EXECUTIVE SUMMARY
This report presents the findings from the twelfth year in which data has been collected in South Australia. The Ecstasy and Related Drugs Reporting System (EDRS; formerly the Party Drugs Initiative, or PDI), monitors the price, purity and availability of ‘ecstasy’ (MDMA) and other drugs such as methamphetamine, cocaine, gamma-hydroxybutyrate (GHB), d-lysergic acid (LSD), 3,4-methylendioxyamphetamine (MDA) and ketamine. It also examines the demographic characteristics and patterns of drug use among regular ecstasy users (REU), the prevalence of risk-taking and harms related to drug use, as well as the level of criminal involvement among this group. It utilises data from three sources: (a) surveys with regular ecstasy users (REU); (b) surveys with key experts (KE) who have contact with REU through the nature of their work; and (c) the analysis of existing data sources that contain information on ecstasy and related drugs (ERD). The EDRS surveys are not representative of ecstasy and other drug users in the general population. The REU are a sentinel group that provides information on patterns of drug use and market trends.
The findings from each year not only provide a snapshot of the ERD market in Australia, but in total they help to provide an evidence base for policy decisions; for helping inform harm reduction messages; and to provide directions for further investigation when issues of concern are detected. Continued monitoring of the ERD markets in Australia will help add to our understanding of the use of these drugs; the price, purity and availability of these drugs and how these may impact on each other; and the associated harms which may stem from the use of these drugs.
Drug trends in this publication primarily represent trends in Adelaide, where new drug trends are likely to emerge. Patterns of drug use may vary among other groups of REU in Adelaide and in regional areas.
Demographic characteristics of regular ecstasy users
Ninety two participants were recruited to the 2012 sample. As in previous years, the REU interviewed were young, with a median age of 22 and three-quarters of the participants were male (73%). Almost one-third of the sample (30%) reported being in full-time employment with a mean income of $510 per week. Most participants were well educated and about half of the sample had completed some kind of post school qualification, while 9% were full-time students. The large majority of the sample identified as heterosexual and 3% were currently undergoing treatment for their drug use. In comparison to participants in 2011, the 2012 sample were generally similar; however, there were significant decreases in heterosexuality, employment on a part-time/casual basis and completion of a university or college course.
Patterns of drug use among participants
Alcohol was the main drug of choice nominated by participants, meaning that, for the second year running, ecstasy had dropped out of favour as the preferred drug of choice among REU. However, of the illicit drugs, ecstasy re-emerged as the main drug of choice, followed by cannabis and then cocaine. Aside from ecstasy, alcohol was the most commonly used drug among REU, followed by cannabis, tobacco and methamphetamine. As in 2011, polydrug use was common among this sample, with participants having tried a median of eleven different drugs in their lifetime, and six within the preceding six months. In 2012, there were significant decreases in the recent use of methamphetamine powder and nitrous oxide.
The proportion of participants who reported recent bingeing on ecstasy or other related drugs increased slightly in 2012. The type of drugs that participants reported as being used in a binge session were similar to those reported in 2011. Alcohol was the most commonly used drug in a binge session, followed by ecstasy, tobacco, cannabis and crystal methamphetamine.
Injecting drug use remained low in 2012, with only five participants reporting that they injected any drug within the preceding six months.
Ecstasy
Although the ecstasy market appears to have made a small recovery in 2012, there has been little change in the parameters of ecstasy use, with the reported median age of first use, ‘average’ or ‘most’ amount used in a typical session, and median days of use in a six month period all remaining relatively stable. The proportion of participants who reported using more than one tablet in a typical session increased, albeit non-significantly, to 92%. Over two-fifths of REU reported that they had binged on ecstasy in the past six months, stable from 2011. Swallowing was the main route of administration (ROA) for ecstasy pills and capsules, whilst snorting was the main ROA for ecstasy powder. Approximately half of the sample reported that the last time they consumed ecstasy they had been at a nightclub.
The proportion of participants who reported using other drugs ‘with ecstasy’ increased slightly in 2012, whilst the use of other drugs to come down from ecstasy decreased (although neither of these changes were significant). Cannabis was the most common drug used to come down from ecstasy, whilst alcohol was the most common drug used in combination with ecstasy.
The reported price of ecstasy remained stable in 2012, at $20 for a pill. This was confirmed by almost two-thirds of the sample who reported that price had remained stable over the preceding six months. Availability continued to be considered ‘easy’ or ‘very easy’ by participants. There was, however, a significant increase in the proportion of REU who reported that ecstasy was ‘very easy’ to obtain, and an inverse significant decrease in those who reported availability to be ‘difficult’. The largest portion of REU reported that current purity of ecstasy was medium, although there was a significant increase in the proportion of REU who perceived purity to be high and an inverse decrease in those who reported in to be low. This increase in purity is verified by data from the Australian Crime Commission (ACC) who reported that the median purity of South Australian Police (SAPOL) seizures of phenethylamines almost doubled in 2010/11, from 6.8% in 2009/10 to 11.8% in 2010/11.
Ecstasy was generally purchased for both self and others, with three participants reporting purchasing ecstasy for others only. Ecstasy was purchased from a median of four people in the six months prior to interview. The majority of participants purchased ecstasy one to 12 times in that period, with 11% purchasing ecstasy between 13−24 times in that period. REU obtained a median of five pills on the last occasion of purchase, and mainly purchased ecstasy from friends.
Methamphetamine
In 2012, the proportions of the participant sample reporting recent use of crystal and base remained relatively stable, whilst there was a significant decrease in the use of methamphetamine powder. The frequency of use within the preceding six months remained relatively stable, and low (range 2.5−6 days) for all three forms of methamphetamine. In the six months prior to interview, smoking emerged as the preferred route of administration for both base and crystal methamphetamine, whilst snorting and smoking were the preferred methods for administering powder methamphetamine.
The price for a point of crystal methamphetamine remained stable in 2012, whilst the price for a point of base and methamphetamine powder increased to $85 and $100 respectively. However, despite these changes in the median price, the majority of participants reported that the price of all three forms of methamphetamine had remained stable in the six months preceding interview.
The purity of all three forms of methamphetamine was largely perceived as high, with crystal methamphetamine appearing to have the highest purity according to participant reports. In addition, seizures analysed by South Australia Police (SAPOL) revealed that the median purity of methamphetamine in 2010/11 had more than quadrupled compared to 2009/10. All forms of methamphetamine were considered easy to very easy to obtain recently, and participants reported that this had remained stable within the last six months.
Overall, participants mostly reported obtaining all three forms of methamphetamine from friends, and at their friend’s home.
Of the illicit drugs, most key experts (KE) considered methamphetamine to be an issue of particular concern at the moment. This was attributed to its high prevalence and the effects (health, mental and social) that it has on both the individual and their family/friends.
Cocaine
There were slight, albeit non-significant, declines in the proportion of REU who reported lifetime and recent use of cocaine in 2012. Among those who had used cocaine in the six months preceding interview, frequency of use remained low and stable at a median of two days.
The median price paid for a gram of cocaine decreased slightly to $350, although the majority of those able to answer perceived that the price had remained stable in the six months preceding interview. Reports regarding the purity of cocaine were mixed, with almost equal proportions reporting it to be low (30%), medium (33%) and high (27%). Interestingly, seizures analysed by SAPOL revealed that the median purity of cocaine in 2010/11 had more than halved compared to 2009/10. Participants largely reported that cocaine was ‘difficult’ to obtain.
LSD
Almost one-fifth of the participant sample in 2012 reported recent use of LSD, declining slightly from 2011. Frequency of LSD use was stable and remained consistently low. The amount of LSD used in a typical and heavy session remained stable, and the majority of participants reported being at a private venue (own/friend’s home) at last time of intoxication.
The median price of LSD remained stable in 2012, at $15 for a tab. The purity of LSD was perceived as high, and participants largely believed this had remained stable over the past six months. The availability of LSD remained stable in 2012, with almost equal proportions reporting that LSD was easy or difficult to obtain.
Virtually all of the KE reported that the prevalence of LSD was very low, and that they had seen very little of it among their clientele. One KE noted that LSD had been replaced with 2, 5-dimethoxy-4-iodoamphetamine (Death on Impact − DOI), although another reported that there had been a decrease in DOI as well. A couple of KE also noted the emergence of 25-B-NBOMe, a low dose hallucinogen that is often sold as LSD.
Cannabis
The prevalence of cannabis use remained exceptionally high in 2012, with 98% of the sample reporting lifetime use and 88% reporting use within the preceding six months. The frequency of recent cannabis use by participants remained stable in 2012, at a median of 48 days within a six month period. Participants reported spending most of their time, whilst intoxicated, at their own home or at a friend’s home.
The price reported for a bag of hydro/bush remained stable in 2012, as did the availability (with participants reporting that cannabis was easy or very easy to obtain). The purity of both hydro and bush was reported as high, with the purity of both types of cannabis perceived as stable in the previous six months.
Emerging psychoactive substances
Participants in 2012 were asked about their use of a range of emerging psychoactive substances (EPS). Those most recently used were herbals highs, unknown capsules and synthetic cannabinoids. Interestingly, there were significant decreases in the recent use of 4-bromo-2,5-dimethoxyphenethylamine (2CB), 2,5-dimethoxy-4-ethylphenethylamine (2CE), 2,5-dimethoxy-4-iodophenethylamine (2CI) and DOI.
It was reported by KE that in 2011 there were 20 new drugs that entered the SA drug market. Three KE reported that MDPV was the main analogue drug in Adelaide; however, reports regarding the remaining EPS were somewhat mixed. Other drugs of concern were benzylpiperizine (BZP), 3-trifluoromethylphenylpiperazine (TFMPP), 25-B-NGOMe, growth hormones and pre-workout analogues.
It was interesting to note that, despite the resurgence of the ecstasy market, over a third of the sample still reported the use of ‘any’ EPS in the six months preceding interview. This may suggest that, even if the ecstasy market were to make a full recovery, participants would continue to experiment with a range of different drugs.
Other drugs
For the first time in the history of the SA EDRS, alcohol emerged as the main drug of choice nominated by participants. As in previous years, the large majority of the participant sample reported recent use of alcohol, and frequency remained stable at a median of 48 days in a six month period (approximately twice a week). Many KE considered alcohol to be a particularly problematic drug due to its widespread prevalence, availability and social acceptability. Binge drinking and pre-loading were raised as issues of particular concern.
Almost the entire sample reported lifetime use of tobacco, and 85% reported use of tobacco in the six months preceding interview. Almost two-thirds of REU reported daily tobacco use, and this continues to far exceed the daily smoking prevalence rate among the general population.
Twenty-four percent of participants reported recent use of illicit benzodiazepines, at a frequency of less than once a month. Only one participant reported recent use of illicit antidepressants.
Recent use of nitrous oxide decreased significantly in 2012, with a fifth of the sample reporting use within the preceding six months. The prevalence of recent amyl nitrate use remained stable at 17% of the sample. Frequency of use remained low for both inhalants. There were no significant changes in the use of ketamine, GHB or MDA; however, it is interesting to note that two KE from the law enforcement field reported a resurgence in the GHB market.
Lifetime use and recent use of illicit pharmaceutical stimulants remained stable in 2012. One-quarter of the sample reported that they had used magic mushrooms in the six months prior to interview, although frequency remained low. Recent use of heroin and other opioids remained low and stable, there were no participants that reported recent steroid use and there were significant decreases in the recent use of over the counter (OTC) codeine and stimulants.
Health-related issues
The prevalence of recent (past 12 month) stimulant overdose remained stable in 2012, whilst there was a slight, non-significant decrease in the prevalence of recent depressant overdose. Overall, 60% of REU reported that they had overdosed on either a stimulant or depressant drug in the 12 months preceding interview. When analysing this data it is important to keep in mind that this is self-report data, with overdose defined as symptoms that occurred “outside your normal drug experience, or where professional assistance would have been helpful”.
Thirteen percent of participants reported having accessed professional help for a drug and alcohol related issue in the six months prior to interview, and one in five participants reported that they had thought about seeking help for their drug and alcohol use. The most commonly accessed services were psychologists and drug and alcohol workers.
The proportion of clients attending Drug and Alcohol Services South Australia (DASSA) treatment services, with ecstasy as the primary drug of concern, remained stable in 2012 and accounted for a very small proportion of total attendances. Alcohol dominated as the primary drug of concern for the largest proportion of total clients to DASSA treatment services, followed by amphetamines, cannabis, opioid analgesics and heroin.
Telephone calls made to the SA Alcohol and Drug Information Service (ADIS) remained stable for ecstasy, cocaine and cannabis; increased for methamphetamine; and decreased for alcohol.
In 2012, 28% of the participants were assessed at high to very high risk of psychological distress as measured by the Kessler Psychological Distress Scale (K10), in the four-weeks prior to the survey.
Risk behaviour
Injecting risk behaviour
Seven percent of the sample reported that they had ever injected any drug. Five participants reported recently injecting any drug in 2012, most commonly heroin. With regard to longer-term trends, there was no evidence of a change in the prevalence of recent injecting amongst participants across the years. Among those who had injected in the past six months, there were no participants who reported that they had shared needles or injecting equipment.
Sexual risk behaviour
Evidence of risky sexual behaviour was again apparent among the participant sample in 2012. Of the participants who reported having had penetrative sex with a casual partner in the last six months, about a third of the sample reported that they did not use protection during their last sexual encounter, regardless of whether they were sober or intoxicated. In addition, the vast majority of those who reported recent penetrative sex reported having done so whilst under the influence of drugs – most commonly ecstasy, followed by alcohol and cannabis. Seven participants reported that they had been diagnosed with a sexually transmitted infection (STI) in the past year, most commonly Chlamydia.
Driving risk behaviour
Fifty-seven percent of those who had driven in the six months prior to interview reported that they had driven whilst under the influence of alcohol; of these participants, the majority reported driving over the legal blood alcohol concentration (BAC) limit on a median of two occasions in that period. Fifty-six percent of recent drivers reported driving after consuming an illicit drug, and these participants had done so on a median of six times in the six months prior to interview. Cannabis and ecstasy were the most commonly used illicit drugs prior to driving.
Alcohol risk behaviours
The Alcohol Use Disorders Identification Test (AUDIT) is a brief screening tool which is used to identify individuals with alcohol problems. Using this test, participants scored a mean of 16.2. Eighty-eight percent of the sample scored eight or more; these are levels at which alcohol intake may be considered hazardous.
Law enforcement-related trends
The prevalence of past month criminal activity among REU remained stable in 2012. Drug dealing continued to be the most common offence which had been committed, followed by property offences. Fraud and violent crime remained low among REU. The number of participants reporting past-year arrest remained stable.
Two-thirds of the sample reported that the level of police activity had remained stable over the preceding six months, while one-third reported an increase in activity.
Special topics of interest
Heavy Smoking Index nicotine dependence
Among those who had smoked daily, about one-third reported waiting 60 minutes or longer before smoking their first cigarette, and 45% reported smoking 10 or less cigarettes a day. Approximately one-fifth of daily smokers scored 6 or above, indicating high-very high dependence, with the mean Heavy Smoking Index (HSI) score being 3.0.
Neurological history
Traumatic brain injury (TBI) was surprisingly common among REU, with 44% of the sample reporting a lifetime history of a TBI. Among those who had a lifetime history of traumatic brain injury, almost half reported being under the influence of alcohol at the time of injury, a fifth had been under the influence of illicit drugs and three-quarters reported that they had experienced neuropsychological sequelae following the injury.
Body image
Fourteen percent of REU reported that they had used illicit psycho-stimulants at some stage in their life to help them lose or maintain weight. The most commonly used drugs for this purpose were ecstasy and methamphetamine. Participants who had ever used illicit psycho-stimulants to help control their weight were significantly more likely to be female and were also more likely to be worried about gaining weight should they cease their psycho-stimulant use.
Drug policy attitudes
In 2012, participants were asked a number of questions regarding their attitudes towards a range of different policy initiatives. In regards to policies that are designed to reduce the problems associated with heroin, it was found that REU were most supportive of needle and syringe programs, methadone/buprenorphine maintenance programs and regulated injecting rooms. In addition, the majority of the sample supported legalisation of cannabis, and over a third supported the legalisation of ecstasy. Forty-two percent of REU supported increased penalties for the sale or supply of heroin, and approximately one-third supported increased penalties for the sale or supply of methamphetamine.
Ecstasy dependence
Over one-third of the sample (37%) obtained a score of zero on the ecstasy Severity of Dependence Scale (SDS), and 14% obtained a score of 1 on the scale. This indicates that half of the sample reported no or few symptoms of dependence in relation to ecstasy use.
Conclusions
The results reported here describe trends in the use of ERD in 2012 in Adelaide, South Australia, and provide comparisons with the findings of the 2011 study. Many characteristics of ERD in the current study were comparable to previous years and remained stable. The notable changes in 2012 centred on the re-emergence of the ecstasy market. More specifically, there were significant increases in the reported availability and purity of ecstasy; these reports were supported by the ACC data which found that the median purity of phenethylamines seizures almost doubled in the 2010/11 financial year. Perhaps in response to the recovery of the ecstasy market, there were significant decreases in the recent use of methamphetamine, nitrous oxide, OTC codeine and stimulants, 2CI, 2CB, 2CE and DOI.
However, despite the decreases noted above, the use of emerging psychoactive substances remained common, with over a third of REU reporting that they had used some form of EPS in the six months preceding interview. In addition, alcohol appears to be gaining popularity among REU; for the first time in the history of the SA EDRS it was nominated as the primary drug of choice, and its use remains highly prevalent.
Behaviours such as inconsistent condom use, driving under the influence of alcohol and other drugs, criminal activity, bingeing and overdose remained stable in 2012, and continue to carry serious public health concerns.
Implications
The findings from the 2012 SA EDRS have policy and research implications, and several recommendations are outlined below. It is worth noting that several of these issues may have already received attention and/or may be in the process of further investigation.
- The apparent re-emergence of the ecstasy market, and in particular the increase in purity, raises concerns regarding the potential to overdose. As such, it is essential that harm reduction messages − such as only taking one pill (or less) to start with − be promoted among REU.
- Continued use by REU of multiple drugs in combination, and binge use of drugs, warrants continued education regarding the harms associated with such behaviour, and continued promotion of harm reduction strategies.
- The majority of REU reported that they had overdosed on either a stimulant or depressant drug in the 12 months preceding interview. This is a serious public health concern, and it is essential that education and harm reduction be developed to address this issue.
- The use of emerging psychoactive substances remains popular among REU, and as such it is important that we continue to monitor this market and assess the harms associated with these drugs. If the ecstasy market continues its recovery, it will be interesting to observe whether this signals a shift away from the EPS market.
- Given the prevalence of supply of ecstasy to friends among REU, there is a need for education strategies to better inform this group of the illegality of their behaviour and the consequences of such behaviour. This is highlighted by the lack of knowledge participants had about the laws surrounding the trafficable quantities of MDMA.
- Increased promotion of ‘safe sex’ practices is needed within this population of illicit drug users, especially regarding casual sexual experiences.
- Given the prevalence of drink and drug driving among REU, and the introduction of roadside drug testing in SA, there is a need for development and implementation of education and harm-reduction programs, targeted at young people, addressing the harms associated with such behaviour and the effects of different drug types upon driving ability.
- Considering the prevalence of alcohol-related harm among REU, and daily alcohol consumption by some REU, specific harm reduction information is needed to target this group. Key experts also noted that binge drinking and pre-loading were problems that need to be addressed. The high prevalence of tobacco use among REU continues to be an issue of grave concern.
- Considering the substantial prevalence of mental health issues, development and implementation of strategies is needed to address issues associated with drug misuse and dependence.