NDARC Technical Report No. 177 (2004)
EXECUTIVE SUMMARY
The Illicit Drug Reporting System (IDRS) is funded jointly by the Australian Government Department of Health and Ageing and the National Drug Law Enforcement Research Fund (NDLERF), and is designed to monitor patterns and trends in illicit drug use and associated harms, with a view to highlighting issues that require further attention from relevant health or law enforcement agencies. Each year and in each state and territory of Australia, interviews are conducted with a sample of regular injecting drug users (IDU) and a sample of key informants (KI) working in the drug and alcohol field. Together with indicator data from other agencies, the IDRS aims to identify emerging trends in illicit drug use and associated harms, and to act as an early warning system for intervention. The IDRS focuses primarily on patterns and trends relating to heroin, methamphetamine, cocaine and cannabis, however data relating to other drugs and to drug-related issues are also collected.
Demographic characteristics of injecting drug users (IDU)
The 2003 IDRS surveyed 135 injecting drug users (IDU) in south-east Queensland. Continuing a trend from previous years, IDU in 2003 were on average slightly older (mean = 32.8 years) than in 2002 (mean = 29.9 years). The sample was almost two thirds male and almost half reported a prison history. More males than females reported a prison history.
Seventy percent of the IDU sample was unemployed and just over a quarter had completed high school. Over two thirds reported living in their own house or flat, however seven percent were homeless and eleven percent were living in a boarding house or hostel. The proportion of IDU identifying as Aboriginal or Torres Strait Islander (ATSI) has increased in each year of the IDRS. In 2003 14% of the sample identified as ATSI.
Patterns of drug use among IDU
IDU in 2003 reported first injecting a drug at an average age of 18.4 years, although males reported injecting earlier (mean = 17.9 years) than females (mean = 19.2 years). Younger IDU also reported first injecting at a younger age, suggesting that initiation to injecting may be occurring at a younger age.
Out of a total of 17 possible drug classes, IDU on average reported having used 10.5 drug classes in their lifetime, and having injected 5.1 drug classes in their lifetime. These figures are comparable to those for 2002. In 2003 30% of IDU nominated heroin as the drug they had injected most in the last month, and 57% nominated methamphetamine. Over a third of IDU in 2003 reported injecting at least once a day in the last month.
Heroin
Despite evidence of an increase in heroin use among IDU interviewed in 2002, use appears to have declined again in 2003. This prolonged decrease in heroin use among IDU participants in the IDRS has been paralleled by a sustained increase in price, a sustained reduction in purity and, to a lesser extent, a sustained decrease in the perceived availability of heroin in Queensland.
Among those who have continued to use heroin in 2003, there appears to have been little change in patterns of use. IDU who nominate heroin as their drug of choice are still characterised by above-average levels of polydrug use, with recent use of other CNS depressants including alcohol, benzodiazepines and morphine not uncommon. Despite this, there was some evidence of a continued reduction in the incidence of both fatal and non-fatal overdose among heroin users in 2003.
The number of opioid treatment registrations in Queensland has continued to rise, with 3,929 client registrations throughout the State in 2003. An increasing minority of IDU are opting to receive buprenorphine rather than methadone. The vast majority of opioid pharmacotherapy clients in Queensland receive their dose from a public prescriber and only a small minority receive their dose within a correctional setting.
Methamphetamine
Methamphetamine seems to have established itself as a relatively cheap, readily available and potent injectable drug in Queensland. Crystal methamphetamine (‘ice’) in particular seems to have gained a reputation among many IDU as a potent, highly desirable drug, despite the negative physical, social and psychological effects that many associate with its use.
In 2003 methamphetamine was the most frequently injected drug among IDU sampled for the IDRS, despite the fact that a larger proportion nominated heroin as their drug of choice. Ninety percent of IDU reported having injected some form of methamphetamine in the last six months, with over half reporting recent injection of ice. Fewer than one in ten reported smoking ice recently although anecdotal reports suggest that smoking of ice may be more common among non-injecting drug users, among younger users and in the party drug subculture.
Whereas IDU who nominated heroin as their drug of choice were characterised by above-average levels of polydrug use, those who nominated methamphetamine as their drug of choice in 2003 were characterised by below-average levels of polydrug use.
Cocaine
Although two thirds of IDU sampled for the IDRS in 2003 reported having used cocaine at some point in their life, fewer than a quarter reported using recently and only one in ten reported recent injection. Cocaine use among IDU in Queensland remains sporadic and, for the most part, opportunistic. Nevertheless, there were anecdotal reports in 2003 of an increase in the use of cocaine in a party drug context, perhaps with methamphetamine, and typically among more affluent users.
Consistent with this, while IDU report that the price of cocaine is still high, the availability low and the purity variable, law enforcement data show an increase in the number of cocaine seizures in Queensland, in the last financial year.
Cannabis
The cannabis market in Queensland, as in other jurisdictions, continues to be distinguished by its consistency. Despite significant fluctuations in the prevalence of use of a range of other illicit drugs, the IDRS has recorded very little change in the price, potency, availability or use of cannabis among IDU, over the past four years.
Cannabis use continues to be endemic among IDU in Queensland with roughly four out of every five reporting recent use. Over the last few years there appears to have been a consistent increase in the frequency of use, with the average user in 2003 smoking cannabis on four or five days out of every week and more than a third smoking daily.
The majority of IDU report recent use of both hydroponic and ‘bush’ cannabis, however roughly three quarters report mostly using ‘hydro’ – a form they report to be both more potent, and more expensive. Most report obtaining their cannabis from either a friend or a dealer’s home, while roughly equal proportions identify the original source of their cannabis as a large-scale cultivator, or a small-time backyard grower.
Illicit use of methadone
While rates of use of both licit and illicit (i.e., not prescribed) methadone have decreased in 2003, rates of injection have increased. Over one quarter (26%) of IDU in 2003 reported recent injection of methadone, compared with 19% in 2002. Fewer than one in five IDU (18%) in 2003 reported recent use of illicit methadone syrup, and only 4% reported recent use of illicit physeptone, indicating that a proportion of IDU are injecting methadone that has been prescribed to them.
Illicit use of buprenorphine
Where use of methadone has decreased in 2003, use of buprenorphine has increased. More IDU in 2003 are being prescribed buprenorphine, with 16% reporting use of licit buprenorphine in the last six months. Only 7% of IDU in 2003 reported recent use of illicit buprenorphine. Ten percent reported recent injection of buprenorphine, representing a 100% increase in buprenorphine injection from 2002.
Morphine
The 2002 IDRS identified an increase in the use and injection of morphine, particularly MS Contin®, among IDU. This trend has continued in 2003 with forty percent of IDU reporting recent injection of morphine. Among those who reported injecting morphine in the last month, almost half reported experiencing problems associated with their use.
In the context of continued poor quality heroin, unreliable supply and (relatively) inflated heroin prices, many IDU seem to consider morphine a more reliable and desirable option. A 50mg ‘grey nurse’ costs $50 on the illicit market, compared with $200 or more for a comparable quantity of heroin.
Benzodiazepines
The 2003 IDRS identified a reduction in the use and, in particular, injection of benzodiazepines among IDU in Queensland. The reported incidence of recent benzodiazepine injection dropped markedly from 2002 (25%) to 2003 (11%). Whereas the benzodiazepine most commonly used by IDU in 2002 was Temazepam®, in 2003 the overwhelming majority reported using Valium®.
Associated harms
Blood-borne viruses (BBV), injection-related problems, mental health problems and involvement in the criminal justice system continue to feature prominently among the hazards faced by IDU in Queensland. While Hepatitis C rates seem to be dropping in the general Australian population, they appear to be climbing among IDU: In 2002, almost half of the IDU surveyed in the Queensland arm of the national NSP survey tested positive for Hepatitis C.
Despite an almost linear increase in the number of syringes being distributed to NSPs in Queensland since 1996/97, sharing of needles and other injecting equipment among IDU remains far from uncommon. In 2003 more than one in ten IDU reported using a needle after someone else in the last month, and more than one in five reported that someone had used a needle after them in the last month.
While the majority of IDU in 2003 reported injecting in a private home, more than one in ten reported last injecting in a community location, and more than one in ten reported last injecting in a car. Those injecting heroin were particularly likely to inject in either a car or a public toilet.
Over half of the IDU surveyed in 2003 reported at least one injection-related problem in the last month, with the most common problems being scarring or bruising, and difficulty injecting. These figures are not significantly different from those recorded in 2002, 2001 or 2000. Injection-related problems were particularly common among those reporting recent injection of benzodiazepines, buprenorphine or methadone, although almost half of those reporting recent morphine injection also reported at least one problem related to injection, in the last month. Injection of diverted pharmaceutical preparations continues to be a significant health risk among IDU in Queensland.
In 2003 over a third of IDU reported seeing a mental health professional in the last six months, with the most common problem (other than drug dependence) being depression. There has been little change from 2002 to 2003 in the prevalence of self-reported mental health problems among IDU in Queensland.
As in previous years, over half of the IDU surveyed in 2003 reported engaging in some form of criminal activity in the past month – typically drug dealing or property crime, however in 2003 one in ten reported engaging in some form of violent crime in the last month. Since 2000, self-reported rates of violent crime and of arrest for violent crime among IDU have increased linearly, with more than one in five IDU in 2003 reporting arrest for a violent crime in the last year.
Implications
The IDRS identified a number of new drug trends in 2003, and confirmed that other trends, observed in 2002, have continued into the current year. Among the key issues arising from this year’s report are:
- the apparent interaction between the heroin and methamphetamine markets in Queensland
- an increase in the frequency of cannabis use among IDU
- a continued increase in the use and injection of morphine among IDU
- suggestions of an increase in the use of cocaine among non-injecting drug users
- continued high rates of Hepatitis C, injection-related problems, mental health problems and involvement with the criminal justice system, among IDU
- evidence of a continued increase in the availability and use of crystal methamphetamine, and an associated increase in methamphetamine-related harms
These trends raise some important questions for research and for policy makers, and highlight areas in which appropriate and targeted intervention must begin or be continued.
Citation: Kinner, S. and Fischer, J. (2004) Queensland Drug Trends 2003: Findings from the Illicit Drug Reporting System (IDRS), Sydney: National Drug and Alcohol Research Centre.