NDARC Technical Report No. 225 (2005)
The Party Drug Initiative (PDI) is a companion project to the Illicit Drug Reporting System (IDRS), designed specifically to examine trends in use, price, purity and availability of ecstasy and related drugs across Australia. For the purpose of this study, the group of drugs under consideration, sometimes termed 'party drugs', includes drugs that are routinely used in the context of entertainment venues such as nightclubs or dance parties / events. These drugs may include ecstasy, methamphetamine, cocaine, LSD, ketamine, MDA (3,4-methylenedioxyamphetamine) and GHB (gammahydroxybutyrate).
In 2000, the National Drug Law Enforcement Research Fund (NDLERF) funded a two year, two state trial of the feasibility of monitoring emerging trends in the markets for ecstasy and related drugs. This used the IDRS methodology of triangulation of information from standardised interviews with people who regularly consume such drugs, a qualitative survey of individuals who have regular first-hand contact with such groups of people, and an examination of existing available data sources or indicators relevant to drug use in each state. Following successful utilisation of this methodology to gather information about trends in use, price, purity, and availability of party drugs, the NDLERF funded a two-year expansion of the project into each Australian jurisdiction. This report represents the second year that this study has been employed in Tasmania.
Demographic characteristics of regular ecstasy users (REU)
The one hundred regular ecstasy users interviewed in the present study were typically young, with ages ranging from 18 to 32 years and the majority in their early to mid twenties. Participants were generally well educated and either employed on a fulltime or part time/casual basis or currently engaged in full time study. Few participants were currently in drug treatment or had come into contact with the criminal justice system.
Patterns of drug use among REU
While the participants were selected on the basis of ecstasy use and over half nominated ecstasy as their drug of choice, polydrug use was the norm among the regular ecstasy users interviewed. Participants had use a median of eight drug types (from the investigation of 19 drug types) at some stage of their lives and a median of six drug types in the six months preceding the interview. Participants typically reported recent use of alcohol, cannabis, tobacco, and methamphetamine powder, over one third of participants had recently used LSD, psychedelic mushrooms and nitrous oxide.
Participants had first started to use ecstasy on a regular basis at 20 years and three quarters had been using ecstasy for two years or more. Ecstasy was typically taken orally, though snorting was also a common route of administration. There was a wide variation in the frequency of ecstasy use among the sample ranging from monthly to several times a week. One quarter had used ecstasy weekly or more frequently, and over one third had used either fortnightly but less than weekly. Two thirds typically used more than one tablet per session and one third used four or more tablets in a typical session of use. Males tended to use larger amounts of ecstasy in a typical session in comparison to females. In comparison to the 2003 sample, frequency of use was slightly lower but the number of tablets used in a typical session and the proportion using more than one tablet in a typical session was higher. One third had recently 'binged' on ecstasy, using the drug continuously for 48 hours or more without sleep. Whereas the long term effects and risks of extended ecstasy use are largely unknown, evidence from toxicology studies in rats and neuropsychological studies in humans indicate that the safest pattern of use is to use the drug infrequently and in small amounts. Thus, those using the drug frequently or in large amounts for extended periods of time may be at a greater risk for neurological and neuropsychological harm.
Ecstasy was typically consumed in combination with other drugs. Alcohol, cannabis, and tobacco were commonly used in a typical session of ecstasy use and one quarter typically used methamphetamine powder when under the influence of ecstasy. Over two thirds of the sample typically consumed more than five standard drinks in combination with ecstasy, compared to less than half in 2003. Similarly, one third had typically consumed more than five standard drinks when coming down from ecstasy compared to one in five among the 2003 sample. This is noteworthy due to the increased risk of dehydration when alcohol is combined with ecstasy and the fact that larger quantities of alcohol can be consumed when under the influence of psychostimulants without experiencing immediate effects of intoxication. Though the harms associated with such use may still occur.
The reported median price for one tablet of ecstasy decreased from $50 in the 2003 study to $40 in the current study. Consumers considered this price to have remained stable, but key experts indicated a recent decrease in price. Participants typically paid for ecstasy through money earned through employment and ecstasy was typically purchased from friends or people selling for ecstasy profit (offsetting the cost of their own use of the drug). Ecstasy was considered to be very easy to obtain by both regular ecstasy users and key experts and availability had recently been either stable or had increased. Ecstasy was reported to be either high or fluctuating in purity and there were some indications that the purity of ecstasy had recently increased. There was a marked increase in the number of ecstasy tablets seized in 2003/04 in relation to previous years (over 1000 tablets compared to less than 100 in the previous year). This increase was also associated with a greater number of seizures, but largely related to two large seizures of the drug.
Few participants had recently accessed any health service in relation to ecstasy which is consistent with the small percentage of calls made to the Tasmanian Alcohol and Drug Information Service (ADIS) in relation to ecstasy over the last four years. Only four participants indicated that they had recently accessed a health service in relation to ecstasy use and few noted that they had overdosed (passed out/fallen into a coma) on ecstasy in the six months preceding the interview. Although the majority of participants did not experience significant symptoms of dependence in relation to their ecstasy use, one in ten, and a greater proportion of younger participants, experienced some symptoms of dependence toward the drug when assessed by the Severity of Dependence Scale. Whereas this scale does not have demonstrated reliability and validity in relation to ecstasy, these findings suggest that future research in the area of ecstasy dependence/addiction may be warranted.
Whereas the majority of participants reported experiencing few problems in relation to their ecstasy use, one third had recently experienced work/study or financial problems and one fifth had recently experienced social/relationship problems that were attributable, at least in part, to ecstasy use. Consistent with low levels of self reported criminal activity among the sample, few participants had experienced legal problems of any sort. The majority of drug-related problems experienced by regular ecstasy users were relatively minor, but a small proportion experienced more serious problems such as having no money to pay for essentials such as food and rent and the ending of relationships. Females were more likely to report recent work/study problems in relation to ecstasy use. Social/relationship problems were generally associated with a greater frequency of drug use, binge drug use, and recent use of other drugs such as methamphetamine powder, crystal methamphetamine, cocaine, and ketamine.
Almost half of the participants had recently driven soon after (within an hour) of using ecstasy in the six months preceding the interview. Those that had driven under the influence of ecstasy had been using ecstasy for longer and had used the drug more frequently and in greater amounts compared to those that hadn't driven under the influence of ecstasy. They had also experimented with a greater number of drugs and were more likely to have recently used methamphetamine powder and to typically use methamphetamine powder when under the influence of ecstasy.
It would seem that there are clear indications of an expanding ecstasy market, the price of ecstasy has decreased and availability and purity of the drug have increased in comparison to the findings of the 2003 study, and Tasmania Police seizures of the drug have increased. There are also anecdotal reports of a broadening demographic of people consuming the drug locally including the use of ecstasy by younger people as well as an increase in the social acceptability of the drug. Ecstasy appears to have become enmeshed in drinking culture and is more likely to be used in combination with binge alcohol drinking. Whereas little harm was experienced in relation to ecstasy use among the current sample, with low reports of overdose, help seeking behaviour, symptoms of dependence and generally only minor work/study, financial, and social/relationship problems, small proportions of participants had experienced more serious harms and larger proportions had engaged in potentially risky behaviour such as polydrug use, binge drug use and driving under the influence.
Use of methamphetamine was common among the group of regular ecstasy users sampled in the present study. A large majority had ever used some form of methamphetamine and three quarters had used some form of methamphetamine in the preceding six months. The median frequency of methamphetamine use was six days in the preceding six months or approximately monthly. Two thirds had recently used methamphetamine powder, one fifth had recently used methamphetamine base, and less than one fifth had recently used crystal methamphetamine. Methamphetamine powder and base were typically taken orally and crystal methamphetamine was typically smoked. There was a substantially lower level of lifetime and recent use of crystal methamphetamine in comparison to the 2003 sample. Participants typically used small amounts of methamphetamine (0.1 of a gram) on a typical occasion of use and frequency of use for each form was less than once monthly.
Less respondents were able to confidently comment on the price, purity and availability of methamphetamine base and crystal methamphetamine in comparison to methamphetamine powder. The price for one point of methamphetamine powder was $40 which is less in comparison to the price of $50 reported by the 2003 sample. The median price for one point of methamphetamine base and crystal methamphetamine was $50, and prices had remained stable during the six months preceding the interview. The purity of methamphetamine powder was considered to be medium to high and the purity of methamphetamine base and crystal methamphetamine was considered to be high. The purity of these forms was thought to have been either stable or fluctuating in the preceding six months. Methamphetamine powder was reported to be easy or very easy to obtain, and methamphetamine base and crystal methamphetamine were reported to be more difficult to obtain respectively. Whereas the availability of these forms was considered to be stable in the preceding six months, there are indications that the availability and use of crystal methamphetamine has decreased markedly in the last year.
One third of participants had ever used cocaine and one tenth had used cocaine during the six months preceding the interview, which is similar to the proportion that had used the drug among the 2003 sample. A greater proportion of males had ever used cocaine in comparison to females. Cocaine had been used relatively infrequently with a median frequency of two days in the preceding six months. Cocaine was typically snorted and a median of 0.1 to 0.5 grams used in a typical session. The price for a gram of cocaine ranged from $200 to $400 and this price had remained stable during the last six months. Reports on the purity of cocaine were varied and both regular ecstasy users and key experts considered the availability of cocaine to be low in Tasmania which is consistent with the situation reported in 2003.
Less than one fifth of the regular ecstasy users reported lifetime use of ketamine and only one in twenty had recently used ketamine. Ketamine was used on an average of two occasions in the preceding six months in relatively small amounts, indicating predominately experimental use by a small number of people in the current sample. Ketamine was typically swallowed or snorted and could be purchased in tablet, powder or liquid form. There was substantially less recent use of ketamine in comparison to the 2003 sample and fewer participants were able to confidently comment on the price, purity and availability of the drug. Reports on the price of ketamine were varied making it difficult to delineate clear trends. Ketamine was considered to be high in purity, with this level of purity regarded as remaining stable in recent months. Ketamine was typically considered to be difficult to obtain.
Less than one tenth of respondents had ever used GHB and only three participants had used GHB during the six months preceding the interview, compared to only six participants among the 2003 sample. There was no lifetime or recent use of GHB-like substances such as 1,4B or GBL among the current sample. GHB had typically been used orally and only on a total of three or less occasions in the six months prior to interview. As such, this indicates predominantly experimental use by few people. Few participants were able to confidently report on the price, purity or availability of GHB in Tasmania, though key experts generally indicated that the availability, use and popularity of the drug is relatively low.
LSD and other psychedelics
Half of the REU respondents had used LSD at some stage of their lives and one third had used LSD in the six months preceding the interview, which is slightly greater in comparison to the 2003 sample. A significantly greater proportion of males had ever and recently used LSD in comparison to the proportion of females. One tab or drop of liquid of LSD was taken orally in a typical session of use, and LSD had been used on a median of 2.5 days in the preceding six months which is greater than the frequency of use of 1 day among the 2003 sample. The median price for one tab of LSD was $20, which has remained stable over the last two years. A greater proportion of users perceived that LSD was low in purity in comparison to 2003. There were mixed reports in regard to the availability of LSD, with it being considered as difficult to obtain by half of those that commented and easy to obtain by the other half.
Sixty percent of respondents had used psychedelic mushrooms and over one third had used mushrooms during the six months preceding the interview. A greater proportion of males had ever used mushrooms in comparison to females. Mushrooms had been used on a median of three days in the preceding six months or approximately every two months, and this was greater for males in comparison to females. Over half of the sample had used some form of psychedelic (either LSD or mushrooms) in the last six months.
Recent experimental use of hallucinogenic phenethylamines was also noted among some participants. A recent increase in the use of the research chemical 2C-I was noted by both REU and KEs, and five regular ecstasy users had recently but infrequently used the drug. Use of this drug was not noted among the 2003 participant sample. Despite the fact that the effects and risks of research or experimental chemicals are largely unknown, these drugs may be available and not necessarily illegal in all countries.
One fifth of participants had used MDA at some stage of their lives and less than one fifth had recently used MDA, which is slightly less in comparison to the proportion of participants in 2003. Use of MDA was more common among males in comparison to females. MDA had typically been used three times or less in the six months preceding the interview, with one capsule consumed orally in a typical session of use. Fewer respondents were able to confidently comment on the price, purity or availability of MDA in comparison to the 2003 sample. The median price for one MDA capsule was $40 which is $10 less in comparison to the price reported in 2003, but was considered to have remained stable in the six months preceding the interview. MDA purity was considered to be medium or high and stable over the preceding six months. While consumer reports on the availability of MDA were mixed, based on the pattern of MDA use and the comments of several KEs the local availability of MDA appears to be relatively low, and to have declined slightly since 2003.
Patterns of other drug use
A majority of participants had recently used alcohol, cannabis, and tobacco. Alcohol had been used on median of two days per week in the six months preceding the interview, or approximately twice a week. Cannabis had been used on a median of one day per week by the current participants compared to the median of two days per week amongst the participants interviewed in 2003. The frequency of this use was greater for males in comparison to females. Two thirds of the sample had typically used cannabis when coming down from ecstasy. Tobacco had recently been used by three quarters of the sample and over half of these participants had smoked tobacco on a daily basis in the last six months, and others had smoked tobacco less frequently. The proportion of daily smokers amongst the current sample of participants was greater in comparison to the proportion of regular smokers in the general population, possibly suggesting a greater prevalence of this risky health behaviour among this population.
Use of inhalants such as amyl nitrite and nitrous oxide were relatively common. One quarter of the sample had recently inhaled amyl nitrite which is a substantial reduction in comparison to the level of use reported among the 2003 cohort (43%). Several KEs indicated that the use of amyl nitrite had decreased in recent months. One third of participants had recently used nitrous oxide compared to one quarter among the 2003 sample. However, nitrous oxide had been used relatively infrequently with three quarters using less than monthly.
Almost one quarter of the sample had recently used benzodiazepines, on a median of one day per month in the last six months. Recent use of benzodiazepines was more common among females in comparison to males and was typically used by one tenth of the sample, when coming down from ecstasy. Only four participants had recently used antidepressants and there was less recent use of antidepressants among the sample in comparison to 2003. Antidepressants were typically taken either as prescribed or infrequently and not in conjunction with ecstasy.
The use of other pharmaceuticals and opioid drugs was relatively rare among the regular ecstasy users interviewed in the current study and those that had recently used these drugs had generally done so infrequently. Just over one tenth had recently used pharmaceutical stimulants (such as dexamphetamine or methylphenidate), with a median frequency of approximately once every two months. Only small proportions of the sample had recently used methadone, or 'other opiates' such as morphine, pethidine and opium and there was no recent use of heroin or buprenorphine.
Less than one in ten regular ecstasy users (9%) had recently used substances intravenously compared to one in 5 among the 2003 cohort. Methamphetamine was typically the first drug ever injected and the most common drug ever and recently injected. The sharing of needles was relatively rare; however, two out of five had recently shared other injecting equipment such as spoons, tourniquets, filters and water. All recent injecting drug users had obtained injecting equipment from NSP/NAP outlets during the preceding six months; however, one fifth reported some difficulty in obtaining needles during this time in terms of the accessibility of outlets.
Eighty percent of participants that had been sexually active in the preceding six months reported recent penetrative sex under the influence of ecstasy and related drugs during this time. Those that had recently binged on ecstasy and related drugs were more likely to have recently had sex under the influence of drugs. One in five used protection every time they had sex under the influence with a regular partner, and one in three used protection every time that they had sex with a casual partner when under the influence of ecstasy and related drugs. Whereas one third of regular ecstasy users (33%) had been for a sexual health check up in the last year, one half (53%) had never had a sexual health check up. Two thirds of the sample had not ever been tested for hepatitis C or HIV.
Over half of the participants interviewed in the present study had driven soon after using drugs other than alcohol in the six months preceding the interview, typically, cannabis, ecstasy, and methamphetamine powder. A greater proportion of males had recently driven under the influence of drugs in comparison to females. Those who had driven under the influence of ecstasy and related drugs had typically used ecstasy more frequently and in greater amounts in the preceding six months compared to those that had not. Those that had recently binged on ecstasy and related drugs were more likely to have recently had driven under the influence of drugs.
One third of participants had recently binged on or used ecstasy and related drugs for more than 48 hours without sleep. Those that had recently binged had generally been using ecstasy for a longer period of time, had recently used ecstasy more frequently, had experimented with a greater number of drugs, and were more likely to have recently used methamphetamine. As mentioned above, those that had recently binged were also more likely to have recently had penetrative sex under the influence of drugs and to have recently driven under the influence of drugs. However, it is not possible to clearly dissociate the relationship between these risk behaviours and the associated drug use factors in the present report.
Health related Issues
Less than one fifth of the sample had overdosed (passed out or fallen into a coma) on any drug in the six months preceding the interview, and alcohol was the main drug involved in thirteen out of these eighteen cases, and had been used in all but one of these cases. Ecstasy was the main drug attributed as underlying the experience of overdose in only two cases, and had been used in a further four cases that were attributed to alcohol. With the exception of alcohol, all overdoses involved more than one drug. Those who had recently overdosed were more likely to be injecting drug users and were more likely to have recently used other opiates and antidepressants.
One tenth of the sample had accessed health services in relation to drug use in the preceding six months. Only four participants had accessed health services in relation to ecstasy use. Those that had recently accessed health services had used a greater number of drug types in their lifetime ever and in the six months preceding the interview, than those that did not.
Whereas approximately half of the participants interviewed had actively sought information about the effects or risks associated with different drug types and 'batches' of ecstasy pills, half of the participants only sometimes or never found out about these effects or risks. Friends and websites were the most commonly accessed information resources followed by information pamphlets and other people or dealers. Close to two thirds of the regular ecstasy users (64%) indicated that they had 'sometimes' bought a drug and it turned out to have different effects than they expected in the last six months. Regular ecstasy users indicated that resources such as a local website, information pamphlets, and testing kits would be most useful harm reduction options for either themselves or the local ecstasy and related drug user community. Posters and venue outreach at organised events were also considered to be useful resources.
Criminal and Police Activity
With the exception of dealing drugs, only one in twenty participants had committed criminal offences in the six months preceding the interview, and all of these related to infrequent property crime offences (such as shoplifting). Similarly, key experts generally indicated that there was little or no crime among the group of regular ecstasy users that they were familiar with. One sixth of the sample had recently sold drugs for cash profit compared to one quarter of the 2003 cohort. Over half of those that had sold drugs had done so less than monthly. Less than one tenth of the sample had funded their own ecstasy use through selling drugs, compared one fifth among the 2003 sample. One third of regular ecstasy users and several key experts perceived that there had been an increase in police activity towards ecstasy users in the last six months. The perceived increase in activity was generally related to covert surveillance, particularly at events and venues.
The participants in the current study were generally young, employed or studying and not currently in drug treatment or in legal trouble. While ecstasy was the preferred drug of most, polydrug use was the norm and the use of alcohol, cannabis, tobacco and methamphetamine common. The proportion that reported binge alcohol consumption in combination with ecstasy is concerning and had increased. Those using ecstasy frequently or in large amounts for extended periods of time may be at a greater risk. The safest pattern of use may be to use the drug infrequently and in small amounts to minimise the risk of neurological and neuropsychological harm, and this was perceived to be one of the biggest risks associated with the use of ecstasy for many participants. Those that had used ecstasy more frequently and in larger amounts and had recently used a greater number of drug types were more likely to have recently engaged in binge drug use which was associated with other risk behaviours such as driving under the influence of drugs and sexual risk behaviour, possibly indicating a relationship between these factors. The level of harm experienced by the majority of participants was relatively low, with few recent overdose episodes, few people accessing health services in relation to drug use, only relatively minor work/study, financial, and social problems experienced by most users, and most not experiencing significant symptoms of dependence in relation to either ecstasy or methamphetamine use. The use of alcohol and polydrug use were associated factors for the majority of those that had recently overdosed on any drug. Half of the participants had actively sought harm reduction information about the risks and effects of the drugs that they chose to use. These messages were not necessarily reaching other participants despite the fact that most of the people were receptive, and indicated that harm reduction information would be useful both to themselves and the ecstasy and related drug using community.
It is important to remember that the aim of the PDI is to investigate the patterns of drug use, drug markets and associated risks and harms among a sentinel group of participants that use ecstasy on a regular basis, as such, this population is not necessarily representative of all users of ecstasy and related drugs and the prevalence of ecstasy and other drug use can not be directly inferred. However, the study is designed to identify emerging trends and important issues and the findings of the 2004 PDI suggests the following areas for future monitoring, research and consideration in policy:
Citation: Matthews, A. and Bruno, R. (2005) Tasmanian Trends in Ecstasy and Related Drug Markets 2004: Findings from the Party Drugs Initiative (PDI), Sydney: National Drug and Alcohol Research Centre.