NDARC Technical Report No. 267
EXECUTIVE SUMMARY
Demographic characteristics of injecting drug users (IDU)
Sample characteristics in 2006 were somewhat similar to previous years, with 100 IDU participating in the 2006 IDRS. The median age of the sample was 37 years, with slightly more male (53%) than female participants. Over two-thirds (71%) of the sample were unemployed and just over half (52%) had a history of previous imprisonment. The median number of years spent at school was ten, but over half (60%) reported having some kind of post-secondary qualification (primarily a trade or technical qualification). Over half (52%) were currently undertaking some form of treatment for drug use, most commonly pharmacotherapy.
Patterns of drug use among IDU
The median age of first injection by the IDU sample was 18 years, and the drug most commonly first injected was amphetamine (49%), followed by heroin (39%). Heroin was nominated by nearly two thirds of the sample (63%) as the drug of choice, followed by methamphetamine (13%). However, methamphetamine remained the drug most commonly injected by IDU in the last month (by 31%), followed closely by heroin (by 28%) and morphine (by 21%). Therefore, in 2006 there was still a discrepancy between what people wanted to use and what they are using most, suggesting the current price, availability and quality of heroin, in particular, was impacting on frequency of use (see heroin section below).
Polydrug use was common among the IDU in 2006 and has remained consistently so across the years of the IDRS. Similar to 2005, in 2006 there was substantial crossover between heroin users and methamphetamine users in the IDU sample. Forty-two IDU (42%) had used both heroin and some form of methamphetamine in the last six months.
Frequency of injecting in the last month was greater than weekly for three-quarters of the sample (73%), with 32% reporting injecting at least once a day.
Heroin
The price of heroin remained stable in 2006, with the median price reported as $400 per gram by IDU. Heroin was still considered ‘easy’ or ‘very easy’ to obtain, while perception of heroin purity remained low among IDU, with two-thirds of IDU reporting the purity of heroin as low (65%). Unlike 2005, where there was an increase in the proportion of IDU obtaining heroin from a mobile dealer, in 2006 more IDU reported obtaining heroin at an agreed public location (49%), or by home delivery (30%).
The proportion of IDU who reported recent use of heroin remained stable compared to 2005 (at 60%). There was, however, a decrease in the frequency of use of heroin for the third year in a row (following the substantial rise in frequency seen in 2003) to a median 19 days. Heroin users continued to supplement or substitute their heroin use with other opioid substances such as morphine and methadone, and also methamphetamine.
Experience of recent heroin overdose among IDU in the sample remained low. Other available treatment services and hospital data indicate that, over the last few years, heroin-related numbers have been stable to decreasing, while other opioid numbers have been stable to increasing.
In general, it seems that despite the ease of availability of heroin for most IDU and the predominance of heroin as the drug of choice among this year’s sample, the continuing poor quality of heroin was reflected in decreased frequency of use among IDU in 2006. In addition, over the long-term, indicators (such as treatment services and hospital data, police offences and seizure data) suggest stability or decline in the heroin market, which has not returned to pre-shortage conditions in Adelaide.
Methamphetamine
In 2006, there was no increase in the median price paid per point of base methamphetamine, but the price per point for the powder form increased. The median price per gram decreased in 2006 for the powder form, with the base form remaining stable. All forms of methamphetamine were considered ‘easy’ or ‘very easy’ to obtain in 2006. There was a decrease in the proportion of IDU reporting that they usually obtained any form of methamphetamine from mobile dealers, with a subsequent increase in IDU reporting that they usually obtained any form of methamphetamine from a friend’s home or an agreed public location. The purity of the base form of methamphetamine, as perceived by IDU, had increased slightly and remained as high. However, the purity of the crystal form of methamphetamine, as perceived by IDU, had decreased slightly, though it remained medium to high. SAPOL data on clandestine laboratory detections suggest that local manufacture of methamphetamine was still a contributor to the SA methamphetamine market.
The proportion of IDU reporting recent use of any methamphetamine remained stable (78%), but the frequency of use of any methamphetamine decreased in 2006 (from a median of 30 days in 2005 to a median of 12 days in 2006). Decreased frequency of use was noted across all main forms of methamphetamine, particularly base, although this form remains the most used type of methamphetamine among IDU. There was an increase in the recent use of crystal methamphetamine (or ‘ice/crystal’) by smoking (16% of IDU in 2006, with 10% in 2005).
Calls to the Alcohol and Drug Information Service (ADIS) in SA regarding methamphetamine remained stable, as have the number of clients (with amphetamines as the primary drug of concern) to all DASSA services. However, the number of clients admitted to DASSA inpatient (detox) services with amphetamine as the primary drug of concern continued to decline, and in 2006 was at the lowest since 2001/2002. In contrast, state (SA) hospital admissions data showed the number of amphetamine-related admissions remained stable (as at 2004/05), though this data lags behind other indicators.
In general, an increase in the price of a point of methamphetamine powder and a decrease in the price of a gram of methamphetamine powder was noted in 2006, though availability and perceived purity remained relatively stable. Use of all forms among IDU decreased. These parameters, along with other indicator and key expert (KE) data, suggest that the methamphetamine market remains strong and generally stable in Adelaide, although, over the longer-term, frequency of use and problems with use seem to have declined somewhat compared to earlier years.
Cocaine
Similar to 2005, only a very small number of IDU were able to supply information regarding the price, purity or availability of cocaine, which was reflective of the relatively low numbers of IDU who had used cocaine in the last six months (a total of eight). In addition, although several KE were able to provide some information on cocaine, this was limited and none could nominate cocaine as their main area of expertise. Consequently, the data for price, purity and availability of cocaine in 2006 are again of limited value. In 2006, a decrease was seen in the number of IDU who reported recent use of cocaine (eight compared to 16 in 2005), but frequency of use decreased and remained low (at a median of two days in the last six months), and use of cocaine in general remained well below other illicit drug use among this sample.
The fact that only a small number of KE and IDU were able to provide information on cocaine use in itself indicates the lack of a sizeable and visible cocaine market in Adelaide, particularly amongst the IDU sampled by the IDRS. Indicator data – such as the number of cocaine possession and provision offences, calls to ADIS, DASSA treatment services data for cocaine, and SA hospital admissions data – also support this presumption. The possibility that a cocaine market exists beyond the scope of this survey should not be excluded, and readers are directed to the Ecstasy and Related Drugs System findings (formerly the PDI; Weekley, Pointer & Ali, 2005), which show a higher level of use and availability of cocaine among a sample of regular ecstasy users in Adelaide.
Cannabis
In 2006, the median price reported for cannabis was $200 an ounce for hydro, with the median price of bush decreasing slightly to $160 an ounce. The median price of a ‘bag’ remained stable at $25 for either ‘hydro’ (hydroponically grown) or bush (grown outdoors). With the exception of the decrease in price of an ounce of bush, the price of these quantities has remained stable for years. Both hydro and bush cannabis were considered ‘very easy’ or ‘easy’ to obtain, and most cannabis-using IDU reported scoring the cannabis from a friend. Most also perceived the potency of either hydro or bush as high or medium.
Cannabis, though generally not the drug of choice among the IDU sample, was used commonly (by 77%), and the percent of IDU who had recently used cannabis has been stable across all the years the IDRS has been conducted. However, frequency of use of cannabis again increased markedly in 2006 (to a median 180 days), after a decrease in 2005 where it had decreased to a median of 120 days following four years of stability (at a median 180 days). Almost all cannabis users reported they had used hydroponically grown cannabis in the last six months, with a large majority reporting they mostly used hydro. KE generally reported no changes in any parameter of the cannabis market, or use of cannabis among IDU.
The number of calls to ADIS concerning cannabis remained stable, but the total number of clients to DASSA treatment services increased; however, the numbers of clients attending inpatient detox services of DASSA decreased in 2005/06. Cannabis-related hospital admissions in SA remained stable in 2004/2005.
Overall, the cannabis market remains generally stable in Adelaide, and IDU use remains common, despite a decrease in reported recent use among the 2006 sample.
Other opioids
In 2006, as in recent years, the use of other opioid substances by IDU was common, with 90% reporting recent use of some type of opioid substance, excluding heroin. There were some changes, however, in the use of other opioids by IDU in the 2006 sample, as follows.
Morphine
In 2006, the prevalence of recent morphine use among IDU increased, and there was an increase in the frequency of use of morphine. The price of MS Contin – 100mg increased slightly in 2006, but the availability of morphine was unchanged compared to 2005. As in previous years, the majority of morphine users reported use by injecting, and mainly used illicit supplies of Kapanol and MS Contin.
Methadone and Buprenorphine
In 2006 there was a slight decrease in the proportion of IDU that reported recent use of illicit methadone syrup, while the proportion reporting use of illicit buprenorphine remained stable. The frequency of illicit use of both pharmacotherapy medications increased in 2006. The percentage of IDU reporting injecting of either licit or illicit methadone or buprenorphine remained stable compared to 2005, at approximately a quarter of recent users of these substances. While there was no change in the proportion of IDU reporting mainly using an illicit supply of buprenorphine, there was a small increase in the proportion of IDU reporting mainly using an illicit supply of methadone. It is worth noting, however, that the majority still report mainly licit (prescribed) use of these substances.
Oxycodone
In 2006, for the second year, IDU were asked about use of oxycodone specifically, and a small proportion of the sample (20%) reported illicit use of oxycodone at very low frequency. During this year, there was an increase in the proportion of IDU that had used illicit oxycodone in the last 6 months, and there was also an increase in the frequency of that use.
Other drugs
The proportion of IDU reporting recent use of ecstasy or hallucinogens decreased and frequency of use remained low in 2006.
There was a small increase overall in the percentage of IDU reporting recent use of benzodiazepines in 2006, and there was a dramatic increase in the frequency of use. The majority of benzodiazepine users reported mainly licit use, primarily of diazepam.
Antidepressant use decreased slightly in 2006 in terms of percentage reporting recent use, but the frequency of use increased. Almost exclusively licit use was reported, primarily of a selective serotonin re-uptake inhibitor (SSRI).
Associated harms
The high prevalence of sharing of injecting equipment (other than needles) first noted in 2004 decreased slightly in 2006, with 27% (from 39% in 2005) reporting having shared equipment such as tourniquets, water and spoons.
While the prevalence of injecting of methadone and buprenorphine remained stable compared to 2005, there were some increases seen with regard to injecting-related problems associated with these substances in 2006. In 2006, the number of IDU who reported recent injecting of morphine had more than doubled (from 18 to 40), however the reported experience of injecting related problems showed a four-fold increase (from 7 in 2005 to 28 in 2006). However, a third or more of injectors of morphine, methadone and buprenorphine still reported experiencing injecting-related problems in the month prior to interview, such as substance dependence, scarring and bruising, difficulty finding veins and abscesses or infections. Several KE commented that these problems were exacerbated by lack of IDU access and/or proper (single) use of filters and other injecting equipment, primarily due to financial constraints.
There were increases in the number of IDU reporting that they had attended a GP, a psychiatrist, a psychologist, or a counsellor in response to mental health issues in 2006. Depression and/or anxiety again predominated as the most commonly experienced mental health problem reported by IDU. KE reported mental health issues as generally stable in 2006, although, there was consensus by all KE, who were able to comment, that mental health problems had increased in frequency in the last year primarily with regard to methamphetamine users.
The number of IDU who reported they had become verbally aggressive following use (under the influence) of a drug in the preceding six months had increased from 2005 to 2006. Overall, a greater proportion of IDU reported becoming verbally aggressive (particularly during withdrawal), rather than physically aggressive following drug use or during drug withdrawal. Alcohol and methamphetamine (particularly base) were most commonly associated with physical or verbal aggression, though the number of IDU per drug type was small.
In 2006, the median expenditure on illicit drugs decreased overall compared to 2005, with IDU who used primarily heroin or methamphetamine spending equivalent amounts on average in 2006.
There was a decrease in the prevalence of criminal involvement reported by IDU, and of experience of arrest in the preceding 12 months, with drug dealing and property crime remaining the most common. Most IDU perceived that police activity was either stable or increasing and the majority reported that police activity had not made it more difficult to obtain drugs recently.
Implications
The findings from the 2006 SA IDRS have policy and research implications, and recommendations are outlined below. It is worth noting that several of these issues have already received attention and/or may be in the process of further investigation.
- Development of improved treatment protocols for methamphetamine use and dependence (underway at DASSA).
- Continued close monitoring of indicators of use of crystal methamphetamine (‘ice’/‘crystal’), which is known to have very high purity and subsequently increased risk of harm associated with its use.
- Monitoring and characterisation of changes in purity and chemical structure of amphetamine and methamphetamine seizures, through forensic analysis.
- Continued focus on reducing supply of amphetamine and methamphetamine from local clandestine laboratory manufacture.
- Development and implementation of strategies to reduce diversion of prescribed pharmaceuticals (morphine, methadone, buprenorphine, and other opioid analgesics).
- Development and implementation of strategies to reduce behaviour and harms associated with injecting of formulations not intended for injection, such as morphine, methadone and buprenorphine.
- Development and implementation of strategies to address issues associated with drug misuse and dependence and mental health co-morbidity (particularly effective concurrent treatment).
- Given the increase in use of benzodiazepines, development and implementation of strategies to reduce illicit use of prescribed pharmaceuticals.
Citation: White, N., Vial, R. & Ali, R. (2007) SA Drug Trends: Findings from the Illicit Drug Reporting System (IDRS), Sydney: National Drug and Alcohol Research Centre.