Key findings from the 2012 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 (PWID) 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 2012 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
Nine hundred and twenty four participants were recruited to the 2012 IDRS participant survey component. The mean age of the national sample was 39 years (range 17-71 years) and 66% were male. The vast majority of the sample spoke English as their main language at home (97%), and 16% identified as being of Aboriginal and/or Torres Strait Islander descent. More than three-quarters (84%) of the sample were currently unemployed, over half (54%) reported a previous prison history and nearly half (44%) 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, 50% reported that an amphetamine (including methamphetamine) was the first drug injected, followed by heroin (37%). Heroin was nominated by approximately half (54%) 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 (46%) 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 (60%) of the sample reported using heroin in the last six months on a median of 72 days. Twenty-eight 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 (68%) of the national sample reported using one or more forms of methamphetamine recently on a median of 22 days. Recent speed use remained fairly stable, while the recent use of base was significantly lower and the recent use of ice/crystal 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 (44%), with proportions elsewhere reporting use in the preceding six months remaining at less than 16%. 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 seven 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.
- Around half of the national sample reported recent use of methadone (any form) and around one-third reported recently injecting. Twenty percent of the national sample reported the use of ‘illicitly’ obtained methadone liquid in the six months preceding interview, and 10% the recent use of ‘illicitly’ obtained methadone tablets (Physeptone).
- Six percent of the national sample reported use of ‘licitly’ obtained buprenorphine in the six months preceding interview and 14% the use of ‘illicitly’ obtained buprenorphine.
- Nine percent of the national sample reported using ‘licitly’ obtained buprenorphine-naloxone ‘tablet’, while 8% reported recently using buprenorphine-naloxone ‘film’.
- Eleven percent reported ‘illicitly’ obtained buprenorphine-naloxone ‘tablet’ in the preceding six months, while 7% reported recently using buprenorphine-naloxone ‘film’.
- The recent use of ‘licit’ morphine was reported by 9% of the sample compared to 38% for ‘illicit’ morphine. Morphine remained the most commonly injected pharmaceutical in the national sample (40% in 2012). 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 7% of the national sample compared to 35% for ‘illicit’ oxycodone in the last six months.
- Fifteen percent of the national sample reported using over the counter codeine on a median of seven days in the last six months.
- Twenty-one percent of the national sample reported recent use of ‘other’ opioids (i.e. those not elsewhere classified – mainly Panadeine FORTE®) on a median of ten days. Recent injection of these preparations was low at one percent.
- Around two-thirds (63%) of the national sample reported using ecstasy in their lifetime with 12% 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 six percent reporting use in the six months preceding interview.
- Sixty percent of the national sample reported using some form of alprazolam in their lifetime, with nearly half (44%) reported recently using any form of alprazolam on a median of 10 days. Six percent reported recently injecting alprazolam.
- Three-quarters (72%) of the national sample had used another form of other benzodiazepines not including alprazolam in their lifetime. Over half (54%) reported recently using any form of other benzodiazepines on a median of 56 days. Small proportions reported recently injecting other benzodiazepines (6% or less).
- The majority (79%) of the national sample had reported the use of benzodiazepines (including alprazolam) at some stage in their lifetime. Sixty-four percent reported the recent use of benzodiazepines on a median of 91 days. Only small numbers reported recently injecting benzodiazepines on a median of six days in the last six months.
- Fourteen 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 48% of the sample, 25% reported recently using Seroqual®.
- Lifetime use of inhalants was reported by 21% of the national sample; however, only small numbers reported using inhalants in the last six months (2%).
- 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. Eighteen percent of the national sample reported daily use of alcohol.
- As in previous years, tobacco was widely used among the 2012 sample, with 93% having used it in the preceding six months. The vast majority of participants (95%) 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 2011. 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 nationally for speed and base and $100 for ice/crystal, 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/high’ 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 $375 and $50 respectively. The purity of cocaine was considered ‘medium’ with most reporting purity as stable over the last six months. The availability of cocaine was reported as ‘easy’ to obtain in NSW and 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 $220 and $420. 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 cannabis (both forms) was 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 $15 per 10mg tablet. Over 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, purchasing from the street market or home delivery.
The median price for buprenorphine-naloxone ‘tablet’ and ‘film’ varied among the jurisdictions. Over three-quarters reported the availability of ‘illicit’ buprenorphine-naloxone ‘tablet’ and ‘film’ 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, purchasing from a friend’s home or an agreed public location.
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 ‘very easy’ or ‘difficult’. The majority reported purchasing ‘illicit’ oxycodone through a friend or street dealer usually from either a friend’s home or an agreed public location.
Health-related trends associated with drug use
Overdose and drug related fatalities
- Twenty 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 the WA and QLD (36% and 29% each respectively).
- Of those who had ever overdosed on another drug (not including heroin), 28% had done so in the past year, and 5% had done so in the last month preceding interview.
- Indicator data from the Australian Bureau of Statistics reported 500 accidental deaths due to opioids in 2008. The majority occurred in NSW and VIC. Males comprised the majority of accidental opioid deaths among 15-54year olds. Methamphetamine was determined to be the underlying cause of death in 20% (n=16) of all methamphetamine related deaths, and cocaine was determined to be the underlying cause of death in 13% (n=2) of all cocaine-related deaths in 2008.
- Nearly half (44%) 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 2011. 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, NSW cocaine and TAS cannabis.
- The number of opioid-related hospital separations remained relatively stable between 2008/09 and 2009/10, the most recent data available at the time of publication. Separations relating to opioid use were higher than for methamphetamine at the national level. Differences were noted in the jurisdictions.
- Cocaine-related hospital separations remained low relative to those for heroin and methamphetamine. Figures were highest in NSW in 2009/10. Cannabis-related separations have remained relatively stable between 2008/09 and 2009/10.
- Injecting risk behaviours
- Needle and syringe programs were by far the most common source of needles and syringes in the preceding six months (95%), followed by chemists (16%). Receptive sharing (‘borrowing’) of needles/syringes was reported by 7% of participants in the month preceding interview, usually after a regular partner or close friend. While 14% reported that somebody had used a needle after them (lent) in the month preceding interview.
- Nationally, around half (47%) reported re-using their own needle ranging from 26% in the NT to 63% in TAS. One-quarter reported the sharing of injecting equipment such as filters, water and mixing containers (e.g. spoons) nationally in 2012. 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 (80%), with smaller proportions last injecting in a public location such as on the street, in a car or in a public toilet. Over half (59%) 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).
Blood-borne viral infections
- Of those who commented, 93% reported testing for HBV in their lifetime compared to 96% for HCV and 94% for HIV.
- Among those who had tested for HBV, 62% had a test within the past year and 30% within the last three months. Six percent reported a positive result.
- Sixty-one percent of those who commented had been vaccinated against HBV. The main reason for vaccination was ‘at risk – injecting drug use’.
- Among those who had tested for HCV, 65% had a test within the past year and 31% within the last three months. One percent reported a positive result. The main reason for testing was a ‘matter of routine’.
Alcohol use disorders Identification test - consumption
- Sixty percent of males and 50% females scored 5 or more on the AUDIT-C, indicating the need for further assessment
- The mean score on the AUDIT-C among those who drank alcohol recently was 5.6.
Mental health problems and psychological distress
- Forty-three percent of the IDRS sample self-reported a mental health problem in the preceding six months, most commonly depression (70% of respondents) and/or anxiety (52% of respondents).
- Among those who had experienced a problem, the number who reported seeing a mental health professional during the last six months significantly decreased between 2011 and 2012 (71% and 58% respectively).
- Eighty 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 (37%).
- 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 (7.4% in the general population) and 32% reporting ‘very high’ distress (2.4% in the general population). Those reporting a ‘very high’ level of distress have been identified as possibly requiring clinical assistance.
- IDRS participants scored a mean of 35.3 for the mental component score and 41.9 for the physical component score. These scores are significantly lower compared to the Australian population.
- Scores indicated that IDRS participants had poorer mental and physical health than the population average.
Health service assess
- The majority of participants reported visiting a GP in the last four weeks on a median of two occasions, followed by an OST doctor on a median of one occasion in the last four weeks. One-third (29%) of those who saw a GP reported visiting on one occasion for a substance use reason whereas 72% of those who saw an OST doctor had visited on one occasion for a substance use reason.
Driving risk behaviour
- Driving under the influence of alcohol was reported by 20% of participants who had driven in the preceding six months. Seventy-seven 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. Eighteen percent felt that their driving had been ‘slightly impaired’, 5% ‘quite impaired’, 10% ‘slightly improved’ and 3% ‘quite improved’.
- Twenty-one percent reported being saliva drug tested soon after taking an illicit drug, with 16 participants reporting 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 37% 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-three 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 2010/11. In 2010/11, numbers of consumer and provider arrests for heroin and other opioids were lower than 2009/10 numbers.
- The number of arrests for amphetamine-type stimulants (including phenethylamines such as 3,4-methylenedioxymethamphetamine [MDMA]) and cocaine, while cannabis was 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, 61% reported spending money on illicit drugs the day before interview. The median amount spent by those who had purchased drugs was $80.
Special topics of interest
- Nearly the entire IDRS sample (94%) reported smoking tobacco (at any stage) during the last 12 months.
- Forty-four percent of those who had smoked in the last 12 months had reduced the amount of tobacco smoked in a day and 31% tried to give up.
- Among those who had tried to give up, cut down or changed to a lower tar/nicotine content, the main motivator was ‘worried that smoking was affecting health or fitness’ (68%).
- Among those who reported daily smoking, half reported having their cigarette within the first five minutes of waking. Forty-six percent of daily smokers reported smoking between 11-20 cigarettes a day.
- Thirty-eight percent of daily smokers found it difficult to refrain from smoking in forbidden places.
- Two-thirds reported that they would hate giving up the first cigarette in the morning.
- Nearly half of daily smokers scored 6 or above indicating high/very high nicotine dependence. The mean Heavy Index Score was 5.0.
- Seventy-four percent of the national sample recently used pharmaceutical opioids such as methadone and oxycodone.
- Of those who recently used pharmaceutical opioids, nearly half reported using them to treat self-dependence and around one-third for pain relief.
- Twenty-one percent of those who commented reported being refused pharmaceutical medications due to injecting history.
- Of those who commented, 41% were prescribed pharmaceutical medications for pain relief in the last six months.
- Of those who commented, 40% reported sourcing information about pill filtering from an Needle and Syringe Program.
Brief Pain Inventory
- One-third of the national sample experienced pain (other than everyday pain) on the day of interview.
- Of those who experienced pain, 73% reported the pain as non-cancer, 16% acute pain and 9% chronic cancer/malignant pain.
- The mean ‘pain severity score’ was 4.7, with one percent scoring 10 and the mean ‘pain interference score’ was 5.2, with three percent scoring 10.
- The mean score for ‘relief from pain medication’ was 4.7, with 10% scoring 10.
- Of those who experienced pain, around half reported trouble obtaining pain relief medication in the last six months.
Opioid and Stimulate Dependence
- Of those who recently used a stimulant drug (mainly methamphetamine) and commented, the median SDS was 3.7, with 43% scoring four or above indicating dependence.
- Of those who recently used an opioid drug (mainly heroin) and commented, the median SDS score was 7.6, with 76% scoring five or above indicating presence of dependence.
- Life prevalence of epilepsy and cerebrovascular disease (e.g. stroke) was higher in the IDRS sample than the general population.
- Nearly half of the IDRS sample reported a lifetime history of a Traumatic Brain Injury on a median of two occasions.
- Eighteen percent of those who experienced a Traumatic Brain Injury reported a level of consciousness greater than half an hour.
- The median age of most severe Traumatic Brain Injury was 25 years.
- One-third of the group reported being under the influence of alcohol, and 34% were under the influence of at least one drug (mainly heroin) at the time.
- Of the national sample, 18% reported recently injecting methadone, 12% buprenorphine, 9% buprenorphine-naloxone ‘tablet’ and 4% buprenorphine-naloxone ‘film’.
Injection-related injuries and diseases
- The IDRS gathered information on injection-related injuries and diseases which were then compared to the injection-related injuries and diseases project.
- The most common injection-related injury reported ever by the IDRS sample and in the Injection-Related Injuries and Diseases project was a dirty hit (59% and 67.9% respectively).
- In the last six months, the most common injection-related injuries or diseases reported by the IDRS sample was redness near the injection site (30%).
- Three-quarters of the national sample believed the quantity of drugs they were caught with would affect the type of charge received.
- Of those who believed this, the median number of two points for heroin and methamphetamine was the quantity though to affect the type of charge.