular ecstasy users are also polydrug users, it is important to provide accurate information to users regarding combinations of ecstasy and related drugs and their effects. The provision of evidence-based information to reduce the harm associated with the use (and poly-use) of these drugs may help to avoid some of these harms. Further research may be required to provide a better understanding of harms associated with specific drug combinations. In addition it is important to acknowledge that users may be using specific combinations of drugs to enhance effects or decrease the side effects of others. Some users of speed, ketamine, GHB and amyl nitrate reported that the benefit of these drugs was the ability to enhance effects or decrease the side effects of other drugs. It is a challenge to provide effective harm reduction strategies to this group, acknowledging their knowledge of these drugs while also attempting to limit harm.
The content of ecstasy tablets is variable, and this is an issue of concern that could be potentially addressed by the consistent analysis of seizures by law enforcement agencies. Since 1997, the Victoria Police Forensic Services Department, Chemical Drugs Intelligence Team, has maintained a database on drug seizures. Over the last seven years this database has developed into a comprehensive record of drug seizures and trends within Victoria. This database will contain a greater number of seizures from other jurisdictions in the future, but at time of publication data for NSW was not available.
The use of other drugs appears to be more selective, possibly suggesting that these drugs are used for specific occasions by users. While there has been a change in the number of users reporting lifetime and recent use of ketamine, GHB, LSD and MDA in the 2005 sample, as with other years, only small proportions of respondents were confident about commenting on the price, purity and availability of these drugs. Thus, many of the people who report the recent use of these drugs may not seek them out, or have infrequent contact with them; hence, this may be why they are unfamiliar with market indicators for them. However, the use of these drugs is of interest as it may be that the most important concern related to REU use of these other drugs is the risks associated with the combinations of drugs used, i.e. the polydrug use itself. The fluctuation that was seen in 2005 regarding the use of these drugs e.g. a decrease in the proportion reporting recent GHB use, the increase in the proportion reporting recent LSD use highlights the usefulness that comes from investigating these drugs and warrants continued monitoring.
The 2005 NSW PDI results highlight that the use of crystal methamphetamine among regular ecstasy users has decreased slightly in 2005 compared to other years. However, anecdotal evidence from KE suggested an increase in use amongst this group of users and a move towards using crystal in more private locations. Reports from KE also suggest that there is a group of crystal users who have, to some extent, become a group firmly entrenched in the use of this drug; that in this group there are users who are no longer irregular users or experimenters, but who have experience with the drug and will continue to use it. This has implications for health promotion and health services. The market for crystal methamphetamine needs to be monitored, the routes of administration considered, and this has been examined in separate research conducted at NDARC in 2005 (e.g. McKetin, McLaren & Kelly, 2005a). The harms associated with smoking crystal need to be examined.
For the first time, in 2005, the PDI examined factors which regular ecstasy users believed affected the price and use of ecstasy, with findings suggesting that the large majority of respondents would reduce their use of ecstasy if their use caused social/relationship, legal, financial or occupational/study problems. Also for the first time in 2005, the PDI included a section which examined respondents drug information-seeking behaviour, the results of which will be considered in greater detail in the coming months.
The health effects of ecstasy and related drug use were often considered relatively benign by users in the study. However, the harms associated with injecting drug use, drug taking during sex and driving under the influence are substantial. It is important to investigate risk-taking behaviour in this population and monitor blood-borne viral infections (vaccination and testing) as an outcome. This will allow an examination of whether harm reduction messages are reaching this group, and promote safe practices.
The regular ecstasy users interviewed reported slightly higher levels of criminal activity, the most common of which was drug dealing. We found in 2005 that the majority of regular ecstasy users who deal drugs do so to pay for their ecstasy use (ecstasy profit).
Continued monitoring of the ecstasy and related drug markets will enable the collection and dissemination of information that will allow the implementation of timely policy responses to market developments. Continued monitoring will also enable the regular collection of indicative data relating to the size of the markets for other ecstasy and related drugs, such as GHB and ketamine, and will point to the need for research specific to such drugs. The replication of the Party Drugs Initiative (PDI) in 2006 in all jurisdictions across Australia will be a useful addition to current knowledge about ecstasy and related drug markets across the country.
Citation: Dunn, M., Degenhardt, L. & Stafford, J. (2006) NSW Trends in Ecstasy and Related Drug Markets 2005: Findings from the Party Drugs Initiative (PDI), Sydney: National Drug and Alcohol Research Centre.