NDARC Technical Report No. 176 (2004)
EXECUTIVE SUMMARY
Demographic characteristics of injecting drug users (IDU)
One hundred and twenty IDU participated in the 2003 IDRS. The median age of the sample was 34 (range 16 to 54 years) and 53% of participants were male. Over two-thirds (68%) of the sample was unemployed and a third (33%) had a history of previous imprisonment. The median number of years spent at school was 10 (range 3 to 12 years). Over half the sample (53%) reported having no tertiary qualifications. Compared to 2002, in 2003 there were more females in the sample, fewer who identified as Aboriginal or Torres Strait Islander or with a history of imprisonment, and slightly more who were in some form of treatment for drug use at the time of interview.
Patterns of drug use among IDU
The drug most commonly first injected by the sample was amphetamine (61%), followed by heroin (30%). Compared to 2002, in 2003 there was a shift from methamphetamine to heroin as the most preferred drug among the IDU sample. However, methamphetamine remained the drug most injected by the IDU in 2003.
Frequency of injecting in the last month was at least greater than weekly for 87% of the sample, with nearly half injecting at least once a day (47%). Reported frequency of injecting in the last month increased overall from 2002 to 2003, in particular there was an increased proportion of IDU injecting at least once a day, from 33% to 47%, in 2003.
Polydrug use was common among the IDU in 2003 and has remained consistently so across the years, with no real differences being reported from 2002 to 2003. There was substantial crossover between heroin users and methamphetamine users in the 2003 IDU sample. Thirty-eight IDU (32%) had used both heroin and some form of methamphetamine, and 58 IDU (48%) had used both opioids and some form of methamphetamine, in the last six months.
Heroin
The median price most recently paid for a gram of heroin was $425, a decrease from 2002 when the median last purchase price was $450/gram. Of those IDU who were confident to report on the current price of heroin (n=68), over two-thirds (71%) reported the price as stable. Overall, there was a trend toward a decrease in the median price for a gram of heroin from 2002 to 2003, but not as great as to reach the pre-shortage price reported in 2000.
The majority of the IDU reported it was either easy or very easy to obtain heroin and that availability was stable or had become easier in the last six months, these results are slightly lower than those reported in 2002. KIS comments on price and availability of heroin were consistent with IDU.
In 2003, the purity of heroin was largely reported as low to medium and that this had remained stable or was increasing over the last six months. There appears to be a trend toward an increase in purity of heroin reported by IDU in 2003, some support for this belief was obtained from recent key indicator data provided by SAPOL.
An increase in the proportion of IDU that had recently used heroin was noted, with a significant rise in the median number of days used to pre-shortage levels. This increase in median days used was primarily due to an increase in the proportion of IDU reporting daily use in 2003.
An increase was apparent in the proportion of clients presenting to DASC treatment services nominating any type of opioid substance (including heroin) as their primary drug of concern, representing a higher proportion than those nominating amphetamines as their primary drug of concern.
Methamphetamine
There has been a clear increase in the price of a point of either base or crystal, and grams of powder, methamphetamine since 2002. Both a point of crystal and a gram of powdered methamphetamine have doubled in price in this time. The majority of IDU able to comment reported that price was stable. KIS largely agreed with IDU regarding price and stability.
Powdered methamphetamine was reported as easier to obtain than the other two forms, although all three were still reported as easy or very easy to obtain and that availability was stable in the previous six months. With respect to the location where IDU obtain methamphetamine there has been a decrease in reports of IDU obtaining powder and base methamphetamine from dealers homes and a concomitant rise in the use of mobile dealers.
Overall the purity of all three forms was reported to be stable to decreasing by IDU. KIS recorded little agreement in the trends of methamphetamine purity in the preceding six months, but did agree with IDU reports that methamphetamine was very easy to obtain.
There has been a decrease in the proportion of IDU reporting recent use of base and crystal methamphetamine in the 2003 sample. However, there was a small rise in the median number of days IDU reported using powder and base methamphetamine since 2002 and an overall rise in the proportion of IDU that had used some form of methamphetamine daily in the previous six months.
SAPOL data revealed a decrease in the number of methamphetamine related offences particularly in regard to possession/use offences. This corresponds to law enforcement KIS reports of an increasing focus on supply level crime and, according to at least one other law enforcement KIS, the introduction of police diversion programs.
Presentations to DASC treatment services with methamphetamine as the primary drug of concern continued to increase, while inpatient admissions for methamphetamine declined during the same period. The inpatient figures for methamphetamine, however, are still twice as large as those reported for heroin across the same time frame.
Cocaine
The small number of KIS and IDU either using cocaine or able to provide information on price, purity and availability on cocaine in itself indicates the lack of a sizeable and visible cocaine market in Adelaide.
Not enough data was available to make any definitive comments with respect to trends associated with the key indicators.
Cannabis
The median price paid for a ‘bag’ of cannabis (bush or hydro) was $25 and this price has remained unchanged since 1997. The majority of IDU reported that the price of cannabis had remained stable in the past six months but compared to 2002 there was a slight rise in the proportion of participants reporting that the price was fluctuating.
Ease of availability, though still considered ‘easy’ or ‘very easy’ by over 80% of IDU, had decreased since 2002 with fewer reporting that cannabis is very easy to obtain. KIS reports suggest that there had been no dramatic changes in availability of cannabis, apart from some minor fluctuations at the beginning of the year.
The majority of IDU reported that the current strength of cannabis was high, but there has been a noticeable shift in reported purity from high to medium compared to 2002. The majority of IDU in the 2003 sample however, reported that strength had remained stable in the past six months.
A slight decrease in the number of possession/use offences related to cannabis was noted in SAPOL indicator data but again, no dramatic changes were noted.
The number of calls to ADIS concerning cannabis remained stable.
Other opioids
Morphine
The reported last purchase price for morphine was a median of $30/100mg (n=27). One hundred milligrams (in tablet form) was the most commonly purchased amount and Kapanol® was the most commonly purchased brand of morphine, in the six months prior to interview. The price was reported to be stable to increasing by IDU.
The majority of IDU reported morphine as generally easy or very easy to obtain, and that availability was stable (54%). Most IDU stated that they usually obtained morphine from a friend (48%), from a dealer’s home (32%), or from a mobile dealer (13%).
Forty-three percent of IDU reported they had used morphine in the last six months a median 50 days. Although the proportion of the sample reporting recent use of morphine remains stable compared to 2002, there has been a dramatic increase in the median number of use days from 2002 to 2003 (12 v 50). All but one of the IDU that had used morphine reported having done so by injecting. More than half those IDU reporting morphine use in the last 6 months had nominated heroin as their drug of choice.
The majority of recent morphine users reported that the main form of use during the last six months was illicit and that the main brand of morphine they had used in that time was Kapanol® (by 65%), followed by MS Contin® (by 12%).
Methadone
The reported last purchase price of methadone was a median $1/ml of syrup (n=5). More IDU were able to provide information on the last purchase price of physeptone tablets, reporting a median price of $10/10mg tablet (n=15). The majority of IDU reported methadone as generally easy or very easy to obtain, with two thirds of reporting that availability was stable.
Twenty-two (18%) IDU reported having used methadone syrup illicitly a median of 5 days and 27 (23%) IDU reported having used physeptone tablets illicitly a median of 4 days in the last six months. No IDU reported daily use of illicit methadone syrup or physeptone tablets on a daily basis.
There was a small increase in the proportion of IDU reporting use of syrup illicitly since 2001, and substantial increase in the proportion of IDU reporting illicit use of physeptone tablets compared to both 2001 and 2002 (from 11% and 6%, respectively, to 23% in 2003).
In 2003 roughly equal proportions of the IDU reported mainly using methadone licitly (53%) and illicitly (47%) in the last six months. In 2003, ten IDU stated that they were currently on a methadone maintenance treatment program and had been for the preceding six months. Of these, nine also reported use of either illicit methadone syrup (n=5) or physeptone tablets (n=4) during the six months prior to interview.
Buprenorphine
Twelve (10%) of participating IDU reported having used buprenorphine illicitly a median of 4 days in the last six months. No IDU reported use of illicit buprenorphine on a daily basis. There has been an increase in the illicit use of buprenorphine among IDU since last year, both in terms of the proportion of the IDU that reported recent use (from 5% to 10%) and in the proportion reporting having injected illicit buprenorphine recently (from 3% to 9%).
The majority of those IDU reporting use of any buprenorphine did so licitly.
In 2003, of the five IDU that stated they were currently on a buprenorphine maintenance treatment program, and had been for the preceding six months, none reported concurrent use of illicit buprenorphine in that time.
Other drugs
There were no reported changes in the patterns of use of ecstasy and hallucinogens among the IDU, though methamphetamine users were more likely to also report use of these drugs compared to heroin users.
Parameters of benzodiazepine use in the 2003 sample also remained largely unchanged with over 50% of IDU reporting recent use. A small increase in the median number of days used and the proportion reporting daily use was reported compared to 2002.
Anti-depressant use was also stable.
Associated harms
A decrease in the number of unspecified Hep B and C cases Nationally and locally since 2001 was observed in the general population, along with a decline in the proportion of HCV positive cases among IDU (NSP).
Sharing of needles and equipment has remained at similar levels compared to 2002. Over a quarter of all IDU still report unsafe practices through the sharing of injecting equipment. Injecting related health issues were still present with sizable proportions experiencing scarring, bruising and difficulty with injecting.
For the first time the IDRS distinguished large proportions of methadone and morphine injectors reported injecting problems.
An analysis of expenditure on drugs demonstrated that heroin users had spent twice as much on drugs in the day prior to interview than methamphetamine users.
There were no substantial changes from previous years regarding mental health issues other than an increase in IDU attendance of a health professional for anxiety and panic and a concomitant increase in comments from health related KIS on the increase in anxiety and panic problems.
The most commonly reported crimes committed by IDU were drug dealing and property crime. IDU reported stable police activity in the six months leading up to the survey and the majority of IDU believed that police activity had not made it more difficult to obtain drugs. KIS reports continued to highlight the increase in violent crimes associated with methamphetamine use.
Implications
The results of the 2003 SA IDRS survey have highlighted a number of similarities and differences in the IDU population compared to previous years. The effects of the heroin shortage are still being felt in some areas and it appears as if the landscape may have evolved in substantial ways . Whether these changes emerge as permanent markers of the injecting drug user population within South Australia remain to be seen.
The following areas were highlighted as issues requiring further investigation; explorations of the dynamic nature of current injecting drug use, examination of treatment options for methamphetamine users and training for health professionals, investigations of barriers among IDU to use of safe injecting practices, and the impact of legislative change on cannabis use and availability in South Australia.
Citation: Weekley, J., Pointer, S. & Ali, R. (2004) South Australian Drug Trends 2003: Findings from the Illicit Drug Reporting System (IDRS), Sydney: National Drug and Alcohol Research Centre.