NDARC Technical Report No. 255 (2006)
EXECUTIVE SUMMARY
This report presents the results of the PDI, a study undertaken to monitor ecstasy and related drug markets in South Australia. 2005 was the sixth year in which regular ecstasy users in Adelaide have been surveyed, and comparisons with previous years have been drawn where possible. Trends in the demographic characteristics and patterns of drug use among regular ecstasy users, the prevalence of risk-taking and harms related to drug use, as well as the level of criminal involvement among this group, are presented. Also presented are details on current price, purity and availability of ecstasy and related drugs in Adelaide, and the trends in these drug markets.
Demographic characteristics of regular ecstasy users (REU)
Similar to previous years, the majority of REU were male, and, on average, aged in their early 20s. They were also generally either employed or full-time students with less than a fifth of the sample unemployed. Most REU were well educated and over half had completed some kind of post-school qualification. Very few had a history of imprisonment or were currently undergoing treatment for drug use. Key expert (KE) reports of the demographics of ecstasy users were generally consistent with the 2005 REU sample.
Patterns of drug use among REU
Regular ecstasy users have been consistently described as polydrug users and the PDI samples continue to verify this. In 2005, as in previous years, most of the sample reported recent use of some form of methamphetamine (at levels equivalent to ecstasy use), as well as cannabis, alcohol and tobacco. Other substances reported as recently used by substantial proportions of REU were nitrous oxide, LSD and cocaine, though use of these and other drugs was at a much lower frequency. Compared to 2004, there was an increase in the proportion of REU reporting recent use of tobacco, base methamphetamine, cocaine and LSD, and a decrease in the proportions of REU reporting recent use of ketamine and benzodiazepines.
The trend in increasing binge behaviour continued in 2005 with 58% reporting having binged at least once in the preceding six months. Increases in binge use of ecstasy, base methamphetamine, cocaine, cannabis and alcohol were seen, compared to 2004.
The majority of REU report use of any drug primarily by swallowing or snorting. However, 10% of REU in 2005 reported recent injecting, most commonly some form of methamphetamine. No clear long-term trend in prevalence of injecting among REU was discernible. In reference to route of ecstasy administration, KE comments indicated that injecting was uncommon among this group of drug users. Also noted in 2005 was an increase in the prevalence of smoking of crystal methamphetamine.
Ecstasy
Over the last five years there has been little change in parameters of ecstasy use, with the reported age of first use, frequency of use, average or most amount used in a typical session all remaining relatively stable across this period. There has, however, been a gradual increase in the proportion using more than one tablet in a typical session, to the point that in 2005 this was reported by the majority of the sample (73%) compared to less than half the sample in 2000 (44%). In addition, a large proportion of the sample has consistently reported binge use of ecstasy across this time, with over half the sample having done so in 2005. REU mainly use ecstasy by swallowing, with substantial proportions also reporting recent use by snorting. Ecstasy continued to be used most commonly at nightclubs, friends' homes, raves/doofs/dance parties, private parties or at their own homes.
Most REU report typically using at least one other drug either with ecstasy or at comedown - with tobacco, alcohol, cannabis and some form of methamphetamine most common. There was a decrease in the proportion of REU reporting typically using LSD with ecstasy, and increases in the proportion of REU reporting use of alcohol, tobacco and cannabis at comedown.
The reported price of ecstasy was stable (at $30/tablet), availability continued to be considered easy or very easy by REU, and most reported usually obtaining their ecstasy from a friend. Almost three-quarters (74%) of REU were able to obtain drugs other than ecstasy from their main ecstasy dealer, the most common being some form of methamphetamine, cannabis, LSD and cocaine. The majority of REU believed that the purity of ecstasy was either medium or fluctuating in 2005, similar to previous years. The ACC reports that the median purity of SAPOL seizures of phenethylamines in 2004/05 was 29%, the same as that reported in 2003/04.
The majority of REU reported paying for ecstasy through paid employment or receiving ecstasy as a gift from a friend. Ecstasy was generally purchased for both self and others, and purchased from a median of four people in the last 6 months. Knowing the supplier, the supplier being close to the source, and purchasing larger quantities, were the most commonly reported factors believed to lead to a decrease in the price of ecstasy, whereas buying the drug at a public venue and a decrease in the availability of ecstasy were factors perceived to increase the price of ecstasy. Negative effects on mental health, physical health, work/study and relationships, as well as decreased access to ecstasy, were the main factors that would reportedly lead to a decrease in ecstasy use among REU.
The most commonly perceived benefits of ecstasy use among REU were enhanced communication and sociability, enhanced closeness and empathy toward others, that it added more fun or enjoyment to an occasion, and enhanced mood. The most commonly perceived risks associated with taking ecstasy were some kind of physical, psychological or neuropsychological harm, or risk associated with the unknown content of ecstasy pills.
Methamphetamine
In 2005, more REU reported recent use of base methamphetamine (82%), but recent use of powder (66%) and crystal (41%) forms of methamphetamine remained stable, compared to 2004. The frequency of recent methamphetamine use was somewhat different for the three forms of methamphetamine (a median of 8 days for powder, 12 days for base and 6 days for crystal). This level of use was unchanged for powder and crystal, but frequency of base use doubled compared to 2004. Despite no change in the prevalence or frequency of recent crystal (or 'ice') use, an increase in the percentage of REU reporting recent use of crystal by smoking was noted (from 14% in 2004 to 27% in 2005). There was some support of increased smoking of crystal among REU from KE reports, including reports that glass pipes (for smoking) were more frequently seen by police.
There has been little change in price ($20 - $25/point or $200/gram for base and crystal), purity (medium to high for base and crystal), or availability (easy) of all forms of methamphetamine since 2004. However, ACC data indicate that the median purity of methamphetamine seized by SAPOL in SA for 2004/05 had decreased (to 11.6%) compared to the previous year, and the lowest seen in the past four years. SAPOL data on clandestine laboratory detections suggest that local manufacture of methamphetamine was still a contributor to the SA methamphetamine market.
Cocaine
There was an increase in the proportion of REU reporting recent use of cocaine in 2005 (up to 49%, compared to 26% in 2004), though no change in the frequency of cocaine use, which remains low among those that had used recently.
Though the number of REU able to comment on these parameters was small, reports indicated that cocaine price was stable (at $250/gram), and the perception was that purity had increased (medium or high), and availability had increased (though equal proportions reported it was easy or difficult to obtain), compared to 2004. Data from the ACC show an increase in the number of cocaine seizures by SAPOL in 2004/05, while the median purity was relatively stable at 31%. As in previous years, KE suggested that the cocaine market in Adelaide was mostly restricted to a small subset of users.
Ketamine
Almost one-quarter of REU reported recent use of ketamine in 2005, though frequency of use remained low. The prevalence of recent use of ketamine among REU had decreased, following a steady increase in use from 2001 to 2004. The most commonly reported locations of both usual and last use of ketamine was a friend's or their own home. KE comments suggest use of ketamine is either accidental (in ecstasy pills) or restricted to a subset of users, and supports REU reports of use at private venues. Though the number of REU able to comment on these parameters was very small, reports indicated that the current estimated price of ketamine was stable at $200/gram, and it was considered to be of good quality, though difficult to obtain.
GHB
Almost a fifth of REU reported recent use of GHB, a small increase compared to the last two years. The frequency of recent use was low, consistent with previous years.
Price, purity and availability data for GHB in 2004 were based on a very small sample of REU and are therefore of limited value. Data suggest that the price of GHB was stable and that it remained more difficult to obtain GHB in general compared to earlier years (2001 and 2002).
KE information suggested that GHB use was not common among REU generally, but evidence of harm associated with its use was evident in emergency department attendances.
LSD
Approximately half of the REU sample reported recent use of LSD, and prevalence of recent use increased slightly over the last two years. Frequency of use of LSD remains consistently low. KE reports suggest that LSD use was not common among REU, and used only occasionally among those that did use.
The price of LSD was stable (at $10 per tab) and low, perceived purity had increased, and availability remained stable and generally easy, compared to 2004.
MDA
Nine percent of REU reported recent use of MDA in 2005. The proportion of REU reporting recent use of MDA was decreased compared to previous years, but the frequency of use was relatively stable and has remained consistently low across the five years of the PDI survey. KE information suggests that MDA was not commonly used by REU, except as a (suspected) constituent of pills sold as ecstasy.
Price, purity and availability data for MDA in 2005 were based on a very small sample of REU and are therefore of limited value. Data suggest that the price and purity of MDA was stable, and that it remained more difficult to obtain MDA compared to earlier years (2001 and 2002).
Other drugs
As in previous years, the majority of the REU sample reported recent use of alcohol, tobacco and cannabis, and, although the frequency of use of both these drugs has fluctuated somewhat across the years, it has remained relatively high. KE information also suggests that use of these substances was common, but that frequency of use varied widely. Substantial proportions of the samples have also consistently reported recent use of benzodiazepines, though frequency of use was generally low. KE reports suggest that use of benzodiazepines was limited among REU, and was generally low level use associated with getting sleep after being up for long periods, or to help with comedown from drug use. Anti-depressants were recently used by a small proportion of REU, and KE reports suggest use was primarily as prescribed among this group. Use of inhalants has also remained fairly stable across the years, with almost half the REU sample in 2005 reporting recent use of nitrous oxide, and almost one-tenth reporting use of amyl nitrate, with frequency of use of both substances remaining consistently low. Approximately a quarter of REU reported recent use of some type of pharmaceutical stimulant (eg. dexamphetamine), and 14% reported recent use of magic mushrooms, both at low frequency.
Drug information-seeking behaviour
Data from new questions included in 2005 confirm that REU are aware of the variability of drug purity in general, and purity and content of ecstasy pills in particular. Approximately a third of the REU sample reported that they always found out about the purity or content of ecstasy or other drugs before taking them, the majority relying on information from friends that had experience with use of the drug concerned. However, a quarter reported that they used reagent-based testing kits to find out the content of ecstasy pills, with over a third of these unaware of any limitations regarding use of such kits, and a quarter stating they would still take the pill if no reaction occurred on testing (meaning the content was not fully elucidated). Further, although REU reported that it was not uncommon for a drug to have a different content to what was expected, over a quarter of REU stated they didn't care what a pill contained, as long as they had a good time.
Risk behaviour
Injecting
Ten REU reported recently injecting any drug in 2005, most commonly some form of methamphetamine (particularly base) or ecstasy. With regard to longer-term trends, there was no evidence of an increase in the prevalence of recent injecting among REU across the years. Injecting drug use was considered generally rare, and still taboo, among this illicit drug-using group, and more likely to occur among primarily methamphetamine users, rather than primarily ecstasy users.
As was seen last year, in 2005 there was little reported sharing of needles, or sharing of other injecting equipment among recent injectors, and most reported usually injecting themselves, in the company of close friends, in private homes.
Blood-borne viral infections
At the time of interview, 44 REU stated that they had completed a hepatitis B virus (HBV) vaccination schedule, mostly unrelated to susceptibility due to any risk factor. Approximately a quarter of the REU sample reported that they had been tested for either hepatitis C virus (HCV) infection or for human immunodeficiency virus (HIV) infection, with almost all in both cases reporting that their status was negative.
Sexual risk behaviour
Evidence of risky sexual behaviour was again apparent among the REU sample in 2005. Of the REU that reported having had penetrative sex with a casual partner in the last six months, 43% reported that they had not always use a condom. In addition, 83% of those who reported having had penetrative sex recently, reported having done so whilst under the influence of a drug or drugs - most commonly ecstasy, followed by alcohol, cannabis or some form of methamphetamine - and, of those, 42% reported that they had not always used a condom. In this context, almost half the REU sample reported they had never undergone a sexual health check-up.
Driving risk behaviour
Half of the REU that had driven a vehicle recently reported that they had driven over the limit for alcohol, a median 3.5 times in the last six months. Further, 81% of recent drivers reported having driven within an hour of use of any illicit drug, most commonly ecstasy, methamphetamine and cannabis.
Ecstasy and related drug harms
Health
In 2005, 13% of recent methamphetamine users were found to fit the criteria of clinically significant dependence, according to the Severity of Dependence Scale. Six percent of REU were also found to fit the criteria of dependence for ecstasy, using the validated amphetamine cut-off score. Substantially more users of each drug reported one or more symptoms of problematic drug use.
Twelve REU reported that they had ever overdosed on a 'party drug', most commonly involving GHB and ecstasy. Only two REU reported recent experience of overdose: the main drugs believed responsible were GHB and nitrous oxide, respectively, though multiple drugs were involved in each case. Indicator data from the RAH Emergency Department show the number of GHB-related attendances increased in 2004/05, following two years of stability.
The proportion of clients attending DASSA treatment services with ecstasy as the primary drug of concern has been stable for the last two years, and relatively low compared to other illicit drugs (less than 1% of total clients). The proportion of clients nominating amphetamines as the primary drug of concern has remained relatively stable over the last three years, and was 20% in 2004/05. As such, amphetamines were the second most commonly nominated primary drug of concern by clients of DASSA, after alcohol (48%), and dominated as the most common illicit drug of concern.
As in previous years, over two-thirds of the REU sample reported having experienced one or more problems related to their drug use in 2005; the majority of which related to some aspect of their social life or relationships, followed by work or study problems, and financial problems. Use of ecstasy or some form of methamphetamine was most commonly held responsible, at least in part, for these problems.
Criminal activity and perception of police activity
In 2005, 27% of REU reported involvement in some type of crime, and 8 REU reported having been arrested in the last 12 months, similar to the previous year. Drug dealing was the most commonly reported crime across all years of the survey. A fifth of REU reported that they 'paid' for ecstasy by dealing drugs for a 'cash profit', and over a quarter (28%) reported that they did so by dealing for an 'ecstasy profit'. In 2005, no REU reported using any other illegal method of paying for ecstasy in the six months prior to interview.
As has been consistent across the last four years, the majority of REU reported that their ability to obtain drugs had not become more difficult due to police activity in 2005. The majority of REU believed that police activity had been stable recently.
Implications
The findings from the 2005 SA PDI 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.
- Continued use of multiple drugs in combination, and binge use of drugs, by REU warrants continued education regarding the harms associated with such behaviour, and continued promotion of harm reduction strategies.
- Given the high level of use of methamphetamine, a drug of dependence, among REU development and dissemination of education and harm reduction strategies, regarding the harms associated with use of methamphetamine, need to be directed at young people.
- Continued close monitoring is required of indicators of use, including use by smoking, of crystal methamphetamine ('ice'), which is known to have very high purity and subsequently increased risk of harm associated with its use.
- Continued focus is required on reducing supply of ecstasy and amphetamines, including from local clandestine laboratory manufacture.
- Continued close monitoring is required of the prevalence of injecting among REU, and development and implementation of strategies to reduce harms associated with injecting among this group of illicit drug users.
- Increased promotion of 'safe sex' practices is needed within this population of illicit drug users.
- Given the prevalence of drink and drug driving among REU, and the imminent introduction of roadside drug testing in SA, development and implementation of education and harm-reduction programs directed at young people, regarding the harms associated with such behaviour is needed.
Citation: Weekley, J., Simmonds, L. et al (2006) South Australian Trends in Ecstasy and Related Drug Markets 2005: Findings from the Party Drugs Initiative (PDI). Sydney: National Drug and Alcohol Research Centre.