NDARC Technical Report No. 216 (2005)
EXECUTIVE SUMMARY
Demographic characteristics of injecting drug users (IDU)
Males made up 67% of the IDU sample which had an age range of 18-50 with a mean of 33 years. There were just three IDU who came from non-English speaking backgrounds and six who identified themselves as having indigenous heritage. The average number of years of schooling was 10 years with 44% not having gone on to further study. With regards to accommodation 71% lived in their own or rented homes or flats. A majority (61%) was not employed at the time of interview. There were 51% of IDU currently in treatment for their drug use, however, this apparently high figure is likely to be a function of the removal of the sample quota strategy which in previous years of IDRS data collection had limited the maximum proportion of the IDU sample currently in treatment to X%. A history of having been imprisoned was held by 37% of IDU.
Patterns of drug use among IDU
As in previous years, heroin remained the most popular drug of choice, nominated by 47% of the sample with methamphetamine once again the second most common nominated by 35%. Despite this, the various forms of methamphetamine were found to be the most commonly injected drug class of drug is the month prior to interview. The rate at which they were nominated in this context (44% of IDU) was a significant decline from the figure of the previous year (56%) while those nominating heroin as drug most injected (42% of IDU) was a significant increase thereby suggesting the margin between the popularity of these two drug classes may have narrowed substantially. The average age of first injection was 19 with an average length of injecting career of 15 years was not significantly different from the findings of 2003. Frequency of injection in the month prior to the survey ranged from ‘no instances’ up to ‘more than three times a day’ with the largest group (49%) injecting more than weekly but not daily. Injection on a daily basis was reported by 41% which was not significantly different from the 2003 figure of 40%.
The drug was reported to be ‘very easy’ and ‘easy’ to obtain, a situation which also had remained unchanged from the previous year. Despite this, numbers reporting recent use of the drug continues to remain lower than was seen in 2000 prior to the ‘heroin shortage’. A significant increase was observed however in the numbers of IDU reporting heroin as the most commonly injected drug in the month preceding the interview.
Purity was reported as being ‘low’ to ‘medium’ by users, a perception supported both by median purity levels of 25% found in heroin seizures analysed by WA police and by the continuing low rates of opiate overdose.
Use of heroin amongst IDU remained relatively unchanged with recent use reported by 69% of the sample and use on a daily basis by sixteen percent of those who had recently used heroin. The trend from recent years towards the use substitute drugs such as homebake heroin and buprenorphine in situations where heroin was not readily available was observed to be continuing. Use of homebake heroin in particular remained common amongst Perth IDU, with a significant increase in IDU numbers (37 up from 27 in 2003) reporting its recent use.
Methamphetamine
Price, purity and availability of methamphetamine were all found to be influenced by the form of the drug.
A gram of powder had a median cost of $260, base of $250 while the price of a gram of crystal methamphetamine was $350. These prices did not differ significantly from those reported in the previous year.
The availability of crystal and paste methamphetamine was reported as being ‘very easy’ while availability of methamphetamine powder was reportedly ‘easy;’. The availability of all forms of methamphetamine had remained unchanged over the previous six months. A minority reported ice had become ‘easier’ to obtain.
Purity of powder was viewed by users as being of ‘medium’ purity and stable while base was seen as ‘high’ and ‘stable’. Crystal methamphetamine was reported to be consistently ‘high’. Analysis of methamphetamine seized by police was not differentiated by form and revealed a median purity for the 2002/2003 period of 30% being a substantial increase on the previous year’s median of 18%. Further, analysis of seizures in the most recent two quarters reveal continuing steep rises in methamphetamine purity to an unprecedented level of 52% in the second quarter of 2004.
Recent use of crystal methamphetamine was reported by 83% of IDU of the sample and continues to be the predominant form in WA. Methamphetamine was the most commonly injected drug amongst the 2004 IDU sample despite its remaining second to heroin as the most commonly nominated drug of choice. Although there had been no decrease in the numbers of IDU reporting the recent injection of crystal methamphetamine, there had been a significant increase in the numbers of IDU reporting that they had recently smoked this form of the drug. This trend was especially noticeable among younger IDU.
Cocaine
There were only fifteen IDU reporting use of cocaine in the last six months. Of this number only seven IDU and no key experts were able to provide detailed information concerning the price, purity or availability of cocaine in Perth. The only two purchases of cocaine by IDU suggested a price of $350 for a half weight. Where information on purity or availability was provided, it was often seen to be conflicting. Analysis of just four seizures of cocaine by WA police during the 2003/2004 financial year shows a median purity of three percent. It is apparent that cocaine remains scarce in Perth and its regular use amongst injecting drug users continues to be rare. Small numbers of key experts have suggested however that this situation may be beginning to change.
Cannabis
The price of hydroponic cannabis was found to be to have fallen somewhat from $270 an ounce of hydros to a median price of $250. In the case of bush or naturally grown cannabis the price of an ounce remained unchanged at$200. Median prices of a gram (or ‘bag’ or ‘foil’) remained stable at $25 regardless of the type of cannabis involved.
The drug was almost invariably reported as being ‘easy’ or ‘very easy’ to obtain, a situation that has remained unchanged in the last year. Similarly, the strength of hydroponic cannabis was reported by IDU as being ‘high’ and bush cannabis as ‘medium’. The reported availability of both forms was rated as ‘stable’.
Use of cannabis was widespread with 84% of the IDU sample reporting recent use of the drug and 35% (ie: 42% of recent cannabis users) consuming it on a daily basis. Hydroponically cultivated cannabis and bush were the predominant types with forms of hashish being relatively uncommon.
Illicit use of methadone
Methadone syrup had been licitly used by 30% of IDU in the preceding six months and illicit methadone syrup by 16%. More IDU used illicit (8%) than licit (1%) physeptone tablets. Injection of illicit methadone was reported by 63% (79% in 2003) of IDU who had used it. Of the eight IDU that used illicit Physeptone®, six (75%) had injected the drug in the last six months.
Illicit use of buprenorphine
There was some evidence that illicit use of buprenorphine is continuing with rates of illicit use amongst the IDU sample (23%) at the same level as licit (22%) use. Injection appeared to be the most common means of administration employed by 91% (increased from 83% in 2003) of IDU who had used the drug illicitly. Mean days of use of buprenorphine was found to have significantly increased from seven in 2003 to 44 in 2004.
Morphine
Morphine continued to be the most commonly used illicit opioid with 46% of the IDU sample reporting its recent use. Although the recent use of morphine is high, the median days of use was six. This is dramatically lower than the median days in previous years (60 days in 2003, 33 days in 2002) suggesting less intensive drug use compared to previous years. Injection of morphine was seen to almost invariably involve the MS Contin® form of the drug although small numbers of IDU mentioned the use of Kapanol® and Anamorph®. Morphine was generally viewed as being ‘easy’ to obtain with a 100mg tablet carrying a median price of $50. Availability was generally viewed as being ‘stable’ although a substantial minority believed that the drug may have become ‘more difficult’ to obtain.
Other opioids
The use of other opioids in the last six months was reported by 31% of IDU, a figure not dissimilar from that reported in 2003. The average number of days of recent use was 25 which was also comparable to the previous year’s findings. Other pharmaceutical opiates were also mentioned by both IDU and key experts on a primarily included codeine based preparations followed by Oxycontin ®, pethidine and Tramal ®. There was also one IDU who indicated that they had recently used opium.
Benzodiazepines
Benzodiazepines remained commonly used with 71% of the IDU sample having consumed these drugs within the last six months. The average of 68 days of use was not significantly different from rates reported the previous year. The licit use of these substances was more common than their illicit use. Most benzodiazepine use was by oral administration however, 17% of those who had recently used benzodiazepines reported injecting them. As in previous years the most commonly used benzodiazepine was diazepam by a substantial margin.
Associated harms
According to figures obtained from HDWA and the 2003 NSEP Survey, incidence of both hepatitis B and C appears to have increased in recent years. Rates of HIV however remain low amongst Western Australian IDU.
Rates of using reusing syringes after another person remained relatively low with 13 IDU reporting having done so and for the most part only involved sharing with one individual, generally a regular sexual partner. Rates of sharing other equipment such as spoons or water was rather more common with 44 IDU having done this recently. There were also 23 IDU who had allowed someone else to use their syringe after them. None of these figures differed significantly from those observed the previous year.
Overdose remained uncommon with four cases in the month preceding the interview reflecting the continuing lowered availability and purity of heroin in Perth. More common harms from injecting were ‘scarring or bruising’ reported by 56 IDU and difficulty injecting by 48. Just over a quarter of the sample had experienced a ‘dirty hit’ in the last month that made them feel unwell.
There were 30 IDU who had attended a health professional for problems relating to mental health, the most common of these problems being depression reported by two thirds of these IDU.
Questions about acts of aggression following drug consumption revealed methamphetamine to be the most commonly implicated substance involved in 57% of acts of verbal aggression and in 62% of cases of physically aggressive acts.
Implications
The continued widespread availability and use of methamphetamine in WA merits further attention. This strong presence, accompanied by recent substantial increases to purity and the quantity of the product being manufactured domestically will likely see the drug continue to present real challenges to both service providers and law enforcement agencies for the foreseeable future. The nature of these challenges is likely to include aspects of client behaviour, rates of drug induced psychosis, rates of violent offending and problems associated with clandestine laboratories and the often toxic chemicals employed in the process of methamphetamine manufacture.
The recent trend towards the smoking of crystal methamphetamine may present a positive development in that it offers a lower level of risk in terms of blood borne virus transmission and other harms associated with the injection of drugs. As there has been no corresponding fall in the rates of injecting crystal methamphetamine however, the impact of these positive effects is likely to be minimal and in fact, by adding smoking to their other drug use this may actually result in a net increase in harm. It has also been suggested that some of the younger users utilising this route of administration may be under the mistaken impression that it also offers protection from other amphetamine related harms including dependence and psychosis. This may highlight a need for targeted education to raise awareness of these hazards amongst methamphetamine smokers.
It is evident that the numbers of recent heroin users amongst IDU remains lower than in years preceding 2001. That said, the significant increase in the number of recent heroin users since 2001 and the significant increase in numbers reporting heroin as the drug most injected in the month prior to interview since 2003 warrants continued monitoring of the situation. That heroin continues to be the most commonly nominated drug of choice amongst the IDU sample suggests there is an unmet demand here which in the event of heroin increasing in availability may result in rapid uptake of the drug and a return of its associated problems.
The use of pharmaceutical opiates and homebake as substitutes for heroin continues but with differences noted from year to year in the relative popularity of various preparations. The fact that much of this use involves the injection of compounds intended for oral administration is cause for concern in itself due to the potential for harm. That the market for these substances appears to be dynamic over time however, not only requires continued monitoring of the situation but also provides opportunities for research exploring the engines driving the market forces of supply and demand.
Citation: Fetherston, J. and Lenton S. (2005) WA Drug Trends 2004: Findings from the Illicit Drug Reporting System (IDRS), Sydney: National Drug and Alcohol Research Centre.