EXECUTIVE SUMMARY
The Ecstasy and Related Drugs Reporting System (EDRS, formerly the Party Drugs Initiative, or PDI) arose out of the Illicit Drug Reporting System (IDRS). The EDRS is a study that acts as a strategic early warning system for trends and issues emerging from illicit drug markets in Australia. The data collected examines the price, purity and availability of four primary illicit drug classes – ecstasy, methamphetamine, cocaine and cannabis as well as niche market drugs such as GHB and LSD – and are used to supplement other data, such as key expert (KE) reports and indicator data, thus providing a multifaceted approach to the task of monitoring the Australian ecstasy and related drug (ERD) market. Regular ecstasy users (REU) have been identified as a sentinel group of ERD users and are able to provide the required information on patterns of use, market characteristics, related harms and other issues associated with ERD use. KE include nightclub owners, treatment providers and law enforcement personnel.
Demographic characteristics of REU
In 2012 two-thirds of the REU interviewed for the ACT EDRS were male (71%) and, similar to last year, most participants were aged between their late teens to early twenties. Consistent with previous years, the majority of REU interviewed were from an English-speaking background (ESB), and predominantly heterosexual. The majority of the sample had completed 11 years of schooling, and at the time of interview the majority of REU were either studying at a tertiary level or employed full-time. A minority of the sample reported currently accessing a drug treatment facility. KE reports are generally consistent with REU demographics.
Patterns of drug use among REU
In 2012 there was a significant increase in the number of REU who reported ever injecting any drug, 28% in 2012 and 9% in 2011. In 2012, the proportion of REU reporting ecstasy as their drug of choice increased in relation to 2011. There was a decrease in the proportion of participants reporting cocaine as their drug of choice, compared to 2011. Polydrug use was commonly reported by REU, consistent with KE interviews.
Forty-five percent of the sample reported having ‘binged’ (used continuously for 48 hours or more) on ecstasy and other drugs in the six months prior to interview, similar to 2011. Other drugs commonly used in these binge episodes were alcohol, cannabis, methamphetamine powder, LSD, cocaine and mushrooms.
Ecstasy
Ecstasy pills were the most commonly used form of ecstasy by REU. Increasing proportions of the sample reported having used ecstasy capsules in the past six months (61%) and ecstasy powder (35%). In the six months prior to interview, the median number of days of any form of ecstasy use was 19. Two-thirds (67%) of the sample reported using ecstasy on a fortnightly to weekly basis in the past six months, 12% of the sample reported using ecstasy on a monthly basis, with a further 14% reporting greater than weekly use. The median number of ecstasy tablets consumed in a typical session of use was two, whereas a median of five tablets were taken by REU in the heaviest session of use.
Price, purity and availability of ecstasy
The median reported price for a tablet of ecstasy remained stable at $25. The reported current purity of ecstasy was varied with equal proportions reporting medium and high (both 26%). Thirty-one percent of the sample reported purity of ecstasy to be low. There was a significant decrease in the proportion of REU reporting purity to be high compared to 2011 (p<0.001). There was also a corresponding increase (28% in 2012, compared to 10% in 2011) in the proportion of respondents reporting purity had decreased in the past six months.
With respect to availability, the majority of the sample reported that ecstasy was very easy to easy to obtain in the ACT.
Ecstasy markets and patterns of purchasing
In the six months prior to interview, REU had purchased ecstasy from a median of three people. Participants indicated that when purchasing ecstasy they typically bought it for themselves and others, and they typically purchased a median of five pills on each purchase occasion.
Methamphetamine
Methamphetamine is available in three forms: methamphetamine powder (speed), methamphetamine base (base) and methamphetamine crystal (crystal). Almost three-quarters (73%) of REU reported having used at least one form of methamphetamine in the past six months which is a significant increase from 51% in 2011 (p<0.05).
The majority (82%) of participants reported ever having used speed and 63% reported having recently used speed. Recent speed users reported a median of ten days of use in the six months prior to interview. Swallowing and snorting were the main routes of administration (ROA) reported by recent speed users. The amount of speed used by REU in a typical session was 0.5 grams and one gram in the heaviest episode of recent speed use. Speed was used during binges by more than half (53%) of the REU who reported recently having binged on ERD.
Base methamphetamine had been used by 37% of REU at least once, with 28% of the 2012 sample reporting having used base in the previous six months, this was a significant increase from 10% in 2011 (p<0.05). A median of three and a half days of use in the six months prior to interview was reported (range=1-20). Swallowing was the most common (86%) ROA reported by base users.
Crystal methamphetamine had been used by almost two-thirds (66%) of the sample and by 50% of the sample in the past six months. This is a significant increase across both groups lifetime use increased from 23% in 2011 (p<0.001) and recent use increased from 9% in 2011 (p<0.001). Recent crystal users reported a median of five days (range=1-48) of crystal use in the past six months.
Methamphetamine price, purity and availability
In 2012, the median price for speed remained stable at $200 per gram and $40 per point. Small numbers of REU were able to comment (n<10) on the price of base the median price for a point of base was $50 and $250 for a gram. The median price for a point of crystal increased from $80 in 2011 to $100 in 2012. Reports of the purity of speed varied whilst crystal was reported to be of high purity. Only small numbers were able to comment on the purity of base, with most comments reporting purity to be high. The availability of speed and crystal was reported to be very easy to easy and reports of the availability of base varied. Small numbers were able to comment on the purity of base.
Cocaine
Seventy-eight percent of the 2012 EDRS sample had ever tried cocaine, and 37% of the sample reported using cocaine in the previous six months (a decrease from 43% in 2011). Those REU who had recently used cocaine had used the substance on a median of four days in the preceding six months. Snorting remained the most common ROA, followed by swallowing. The median amount of cocaine used in a typical episode of use was one gram - the same amount reported when referring to the heaviest episode of use.
The median price for a gram of cocaine remained stable in 2012 at $300. Reports of purity were varied as were reports of cocaine availability.
LSD
More than four-fifths (86%) of the 2012 EDRS sample reported lifetime use of LSD, with 38% reporting recent use. LSD was used on a median of five days in the preceding six months. REU had used a median of one tab of LSD in a typical session and two tabs during the heaviest sessions of recent use. One-fifth (22%) of participants who reported having recently binged on ERD had used LSD during these binge episodes.
The median price for a tab of LSD remained stable at $20. Reports of purity of LSD were varied as were reports of the current availability of LSD.
Cannabis
Lifetime cannabis use was universal among REU and 92% had used cannabis in the six months preceding interview. Median days of use increased to approximately five times per week (from twice per week in 2011). Thirty-six percent of respondents reported daily use of cannabis. Smoking was almost universal, and a third reported that they had swallowed cannabis in the preceding six months. Three-quarters (70%) of those who reported that they had binged in the preceding six months reported that they had used cannabis.
The median price for a gram and an ounce of hydroponic cannabis was $20 and $280 respectively, and the median price for a gram and an ounce of bush cannabis was $20 and $240 respectively. The majority reported that the prices for both forms had remained stable in the six months preceding interview. The current potency of hydroponic cannabis was reported to be medium to high, while current potency for bush was varied. Both hydroponic and bush cannabis were reported to be very easy to easy to obtain, similar to 2011.
Emerging psychoactive substances (EPS)
Participant numbers reporting use of emerging psychoactive substances were low and caution is advised in interpreting this data.
Drugs in the 2C-family had significant increases reported in lifetime use and recent use however numbers reporting use remained low. There were also increases in the lifetime and recent use of methylone although very small numbers were reported also. For more information regarding these drugs see Bruno et al (in press) 'Emerging psychoactive substance use among regular ecstasy users in Australia'. Drug and Alcohol Dependence: http://www.sciencedirect.com/science/article/pii/S0376871611005205
Patterns of other drug use
Almost the entire sample had used alcohol in the six months prior to interview. Alcohol was consumed on a median of one day per week. Fourteen percent of respondents reported that alcohol was their drug of choice. The use of tobacco was also common in the EDRS population, with 92% reporting recent use of tobacco. Recent use of the following substances was also commonly reported: mushrooms (45%), benzodiazepines (24%), nitrous oxide (24%), amyl nitrate (20%), and ketamine (14%).
Health-related issues
Overdose
Over one-third (36%) of all REU indicated that they had overdosed on a stimulant drug in their lifetime, of those, 90% had done so in the past 12 months. Recent overdoses (last 12 months) were most commonly attributed to ecstasy. The majority reported that they received no treatment for their overdose. Slightly more (39%) reported that they had ever suffered a depressant overdose, of which 87% had done so in the past 12 months. Recent overdoses were most commonly attributed to alcohol (84%). The majority reported that they received no treatment for their overdose.
Drug-related problems
Almost half (48%) of the sample reported that they had experienced risk-related problems as a result of their drug use. Thirty-two percent reported that they had experienced responsibility-related problems and 18% of the sample reported they had experienced reccurring relationship/social problems due to drug use. Six percent reported experiencing legal problems as a result of their drug use. The main drugs that were nominated as the most common drugs that problems were attributable to were cannabis, alcohol and ecstasy.
Mental health
Forty-two percent of participants reported that they had experienced a mental health problem in the preceding six months. Depression and anxiety were the most commonly reported.
Thirty-two percent of respondents were classified as currently experiencing high or very high distress on the Kessler Psychological Distress Scale.
Risk behaviour
Injecting
Twenty-eight percent of REU reported ever having injected a drug and the median age of first injection was 19. No recent injectors reported using needles after someone else in the past six months; however, four participants reported using equipment such as spoons/mixing containers, water and tourniquets after someone in the preceding six months.
Blood-borne viral infections
In 2011, EDRS participants were asked about vaccination, testing and diagnosis of blood-borne viral infections. Of those that responded, more than half indicated that they had been vaccinated for Hepatits B (most commonly vaccinated as a child) and 1 in 20 vaccinated due to travelling overseas. Half of REU reported being tested for Hepatitis C in the past 12 months and similar proportion reported being tested for HIV. A third had never had a sexual health checkup and 16% of REU indicated that they had received a positive diagnosis for any sexually transmitted infection.
Sexual behaviour
The majority (67%) of REU reported having had casual penetrative sex in the six months prior to interview. When having sex with a casual sex partner whilst not under the influence of alcohol or drugs, 47% reported not using protection on their last occasion of casual sex. Of those who reported having casual penetrative sex in the past six months whilst under the influence of ERD 40% reported using protection on their last occasion of casual sex.
Driving
Of those REU who indicated they had driven a car in the past six months, half reported that they had done so while under the influence of alcohol and over half of those reported that they had driven whilst over the legal blood alcohol limit. Of those participants who had driven a car in the previous six months, 79% reported driving after taking an illicit drug with a median of 2 hours since taking an illicit drug and driving.
Alcohol use
Using the AUDIT, 71% of respondents scored eight or above, indicating alcohol intake that is possibly hazardous. Less than one in ten respondents scored in Zone 4 of the AUDIT, indicating the need for evaluation for possible alcohol dependence.
Criminal activity, policing and market changes
Forty-seven percent of the sample reported engaging in some form of criminal activity in the month prior to interview. Drug dealing was the most common crime reported; followed by engagement in property crime. Small proportions reported engaging in violent crime.
Key findings and implications
In 2012, for the tenth consecutive year, the Australian Capital Territory (ACT) Ecstasy and Related Drugs Reporting System (EDRS) provides an opportunity to examine trends within the ACT through interviews with a sentinel group of people who regularly use ecstasy or ‘regular ecstasy users’ (REU), interviews with key experts (KE), and the collation of indicator data. This is done with the aim of informing further research and contributing to the evidence base from which policy decisions can be made. The continued monitoring of ecstasy and related drug markets within the ACT for changes in the price, purity, availability, use patterns and issues associated with drug use will add to our understanding of drug markets and our ability to inform policies to minimise harms. The findings of the 2012 ACT EDRS indicate that further attention is required in the following areas:
i) Polydrug use
As in previous years, the majority of ACT EDRS participants in 2012 were polydrug users. Ninety-four percent of participants reported that the last time they used ecstasy they had used other drugs in combination with ecstasy. The drugs most commonly used in combination with ecstasy by REU were tobacco, alcohol, cannabis and speed. Polydrug use can increase or alter adverse effects in ways that are often unpredictable and problems relating to intoxication may be enhanced due to the drug interactions arising from polydrug use. Treatment approaches and harm reduction interventions need to take this into account, especially in relation to the effects of drugs, safer use, withdrawal and overdose risk.
ii) Ecstasy
There has been a significant increase in the proportion of participants reporting recent use of ecstasy capsules, increasing from a third in 2011 to two-thirds in 2012. This increase in capsule use has not seen a corresponding decrease in any other forms, suggesting that REU are using diverse forms rather than changing their preferred form. KE also commented on the appearance of ecstasy crystals and although only small numbers reported ecstasy crystals being used, this is a form that has previously not been seen in the ACT. Despite the diversification of forms used, there was no reported change in frequency or level of ecstasy use compared to 2011.
iii) Alcohol
The use of alcohol remains high and problematic amongst REU, with use occurring once to twice a week. Furthermore, high proportions of REU report using alcohol during binge sessions. In the 2012 EDRS, REU were administered the Alcohol Use Disorders Identification Test (AUDIT). Using this measure, 8% of respondents scored in Zone 4 of the AUDIT, indicating the need for evaluation for possible alcohol dependence. KE also reported that alcohol use was common amongst REU and that binge drinking was frequent.
Alcohol was one of the main drugs associated with recurring social and relationship problems, legal problems and increased exposure to risky situations. While it is important to focus on the risks associated with illicit drug use, the excessive use of alcohol is of great concern amongst this group, as this type of polydrug use carries a high level of risk.
iv) Cannabis
The use of cannabis also remains high and problematic. The median frequency of use increased in 2012 to approximately five days a week. In 2012 there was also an increase in the proportion of participants reporting cannabis to be their drug of choice, so that cannabis was the most commonly reported drug of choice equal with ecstasy. As in previous years, cannabis was commonly reported as a drug associated with recurring social and relationship problems, legal problems, increased exposure to risky situations and recurring problems associated with lack of responsibility at home, work or study. Efforts to target users with information concerning harms associated with its use, including dependence and comorbid mental health problems, remain important.
v) Other drugs
In 2012 there was an increase in the proportion of participants reporting lifetime use and recent use of methamphetamines, notably a significant increase in the proportion reporting lifetime and recent use of crystal methamphetamine. The popularity of these drugs has experienced a downward trend over recent years and future monitoring of the use of these drugs is necessary to identify and confirm changes in market dynamics.