NDARC Technical Report No. 252
EXECUTIVE SUMMARY
Demographic characteristics of injecting drug users (IDU)
There were no significant differences between the demographics of the IDU sample in 2005 and that of the previous year with the exceptions of an increase in mean age from 33 to 35 and a rise in the proportion of IDU residing in their own house or rental accommodation from 71% to 84%.
Males comprised 66% of the sample and 66% of the sample were unemployed at the time of interview. Involvement in sex work was reported by four percent. Aboriginal and Torres Strait Islanders made up six percent of the sample and there was just one individual who reported that English was not the main language spoken at home. The average number of years of school education was eleven and 42% of the sample had not progressed to any form of tertiary education or training. Half (50%) of the sample were in some form of treatment for their drug use at the time of interview and 33% had a history of imprisonment.
Patterns of drug use among IDU
Average age of initiation to injecting drug use remained 19 years, with users in the sample having been injecting for an average of 16 years, a figure not significantly different from the 15 years reported the previous year. Amphetamine remained most commonly reported as being the first drug injected by 49% and heroin second by 40%. As in previous years the most commonly cited drug of choice was heroin, but this response was given by 63%, up from 47%, a figure unprecedented since collection of IDU data in WA commenced. Conversely, methamphetamines remained the second most common drug of choice but these had fallen to an unprecedented low of 15% (down from 35% in 2004). Heroin was reported as the drug most often injected in the month prior to interview by 37% of the IDU sample, down from 42% the previous year. Despite this, for the first time since 2000, a larger proportion of the sample identified heroin, rather than amphetamines, as the drug most often injected in the past month, with the latter falling from 44% in 2004 to 32% in 2005. Opiates other than heroin were reported as the most injected substance by 27%, up from 10% the previous year. Similar patterns were observed with the most recently injected drug, with 38% stating heroin, 32% methamphetamine and 24% opiates other than heroin. Polydrug use was typical amongst the sample with a mean of eight different drug classes used in the last six months and no IDU reporting less than two classes of drug used in that time.
Heroin
Heroin remained the most commonly cited drug of choice amongst the WA sample with 63% of IDU mentioning it this context, up from 47% in 2004. Despite this, numbers of recent users had remained unchanged from 2004 with 69% of the IDU interviewed having consumed heroin in the past six months. One contributing factor in this may be the increase in the price of heroin, with a gram now costing $550 ($500 in 2004), thereby making the cost of heroin in Western Australia more expensive than any other Australian jurisdiction. The availability of heroin remained unchanged with 81% of those responding reporting obtaining the drug as being either 'very easy' or 'easy'. Some 45% of heroin users interviewed in 2005 said that heroin in Western Australia was of 'medium' purity, up from 38% in the previous year. The mean number of days of use was 81 with 16% IDU reporting use on a daily basis, which was not a significant increase on 2004 findings (69 days and 11% using daily).
Use of homebake heroin remained relatively unchanged with 34 IDU reporting its recent use compared with 37 the previous year. Mean days of use also did not significantly differ, with an average of 30 days compared with 44 in 2004.
Methamphetamine
For the first time since 2000, methamphetamines were not the drug most commonly reported as most injected in the month prior to interview, having been narrowly overtaken by heroin. They remained the second most commonly nominated drug of choice, despite having declined from 35% of the 2004 IDU sample citing them in this role to just 15% of the 2005 sample. There had also been a significant drop in the number of IDU reporting recent use of any form of amphetamines from 85% in 2004 to 77%. Much of this drop was attributable to lower numbers (68%, down from 83% in 2004) reporting recent use of crystal methamphetamine. Recent use of the paste form had actually risen from 40% to 54% while rates of use of powder methamphetamine remained unchanged at 61%. This decline in the use of crystal was also reflected in a significant fall in numbers of IDU reporting recent smoking of crystal methamphetamine from 42 in 2004 to just 19 in 2005.
There was evidence that prices of both the powder and base forms had increased significantly, with user estimates of the cost of a gram of either form in 2005 being $300, up from $260 and $250 respectively in 2004. The estimated price of a gram of crystal methamphetamine in 2005 was $400, as opposed to the 2004 price of $350; however, this change was not statistically significant.
There was evidence of a decline in purity regardless of methamphetamine form. Thus: 20% of those responding in 2005 rated the purity of powder as 'high' as opposed to 33% in 2004; 32% rated paste purity as 'high' compared with 44% the previous year; and 51% described the purity of crystal as 'high', down from 65% in 2004.
The availability of both powder and paste appeared to have increased, with 100% of those responding describing powder as 'easy' or 'very easy' to obtain and 82% saying this of paste. Crystal, however, had become significantly harder to get with just 67% rating its availability as 'easy' or 'very easy', down from 94% the previous year.
Days of recent use for any form of amphetamine ranged from one to 180, with a mean of 58 days, representing a significant decline from the 83 days in 2004. There were seven IDU reporting daily use of amphetamines compared with 13 in the 2004 sample.
Cocaine
Recent use of cocaine remained relatively uncommon amongst the WA IDU sample with just 19 respondents reporting having used the drug within the last six months. The very small number of purchases maKE it difficult to provide accurate information on the price of cocaine, although available data suggest a price range of $100-$250 for a halfweight and $475 for a gram. Similarly, the small number of reports concerning purity and availability of the drug necessitate that these data be treated with caution. With regards to purity, three of the five IDU responding believed this to be 'high' and four of the five commenting on availability described this as being 'easy'. There were no individuals who had used cocaine for more than 15 days out of the last six months and the median days of use was just three, indicating that regular use of cocaine amongst WA IDU continues to be extremely uncommon.
Cannabis
Despite a significant decline in numbers reporting its use the previous year (from 84% to 76%), cannabis recent use remained extremely common amongst the WA IDU sample. Among recent users, 96% had used hydroponically grown cannabis and 92% had used 'bush', yet 76% said that hydroponic was the form that they had used most. There was evidence that the price of cannabis had significantly increased from the previous year, with purchase data suggesting that an ounce of hydroponic cannabis cost an average of $287 and an ounce of bush cost $224, up from $250 and $200 respectively.
Most users continued to experience little difficulty in accessing cannabis, with the hydroponic variety described as 'easy' or 'very easy' to obtain by 84% of those responding and bush by 67%. A clear majority (69%) of those who commented viewed the potency of hydroponic cannabis as being 'high' while bush was mainly described as being of 'medium' strength. Average number of days of use remained high at 112 days in the last six months. There were 31 IDU who reported using cannabis on a daily basis, representing 41% of all respondents who had recently consumed the drug.
Use of illicit pharmaceuticals
Use of illicit opioids other than heroin has substantially increased in recent years. Of the 2005 IDU sample 78% reported the recent consumption of opiates other than heroin, compared with 82% in 2004. In 2005 this class of drugs was most commonly injected in the month prior to interview by 27% of the IDU sample. Further, amongst IDU whose drug of choice was heroin, other opioids were the drug most injected by 21%. Some 61% of the entire IDU sample reported the recent injection of some form of opioids other than heroin.
Pharmaceutical stimulants had recently been used by 47% of the sample, a figure not dissimilar to the 43% in the previous year. There were no IDU in the 2005 sample who had a valid prescription for these drugs. Mean days of use was 15, which was a significant decline from the mean of 38 in 2004, although this is likely a reflection of the absence of any respondents with a valid script in the 2005 sample.
Illicit methadone
The recent use of illicit methadone syrup was reported by 24% of the IDU sample up from 16% the previous year. Injection of illicit methadone syrup was reported by 16 IDU. Mean days of use was 15 which was not significantly greater than the average of seven in 2004. Recent use of illicit Physeptone® was reported by eight IDU, as was the case in the previous year's sample. Seven of these IDU reported having recently injected this preparation. Mean days of Physeptone use was 13 which was not a significant deviation from the 2004 mean of 11. The cost of illicit methadone (any form) had remained stable at one dollar per ml/mg. Access to the drug was mostly described as 'very easy', mainly being obtained through friends.
Illicit buprenorphine
Recent use of illicit buprenorphine was reported by 34% of the IDU sample which was a significant increase on the 23% in the previous year. The proportion having injected the drug in the previous six months also rose significantly from 21% in 2004 to 31% in 2005. The mean number of days of use in the last six months was 34 which did not represent a significant shift from the 2004 mean of 44 days.
Morphine
Morphine remained the most common opioid used other than heroin, with recent (last six months) use reported by 52% of the IDU sample compared with 46% in 2004. Recent injection was reported by 48% compared with 43% the previous year. Days of recent use had risen significantly with a mean of 63, up from 34 days. Similarly, days of injection had increased significantly with a mean of 64, up from 34 days. A 100mg tablet of morphine was generally held to cost $50, a price unchanged from the previous year. Availability of morphine continued to be regarded as 'easy' with most being obtained from friends. The most commonly consumed brand of morphine remained MS Contin®.
Other opioids
Use of illicit oxycodone was reported in the six months preceding the interview by 39% of the IDU sample and its injection by 35%. Mean days of use was 14. Other types of opioids were recently used by 14%. Although this appears to be substantially less than the 31% in 2004, this apparent decrease is almost certainly an artefact of the decision in 2005 to ask about oxycodone separately in the IDRS.
Benzodiazepines
Numbers of IDU reporting recent use of benzodiazepines had changed little, with 73% of IDU reporting having consumed this class of drugs within the last six months compared with 71% in 2004. Similarly, the 82 mean days of use in the last six months was not a significant increase on the 68 reported the previous year. Rates of injection did appear to have fallen, however, with 7% of IDU reporting the recent injection of benzodiazepines in 2005 as opposed to 12% in 2004, and mean days of injection falling significantly from 33 to just three in 2005. As in 2004, the majority of these benzodiazepines were sourced from licit doctors' prescriptions. Diazepam was once again found to be the most common type of benzodiazepine used by a very substantial margin (n=62) followed by oxazepam (n=11) and temazepam (n=5).
Associated harms
In 2005, incident cases of hepatitis C continued to remain more common than those of hepatitis B. With 27 incident cases of hepatitis B, this rate remained relatively unchanged from the 29 cases the previous year. Hepatitis C saw 101 cases, down from 121, but this was still a substantially higher figure than rates prior to 2003.
Although the use of needles after another person had not changed significantly, with nine percent having done so in the last month compared with 13% the previous year, significant drops were noted in the lending of needles (14%, down from 23%) and of sharing other injecting equipment (29%, down from 41%).
The most common recently experienced injection-related difficulties continued to be scarring/bruising (49%) followed by difficulty injecting (36%). Next most common was a 'dirty hit' reported by 22% with methamphetamine being the most commonly implicated substance. Other harms were relatively uncommon. The mean number of harms experienced had decreased from two to one.
Driving a motor vehicle within one hour of consuming illicit drugs (at least once) in the last six months was reported by 70% of the IDU sample. As these data have not previously been collected, it is not possible to draw comparisons with previous years.
Verbal aggression whilst intoxicated was reported by 30% of IDU and physical aggression by 14%. Verbal aggression whilst in withdrawal was rather more common, reported by 43% and physical aggression by 10%. The substances most commonly implicated in aggression whilst intoxicated were alcohol and crystal methamphetamine, whilst heroin was most commonly implicated in aggression during withdrawal.
There were 29% of the IDU sample who had been arrested during the last 12 months, which was not a significant change from the 34% arrested in the 2004 sample. Offences related to use and possession of drugs remained the most common reason for arrest. Involvement in criminal activity in the month preceding interview was admitted to by 37% of the sample, which was significantly less than the 62% the previous year. Dealing drugs remained the most common form of criminal activity by a substantial margin.
Implications
That there has been an apparent decline in users' perceptions of the availability and quality of methamphetamine may be cautiously interpreted in part as a reflection of the success of recent police strategies to reduce the availability of precursor chemicals.
There are indications that opiate users have become less inclined to call for ambulance services as a first response to overdose situations. This may indicate a need for harm reduction/safer using messages to be specifically targeted at this group of users.
Recent increases in the use of pharmaceutical opioids needs to be viewed with some concern. Firstly, these preparations are not intended to be injected and their increased use by IDU is likely to be accompanied by an increase in injection-related problems (abscesses, vein damage etc.). Secondly, experience of similar drug trends involving these substances in Maine, USA provides considerable evidence that the widespread use of drugs such as Oxycontin® may form a precursor to a surge in heroin use.
The significant decline in recent use of cannabis amongst IDU in the IDRS sample and also amongst the general WA population in the National Drug Strategy Household Survey suggests that recent legislative changes to the criminal status of cannabis has not resulted in an upswing in the drug's use.
Citation: Fetherston, J. and Lenton, S. (2006) West Australian Drug Trends 2005: Findings from the Illicit Drug Reporting System (IDRS). Sydney: National Drug and Alcohol Research Centre.