KEY FINDINGS & IMPLICATIONS
The WA arm of the EDRS aims ultimately to monitor trends in the Perth ecstasy and related drug (ERD) markets and investigate harms associated with ERD use. The 2013 WA EDRS revealed ongoing fluctuations in drug markets and signs of drug related harms which are discussed below.
Drug use trends
Over the past two EDRS data collection periods, there has been growing evidence that suspected declines experienced in the WA ecstasy market in the 2010/11 period were coming to an end. EDRS data examined across years suggest that the WA ecstasy market may have seen somewhat of a resurgence. Interestingly, as in other capital cities in Australia, an emerging trend that’s been observed in the WA data, is that there appears to be increasing reports of other non-pill forms of ecstasy use (powder, capsules and crystals). It will be interesting to see if this resurgence continues into future data collection periods. It will also be interesting to see whether these other non-pill forms of ecstasy continue to increase in the market.
There are a number of drug trends findings in this year’s EDRS which will be looked at with interest in 2014 to see whether they continue. These include: (1) indications of a resurgence in the WA ecstasy market; (2) increasing reports of other non-pill forms of ecstasy use (i.e. powder, capsules and crystals); (3) increasing reports of recent cannabis use; (4) decreasing reports of lifetime methamphetamine use; (5) increasing reports of drugs sold as LSD; and (6) increasing reports of 2C-series drug use, and anecdotal reports that 2C-series drugs are being sold on the market as LSD.
Harms
The high level of alcohol use among the sample continues to be of concern. The majority of the sample (85%) obtained AUDIT scores that indicated hazardous and harmful use of alcohol. Additionally, more than half of the sample (62%) consumed alcohol on a ‘more than weekly’ basis. Alcohol was also the main drug implicated in depressant overdoses. These findings are consistent with previous years and have implications for continued harm reduction efforts targeting risky alcohol use among REU/RPU.
Alcohol use in combination with other drug use also continues to present concern. Among the current sample, the use of stimulant drugs concurrently with alcohol was common. The majority of the sample (80%) reported using alcohol with ecstasy last time they used it, and among these participants, the majority (88%) also reported consuming more than five standard drinks. A further indication of concurrent alcohol and stimulant drug use is that stimulant drugs were implicated in depressant overdoses, and depressant drugs were implicated in stimulant overdoses. These findings are consistent with previous years, and indicate that, despite negative symptoms associated with consuming alcohol in combination with stimulants; this behaviour continues to be common. This finding has implications for harm reduction efforts targeting the concurrent use of alcohol and stimulants like ecstasy, pharmaceutical stimulants and energy drinks.
Increasing reports of 2C-series drug use (e.g. 25I-NBOMe) in the current sample is a new issue of concern. Recently, 2C-series drugs have sparked widespread concern in Australia and internationally due to their link to a number of deaths. Some reasons why this class of NPS presents concern include (1) there is a lack of scientific literature examining the short and long term effects of these drugs (2) there are many psychedelic drugs within the series that have varying potency, which might be unclear to consumers and can potentially lead to harm from misuse. Further, in the current sample, there were anecdotal reports by both participants and KE that 2C-series drugs might be getting sold as LSD in the Perth market. There are various reasons why this may occur including (1) 2C drugs are easy to obtain online (2) 2C drugs can be purchased cheaply online (as little as $1.50 per tab) (3) 2C drugs are available in tab/blotter form (i.e. may appear to look like LSD) and (4) both LSD and 2C drugs have psychedelic effects. If this behaviour is occurring, it presents significant concern as it is believed that 2C-series drugs present greater risk of acute harm than LSD due to high potency at low doses, as well as sympathomimetic (i.e. stimulant type) effects which can cause cardiovascular complications (Caldicott, Bright & Barratt, 2013). Adding to this, there were also anecdotal reports that some 2C-series drugs come in pill form, indicating the potential for them to be marketed and sold as ecstasy as well. While it is not possible to determine whether these are behaviours that are actually occurring in Perth, it is an issue that has important implications for harm reduction. It is important that REU/RPU are aware that these drugs exist in the Perth market and that they may be marketed and sold as something else. It is also important that service providers, particularly emergency services, that are managing drug use presentations involving LSD and ecstasy, also consider the diagnosis of an inadvertent 2C-type drug overdose, which mandates a higher level of care than what might be otherwise assumed is needed (Caldicott, Bright and Barratt, 2013). Overall, ongoing and careful monitoring of the use and sale of these drugs is needed, as well as further investigation of online purchasing patterns as drug markets continue to expand. Increasing awareness among REU/RPU of the presence of these drugs in the Perth market, and encouragement of more carful harm reduction measures, is also imperative.
Implications related to changes in methodology
During the 2011 WA EDRS recruitment process, considerable difficulties were experienced, which were believed to be a result of declines in the perceived potency and availability of ecstasy. These recruitment difficulties suggested that a trend away from ecstasy could have been occurring, and it was, therefore, proposed that changes to the WA EDRS methodology be considered in future years to account for this trend. As a result, in 2012 the EDRS selection criteria were expanded in WA to include both regular ecstasy users (REU) and regular psychostimulant users (RPU). These methodological changes were subject to change according to annual review of the Perth ecstasy market. Ecstasy data and user perceptions from both the 2012 and 2013 WA EDRS show preliminary indications that both potency and availability may have seen somewhat of a resurgence in WA. Consequently, there will be ongoing consideration of whether the 2012 selection criteria changes are continued into future data collection periods.