NDARC Technical Report No. 214
EXECUTIVE SUMMARY
Demographic characteristics of injecting drug users (IDU)
In 2004 129 IDU were interviewed in Queensland for the IDRS. As in previous years, about two thirds of the sample was male, almost three quarters were unemployed, one in five had a grade 12 education or higher, 43% had a prison history and a minority (12%) were Indigenous. Over a third were currently in some form of drug treatment, typically methadone or buprenorphine substitution therapy.
IDU in 2004 were on average 33.6 years old: almost one year older than those interviewed in 2003 (32.8 years). The average age of the IDU sample interviewed for the IDRS has increased by an average of 1.8 years each year since 2000, when IDU were on average 26.4 years old. This trend may reflect an ageing cohort of injecting drug users accessing NSPs in south-east Queensland.
Patterns of drug use among IDU
IDU in 2004 reported first injecting at 20 years of age on average - older than in any previous year in which the IDRS has been conducted in Queensland. Also unlike previous years, in 2004 there was no significant difference in the age of first injection between males and females. As in previous years, there was a positive correlation between age and age at first injection, indicating that more recent recruits into injecting may also be initiating into injecting at a younger age.
IDU in 2004 reported having used and injected more drug classes recently and ever, than those interviewed in 2003. This increase in polydrug use may to some extent be a consequence of the heroin shortage of 2001, with IDU continuing to seek out alternative opiates such as diverted morphine, methadone and buprenorphine. It may also be partially a function of the ageing sample of IDU interviewed in 2004.
In 2004 the IDRS documented a number of instances in which the prevalence of use of a particular drug decreased, while the average frequency of use, among those who had used recently, increased. These trends underscore the importance of monitoring prevalence, frequency and quantity of use, in order to gain a full understanding of trends in illicit drug use.
Heroin
The prevalence of heroin use among IDU has fluctuated since at least 2000, with a large decline in use during the heroin shortage in 2001. In 2004 the prevalence of recent use among IDU increased, however the average frequency of use continued to decline. Given that there was no apparent increase in treatment seeking behaviour among IDU, this suggests an increase in the use of alternative opiates, perhaps as a substitute or in preference to heroin.
In 2004 the price of heroin decreased slightly, to $380 per gram. Simultaneously, the perceived availability increased with 93% of respondents reporting that heroin was easy or very easy to get. Purity also increased, with the median purity of analysed seizures at 33% in the second quarter of 2004.
Methamphetamine
The heroin and methamphetamine markets in Queensland continue to demonstrate a reciprocal relationship. Data from 2004 indicate that this relationship, and to some extent overall trends in the use, price, purity and availability of methamphetamine, have been driven by crystal methamphetamine ('ice') in particular. The distinction between ice, which is typically imported into Australia from Asia, and powder and base, which are mostly locally produced in small 'box labs', is critical to a full understanding of the methamphetamine market in Queensland.
Use of methamphetamine - in particular ice - decreased among IDU in 2004, although the proportion reporting recent use still substantially exceeds the proportion nominating methamphetamine as their drug of choice. The converse is true for heroin, suggesting that this opportunistic use of methamphetamine may be driven largely by (easy) availability.
The price of powder and base methamphetamine did not change between 2003 and 2004, however the price of ice increased. Similarly, while the availability of powder and base did not change, IDU reported a decrease in the availability of ice. Finally, the average purity of methamphetamine seizures in Queensland decreased from 2003 to 2004. Other data suggest that this decrease is due to a reduction in the proportion of seizures that are of high-purity ice.
Despite an apparent reduction in the availability and use of ice in 2004, key experts continue to report problems of aggression and mental health problems associated with methamphetamine use. The number of arrests for amphetamine-type stimulants (ATS) in Queensland has increased substantially since 2001/02, although at present arrest data do not distinguish between methamphetamine and MDMA ('ecstasy').
Cocaine
There has been little change in the cocaine market in Queensland. Cocaine use continues to be rare, opportunistic and sporadic among IDU. There was some evidence of further decline in the availability of cocaine for IDU in 2004, however anecdotal evidence indicates that there may be an established niche market for cocaine among non-injectors. This possibility should be explored further, perhaps using qualitative research methods.
Cannabis
The cannabis market in Queensland continues to be distinguished by its relative stability over time. Data from 2004 indicate that the distinction between hydroponic and bush cannabis is important to understanding the dynamics of the cannabis market. Overall, there has been a small but gradual decline in the proportion of IDU reporting recent cannabis use, from 2000 to 2004, with 75% of IDU in 2004 reporting recent use. Over the same time period, however, the average frequency of use among IDU has increased, from every second day to two days out of three. Paralleling this trend has been the increasing availability and use of hydroponic cannabis.
The price of cannabis was stable or perhaps decreasing in 2004, with hydro consistently more expensive than bush. Consistent with previous years, IDU rated hydro as substantially more potent than bush. Nevertheless, IDU reported that hydro was more readily available than bush, although the majority consider both forms very easy to get. Some users consider hydroponic cannabis too potent, and actively seek bush for a 'milder' effect, however due to its limited availability, users are often only able to obtain hydro.
There has been a trend towards sourcing cannabis from street and mobile dealers, and towards the small-scale production of cannabis, presumably hydroponic cannabis. Smallscale producers of cannabis may nevertheless be part of a large, organised network, with the decentralisation of production designed to minimise and limit the impact of law enforcement activity on production.
Key experts are increasingly reporting problems of dependence and mental health problems associated with cannabis use. This may be associated with the increasing use of hydroponic cannabis, and the increasing frequency of use among users. The number of arrests for possession/use of cannabis in Queensland has risen by 33% since 2001/02.
Illicit use of methadone
The proportion of IDU reporting recent use and injection of illicit methadone increased from 2003 to 2004, although the proportion reporting receiving methadone maintenance treatment (MMT) has not increased. According to key experts, a proportion of IDU are becoming increasingly disenchanted with MMT, and are deciding either not to seek treatment, to seek buprenorphine treatment instead, or to 'self-medicate' with illicit methadone, morphine or buprenorphine.
Illicit use of buprenorphine
The proportion of IDU reporting recent use and injection of illicit buprenorphine increased by more than 100% from 2003 to 2004. Over the same period the proportion of IDU reporting currently receiving buprenorphine treatment increased by 38% from 8% to 11%. Buprenorphine is perceived to be reasonably easy to divert, and is reportedly favoured by IDU in a prison setting, because it is also perceived to be reasonably easy to smuggle into correctional centres.
Morphine
The proportion of IDU reporting recent morphine injection has increased by 45% since 2001, with 45% of IDU in 2004 reporting recent morphine injection. The main brand preferred by IDU continues to be MS Contin®, with 100mg tablets selling for an average of $40. Compared to heroin, morphine is perceived by IDU as a relatively reliable, cheap and available opiate. Injection of diverted morphine has for a number of years been common in North Queensland and the Northern Territory, where heroin has traditionally been unavailable. Given the continued suppression of the heroin market in south-east Queensland, the diversion and injection of morphine should be closely monitored in coming years.
Other opioids
Around one in ten IDU in 2004 reported recent use of other opiates, typically Panadeine Forte®, pethidine, codeine or oxycodone. Although oxycodone has not been mentioned by IDU in previous years, one in five of these who report recent use of other opiates in 2004 reported recent use of oxycodone.
The number of arrests in Queensland for other opiate use/possession is very small, however this number has increased quite consistently since 1998/99.
Benzodiazepines
Following the restriction of 10mg temazepam gel capsules in May 2002, the prevalence of benzodiazepine injection among IDU decreased markedly, from 25% of IDU in 2002 to 11% in 2003. In 2004 10% of IDU reported recent benzodiazepine injection, however the proportion reporting recent benzodiazepine use increased markedly, from 48% in 2003 to 72% in 2004. The brand of benzodiazepine that has been favoured by IDU since the increased restrictions of temazepam has been Valium®.
Associated harms
Since the heroin shortage the number of opioid-related hospital treatment episodes in Queensland has declined, presumably reflecting a reduction in both heroin overdose and heroin withdrawal presentations. Overall, however, the number of prescription and nonprescription drug overdoses attended by Queensland Ambulance Service has increased, quite consistently, since at least July 2000.
While key experts reported an increase in the incidence and severity of mental health problems among IDU, often associated with binge methamphetamine use, IDU in 2004 reported an increase in the prevalence of depression. Almost one in four reported seeing a mental health professional for depression recently, and one in three reported experiencing depression recently. Most IDU reported seeing a GP for their mental health problems.
Since at least 2002, self-reported rates of sharing of injection equipment have declined, while the number of syringes dispensed throughout Queensland has continued to increase. Simultaneously, the incidence of injection-related problems among IDU has decreased, although the majority of IDU still experience some problems, typically scarring/bruising or difficulty injecting. Perhaps most significantly, the number of Hepatitis C notifications in Queensland has dropped by 18% since 2000.
Self-reported rates of drug dealing among IDU have decreased by 40% since 2000, although about one in four IDU in 2004 reported dealing in the last month. Overall, 42% of IDU reported engaging in criminal activity in the last month, and more than half reported having been arrested in the last twelve months. Throughout Queensland, the number of drug consumer and provider arrests increased by 13% from 2002/03 to 2003/04. Eighty-four percent of these arrests in the last financial year were of consumers, and 73% of arrests were in relation to cannabis. Self-reported rates of property crime have fluctuated over the last five years, in a pattern similar to that observed for heroin use.
The majority of IDU in 2004 reported witnessing substance-related verbal and physical aggression in the last six months, and a substantial minority reported engaging in substance-related verbal and physical aggression themselves. Methamphetamine, heroin and in particular alcohol, were the drugs most commonly associated with aggression. Given that alcohol is often consumed in public places and licensed premises, there is scope for intervention to reduce the incidence of alcohol-related aggression. Given that most IDU report using methamphetamine and heroin in a private home, however, effective interventions to reduce aggression associated with these drugs will be considerably more difficult.
Implications
Illicit drug markets in Queensland, as in other jurisdictions, continue to fluctuate and to interact. Accordingly, these markets should be monitored on a regular basis, and should not be interpreted in isolation from one another. The 2004 Queensland IDRS documented a number of new trends, and provided further evidence of inter-dependence among illicit drug markets in Queensland. In particular, it seems clear that changes in the availability of heroin are associated with changes in the use of methamphetamine, and changes in the use of other opiates including morphine, methadone and buprenorphine.
To the extent that illicit drug markets are interdependent, supply reduction, demand reduction and harm reduction policies should adopt a holistic view, recognising that targeting the use of one drug may impact on the availability and use of other drugs. In order to minimise drug-related harm, the realities of endemic polydrug use and interdependent illicit drug markets must be recognised. The data presented here further underscore the importance of this recognition.
Citation: Kinner, S. & Fischer, J. (2005) Queensland Drug Trends 2004: Findings from the Illicit Drug Reporting System (IDRS), Sydney: National Drug and Alcohol Research Centre.