EXECUTIVE SUMMARY - INTRODUCTION
The Australian Drug Trends in Ecstasy and Related Drug Markets 2012 report presents the findings from the tenth year in which data have been collected in all states and territories in Australia on the markets for ecstasy and related drugs (ERD). The Ecstasy and Related Drugs Reporting System (EDRS; formerly the Party Drugs Initiative, or PDI) is the most comprehensive and detailed study of ERD markets in Australia.
Using a similar methodology to the Illicit Drug Reporting System (IDRS), the EDRS monitors the price, purity and availability of "ecstasy‟ (3,4-methylendioxymethamphetamine; MDMA) and other drugs such as methamphetamine, cocaine, gamma-hydroxybutyrate (GHB), d-lysergic acid (LSD), 3,4-methylendioxyamphetamine (MDA) and ketamine. It also examines trends in the use and harms of these drugs. It utilises data from three sources: (a) surveys with regular ecstasy users (REU) and regular psychostimulant users (RPU); (b) surveys with key experts (KE) who have contact with REU through the nature of their work; and (c) the analysis of existing data sources that contain information on ERD. The EDRS is designed to be sensitive to emerging trends, providing data in a timely manner, rather than describing issues in extensive detail.
It is important to note that the results from the REU surveys are not representative of ecstasy users and their other drug use in the general population, but this is not the aim of these data. These data are intended to provide evidence that is indicative of emerging issues that warrant further monitoring. REU are a sentinel group that provides information on patterns of drug use and market trends.
The findings from each year not only provide a snapshot of the ERD market in Australia, but in total they help to provide an evidence base for policy decisions; help to inform harm reduction messages; and to provide directions for further investigation when issues of concern are detected. Continued monitoring of the ERD markets in Australia will help add to our understanding of the use of these drugs; the price, purity and availability of these drugs; and how these may impact on each other; and the associated harms which may stem from the use of these drugs.
Drug trends in this publication are cited by jurisdiction, although they primarily represent trends in the capital city of each jurisdiction, where new drug trends are likely to emerge. Patterns of drug use may vary among other groups of REU in the capital cities and in regional areas.
EXECUTIVE SUMMARY - SNAPSHOT
Demographics of EDRS Participants and Patterns of Drug Use
- EDRS participants were primarily recruited through street press adverts and word-of-mouth.
- As a sample, the demographics of EDRS participants were consistent with previous years.
Consumption pattern results
- Ecstasy appears to be returning in relation to preference as a drug of choice (32% in 2012 from 27% in 2011). Alcohol experienced a significant increase in preference in 2012 (11% in 2011 to 15% in 2012, p<0.05) to overtake cocaine (13%) and remain behind cannabis (19%).
- Stable results were reported in those that reported excess stimulant use in a "binge session‟.
- Poly drug use is reported by this sample at a fortnightly to weekly frequency.
- Almost half of the sample commented on changes in the drug market over the preceding six months to interview, the main themes included: The quality of ecstasy/MDMA increasing, new drugs on the market such as: 2C-B, DMT and Caps, and an increase in prevalence of ice/crystal and acid (LSD).
- Ecstasy tablets were used on a median of 12 days in the six months prior to interview, i.e. approximately fortnightly. Thirteen percent of participants reported using ecstasy more than weekly (pills only).
- Ecstasy was again used in a variety of forms: pills/tablets, powder and capsules. In 2012, in VIC and NSW there were reports of a new form of MDMA rock/crystal.
- A significant decrease was detected in those using drugs during the "come down" phase of ecstasy.
- Participants reported using a median of two tablets in a typical session of use, a median of 2 lines, and two capsules in average sessions of use.
- The median age at which ecstasy was first used was 17 years, and was used regularly (at least monthly) at a median age of 19 years. No sex differences were found.
- Ecstasy remained to be seen as a "social" drug with participants reporting "most" (43%) of their friends consumed it.
- Current domestic and EDRS market indicators would suggest that ecstasy consumption is beginning to return to previous levels of those seen in recent years.
- Just under half (48%) of the sample reported the use of speed in the six months prior to interview. The median days of use was five days. As in 2011, VIC was the jurisdiction with the highest reported use of speed powder. The mean age of first use was 19 years.
- Among recent speed users, snorting (73%) and swallowing (60%) were the most common routes of recent (last six months) administration. The amount used in an average session was 0.5 gram and the amount used in a heavy session was one gram.
- Fifteen percent of participants reported using base in the six months prior to interview. The median days of use was three days. SA (24%) was the jurisdictions with the highest reported base use. The mean age of first use was 21 years.
- Among recent base users, swallowing was the most commonly nominated ROA (76%). The average amount used in a typical and heavy session was two points.
- Base is the least commonform of methamphetamine used by participants.
- Twenty-nine percent of the national sample reported recent ice/crystal use. The median days of use among those who had recently used was stable at six days (approximately monthly). VIC (48%) was the jurisdiction with the most recent ice/crystal use reported. The mean age of first use was 22 years.
- The most common ROA for ice/crystal was smoking (88%). The average amount used in a typical session was 1.5 points and for a heavy session 2.5 points.
- Two-fifths (40%) of the national sample reported cocaine use in the six months prior to interview, a significant decrease from 2011 (46%,p<0.05). NSW (57%) and VIC (54%) were the jurisdictions that reported the most amount of recent use.
- Among recent users,cocaine had typically been snorted (97%), or swallowed (31%). The mean age of first use was 21years.
- Frequency of cocaine use remained low at a median of three days (sporadic use) during the six months prior to interview. The majority (76%) had used less than once per month. There were no reports of daily use.
- The median amount of cocaine used in atypical session of use was half a gram and in a heavy session it was one gram.
- Cocaine was the drug of choice for 13% of the EDRS sample, similar to levels reported in 2011 (14%).
- Two-fifths (39%) of the national sample reported lifetime use of ketamine, and 14% reported using ketamine recently. The mean age of first use was 21.5 years.
- Ketamine use is predominantly reported in NSW and VIC. All other states had less than 10 participants reporting recent use.
- Amongst recent ketamine users, the majority (75%) snorted, while one-third (36%) had swallowed it. Less participants reported smoking it in 2012 (2% vs 7% in 2011) which is similar to previous years.
- Among users, ketamine had been used on a median of two days in the past six months; the majority (83%) had used ketamine less than once per month. There were two reports of more than weekly use.
- One-fifth (21%) of the national sample reported lifetime use of GHB, with 7% reporting recent use. The mean age of first use was 21 years.
- There was a comparable level of recent use from 2010 (6%) to 2012 (7%). Most recent use was reported in NSW, SA and QLD. There were no reports of recent use in the NT.
- Recent use occurred on a median of two days in the six months preceding interview; 73% reported using less than once per month.
- Recent GHB users reported using a median of 3 mls in a typical episode of use and a median of 4 ml in the heaviest recent episode of use. GHB was reported only consumed orally.
- Seventy percent of the national sample reported the lifetime use of LSD; 34% reported recent use of LSD, a significant decrease from 2011 (46%; p<0.05). The median age of first use was 18 years.
- The median days of LSD use amongst recent users was three. Recent users reported using a median of one tab in a typical session and two tabs in the heaviest recent session of use.
- LSD remains a drug that a substantial proportion of the sample "binge" on (15%).
- Price, purity and availability had all remained stable.
- Along with alcohol, cannabis was the second most used drug by the EDRS sample recently (82%). While reported recent use remained stable, the proportion of reported daily use significantly increased compared to 2011 (18% in 2011 vs. 24% in 2012, p<0.05).
- 24% of the national sample were daily cannabis smokers.
- Frequency of use was three times weekly and the main ROA was smoking (98%). Smoking cones was more common than smoking joints.
- Prices for hydro cannabis remained slightly higher than for bush cannabis, potency and availability remained stable for both types of cannabis.
- MDA lifetime use was 30% of the national sample, with 10% reporting recent use on a median of three days.
- Almost all (97%) participants reported lifetime use of alcohol, and 96% reported alcohol use in the six months preceding interview. The mean age of first use was 14 years. The median days of alcohol use was 48 days (twice weekly). Daily drinking was reported by 6% of the sample. A significant increase for alcohol as the drug of choice was detected in 2012 (15%) vs. 2011 (11%).
- Ninety-five percent reported lifetime tobacco use and 83% had used tobacco in the six months preceding interview. Over half (59%) of recent tobacco users were daily smokers, with median days use being 180 (i.e. daily).
- Over half (55%) of the sample reported lifetime benzodiazepine (both licitly and illicitly obtained) and one-third (34%) reported recent illicit use. Injecting and snorting were reported as routes of administration for illicit use. Daily use of illicit and licit benzodiazepine use was minimal (9%). The type most used was diazepam for both forms.
- One-tenth (10%) of the national sample reported recent licit use and two percent reported illicit use of antidepressants. Licit use was higher than illicit use in 2011 and 2010. ROA was mainly swallowing for both forms with 30% reporting shelving/shafting (illicit only).
- One fifth (21%) of the EDRS sample reported recent nitrous oxide use in the six months preceding interview on a median of four days, comparable with 2011 results. Use was highest in TAS (27%) and WA (26%).
- Recent use of amyl nitrate (nationally) was reported by one-fifth (21%) in 2012. Use was occasional on a median of two days. Mostly used in NSW (37%).
- Twenty-seven percent of the national sample reported recent mushroom use, comparable to 2011 (29%). Use occurred on a median of two days, and 87% of recent users had used less than once per month.
- Other drugs discussed in this section include heroin and other opiates, methadone, buprenorphine, pharmaceutical stimulants, OTC codeine, OTC stimulants and steroid use.
Emerging psychoactive substances
- In 2012 the number of EDRS participants that have consumed an EPS in the previous six month period was 40% including synthetic cannabis.
- The figure for synthetic cannabis has significantly increased in 2012 (15% in 2012 vs. 6% in 2011) however, days of use nationally remains low (2 days; range 1-180).
- For more information regarding these drugs see: Bruno et al., (2012) Emerging psychoactive substance use among regular ecstasy users in Australia. Drug and Alcohol Dependence: http://www.sciencedirect.com/science/article/pii/S0376871611005205
Health-related trends associated with ERD use
- Of the national sample, 33% reported having ever overdosed on a stimulant drug and, of those, 68% had done so in the preceding 12 months. Ecstasy was the main drug to which participants attributed the stimulant overdose. Most stimulant OD occurred in private locations, which has major health implications. The most common symptoms reported were vomiting and increased heart rate. Of those that sought immediate treatment, most were attended to by an ambulance.
- Thirty-one percent of the national sample reported having ever overdosed on a depressant drug and, of those, 55% reported recent (last 12 months) overdose. Recent overdoses were most commonly attributed to alcohol (72%). Most depressant OD occurred in private locations. The most commonly reported symptom was vomiting. Of those that sought treatment, most were attended to by an ambulance.
- Of the national sample 13% had accessed either a medical or health service in relation to their drug use during the six months preceding interview. The services most commonly accessed by these participants were GPs (27%). In terms of medical issues (e.g. overdoses), the main issue for seeking medical attention was cutting down drug use (17%) followed by dependence/addiction (16%). The main drugs to seek medical attention for were alcohol (25%), cannabis (19%) and ecstasy (10%).
- In 2010/11, treatment seeking for ecstasy use (as the principal drug of concern) remained low in the general population at 1.0% of closed treatment episodes.
- A small proportion of participants (8%) were classified as currently experiencing very high psychological distress on the Kessler Psychological Distress Scale. The majority reported no or low distress (36%).
- Almost a third (32%) of the sample reported experiencing a mental health problem in the preceding six months; depression and anxiety were the most commonly reported.
- Sixteen percent of the national sample reported having injected at some time in their lives; 43% of those reported injecting in the six months preceding interview. The mean age of first injection was 21 years of age. Among those who had injected in the preceding six months, the last drug injected was ice/crystal (31%) which differed from 2011 in which it was heroin.
- Syringes were typically obtained from a Needle and Syringe Program (NSP) (55%). Of those who had injected in the preceding six very few respondents reported using a needle after someone else in the month preceding interview.
- Fifty-eight percent of the national sample reported they had completed the vaccination schedule for hepatitis B virus, the most common reason for the vaccination was being vaccinated as a child.
- Two-thirds (66%) of participants reported penetrative sex in the six months preceding interview with at least one casual partner. A large majority of those had casual sex last time under the influence of mostly alcohol, ecstasy and cannabis. Over half had used protection on this occasion.
- Just over three-quarters (76%) had driven a car in the last six months, 70% of those had reported having been over the legal limit, and 58% had driven shortly after taking an illicit drug on a median of six occasions. The most commonly reported illicit drugs after which these participants had driven were cannabis and ecstasy. A small number reported positive notifications were from being saliva drug tested.
- Eighty-three percent of the national sample obtained eight or more; these are levels at which alcohol intake may be considered hazardous.
Law enforcement trends associated with ERD use
- Almost two-fifths 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 across all jurisdictions, with smaller proportions reported having committed fraud or a violent crime in the last month.
- Reports of recent police activity were that it was stable.
- Fourteen percent of the national sample had been arrested in the past year, compared with 16% in 2011. The most common charges reported were violent crimes (e.g. assault) and alcohol and driving offences.
- Consumer arrests appeared to have remained relatively stable across all drugs with minor decreases reported for cocaine and hallucinogens.
Special topics of interest
- Fagerstrom test for nicotine dependence score was calculated for participants for the first time in 2012. Sixteen percent of daily REU/RPU smokers obtained 6 or above indicating high nicotine dependence.
- In 2012, participants were asked questions regarding dependence on ecstasy based on the Severity of Dependence (SDS) scale. The median score of the scale was 1, with 28% of the sample reporting a cut –off of three or more and 21% reporting a cut-off of four or more both indicating dependence.
- EDRS participants were asked in 2012, questions related to drug policy that were drawn from the National Drug Strategy Household Survey. From those that commented 91% supported needle and syringe programs to reduce problems associated with heroin use, the majority of the participants also supported methadone/buprenorphine maintenance programs, treatment with drugs (other than methadone) and regulated injecting rooms.
- Traumatic Brain Injury (TBI) were also asked about in the 2012 EDRS questionnaire. Multiple TBIs were the norm with the median number of TBIs experienced over the lifetime equalling 2(1-30). Participants were asked further details about the most severe occasion. The vast majority of participants who had experienced a TBI reported that the LOC on the most severe occasion lasted only a few minutes (consistent with a mild injury). However, a reasonable proportion (15%) of this group reported a LOC of greater than half an hour (consistent with a moderate to severe TBI).
- An area of concern for this group is the combination of Body Image issues and psychostimulant use. One tenth of EDRS participants reported ever using illicit psychostimulants (IPS) to lose or maintain weight, of which 60% were female. The most commonly reported drug used for losing or maintaining weight was methamphetamine. Eight EDRS participants reported recent use of IPS to lose or maintain weight.