NDARC Technical Report No. 86 (2000)
EXECUTIVE SUMMARY
Demographics and use patterns: The 1999 IDRS detected some major changes in the injection of drugs in NSW. The frequency of injecting among the IDU sample had increased substantially. In 1997, prior to the major increase in cocaine use in Sydney detected in 1998, 26% of subjects reported injecting more than once a day, compared to 70% in 1999. Importantly, younger IDU (#25 years) reported more frequent injections than older users, with 82% injecting more than once a day in the preceding month, compared to 62% of older users. Younger IDU had also, on average, initiated injecting two years younger than the older IDU (17.1 vs. 19.0).
As with age of initial injection, there was an age-related difference in first drug injected. The younger group of subjects were significantly more likely to report having first injected heroin (76% vs. 49%). Conversely, initial use of amphetamine was more likely among older subjects (47% vs. 21%). Overall, there appears to have been a major shift in initial drug use patterns among younger IDU, who initiated injection at a younger age, and overwhelmingly commenced their IDU careers with heroin. These findings were consistent with key informant reports.
Heroin: The price of heroin in Sydney continued to fall, from $280 per gram in 1998 to $240 per gram in 1999. The average purity of heroin remained reasonably high (67%). The drug was easily available, and all indicators pointed towards an increase in the number of heroin users. Fatal opioid overdoses continued to increase. An increase in the number of younger users, and of more 'mainstream' people using heroin was noted, as was an increase in the frequency of heroin use among regular users.
Amphetamine: Amphetamine use among IDU was low and stable. There was a slight fall in the price of amphetamine, from $100/gram to $80/gram. Amphetamine was easy to obtain, and availability was stable. The average purity of amphetamine seizures was low (14%); but there were reports of more pure forms of amphetamine such as crystal methamphetamine being available.
Cocaine: Cocaine use increased dramatically among IDU in Sydney between 1997 and 1998, reaching a peak in late 1998. The prevalence of cocaine use among IDU increased further during 1999, with 67% of IDU sampled having recently used the drug, and there was also an increase in the proportion of IDU who nominated cocaine as their drug of choice. However, the frequency of use declined. The price of cocaine has stabilized, and its availability appears to have reached a plateau in 1999. Cocaine injection was particularly common among heroin users. The cocaine market among IDU consisted almost entirely of powder cocaine.
Cannabis: The price of cannabis was stable to decreasing relative to 1998, with the price of an ounce now being $350 and a gram $20. Cannabis was easy to obtain and availability was stable. The potency of cannabis was rated as high and had remained stable. According to the 1998 National Drug Strategy Household Survey, there has been an increase in the prevalence of cannabis use since 1995. Patterns of cannabis use among IDU showed no major trends.
Other Drugs: The most notable changes in patterns of other drug use concerned methadone and benzodiazepines. Indicator data showed a decrease in the number of NSP clients injecting methadone after distribution of 20 ml syringes ceased. Although benzodiazepine use remained common among IDU, there was a marked reduction in the use of Rohypnol (flunitrazepam).
General trends showed a continuing high level of polydrug use among IDU. Of particular concern was the use of benzodiazepines, prescribed opiates and tricyclic antidepressants among IDU, because these drugs increase risk of overdose. There was also concern expressed by key informants about the diversity of designer drugs consumed by ecstasy users, and their acute toxic effects.
Drug-Related Issues: Problems associated with drug use related mainly to injecting drug use, particularly injecting heroin use. There were more ADIS inquiries regarding heroin than for any other drug, and the number of calls had continued to increase since 1997/98. There had also been an increase in the number of opioid-related overdose fatalities, a continuing trend since the early 1990s. More IDU reported injection-related problems in 1999 relative to 1998, a finding consistent with the increased frequency of injection also found among IDU in 1999. There was also a continuing increase in the number of needles and syringes dispensed from NSPs in 1998/99. There was a high degree of criminal involvement among IDU, with half reporting criminal activity (other than illicit drug use) in the last month, and just over half having been arrested in the last year. There was a strong consensus that police activity toward drug users, particularly heroin users, had increased, with a substantial proportion of IDU considering that police activity made it more difficult to obtain drugs.
Research implications: The 1999 IDRS findings suggest several areas for further research. These are outlined below.
- Opioid-related overdose continues to be a major harm associated with heroin use, and this problem requires active interventions aimed at reducing fatal overdose.
- There has been an increase in the number of heroin users, particularly young injecting heroin users. The IDU survey found that younger heroin users began injecting heroin at a younger age and used heroin more frequently. Efforts need to be made to reduce the number of new initiates to injecting heroin use.
- Resources need to be allocated to developing a system to monitor the THC content of cannabis. This should involve assessment of the THC content of cannabis being consumed and measurement of THC content of different plant products (e.g., strains, growing methods, and heads vs. leaf).
- There is a high prevalence of cannabis use among the general population and continuing concern from health professionals regarding mental health problems among cannabis users. This suggests a need for further investigation of the implications of cannabis use for mental health and the treatment of comorbid mental disorders among cannabis users.
- Although not widespread, the availability of new and more pure forms of methamphetamine needs to be closely monitored.