NDARC Technical Report No. 269
EXECUTIVE SUMMARY
Demographic characteristics of injecting drug users (IDU)
In 2006, one hundred injecting drug users (IDU) were interviewed for the IDRS in the ACT. The demographic characteristics of the 2006 IDU sample were very similar to those interviewed in 2005. The majority of IDU interviewed for the IDRS study were male (74%). On average respondents were aged 36 years, ranging from 17 to 53 years. In terms of education, IDU had completed an average of 10 formal school years, 23% of respondents had trade or technical qualifications, and 12% reported having university or other tertiary qualifications. Forty-eight percent had a previous prison history. Half (50%) of the 2006 IDU respondents reported currently participating in some form of drug treatment. The most common form of drug treatment, among IDU in the 2006 ACT sample, was opioid maintenance treatment with 72% of those in treatment engaged in methadone maintenance treatment and 22% in buprenorphine maintenance treatment.
Patterns of drug use among IDU
In terms of the injection history of IDU respondents, the mean age of first injection was 18 years. Heroin or methamphetamine (speed, base or crystal) were the drugs first injected by the majority of the 2006 IDU sample. Heroin was the drug of choice for the majority of respondents (46%), followed by methamphetamine (34%) and cannabis (9%). The drugs injected most often by IDU in the month preceding the interview were crystal methamphetamine (‘crystal’ 33%) and heroin (33%). Crystal was the last drug injected by 32% of respondents, followed by heroin (30%).
IDU reporting daily or more frequent drug injection in the month preceding the IDRS survey remained stable from 29% in 2005 to 32% in 2006. However, younger IDU respondents aged 25 years or less were more likely to inject on a daily or more basis (42%) than IDU respondents aged over 25 (31%).
Polydrug use was universal amongst the 2006 IDU sample. The majority (50%) reported that they had used four of the following five drugs; cannabis, heroin, methamphetamine, cocaine and other opioids (i.e. illicit oxycodone, morphine, methadone and/or buprenorphine), in the six months preceding interview. This was consistent with reports from KE who stated that many IDU were polydrug users and it was very unlikely for an IDU to be using only one drug.
Heroin
A summary of heroin use, price, purity and availability is presented in Table 1. The proportion of IDU reporting use of heroin in the six months preceding the interview markedly decreased in 2006 (86% in 2005 to 71% in 2006). In terms of the frequency of use, heroin use patterns varied from less than monthly to daily use. In the six months preceding the interview, the median days of heroin use was 24 (range 1-180, approximately once a week); this was down from a median of 60 days (approximately 2.5 days a week) in 2005. In terms of the frequency of heroin injection, 25% of recent heroin users had injected on a monthly or less basis, 30% had injected heroin on a more than monthly to a weekly basis, 38% had injected heroin weekly to less than daily, and 7% injected on a daily basis.
The median price of heroin remained relatively stable in 2006. The reported price for a cap of heroin remained stable from 2005 to 2006 at $50; the reported price for a gram of heroin increased slightly from $300 in 2005 to $340 in 2006. IDU respondents reported heroin to be ‘very easy’ (36%) to ‘easy’ (30%) to obtain in the ACT. In 2006, IDU perceived the purity of heroin to be currently low (60%).
Just under a half of IDU sample (47%) reported ever having used home-bake heroin and a minority (13%) reported the recent use of home-bake heroin. Among the IDU who had recently used home-bake heroin, the frequency of use was low, with a median of ten days of use in the six months prior to the interview. All of those who had recently used home-bake had injected it.
KE reports were consistent with the reports of IDU. They reported that the use of heroin in the ACT by IDU had decreased, possibly due to heroin becoming more difficult to obtain. Furthermore, indicator data, such as ambulance call-outs and the number in treatment due to heroin, has also declined; again, this is consistent with the decline in use reported by IDU.
Methamphetamine
The IDRS IDU survey collects data on three different forms of methamphetamine: methamphetamine powder (‘speed’), methamphetamine base (‘base’) and crystal methamphetamine (‘crystal’). In 2006, ninety-two percent of the ACT IDU sample reported the recent use of some form of methamphetamine. A summary of findings for each form of methamphetamine is presented below.
Over half (58%) of the sample reported the recent use of speed, similar to the proportion of IDU who had used speed in 2005 (59%). The majority of recent speed users used this substance infrequently in the six months prior to the interview, with a median of ten days of use reported during this period. Three percent reported daily use of speed. Injection was the most common route of administration, with 57% of IDU having injected speed in the six months preceding the interview. The reported price for a point of speed remained stable from 2005 to 2006 at $50 and the reported price for a gram of speed increased from $125 per gram, in 2005, to $175 per gram in 2006. IDU respondents reported speed to be ‘easy’ (53%) to ‘very easy’ (32%) to obtain in the ACT. In 2006, IDU perceived the purity of speed to be currently ‘low’ (37%) to ‘medium’ (27%).
Methamphetamine base was the form of methamphetamine used least by the 2006 IDU sample, with only 32% of IDU reporting recent use. Base users used this substance infrequently, with a median of 4.5 days of use in the six months preceding the interview, with only 1% reporting daily use. As was the case with speed, injection was the most common form of administration, with 32% of the IDU sample reporting recent base injection. The reported price for a point of base remained stable from 2005 to 2006 at $50 and the reported price for a gram of base decreased from $280 in 2005, to $250 in 2006. IDU respondents reported that base was ‘easy’ (41%) to ‘very easy’ (27%) to obtain in the ACT. In 2006, there were mixed reports from IDU regarding the current purity of base, 36% reported it to be ‘low’, and equal proportions (23%) reported it to be ‘medium’ or ‘high’, however, this was based on small numbers (n=6) so results must be interpreted with caution.
In 2006, there was a marked increase in the proportion of IDU reporting recent use of crystal, from 62% in 2005, to 88% in 2006. Crystal was the most common drug used among the IDU sample in 2006. However, use remained infrequent, on average, with recent crystal users reporting a median of 15.5 days of use in the six months prior to the interview. Twelve percent of the sample reported daily use of crystal. There was an expected increase in the proportion of the IDU sample reporting recent crystal injection from 62% in 2005 to 88% in 2006. The median price for a point of crystal remained stable in 2006 at $50. The price for a gram increased from $300 in 2005, to $410 in 2006. IDU respondents reported crystal to be ‘very easy’ (50%) to ‘easy’ (42%) to obtain in the ACT. In 2006, IDU perceived the purity of crystal to be currently ‘medium’ (27%) to ‘high’ (43%).
KE reports are consistent with the reports by IDU in the 2006 IDRS. Whilst, the use of speed and base has remained relatively stable, there has been an increase in the use of crystal methamphetamine (crystal). KE reported that many previous heroin users have begun to use crystal, since heroin is not as easy to obtain. However, the number of clients undergoing withdrawal from methamphetamine has continued to decrease since 2004, and this is inconsistent with an increase in use reported by IDU. However, consistent with IDU reports, there has been an increase in the number of hospital admissions where amphetamine was implicated as the primary diagnosis.
Cocaine
Cocaine was used by 8% of the IDU sample in the six months preceding the interview, down from 20% in 2005. Among those who had recently used cocaine in the ACT, the frequency of cocaine use was low, with a median of three days of use in the six months prior to the interview (range=1-30). Among the IDU who reported recent cocaine use, the most common routes of administration were injection and snorting. There was a decrease in the proportion of IDU who reported recent cocaine injection from 17% in 2005 to 6% in 2006. A small number (n=6) of IDU commented on the price, purity and availability of cocaine in the ACT in 2006, with the majority reporting that cocaine is ‘difficult’ (67%) to ‘very difficult’ (33%) to obtain in the ACT. The median price for cocaine, in 2006, was reported to be $50 for a cap. No IDU were able to comment on the price for a gram of cocaine in 2006. IDU reports were mixed regarding the current purity of cocaine in the ACT, with 33% reporting it be ‘high’, and equal proportions (17%) reporting it to be ‘medium’ or ‘low’, this may be due to the low number of respondents who were able to answer.
Consistent with IDU, KE reported that cocaine use by IDU in the ACT was relatively low and infrequent.
Cannabis
Cannabis use was widespread and frequent amongst the IDU sample in 2006; this was consistent with reports from KE. Ninety-eight percent of the IDU sample had ever tried cannabis and ninety percent had used cannabis in the six months prior to the interview, consistent with the 2005 sample. The majority of the IDU sample used cannabis frequently in the six months preceding the interview with a median of 180 days of use. IDU commented on the price, purity and availability of two different forms of cannabis: outdoor-cultivated cannabis (‘bush’) and indoor-cultivated cannabis (hydroponic), as can be seen in Table 1. The median reported price of a gram of hydroponic cannabis remained stable from 2005 to 2006 at $20, but decreased from $20 in 2005, to $15 in 2006 for bush cannabis. The median price of an ounce of bush cannabis in 2005 was reported by IDU to be $190, while the median price for an ounce of hydroponic cannabis was $300. The majority of IDU perceived both bush and hydroponic cannabis to be ‘easy’ (52% and 54% respectively), with a further 42% reporting that hydroponic was ‘very easy’ to obtain. IDU also reported that availability had remained stable in the six months preceding the interview. IDU commenting on the potency of bush cannabis believed it to be ‘medium’ (57%) and hydroponic cannabis to be ‘high’ (59%). As has been the case in previous years, hydroponic cannabis remains the dominant form of cannabis on the market in the ACT.
Use of illicit methadone
‘Illicit’ methadone use is used in this report to refer to the use of methadone that was prescribed for someone else. The use of diverted methadone among the ACT IDU sample in 2006 was similar to levels reported in the previous year. Approximately one-third (38%) reported recent use, a slight increase from 30% in 2005. Among those who had recently used in the ACT, the frequency of illicit methadone use was very low with a median of five days (approximately, just under once a month) of use in the previous six months. Injecting (90%) and swallowing (34%) were the most common routes of illicit methadone administration.
In 2006, a small proportion of the IDU sample (17%) reported diverting licit methadone for injection (i.e. injecting their own prescribed oral methadone preparation). In the six months preceding the interview, the median number of days, among those who had injected licit methadone was twenty-four days (approximately once a week).
Use of illicit buprenorphine
‘Illicit buprenorphine’ refers to the use of buprenorphine that is prescribed to someone else. The use of diverted buprenorphine among the ACT IDU sample increased from the previous year. There was an increase in the proportion of IDU reporting they had ever used illicit buprenorphine, from 23% in 2005 to 42% in 2006. There was also a corresponding increase in the proportion of IDU who had used illicit buprenorphine in the six months prior to the interview, from 15% in 2005 to 34% in 2006. The majority of IDU used illicit buprenorphine infrequently, with a median of six days (approximately once a month) of use in the six months prior to the interview. Injection (27%), followed by swallowing (10%), were the most common routes of diverted illicit buprenorphine use among the 2006 sample. In 2006, a small proportion of the IDU sample (10%) reported diverting their licit oral buprenorphine via injection. In the six months preceding the interview, the median number of days IDU diverted buprenorphine that was prescribed to them via injection was seven (approximately just over once a month).
Morphine
In the 2006 IDRS survey, IDU were asked about licit and illicit forms of morphine. Use of illicit morphine refers to the use of morphine that is prescribed to someone else. Eighty-two percent of IDU, in 2006, reported that they had used illicit morphine at least once in their life. Fifty-two percent reported using illicit morphine in the preceding six months. The main route of administration for illicit morphine was injection (48%). IDU reported injecting illicit morphine on a median of 4.5 days (approximately once every one and a half months) in the preceding six months. This indicates that use of illicit morphine remains low and sporadic. Eight percent of IDU reported that they had used licit morphine in the preceding six months. Four percent reported the recent injection of their morphine. Median days injected licit morphine was reported to be 13.5 days (approximately once a fortnight), in the preceding six months.
Other opioids
In 2006, thirty-one percent of IDU reported lifetime use of illicit oxycodone. Use of illicit oxycodone refers to the use of oxycodone that is prescribed to someone else. Twenty-two percent reported the recent use of illicit oxycodone, with 14% reporting injecting illicit oxycodone, and 9% reported that they had swallowed illicit oxycodone. Median days injected illicit oxycodone remained low, at 2.5 days (approximately once every two months). Six percent of IDU reported the recent use of licit oxycodone, with half (3%) reporting injection of their oxycodone. Again, median days injected remained low and infrequent at 10 days (approximately just under two days a month) in the preceding six months.
The use of ‘other opioids’ such as codeine by IDU in the ACT was low with 14% reporting lifetime use of ‘other opioids’ and 8% reporting the recent use of ‘other opioids’. The main route of administration was swallowing (8%), and median days of use was low at 8 (approximately just over once a month) in the preceding six months.
Patterns of other drug use
Benzodiazepine use remained high among the IDU sample in 2006. Approximately two-thirds (60%) reported using benzodiazepines in the six months preceding interview. The frequency of benzodiazepine use increased from a median of 31 days (approximately 1.5 days a week) of use in 2005 to a median of 60 days (approximately 2.5 days a week) of use in 2006. Recent benzodiazepine users reported swallowing as the primary route of administration; however, experimenting with injecting and smoking were also reported.
IDU were asked to comment about their use of pharmaceutical stimulants (or prescription amphetamines). This included drugs such as dexamphetamine and methylphenidate, which are medications most commonly prescribed for Attention Deficit Hyperactivity Disorder (ADHD) and flu symptoms. Approximately one-quarter (35%) of the IDU sample reported the recent use of illicit pharmaceutical stimulants, with injection followed by swallowing being the main routes of administration. Median days used illicit pharmaceutical stimulants was 35 days (approximately 1.5 days a week) in the preceding six months. Three percent of IDU reported the use of licit pharmaceutical stimulants in the preceding six months. All (3%) reported that they had injected their pharmaceutical stimulants and 2% reported swallowing them. Therefore, the majority of recent pharmaceutical stimulant users are using pharmaceutical stimulants that are prescribed to someone else.
Alcohol was used by over two-thirds (68%) of the IDU sample in the ACT in 2006. Recent alcohol users reported a median of 68 days (approximately 2.5 days a week) of use in the six months prior to the interview. The majority of IDU (100%) reported the recent use of tobacco, with 99% of those who reported use of tobacco in the six months prior to the interview being daily smokers.
Associated harms
In 2006, IDU were asked questions regarding blood-borne viral infection (BBVI) testing. The majority of IDU had been tested for hepatitis B virus (HBV), C virus (HCV) and human immunodeficiency virus (HIV) in the twelve months preceding interview. While the majority reported that they were HBV and HIV negative, the majority reported that they were HCV positive. Reasons IDU gave for being tested recently (in the preceding 12 months) included; due to a matter of routine, seemed a responsible thing to do, or they were monitoring an existing infection. Of those IDU who had not been recently tested (in the last 12 months) the most common reasons were; never shared needles, they were already positive, they had been vaccinated against HBV or they just never got around to doing it.
In 2006, levels of injection-related risk-taking behaviour remained sufficiently high to warrant concern. The reported rate of ‘borrowing’ used needles among IDU remained relatively stable at 9% in 2005, to 6% in 2006. The proportion of IDU reporting that they had lent needles remained stable at 19% for 2005 and 2006. The proportion of IDU that reported sharing injecting equipment (e.g. spoons, mixing containers, water and swabs) remained relatively stable at 38% in 2005, to 35% in 2006. Given the implication of this for the transmission of HCV, and the high proportion of IDU who reported that they were HCV positive, the sharing of injecting equipment remains a concern.
Almost a half (48%) of the sample reported that they had experienced at least one injection-related problem in the month prior to interview. This figure is comparable to 61% of the sample in 2005, a marked decrease. In 2006, the most commonly reported difficulties were scarring/bruising and difficulty injecting.
In 2006, IDU were asked about driving while under the influence of drugs. Over four-fifths (88%) of the IDU who had driven in the preceding six months had driven under the influence of drugs. IDU most commonly reported driving while under the influence of; cannabis, heroin, crystal and methadone.
In the 2006 IDRS IDU sample, 34% reported recently experiencing mental health problems, other than drug dependence, in the six months preceding the interview, similar to 37% in 2005. Despite this, only 19% of IDU, in the 2006 sample, reported seeing a mental health professional during this period. IDU respondents most commonly sought help from health professionals for depression and schizophrenia. IDU were most likely to attend a GP, psychiatrist or a psychologist for help with mental health problems.
In 2006, just over one-third (38%) of IDU reported engaging in at least one criminal activity in the month prior to the interview, similar to 41% in 2005. The most common crime committed, as reported by IDU in the month prior to interview, was involvement in drug dealing. The proportion of IDU who reported being arrested in the last year remained increased from 36% in 2005 to 46% in 2006. The majority of the sample perceived police activity towards IDU in the ACT was ‘stable’ to ‘increasing’. However, the majority of IDU reported that recent police activity had not made it more difficult for them to score drugs in the six months preceding the interview.
Implications
- Consistent with the previous three years, there has been a decrease in the prevalence and frequency of heroin use. IDU in 2006 reported that heroin was ‘less easy’ to obtain and the majority reported heroin purity as being ‘low’. This trend needs to be monitored to see if it is indicative of a permanent change in the patterns of heroin use by IDU in the ACT. However, it is important to note that many of the IDU interviewed for the IDRS reported a long history of heroin use, and continued demand for heroin treatment is likely to exist. Further, should availability of the drug return, it may be the case that use increases among this group.
- The continuing high levels of methamphetamine use by IDU in the ACT is expected to be associated with a corresponding rise in problems associated with the use of methamphetamine, such as psychosis, methamphetamine dependence, paranoia, cardiac difficulties, and aggressive behaviour (Degenhardt and Topp, 2003). Consequently, health and law enforcement professionals who work regularly with drug-using populations may need to develop and implement strategies for dealing with individuals who are agitated and aggressive due to methamphetamine intoxication. Moreover, there is likely to be an increase in demand for treatment services as people seek help for problems associated with the consequences of methamphetamine use.
- In 2006, IDU were asked about drug driving. Findings indicated that approximately one-third of the IDU sample had recently driven soon after (within one hour) of taking illicit drugs. The most common drugs taken by IDU before driving in the six months preceding the interview were cannabis, heroin, methamphetamine (specifically speed and crystal), and methadone. Use of drugs in combination with alcohol and polydrug use is associated with increased driving impairment and risk of driving accidents (Kelly et al., 2002). Increasing the awareness of risks associated with drug driving is important among IDU populations.
- Levels of injection-related risk-taking behaviour remain sufficiently high to warrant concern. Although the proportion of IDU in the ACT reporting lending and borrowing needles remains low, approximately one-third of the 2006 sample reporting sharing injecting equipment (e.g. spoons, mixing containers, water and swabs). Given the implication of this for the transmission of HCV, and findings from the IDRS in 2006 that the majority of IDU were HCV positive, the sharing of injecting equipment is of concern. Increasing awareness of the harms associated with sharing injecting equipment other than needles is important.
Citation: Campbell, G. & Degenhardt, L. (2007). ACT Drug Trends 2006: Findings from the Illicit Drug Reporting System (IDRS). Sydney: National Drug and Alcohol Research Centre.