Demographic characteristics of people who inject drugs (PWID)
In 2013, 151 people participated in the IDRS survey. Sixty percent were male, 95% reported they were not currently working or were currently receiving income support (such as disability or sickness benefits or the Newstart jobseeker’s allowance) at the time of interview. The average age of respondents was 40 years (range 23−63 years). Twenty-seven percent of the sample identified as Aboriginal and/or Torres Strait Islanders. Ninety-five percent of the sample identified English as the main language spoken at home. Fifty-six percent of the sample had completed year 10, and 19% had completed year 12 at high school. Forty-nine percent had obtained a trade or technical qualification, and 7% had completed a university or college qualification such as a degree. Forty-four percent had not completed any further education after leaving school. The majority (70%) of participants reported previous prison history and the average age of first injection was 20 years (range 10−40).
Patterns of drug use among the PWID sample
Following the trends of previous years, heroin was still the preferred drug of choice (62%) in 2013 and this remained stable with reports from last year (69% in 2012). Heroin was the drug most often injected in the month prior to interview (50%) however, this was a statistically significant decrease (p<0.05) when compared with 2012 (62%). Heroin remains the drug people had injected most recently (50%; 59% in 2012) and 85% of participants reported use on one or more occasions in the six months preceding interview (89% in 2012). The median days of recent heroin use also remained stable at 90 days (96 days in 2012). The proportion of participants reporting daily use was 26% (39% in 2012). This was also a statistically significant decrease (p<0.05).
The median price for a gram ($350) of heroin remained stable ($350 in 2012) as did the price for a cap ($50). Prices continued to remain higher than those reported prior to the heroin shortage in 2001. Heroin remained accessible in 2013, with 86% (84% in 2012) of those who commented reporting that it was either ‘easy’ or ‘very easy’ to obtain. The majority of participants that commented (67%; 77% in 2012) on ease of availability reported it had remained stable.
Participant reports (among those who commented) on heroin purity continued to be mixed in 2013. Thirty-eight percent of the participants that commented reported current purity as low, which remained stable, and over one-third (38%; 35% in 2012) reported it as medium. Thirty-seven percent (33% in 2012) of those commenting considered purity levels to have remained stable over the preceding six months, while just over one-quarter (28%; 26% in 2012) commented that it had decreased.
The proportion reporting any recent methamphetamine use (speed powder, base, ice or liquid) increased in 2013 (from 72% in 2012 to 75% in 2013), though this change was not statistically significant. Among those reporting any recent use (speed, base, ice, liquid) the median number of days decreased to 18 days, down from 24 days in 2012. The majority had used each form of methamphetamine weekly or less over the six months preceding interview. The proportion (7% in 2013) of participants reporting daily use of any type of methamphetamine was lower.
A ‘point’ (0.1 of a gram) remained the most popular purchase amount for all three main forms of methamphetamine, and the median price remained stable at $50 for speed powder, base and ice/crystal. Those purchasing ice/crystal and speed powder by the gram and half-gram increased in 2013, but there were insufficient numbers of purchases of any form of methamphetamine to comment on price changes.
Consistent with 2012, speed and ice/crystal forms of methamphetamine were typically reported by the majority of users as ‘very easy’ or ‘easy’ to obtain, whereas the availability of base varied. Availability for all forms was typically reported to have remained stable over the six months preceding interview.
Cocaine use among PWID remained consistent in 2013 with 47% of the sample reporting recent use (also 47% in 2012). The median days of use among users also remained stable in 2013 at a median of 6 days (approximately monthly use). Daily cocaine use also remained stable with 5% of users reporting daily use (5% in 2012). Reports of crack cocaine were once again almost non-existent among the PWID sample, a finding reflected in KE reports. The majority (70%; 71% in 2012) reported cocaine availability to be ‘easy’ or ‘very easy’. The median price per ‘cap’ of cocaine remained stable in 2013 at $50 and was the most common purchase amount (n=32). The median price of a gram decreased in 2013 from $375 in 2012 to $300 however, there was an increase in those purchases by this amount (n=14). More participants reported purchases in half-grams (n=16), though there were low numbers reporting purchases in any other measurement; therefore, results should be interpreted with caution. Participants reporting cocaine purity as ‘medium’ in 2013 remained ‘stable’ (40% versus 48% in 2012).
The cannabis market continued to remain relatively unchanged since the commencement of the NSW IDRS in 1996. The majority of participants (82%; 72% in 2012) in the 2013 participant sample reported having used cannabis in the six months prior to interview. There was a non-statistically significant decrease in the median frequency of use among PWID from 180 days in 2012 to 100 days in 2013.
In line with previous years, a large proportion of participants reported use of both the hydroponic (‘hydro’) and outdoor-grown (‘bush’) forms of cannabis, with hydro appearing to dominate the market. The number of participants reporting purchase of resin (hashish) and oil (hash oil) continued to remain very rare and infrequent. The price of hydroponic cannabis remained stable at $20 per gram (the most popular purchase amount), and significantly more PWID reported that it was readily available, i.e. ‘easy’ or ‘very easy’ to obtain (97% versus 87% in 2012, p <0.05). The price per gram of bush cannabis was also $20, but, as in previous years, larger purchase quantities of bush were slightly cheaper than for the equivalent quantity of hydro. Bush continued to be reported as less easily available than hydro, with fewer participants able to complete survey items on bush market characteristics (price, potency and availability). Potency of hydroponic cannabis continued to be reported as ‘high’, and bush continued to be reported as ‘medium’.
Use of pharmaceuticals
The IDRS monitors the extra-medical use patterns and market characteristics of opioid pharmaceutical medications including both those prescribed for opioid substitution treatment (OST; i.e. methadone, buprenorphine, buprenorphine-naloxone), and those prescribed for pain relief (i.e. morphine and oxycodone).
One-quarter (25%) of participants reported use of illicitly obtained methadone syrup in the six months preceding interview, which is stable compared with 2011 (23%). Use remained stable and relatively infrequent (approximately monthly). Fifteen percent of participants reported injecting illicit methadone syrup in the preceding six months (18% in 2011), and the frequency (median days) of injection also remained stable at approximately monthly. However, significantly fewer of those that could comment on the availability of non-prescribed methadone reported that it was ‘very easy’ or ‘easy’ to obtain (64% versus 80% in 2011). The median price of 50 cents per millilitre remained stable.
Recent use and injection of Physeptone obtained without prescription continued to remain uncommon.
Non-prescribed buprenorphine and buprenorphine-naloxone
The recent use and injection of non-prescribed buprenorphine in the preceding six months remained stable in 2012. The frequency of injection of non-prescribed buprenorphine over this period continued to remain low and stable.
Buprenorphine-naloxone (Suboxone) tablets have been investigated by the IDRS since it was listed on the Pharmaceutical Benefits Scheme (PBS) in April 2006. In September 2011, buprenorphine-naloxone film was also added to the PBS, and so was also investigated in the 2012 IDRS. Six percent of the sample reported recent use of illicit buprenorphine-naloxone tablets (7% in 2011), with 5% reporting recent use of buprenorphine-naloxone film. The median number of days of use for illicit buprenorphine-naloxone tablets or film was low, with less than monthly use reported. In addition, very low numbers reported recent injection of either tablets or film (2% and 1%, respectively).
An increase in prevalence of any recent morphine use among the NSW IDRS PWID sample had been observed since 2001; however, in 2013 it remained comparable with 2012 (20% versus 23% in 2012). Recent use of non-prescribed morphine also remained stable (19%; 19% in 2012), as did recent injection (19%; 19% in 2012). The median number of days non-prescribed morphine was injected was 6.
MS Contin remained the most common brand of morphine used. The median price for 100mg MS Contin tablets (‘grey nurses’) was $40 per tablet, consistent with 2012 prices. Participants typically reported that it was ‘very easy’ or ‘easy’ to obtain. Availability was generally considered to have remained stable.
Since 2005, a distinction has been made between prescribed and non-prescribed other opioids in an effort to monitor the non-prescribed use of, and problems associated with, the diversion of oxycodone. Until 2005, oxycodone was included under ‘other opioids’.
Seventy-four participants reported use of any (prescribed or non-prescribed) oxycodone in the six months preceding interview, a significant increase on 2012 (n=43). Participants reported using oxycodone a median of 20 days (i.e. almost weekly) which is stable with 2012 (20 days). Although the proportion of PWID reporting recent injection of oxycodone was stable (37% versus 42% in 2012), the median number of days injected increased from 24 in 2012 (i.e. almost weekly use) to 30 days in 2013.
Thirty-nine percent of the sample felt confident to comment on the price and/or availability of illicit oxycodone in 2013, a slight decrease from 42% in 2012. As per previous years the most common purchase amounts were 80mg OxyContin tablets, bought for a median price of $40 (range: $20−$100) each. The majority (83%; 71% in 2012) of participants commenting reported that availability was considered ‘easy’ or ‘very easy’, with availability generally considered to have remained stable.
Over the counter codeine
Since 2009, survey specific questions were asked about over the counter (OTC) codeine use and it was subsequently removed from the ‘other opioids’ classification. In 2013, 42% of the sample reported recent use of OTC codeine, on a median of 24 days with one participant reporting recent injection. Recent injection reports of any other opioids were non-existent.
Prevalence of benzodiazepine use remained relatively stable with 66% (64% in 2012) reporting use in the six months preceding interview and the frequency of use increased from a median of 67.5 days in 2012 to 81.5 days in 2013. The injection of benzodiazepines remained low with 5% (2% in 2012) reporting any injection in the past six months.
Twelve percent had recently used ‘licit’ alprazolam on a median of 60 days while 47% had recently used ‘illicit’ alprazolam on a median of 12 days. Twenty-nine percent of the NSW sample reported having used ‘licitly’ obtained other benzodiazepines on a median of 49 days in the last six months while 33% reported using ‘illicitly’ obtained other benzodiazepines on a median of 10 days in the six months preceding interview.
Excluding alprazolam, the most commonly used brand of benzodiazepine was diazepam (70%; including Valium, Valpam and Antenex), followed by oxazepam (12%; Serepax), and clonazepam (9%; Rivotril).
Twenty-one percent of the sample had used Seroquel® in the last six months (12% licit, 10% illicit), a significant decrease from 38% in 2012. ‘Licit’ Seroquel® has been used on a median of 120 days compared to three days for ‘illicit’ Seroquel®.
Hallucinogens, ecstasy and inhalant use were relatively low within this sample. Four participants reported recent hallucinogen use in 2013. Although more than half (55%) of the sample had tried ecstasy, recent use was reported by only 7% of the sample on a median of 4 days. Prevalence of recent inhalant use (e.g. nitrous oxide, amyl nitrite) remained low at 3%.
Alcohol and tobacco
Sixty-six percent of participants had consumed alcohol in the preceding six months (61% in 2012) on a median of 24 days, i.e. approximately once per week. This was an increase from 2012 in which participants who had consumed alcohol in the preceding six months did so on a median of 12 days (i.e. fortnightly use). Eight percent of participants reported daily use of alcohol.
Tobacco remained the most commonly used substance investigated by the IDRS, with virtually all participants (94%) reporting smoking tobacco in the six months preceding interview on a median of 180 days (i.e. daily); a finding that has remained consistent since 1996 when the project commenced. Unlike smoking prevalence in the general population (Australian Institute of Health and Welfare, 2011a), smoking among IDRS participants has not declined over time.
Health-related trends associated with drug use
Nineteen percent of all participants who had ever experienced a non-fatal heroin overdose had done so in the year prior to interview (13% in 2012). There were three reports of overdose in the month preceding the interview (n=1 in 2012).
Overall, participant reports of borrowing and lending of needles and syringes, as well as sharing of other injecting equipment, remained stable in 2013.
The most commonly reported location for last injection remained a private home and this remained stable with 2012.
Again in 2013, participants were asked the site on their body for their last injection. The majority (70%) reported their arm or hand/wrist (16%) and only small proportions reported their neck, groin, leg or foot.
Sixty-eight percent of PWID participants who had injected in the last month reported at least one injection-related problem during this time (61% in 2012). As per 2013, the most commonly reported problems were prominent scarring/bruising of injection sites (48%; 39% in 2012) and difficulty injecting (46%; 34% in 2012).
Forty-five percent of the sample reported experiencing a mental health problem, other than drug dependence, in the preceding six months (45% in 2012), with 63% reporting seeking advice from a mental health professional (72% in 2012). Depression continued to be the most commonly reported mental health problem (30%; 31% in 2012).
Again in 2013, the 10-item Kessler Psychological Distress Scale (K10) was administered. The K10 assesses recent levels of psychological distress (anxiety and depressive symptomatology). The majority of participants fell into the ‘high’ or ‘very high distress’ level of psychological distress category, at a proportion higher than the Australian normative value.
Three percent of the entire sample had driven under the influence of any alcohol in 2013. Nineteen percent of the entire sample had driven ‘soon’ after taking (an) illicit drug(s), with heroin being the most common drug last taken before driving.
Law enforcement-related trends associated with drug use
The proportion of PWID participants that reported being arrested in the previous 12 months increased to 42% of the entire sample (36% in 2012). Self-reported crime trends continued to follow those reported in previous years with the two most commonly reported crimes in the month prior to interview being drug dealing (30%; 21% in 2012) and property crime (19%; 19% in 2012). The daily expenditure on drugs and alcohol (excluding tobacco and prescribed medication) increased in 2013 to a median of $85 per participant ($50, in 2012). The range of daily expenditure was $7−$1000.