CAVEAT: Substantial difficulties were encountered in 2011 in the recruitment process. While the WA EDRS annually attempts to recruit 100 REU, in 2011 only 28 eligible participants completed the questionnaire.
Use of ecstasy (MDMA) on at least a monthly basis is a criterion for participation in the EDRS survey. Large declines in perceived MDMA purity and availability during the first two quarters of 2011 resulted in a scarcity of potential participants able to meet these criteria. Further, a number of other potential respondents who were eligible declined to participate upon discovering that the interview was in a face-toface format and could not be conducted over the phone or online.
As the final sample of 28 is extremely small, it is vital that all data in this report be interpreted with great caution.
In addition, although participation of small numbers of regular injecting drug users (IDU) in the EDRS survey is not a new phenomenon, in the context of a very small sample size their influence has been disproportionate. This has resulted in apparent increases in both injecting and consumption of heroin and other opiates in this year’s sample which are unlikely to be reflective of actual trends in the Perth REU community. Consequently, results relating to use of opiates and injecting behaviour should be viewed with substantial scepticism.
EXECUTIVE SUMMARY
Demographic characteristics of regular ecstasy users
For the purpose of this study, regular ecstasy users (REU) are a population defined by the use of ecstasy pills, powder or capsules on at least a monthly basis. In 2011, 28 REU were interviewed over the scheduled recruitment time.
It was evident that there were major differences in the demographic data between the 2010 and 2011 samples. The 2011 WA sample was older with a mean age of 27 compared with 23 the previous year, and 68% were male compared with 48% in 2010. All identified as heterosexual compared with 86% in 2010, and they seemed less likely to have attained any qualifications after leaving school (37% vs 48%) and more likely to be unemployed (25% vs 13%). Proportions identifying as Aboriginal or Torres Strait Islander (4%), being from an English speaking background (96%) and the mean years of schooling (11 years) remained relatively unchanged. Due to these demographic differences between 2010 and 2011, and the very small 2011 sample size, attempts to draw comparisons across years have been kept to a minimum throughout this report.
Drug use and markets in the 2011 EDRS
Ecstasy
As regular use of ecstasy is a criteria for participation in the survey, it is unsurprising that both lifetime and recent ecstasy use amongst the sample was 100% (n=28). Mean days of use in the past six months was 17 and 29% (n=8) reported using ecstasy at least weekly. Consuming more than one tablet in a typical session was reported by 70% (n=20) of the sample with an average of 2.3 tablets being consumed each time. “Bingeing” (the use of ecstasy for more than 48 hours without sleep) was reported by 54% (n=15) of the 2011 sample.
Ecstasy was only rated as the “favourite drug” by 26% (n=7) of the sample which was the lowest figure ever recorded in the WA EDRS. It is unclear if this is a result of user perceptions that ecstasy purity at the time of the survey was poor, or the fact that there was a disproportionately larger proportion of IDU in the sample, whose drugs of choice are more likely to be opiates or methamphetamines.
The main route of administration of ecstasy remained swallowing, reported by 93% (n=26) of the 2011 sample. Having ever injected ecstasy was reported by 21% (n=6) of the 2011 sample, compared with just 6% in 2010. This apparent rise in injecting, however, is almost certainly caused by the higher proportion of IDU disproportionately skewing a very small sample, and almost certainly not a reflection of real trends in the Perth REU community.
Use of other drugs while using ecstasy was commonplace and reported by 68% (n=19) of the 2011 sample. Amongst those who had done so, the most common drugs mentioned were alcohol by 79% (n=15), cannabis by 53% (n=10) and tobacco by 47% (n=9). Using other drugs to come down from ecstasy was reported by 54% (n=15). The most common drugs mentioned in this context were cannabis by 73% (n=11), tobacco by 33% (n=5) and benzodiazepines by 27% (n=4).
The median price of a tablet of ecstasy was reported by users to be $30. This price was reported as stable over the last six months by 57% (n=16) of the sample.
Purity of ecstasy currently available was rated as low by 86% of the sample which was the highest proportion reporting this since commencement of the WA EDRS. Conversely, there were no respondents describing the purity of ecstasy as high, which was the lowest proportion reporting this since commencement of the survey. Most respondents (57%, n=16) believed the purity of ecstasy in WA had been decreasing over the previous six months.
Although the majority of those surveyed described current availability of ecstasy as easy (50%, n=14), the combined figure of those REU describing availability as either easy or very easy (64%, n=18), is the lowest rate since EDRS reporting was commenced in WA.
Ecstasy was most commonly purchased through friends with a median of four tablets obtained per occasion. It was typically bought one to six times over a six-month period and was most commonly used at the users’ own homes.
Methamphetamine
Lifetime use of powder methamphetamine was reported by 67% of the sample and recent use by 44% with a mean of 44 days of use in the preceding six months. Amounts used typically ranged from between a half to a full gram. Base methamphetamine was less common with 36% (n=10) of REU reporting lifetime use and 11% (n=3) reporting using base in the last six months. It was used on a median of six days with quantities ranging from 1.5 point in a typical session up to two points in a heavy session. Lifetime use of crystal methamphetamine was reported by 64%. Use in the last six months was reported by 46% up from 22% in 2010. This increase does not appear to be associated with changes in the availability of crystal, but may be reflective of REU turning to alternative drugs in the absence of good quality ecstasy, or possibly because of the disproportionate numbers of IDU skewing the sample. As such, this data needs to be interpreted with caution. Mean days of use of crystal during the last six months was 19, with one point being used in a typical session.
Routes of administration differed between forms, with powder mostly snorted, base typically swallowed and crustal primarily smoked. Small numbers reported injecting powder and crystal.
Powder methamphetamine reportedly cost $100 a point and $800 a gram. Base cost $100 per point and $1,000 a gram. Crystal methamphetamine reportedly cost $100 a point and $400 per gram. It should be noted that price data was provided by very small numbers of respondents and this information should be interpreted with caution. Prices for powder and crystal were reported as being stable.
Crystal methamphetamine purity was generally described as high while opinions on powder methamphetamine was divided between medium and high. Base is not reported on due to the very small number of recent users. Availability of both powder and crystal was reportedly very easy. Despite very small numbers reporting on base, there was unanimous agreement that obtaining it was difficult. Availability of both powder and crystal was described as being stable. Again, base was not reported on due to very small numbers of respondents.
For all forms of methamphetamine, the most common source was friends. The most common locations for use of powder and crystal were private homes. Base was not reported on due to very small numbers of respondents.
Cocaine
Lifetime use of cocaine was reported by 82% (n=22) of the current sample, and recent use was reported by 32% (n=9). Although this figure for lifetime use is by far the highest recorded since the WA EDRS commenced in 2003, it is likely due to the disproportionate numbers of IDU skewing the 2011 sample. Mean days of cocaine use in the last six months was six. One gram was the quantity that was typically used. Snorting remained the most common route of administration.
Median price of a gram of cocaine was $375, but the small number of respondents reporting on this necessitates caution. Purity of cocaine was generally reported as low, but there was no consensus as to whether this had recently changed. Cocaine was reportedly difficult to obtain and this was generally viewed as being stable. Again, small numbers of respondents necessitate caution in interpreting this data.
Ketamine
Ketamine had a life time history of use by 18% (n=5) of respondents. There were no reports of recent use in the 2011 sample.
GHB
A lifetime history of GHB use was reported by 14% (n=4) of respondents. There were no reports of recent use.
LSD
A lifetime history of LSD use was reported by 71% (n=20) and recent use by 36% (n=10). The median price of a tab remained $25. Current purity was generally described as medium or high with smaller numbers reporting it to be fluctuating. Purity over the last six months was generally reported to have been stable. Most respondents believed availability of LSD to be easy and had been stable. LSD was primarily obtained from friends and mostly used in private homes.
Cannabis
A lifetime history of cannabis use was reported by 100% (n=28) of the 2011 sample and recent use by 93% (n=26). Mean days of use in the last six months was 113.
Median price of an ounce of hydroponic cannabis was $350 and an ounce of bush cost $250. These prices were generally described as stable. Potency of hydroponic cannabis was generally described as high and potency of bush as medium. Potency of both hydroponic and bush were primarily viewed as stable. Availability of hydroponic cannabis was most reported as very easy while opinions on the availability of bush was split between being very easy and easy. This availability was reportedly stable. Cannabis was most commonly obtained from friends and most typically used at home.
Patterns of other drug use
Lifetime history of alcohol use was reported by 100% (n=28) and recent use by 93% (n=26). Median days of use was 523, equating to once a week.
Both lifetime and recent use of tobacco was reported by 89% (n=25) of the sample. Use was typically on a daily basis.
Lifetime use of MDA was reported by 25% (n=7) and recent use by 14% (n=4) of the sample. Mean days of use in the last six months was one.
Use of illicitly obtained pharmaceutical stimulants remained common amongst WA REU with a lifetime history of use reported by 89% (n=25) and recent use by 68% (n=19). There were no reports of any licit use.
Lifetime use of illicitly obtained benzodiazepines was reported by 61% (n=17) and recent use by 29% (n=8). Median days of use in the last six months was three.
Lifetime use of amyl nitrate was reported by 29% (n=8) and recent use by 7% (n=2). Median days of use was 18.
Lifetime use of nitrous oxide was reported by 50% (n=14) and recent use by 18% (n=5).
Median days of use in the last six months was two days.
Superficially, there appeared to have been a substantial increase in the use of heroin and of a history of having injected drugs. However, it is highly likely that these increases are due to the disproportionate number of regular IDU in the 2011 sample, and are not reflective of actual trends amongst the broader REU community. With this in mind, this data and also that relating to the use of other opiates should be considered with a degree of scepticism.
A lifetime use of psylocibin mushrooms was reported by 79% (n=22) and recent use by 11% (n=3). Days of use in the last six months was limited to one or two days.
Respondents were asked to report on their use of over-the-counter stimulants, such as cold and flu medications containing pseudoephedrine, for recreational use. Lifetime use in this context was reported by 43% (n=12) and recent use by 11% (n=3). The median number of days of use in the last six months was seven days.
Respondents were also asked about a range of emerging drugs or “research chemicals”. Those with respondents reporting recent use included DMT (25%, n=7), mephedrone (14%, n=4), Salvia Divinorum (11%, n=3), 2C-B (7%, n=2), 2C-E (4%, n=1) and DXM (4%, n=1).
Synthetic cannabis brands such as “Kronic” became an emerging issue in WA during the first half of 2011. Recent use of these was reported by 32% (n=9). Median days of use was two. A range of psychoactive chemicals found in synthetic cannabis were prohibited in WA by the Barnett Government in June 2011, effectively banning this class of drugs. The effectiveness of this ban is yet to be evaluated.
Health-related issues
Since 2007, REU were asked about overdose on a stimulant drug and on a depressant drug. Overdose on a stimulant drug in the last 12 months was reported by 57% (n=16) of the current sample compared to 21% last year, and overdose on a depressant drug was reported by 57% (n=16) in 2011, compared to 29% in 2010. These “increases” seem improbably high and may be because of the very small sample size and disproportionate representation of IDU in the 2011 sample. As in previous years, the most commonly implicated stimulant drug was ecstasy, while the most commonly implicated depressant drug was alcohol. It should be noted, however, that this is a reflection of the preferred drugs of the EDRS target demographic and not solely a reflection of the drugs’ relative potential for toxicity.
In 2011, 18% (n=5) of REU reported accessing a medical or health service in relation to their drug use during the last six months. The most commonly accessed services were general practitioners.
The Kessler Psychological Distress Scale was included in the EDRS from 2006 as a screening tool for symptoms of depression and anxiety. In 2011, the most common categories were none or low distress. Self-reported mental health problems were reported by 14% (n=4).
Ecstasy dependence using the SDS was reported by21% (n=6).
The AUDIT was used to screen for alcohol-related disorders. There were 23 REU (82%) who scored above the cut off score indicating hazardous or harmful alcohol use.
Risk behaviours
Respondents reported on risk behaviours related to injecting, blood-borne viruses, sexual practices, driving behaviour and alcohol use.
Although there appeared to have been a substantial increase in numbers with a history of injecting drugs in the 2011 sample, this is almost certainly the result of a skewing of the sample by disproportionate numbers of IDU whose influence on the findings have been magnified by the small sample size. As such great caution is required in interpreting this data.
Fifty percent of the sample reported that they have been vaccinated for hepatitis B virus (HBV). Having been tested for hepatitis C virus (HCV) within the last year was reported by 15% (n=4) and having been tested over a year ago was reported by 37% (n=10). Having been tested for human immunodeficiency virus (HIV) within the last year was reported by 21% (n=6) and a further 25% (n=7) had been tested over a year ago. There were two respondents who were HCV positive, both with a history of injecting drugs. There were no respondents positive for HIV. It is likely that these findings have been influenced by the high number of IDU in the sample and as such, should be interpreted with caution. Having had other forms of sexual health check-up in the past year was reported by 36% (n=10).
Sex with a casual partner during the last six months was reported by 74% (n=20). Of these, 55% had had sex with multiple partners in that time. Of the 20 REU who had had sex with a casual partner, 95% (n=19) reported that they had done so while under the influence of drugs, most commonly alcohol, cannabis and ecstasy.
Of the current sample, 61% (n=17) had driven a car in the last six months. Among these respondents, 77% (n=13) reported driving whilst affected by alcohol and of these, 77% (n=10) reported driving over the legal alcohol limit. The median number of times these respondents had driven over the alcohol limit in the last six months was two times. Having been breathalysed was reported by 59% (n=10). Just one respondent had been over the legal blood alcohol limit when tested. Alcohol was the substance most commonly believed by respondents to be the most dangerous in the context of driving a car.
Of the current sample that had driven in the last six months, 53% (n=9) reported driving within one hour of taking a drug. Of these respondents, the median number of times driven under the influence of a drug was eight times. The most commonly reported drugs were ecstasy and cannabis. Of those who had driven soon after taking drugs, 33% (n=3) reported their drug use had no impact on their driving. In 2011, three respondents were roadside drug tested and all results were negative.
Criminal and police activity
The proportion of REU reporting criminal activity in 2010 was 39% (n=11). Of these respondents, drug dealing was the most commonly reported activity reported by 73% (n=8). Of the current sample, 18% (n=5) had been arrested in the last 12 months. In WA during 2009/10, there were 8,877 drug related arrests for consumer offences in WA and 2,144 provider offences. The drug most commonly involved was cannabis. There were also 1,391 Cannabis Infringement Notices (CINs) issued for cannabis possession. A total of 118 clandestine laboratories were detected in 2009/10, up from 78 the previous year.
The levels of police activity towards REU was generally perceived as having remained stable during the previous six months.
Heavy smoking
Using the Heavy Smoking Index (HIS), revealed that of those REU who were daily tobacco smokers, most (40%, n=6) were at a very low level of nicotine dependence. The mean score was 2.4.
Pleasure and quality of life
Respondents were asked to rate their quality of life on a scale of one to 10, 10 being the highest quality. The mean score was eight (range=5-10). Being with friends was rated as the most important factor across all three domains of pleasure, happiness and overall quality of life. Although drugs were rated fifth on the pleasure domain, they were only rated as 12th in importance on the overall quality of life domain.
Online drug-related activity
For the first time in 2011, REU were asked about their use of the internet for drug-related activities. Going online for a drug-related activity was reported by 77% (n=16) of those responding. The most common activity was searching for information with buying or selling drugs and precursor chemicals being substantially less common. Websites like Erowid or Pill Reports were the most common type of sites visited. More than half reported that texting was their preferred method for obtaining ecstasy and similar drugs. Respondents were also asked if they had used the internet to buy substances sold as “legal highs”. Having ever done so was reported by 43% (n=12) and, of these, 75% (n=9) had made such a purchase in the last six months.
Sleep
Respondents were asked a series of questions concerning their sleep patterns. For the main part, 68% (n=19) indicated that they felt their sleep to be either fair or good. Just 22% (n=6) felt their sleep to be either poor or very poor. Asked to rate satisfaction with their sleep on a scale of one to 10, produced a median score of seven on week days and of five on weekends. A median of seven hours sleep was reported on weekdays and a median of six on weekends. A median of seven hours sleep was reported as being required not to feel tired the next day. Asked if they felt they had any type of sleep problem, 58% (n=15) said they did not. Medication to assist with sleeping, primarily diazepam, was reported as having been taken in the last month by 21% (n=6) REU.
Ecstasy dependence
For the first time in 2011, prevalence of ecstasy dependence amongst the REU sample was measured. Using the Severity of Dependence Scale (SDS), it was found that 21% (n=6) of the 2011 REU sample scored above the cut-off of four, indicating ecstasy dependence.
Implications for research
It was evident that the 2011 WA EDRS encountered substantial difficulties in recruiting respondents, largely due to shortages of good quality ecstasy rendering potential respondents who met the criteria for participation difficult to find. Difficulties with the resulting small sample size (N=28) were further compounded by the recruitment of regular IDU into the sample. Although this is not a new development, in the context of a very small sample size the influence of such drug users is disproportionate on the results, in particular with regards to injecting behaviour and the use of heroin and other opiates. It may be necessary to make alterations to methods used in recruitment to avoid these problems in the future.