Key findings from the 2011 IDRS
The Illicit Drug Reporting System (IDRS) is intended to serve as a monitoring system, identifying emerging trends of local and national concern in illicit drug markets. The IDRS consists of three components: interviews with a sentinel group of people who regularly inject drugs (PWID1) conducted in the capital cities of Australia; interviews with key experts (KE), professionals who have regular contact with illicit drug users through their work; and analysis and examination of indicator data sources related to illicit drugs. Australian Drug Trends 2011 draws largely on the PWID participant survey and indicator data components of the IDRS, while KE are relied upon to provide contextual information within jurisdictions. As such, this information is reported more fully in the individual state/territory reports, to which the reader is also referred.
Demographics of the participant sample
Eight hundred and sixty eight participants were recruited to the 2011 IDRS participant survey component. The mean age of the national sample was 38 years (range 17-65) and 66% were male. The vast majority of the sample spoke English as their main language at home (96%), and 14% identified as being of Aboriginal and/or Torres Strait Islander descent. More than three-quarters (79%) of the sample were currently unemployed, over half (55%) reported a previous prison history and nearly half (49%) were in current treatment, mainly methadone.
Consumption pattern results
Current drug use
- The mean age of first injection was 20 years. Of the national sample, 52% reported that an amphetamine (including methamphetamine) was the first drug injected, followed by heroin (39%).
- Heroin was nominated by approximately half (53%) of the national sample as their drug of choice, followed by methamphetamine, morphine and cannabis.
- The drug injected most often in the last month broadly followed the same pattern. Forty-two percent of the national sample reported injecting heroin most often in the last month, followed by methamphetamine. Nearly half (42%) of the participants in the national sample reported daily injecting.
Heroin use was reported as the main drug of choice among participants. Around two-thirds (62%) of the sample reported using heroin in the last six months on a median of 72 days. Twenty-four percent of recent heroin users reported daily heroin use. Nearly all of the recent heroin users injected. Small numbers reported using homebake heroin recently. The majority of recent heroin users reported mainly using ‘white/off-white’ coloured heroin compared to ‘brown’ heroin.
The IDRS distinguishes between methamphetamine powder (‘speed’), methamphetamine base, and crystal methamphetamine (‘ice’ or ‘crystal’).
Around two-thirds (66%) of the national sample reported using one or more forms of methamphetamine recently on a median of 19 days. Recent speed and base use remained fairly stable, while the recent use of ice/crystal was significantly higher than the previous year. Ice/crystal was the form mainly used by the sample, followed by speed. Small numbers reported using any form of methamphetamine daily.
The recent use of cocaine remained most common among participants in NSW (47%), with proportions elsewhere reporting use in the preceding six months remaining at less than 17%. The frequency of cocaine use among users remained low and sporadic in all jurisdictions except NSW. Nationally, the frequency of cocaine use was a median of 5 days (10 days in NSW).
The majority of participants in the national sample reported recent cannabis use. Daily use was common. Smoking cannabis in cones was more common then joints. Hydroponic cannabis continued to dominate the market.
- Half of the national sample reported recent use of methadone (any form) and one-quarter reported recently injecting. Twenty-one percent of the national sample reported the use of illicitly obtained methadone liquid in the six months preceding interview, and 11% the recent use of illicitly obtained methadone tablets (Physeptone).
- Eight percent of the national sample reported use of licitly obtained buprenorphine in the six months preceding interview and 15% the use of illicitly obtained buprenorphine.
- Six percent of the national sample reported using licitly obtained buprenorphine-naloxone, while 11% reported illicitly obtained buprenorphine-naloxone in the preceding six months.
- The recent use of licit morphine was reported by 8% of the sample compared to 39% for ‘illicit’ morphine. Morphine remained the most commonly injected pharmaceutical in the national sample (41% in 2011). Jurisdictional variations and changes were observed. The use of morphine remained highest in the NT and TAS, jurisdictions where heroin has traditionally not been freely available.
- Recent licit oxycodone use was reported by 6% of the national sample compared to 32% for illicit oxycodone in the last six months.
- Forty-two percent of the national sample reported using over the counter codeine on a median of 10 days in the last six months.
- Around one-third of the national sample reported recent use of ‘other’ opioids (i.e. those not elsewhere classified – mainly Panadeine FORTE®) on a median of seven days. Recent injection of these preparations was low at one percent.
- Around two-thirds (65%) of the national sample reported using ecstasy in their lifetime with around fourteen percent reporting use in the last six months.
- While fairly large proportions of participants reported having used hallucinogens at some stage in their lifetimes (65%), recent use remained fairly low, with eight percent reporting use in the six months preceding interview.
- Sixty-two percent of the national sample reported using some form of alprazolam in their lifetime, with nearly half (46%) reported recently using any form of alprazolam on a median of 12 days.
- Three-quarters (75%) of the national sample had used another form of other benzodiazepines not including alprazolam in their lifetime. Over half (56%) reported recently using any form of other benzodiazepines on a median of 60 days. Small proportions reported recently injecting other benzodiazepines (5% or less).
- The majority (83%) of the national sample had reported the use of benzodiazepines (including alprazolam) at some stage in their lifetime. Sixty-nine percent reported the recent use of benzodiazepines on a median of 74 days. Only small numbers reported recently injecting benzodiazepines on a median of six days in the last six months. Eight percent reported recently injecting alprazolam.
- Fifteen percent of the national sample reported recently using pharmaceutical stimulants on a median of four days in the last six months.
- The use of Seroqual® ever was reported by 41% of the sample, 22% reported recently using Seroqual®.
- Lifetime use of inhalants was reported by 24% of the national sample; however, only small numbers reported using inhalants in the last six months (3%).
- Two-thirds of the national sample reported having drunk alcohol in the preceding six months, with those who had consumed alcohol having done so on an average of one day per week. Fourteen percent of the national sample reported daily use of alcohol.
- As in previous years, tobacco was widely used among the 2011 sample, with 93% having used it in the preceding six months. The vast majority of participants (96%) were daily smokers.
Drug market: Price, purity, availability and purchasing patterns
Heroin was typically $50 per cap across the jurisdictions and remained stable compared to 2010. The median price for a gram varied. The majority of the participants reported heroin purity as ‘low’. Heroin was considered either ‘easy’ or ‘very easy’ to obtain in the last six months and this was stable. The most common source when purchasing heroin was through a known dealer or friend. The most common place of purchase was at an agreed public location.
Methamphetamines were reported to be around $50 per point regardless of form used, variations were noted across jurisdictions. Price was considered as ‘stable’ over the last six months by the majority of participants. The purity of speed was considered ‘low’, base ‘medium’ and ice/crystal ‘high’. All forms for methamphetamine were generally considered ‘easy’ or ‘very easy’ to obtain. Participants purchased all forms of methamphetamine from a variety of sources, most commonly friends and known dealers. An agreed public location was the most common place of purchase.
Small numbers in all jurisdictions except in NSW were able to comment on the price, purity, availability and purchasing of cocaine. The price of a gram and a cap of cocaine in NSW were $300 and $50 respectively. The purity of cocaine was considered ‘medium’ or ‘low’ which had remained stable over the last six months. The availability of cocaine was reported as ‘easy’ nationally. Purchasing from a friend, known dealer or street dealer was most common nationally and in NSW.
The median cost of a gram of hydroponic cannabis was around $20-$30. While the median cost of an ounce of hydroponic cannabis was between $210 and $450. Price for both forms of cannabis (bush and hydroponic) was reported as ‘stable’ over the last six months. Nationally participants reported the potency of hydro as ‘high’ and bush ‘medium’. This remained stable over the last six months. The availability of both forms of cannabis were considered ‘very easy’ or ‘easy’ to obtain. Either form of cannabis was typically purchased through a friend or known dealer from either a friend or dealer’s home.
The majority of those who commented reported the price of ‘illicit’ methadone syrup to be a median of $1 per millilitre and physeptone at $17 per 10mg tablet. Around two-thirds reported the availability of ‘illicit’ methadone as ‘easy’ to obtain. Price and availability remained stable over the last six months. The majority of participants reported purchasing methadone through a friend, usually from a friend’s home or at an agreed public location.
The median price for buprenorphine varied among the jurisdictions. Around two-thirds reported the availability of ‘illicit’ buprenorphine as ‘very easy’ or ‘easy’ to obtain. Both price and availability were reported as stable over the last six months. The most common source was through a friend or street dealer, purchasing from the street market or an agreed public location.
The median price for buprenorphine-naloxone varied among the jurisdictions. Over three-quarters reported the availability of ‘illicit’ buprenorphine-naloxone as ‘very easy’ or ‘easy’ to obtain. Both price and availability were reported as stable over the last six months. The most common source was through a friend or street dealer, purchasing from a friend’s home or street market.
The median price for each brand of ‘illicit’ morphine varied among the jurisdictions. Nearly two-thirds reported the price of ‘illicit’ morphine as stable over the last six months, while smaller proportions reported an increase in price. Nearly half reported that ‘illicit’ morphine was ‘easy’ to obtain and this remained stable. The majority reported purchasing ‘illicit’ morphine through a friend or known dealer most commonly at a friend’s home
The median price for each brand of ‘illicit’ oxycodone varied among the jurisdictions. Price of ‘illicit’ oxycodone remained stable over the last six months. Nearly half reported the availability of ‘illicit’ oxycodone as ‘easy’, while one-third reported availability as ‘difficult’. The majority reported purchasing ‘illicit’ oxycodone through a friend or street dealer usually from either a friend’s home or street market.
Health-related trends associated with drug use
Overdose and drug related fatalities
- Twenty-three percent of IDRS participants (who reported ever overdosing on heroin) had experienced a heroin overdose in the past 12 months. The highest rates of recent (12 month) overdose were in WA and VIC (29% and 28% each respectively).
- Of those who had ever overdosed on another drug (not including heroin), 23% had done so in the past year, and 3% had done so in the last month preceding interview.
- Indicator data from the Australian Bureau of Statistics reported 433 accidental deaths due to opioids in 2009. The majority occurred in NSW, VIC and QLD. Males comprised the majority of accidental opioid deaths among 15-54year olds. Methamphetamine was determined to be the underlying cause of death in 21% (n=13) of all methamphetamine related deaths and cocaine was determined to be the underlying cause of death in 24% (n=4) of all cocaine-related deaths in 2009.
- Nearly half (49%) of the IDRS sample reported current treatment, mainly methadone with a median of 36 months in treatment.
- In Australia, indicator data from the Australian Institute of Health and Welfare on the total number of clients registered in opioid substitution treatment remained relatively stable in all jurisdictions in 2010. The majority of clients were being prescribed methadone, followed by buprenorphine-naloxone and buprenorphine. This pattern was also reflected among IDRS participants who reported current treatment.
- Data from the Alcohol and Other Drug Treatment Services-National Minimum Data Set indicated that VIC, the ACT and NSW had the highest proportion of closed treatment episodes for clients who identified heroin as their principal drug of concern (drug of main concern). While WA reported the highest proportion of closed treatment episodes for people who identified amphetamines as their principle drug of concern, for NSW it was cocaine and TAS cannabis.
- The number of opioid-related hospital separations remained stable between 2007/08 and 2008/09, the most recent data available at the time of publication. Separations relating to opioid use were higher than for methamphetamine at the national level, and figures for the latter remained relatively stable in most jurisdictions.
- Cocaine-related hospital separations remained low relative to those for heroin and methamphetamine. Figures were highest in NSW in 2008/09. Cannabis-related separations have remained relatively stable between 2007/08 and 2008/09.
Injecting risk behaviours
- Needle and syringe programs were by far the most common source of needles and syringes in the preceding six months (90%), followed by chemists (17%). Receptive sharing (‘borrowing’) of needles/syringes was reported by eleven percent of participants in the month preceding interview, usually after a regular partner or close friend. While 16% reported that somebody had used a needle after them (lent) in the month preceding interview.
- Nationally, around half (49%) reported re-using their own needle ranging from 29% in the NT to 55% in VIC. While the sharing of injecting equipment such as filters, water and mixing containers (e.g. spoons) was more common, sharing of injecting equipment significantly decreased between 2010 and 2011 (39% and 25% respectively). The majority of participants reported last injecting in the arm.
- In Australia, hepatitis C virus (HCV) continued to be more commonly notified than hepatitis B virus (HBV). The prevalence of human immunodeficiency virus (HIV) among those people who inject drugs in Australia has also remained stable at relatively low rates over the past decade, with HCV more commonly reported.
- The majority of IDRS participants reported last injecting in a private location (75%), with smaller proportions last injecting in a public location such as on the street, in a car or in a public toilet. Over half (55%) of the IDRS sample experienced an injection-related problem in the preceding month, most commonly significant scarring or bruising and difficulty injecting (e.g. in finding a vein).
Mental health problems and psychological distress
- Forty-eight percent of the IDRS sample self-reported a mental health problem in the preceding six months, most commonly depression (66% of respondents) and/or anxiety (45%). The majority (71%) of those who experienced a problem saw a mental health professional during this period. Eighty-eight percent of participants who reported experiencing a mental health problem had been prescribed medication for this problem during the past six months, most commonly antidepressants (50%) and/or antipsychotics (45%).
- Higher levels of psychological distress as measured by the Kessler Psychological Distress Scale (K10) were reported by the national sample compared to the Australian general population, with 28% reporting ‘high’ distress (8% in the general population) and 31% reporting ‘very high’ distress (2% in the general population). Those reporting a ‘very high’ level of distress have been identified as possibly requiring clinical assistance.
Driving risk behaviour
- Driving under the influence of alcohol was reported by eighteen percent of participants who had driven in the preceding six months. Seventy-nine percent reported driving under the influence of an illicit drug during that time (mainly heroin), 65% of whom believed that it had had no impact on their driving. Nineteen percent felt that their driving had been ‘slightly impaired’, 5% ‘quite impaired’, 8% ‘slightly improved’ and 3% ‘quite improved’. Nearly one-quarter reported being saliva drug tested (24% of those who had driven soon after taking an illicit drug), of whom twenty-eight participants reported a positive result.
Law enforcement related trends associated with drug use
Reports of criminal activity
Participant reports of criminal activity remained stable compared to previous years, with thirty-nine percent of the national sample reporting engagement in criminal behaviour in the preceding month. The most common types of crime committed were drug dealing and property crime.
- Thirty-six percent of the national sample reported having been arrested in the preceding 12 months.
- The most recent indicator data available on consumer and provider arrests were for the financial year 2009/10. In 2009/10, numbers of consumer and provider arrests for heroin and other opioids were higher than 2008/09 numbers.
- The number of arrests for amphetamine-type stimulants (including phenethylamines such as 3,4-methylenedioxymethamphetamine [MDMA]) were lower, while cocaine and cannabis were higher nationally.
- Cocaine arrests were higher in NSW and remained low and stable elsewhere.
- Cannabis arrests continued to account for the majority of all drug-related arrests in Australia.
Expenditure on illicit drugs
Among the national sample who commented, 59% reported spending money on illicit drugs the day before interview. The median amount spent by those who had purchase drugs was $85.
Special topics of interest
Heavy Smoking Index for nicotine dependence
- Among those who reported daily smoking, half reported having their cigarette within the first five minutes of waking. Forty-one percent of daily smokers reported smoking between 11-20 cigarettes a day.
- Among daily smokers the mean HSI score was 3.4. Half of the daily smokers scored 5 or above indicating high nicotine dependence.
Alcohol Use Disorders Identification Test-Consumption
- Among those who drank alcohol recently the mean score on the Alcohol Use Disorders Identification Test - Consumption (AUDIT-C) was 5.6.
- Fifty-eight percent of males and 49% females scored 5 or more indicating the need for further assessment.
- Around half of the national sample recently used pharmaceutical opioids such as methadone, oxycodone.
- Of those who recently used pharmaceutical opioids, half of them reported using them for pain relief and around one-third to seek an opioid effect.
- Twenty-two percent of those who commented reported being refused pharmaceutical medications due to injecting history.
- Of those who commented, three-quarters were prescribed pharmaceutical opioids by their general medical practitioner.
Over the counter Codeine
- Around two-thirds of the national sample reported the use of OTC codeine in their lifetime, with 42% using OTC codeine in the last six months on a median of 10 days.
- Forty percent of participants reported using OTC codeine for medical purposes in the last six months on a median of 10 days. The main type of medical purpose was short-term pain (71%).
- Six percent of the national sample reported the use of OTC codeine for non-medical purposes on a median of eight days.
Injecting equipment use in the last month
- Seventy-six percent of the national sample who commented reported the use of 1ml needle and syringes in the last month followed by a detachable needle (21%) and 3ml syringe (20%).
- The re-use of 1ml needle and syringe was reported by 39% of the IDRS sample who commented.
- Of those who commented, 39% reported cleaning 1ml needle/syringes, with around two-thirds (65%) reporting last cleaning a 1ml needle/syringe.
Mental and Physical Health problems (SF12)
- IDRS participants scored a mean for 35.7 for the mental component score and 42.2 for the physical component score.
- IDRS had significantly lower MCS and PCS scores compared to the Australian population.
- Scores indicated that IDRS participants had poorer mental and physical health then the population average.
Health Service Access
- The majority of participants (n=535) reported visiting a GP in the last four weeks on a median of one occasion (1-30 occasions). Sixty-two percent reported visiting a GP once in the last four weeks and around one-third reported the visit was substance use related.
- Of the national sample who commented, 61% reported that they never used the internet in the last month, while 13% reported daily internet use.
- Of those who had used the internet in the last month, around one-third reported going ‘online’ to get information about drugs.
- Of those who commented, 15% stopped using a drug and 14% altered drug dose due to information found online.
Text messaging was the preferred medium to obtain drugs.
- Ninety-seven percent of the IDRS sample, who commented, supported needle and syringe programs to reduce problems associated with heroin use. The majority also supported methadone/buprenorphine maintenance programs, treatment with drugs (not including methadone) and regulated injecting rooms.
- The majority of the IDRS sample also supported the legalisation of cannabis (87%) for personal use and just over half (55%) supported the legislation of heroin for person use.
- Small numbers supported the increased penalties for sale or supply of cannabis (9%). Around one-third supported the increased penalties for sale or supply of heroin, methamphetamine or cocaine.