NDARC Technical Report No. 221 (2005)
EXECUTIVE SUMMARY
This report presents the results of an ongoing study that monitors ecstasy and related drug markets in NSW. The 2004 sample provides data for the fifth year on trends in ecstasy and related drug markets. Data collected in 2003 and a feasibility trial of this methodology conducted in 2000, 2001 and 2002 are also included. Trends of the demographic characteristics and patterns of drug use among regular ecstasy users, their criminal behaviour, and perceived regular ecstasy users-related harms are presented. The implications of the results and the nature and characteristics of ecstasy and related drug markets are discussed.
Demographic characteristics of regular ecstasy users (REU)
The 2004 results indicate that regular ecstasy users, a population defined in this study by the regular use of tablets sold as 'ecstasy', tend to be young, relatively well-educated, and likely to be employed or engaged in full time study. Less than one fifth reported engaging in crime, most of which is infrequent and accounted for by drug dealing. Two participants were currently in treatment for a drug-related problem, and three participants had previously been incarcerated. Demographic characteristics of regular ecstasy users interviewed have changed little since 2000.
Patterns of drug use among REU
Participants could be characterised as extensive polydrug users, over half of whom nominated ecstasy as their favourite or preferred drug. On average, participants had used ten drugs in their lifetime and had used seven in the preceding six months. Almost all reported lifetime use of alcohol, cannabis, methamphetamine powder (speed) and tobacco.
The prevalence and frequency of use of other ecstasy and related drugs such as ketamine, GHB, MDA and base stabilised in 2004 which may suggest that while substantial minorities continue to report recent and lifetime use of these drugs, there are relatively few regular users who have access to these drugs. They may not be as widely or consistently available as ecstasy and therefore the use of these drugs may be opportunistic in nature. This is reflected in the relatively low frequency of use of these drugs with most recent users report using less than monthly.
Ecstasy
Participants in the 2004 sample first used ecstasy at a median age of 18 and typically commenced monthly use when they were 19 years old. The reported frequency of use ranged from once a month to three times a week. Most (38%) participants had used ecstasy between monthly and fortnightly and between more than fortnightly and weekly (38%) and 25% percent had used ecstasy on more than one day per week in the preceding six months. Close to a third (28%) of participants reported they had binged (used continuously for more than 48 hours without sleep) on ecstasy and more than half (60%) had taken four or more tablets in a single use episode in the preceding six months. Most (84%) reported typically using more than one tablet per occasion of use. Consistent with previous years, participants primarily administered ecstasy orally. Although 10% reported having injected the drug at some time, only one reported that injection was their preferred route of ecstasy administration.
The use of other drugs in conjunction with ecstasy was commonly reported including alcohol, tobacco, cannabis, speed and ice. Most participants also used a similar range of drugs to ease the 'come down' or recovery period following acute ecstasy intoxication, including alcohol, tobacco and cannabis.
Price, purity and availability of ecstasy
The median price paid for a single ecstasy tablet has remained stable at $35 since 2001 and most participants reported that the price has remained stable. Most participants pay for ecstasy through employment or are given ecstasy as a gift. The majority report 'scoring' from friends and known dealers and the most frequently reported purchase location was a friends' home.
There is little consistency regarding users' subjective reports of the purity of ecstasy and KE reports reflect this inconsistency. The median purity of seizures of tablets containing MDMA/phenethylamines analysed by both AFP and NSW police have remain stable since 2002/03.
Tablets sold as ecstasy have remained readily available in Sydney since 2000; the great majority of users have consistently described the drug as 'very easy' to obtain across time.
Imported tablets are more likely to contain MDMA than locally manufactured imitation tablets that contain methamphetamine. The number and weight of customs seizures of ecstasy seized at the border has increased in recent years suggesting either changes in activity, improvements in detection or more ecstasy being imported into the country or a combination of these factors. The supply of imported MDMA tablets may be being supplemented by domestic production: NSW police reported that the ratio of methamphetamine tablets sold as 'ecstasy' to 'ecstasy' tablets containing MDMA decreased in 2001-02. This may indicate an increase in imported MDMA, some manufacture of local MDMA or that tablets containing methamphetamine are being sold as such. Consistent with the possibility that local manufacture is occurring, there have been seizures of the precursors required to manufacture MDMA and in 2002-03 NSW Police reported seven clandestine MDMA laboratories detected in NSW (Australian Crime Commission 2003). This suggests that there are local manufactures of the ecstasy attempting to compete with importers of the drug.
Methamphetamine
Virtually all (98%) participants in 2004 reported having used methamphetamine powder (speed) at some time and a large proportion (81%) reported using speed in the six months preceding interview. Most recent users reported using speed less than once a month with snorting and swallowing being the most common routes of administration. Lifetime and recent use of speed has remained stable across sampling years although frequency of use increased slightly in 2004.
Approximately two thirds (64%) of the 2004 sample reported lifetime base use and 39% had used base in the preceding six months. The majority of recent users reported using less than once a month and the most common route of administration was swallowing. Prevalence of base use has increased over time although it has remained stable since 2002. Frequency of base use has fluctuated while quantity of use has increased slightly. Median number of days of base used has fluctuated over time.
Over half the sample (68%) reported having used crystal at some time and a similar proportion (46%) reported using in the preceding six months. Prevalence of crystal use continued to increase in 2004. Frequency of use appears to have increased slightly over time while quantity of crystal use seems to have remained relatively stable. Comparable to other forms of methamphetamine, the majority of recent users used less than month although data suggest median days of use has increased over time. In contrast to the other forms, the most common route of crystal administration was smoking. Clearly, there are risks associated with this route of administration. Reports of typical crystal use in conjunction with ecstasy stabilised (9%; 2004 comparable to 2003; 10%), however was more likely to have been used during a binge episode of use. (53% of those who had recently binged used crystal in 2004 compared to 37% in 2003).
The price of speed was commented on by over half (58%) of the sample with $60 for one gram the most common purchase. Half (57%) agreed the price speed had remained stable. Close to one third of the sample (30%) reported on the current price of base. A 'point' (0.1 of a gram) was the most commonly purchased amount for which a median of $37.50 was paid. Most reported the price of base had remained stable (50%) or decreased (23%) although one third (27%) were unable to comment. Slightly more participants were able to comment on the current price of crystal (33%) with a 'point' of crystal the most frequently purchased amount for $40. Most of those who commented reported the price of crystal had remained stable (47%) or decreased (18%) and only seven participants were unable to comment on the price of crystal in the preceding six months.
Most reported the availability of speed was 'very easy' to 'easy' to obtain. Reports of crystal (50% vs. 46 in 2003) and speed (47% vs. 32 in 2003) being 'very easy' to obtained increased, while base remained the same in 2004. The ease of obtaining all forms of methamphetamine was reported to have remained 'stable' over the preceding six months by the majority of those who commented.
Cocaine
The prevalence of lifetime cocaine use remained stable across sampling years, with the majority of participants reporting having used cocaine at some time. However, proportions of REU that reported recent cocaine use is comparable to 2003 data with less than half the sample reporting use in the preceding six months. Further, the median number of days used increased by one, with majority of recent users reported using less than once a month. Snorting was the most common route of administration.
One fifth (23%) of the sample commonly purchased a gram of cocaine for a median of $200, with most (42%) reporting the price had increased. Of those who commented (n=24), most (50%) reported that cocaine was currently 'very easy' to obtain and half (50%) believed the availability had remained 'stable'.
Ketamine
The prevalence of ketamine use stabilised in 2004, although use has increased since 2000. The 2004 sample reported lifetime (58%), while recent ketamine use has decreased by 10% to 39%. Frequency of ketamine use by the majority of recent users was less than one a month which is comparable to previous years. Snorting was the most common reported route of administration.
Close to a quarter (24%) commented on the current price of ketamine. A gram was purchased for $200. The majority (44%) reported the price as 'stable' although more than a quarter (28%) were unable to comment.
The majority of participants who commented reported that ketamine was 'easy' (40%), 'difficult' (40%) or 'very difficult' (12%) to obtain and over half reported that the availability of ketamine had become 'more difficult' (40%) in the preceding six months.
GHB
More than a fourth (28%) of the 2004 sample reported having used GHB at some time in their life, while a fifth (18%) had used the drug in the preceding six months. The prevalence of GHB use has increased over time, with substantial increases in reports of both lifetime and recent use since 2000. The frequency of GHB use is comparable across years although quantities used in 'typical' and 'heavy' occasions of use seem to have fluctuated.
Only a small proportion (10%) of participants in 2004 were able to comment on price and availability so these data must be interpreted with caution. GHB was commonly purchased in a 'vial' for a median of $30. Three (30%) reported the price was 'stable' and four (40%) believed it to be 'decreasing', while two (10%) thought it to be fluctuating. A further two (20%) were 'unable to comment' on price changes which is consistent with the relatively limited experience with this drug. All those commenting reported the availability of GHB as 'very easy' (40%) while three report to be 'easy' and other three reported to be 'difficult' to obtain. The majority reported the availability of GHB in the preceding six months had remained 'stable' (50%).
LSD
Lifetime and recent use of LSD has decreased over time with three fifths (61%) of the 2004 sample reporting having ever used LSD and a quarter (20%) reporting use in the six months prior to interview. Frequency of LSD used by recent users also appears to have reduced while quantity of use has remained relatively stable, with most recent users reporting less than monthly use. Users typically use one tab per occasion of use and this has remained stable across sampling years. All recent users reported swallowing the drug.
Close to one fifth (18%) of the sample reported the current price of LSD to be $20 a tab and most reported the price to be 'increased' (28%) or 'stable' (28%). Reports of the availability of LSD varied; while most (56%) thought LSD 'difficult' to obtain, a further five participants (28%) believed it to be 'easy' and two 'very easy' (11%). Reports of changes in availability of LSD in the preceding six months were similarly inconsistent most (39%) considered the availability of LSD had remained 'stable', five (28%) thought it had become 'more difficult' to obtain, two (11%) thought it 'easier', and four (22%) were 'unable to comment' on the availability of LSD.
MDA
Approximately one third of participants in 2004 had used MDA recently. Prevalence of lifetime and recent MDA use has increased over time, however in 2004 we have seen a slight reduction. Frequency of use has increased slightly while quantity of MDA use has remained stable.
One tenth (10%) of the sample reported the current price of MDA as $47.50 per cap. User reports of current availability less consistent although most thought availability had remained 'stable' over the preceding six months.
Patterns of other drug use
Comparable to previous years, almost all regular ecstasy users report consuming alcohol on a median of two days a week. Similarly, most of the 2004 sample reported recent cannabis use, the majority of who smoke on a median of two days per week. Tobacco use was common although just over half of those reporting recent used were daily cigarette smokers. Also comparable to previous years, half the 2004 sample had used benzodiazepines at some time. Those who reported recent benzodiazepine use did so less than once a month. A small number (3%) of the 2004 sample reported the recent use of antidepressants, one of whom used for reasons other than depression. The use of inhalants such as amyl nitrate and nitrous oxide appear to have remained stable across time.
Risk behaviour
One in five (23%) of the sample reported having injected a drug at some time in their lives and 11% reported injecting in the six months preceding interview. A median of 1.5 drugs (range 1-11) had ever been injected while those who reported injecting in the preceding six months had injected a median of two (range 1-4) drugs.
One third (33%) of lifetime injectors reported injecting for the first time while under the influence of drugs (mainly speed and ecstasy). Of those that were lifetime injectors and had first injected while under the influence of drugs, the first drug injected was speed (46%) followed by heroin (17%).
When lifetime injectors were asked to specify how they learned to inject, two thirds (62%) reported that a friend or partner showed them how. Of those that injected in the preceding six months, two reported using a needle after someone else in the month preceding interview.
Thirty-five percent of the sample reported that they have never been vaccinated for Hepatitis B. A further 39% reported that they have completed the vaccination schedule, 13% did not finish the vaccination schedule and 14% did not know if they have been vaccinated. Of the sample 52% reported that they had never been tested for HCV, while 23% had been tested in the last year, 19% were tested more than a year ago and 6% either did not know or didn't get their result. Thirty two percent of the sample had been tested for HIV in the last year and a further 19% had been tested more than a year ago.
As expected among a sample of young adults, the majority (92%) of participants reported penetrative sex in the six months preceding interview. Most (48%) reported one sex partner during the preceding six months although one fifth (21%) of participants had penetrative sex with two people and almost a quarter (24%) reported sex with between three and five people. The majority (90%) of those reporting recent penetrative sex reported using drugs during sex in the previous six months. One third (33%) of those who reported penetrative sex in the preceding six months had had anal sex.
Of the sample 48% had driven within one hour of taking a drug. The drug most commonly take was ecstasy (56%) followed by cannabis (46%), alcohol (42%) and speed (40%).
Of those that were asked about tattooing and body piercing (n=104), 26% had received a tattoo and a 37% reported body piercing.
Health related issues
Of the PDI sample 12% of the participants had overdosed on either ecstasy or other related drugs. Of those that had overdoses the main drug used was ecstasy (58%) followed by GHB (17%). Of those who had overdosed ten had used more than one ecstasy and related drug. The most common drug used in conjunction reported by this sample was alcohol (80%) and ecstasy (20%), followed by methamphetamine powder (8%), crystal (10%), MDA (10%), ketamine (10%) and tobacco (8%).
For the first time in 2004 the severity of dependence scale (SDS) was used for ecstasy and methamphetamine. The SDS has been validated as a measure of dependence for a number of drugs including methamphetamine. It was administered with reference to ecstasy use to provide some information about users’ concerns about their ecstasy use. The same cut-off score was used as that for methamphetamine; it is important to note that although both methamphetamine and MDMA are ATS (and therefore the cut-off probably a reasonable one for ecstasy), the SDS has not been formally validated for use in indicating ecstasy dependence.
The median SDS score for ecstasy was 2 (range 0-8). Most (32%) participants had obtained an SDS score of 0, 10% a score of 3, 23% obtained a score of 2 and 14% a score of 1. Twenty-one percent of participants who had used ecstasy in the last 6 months obtain a SDS score of 4 or more. Participants were asked if their ecstasy use was out of control with 63% reporting 'never or almost never', 76% reported that missing a dose did not make them feel anxious, almost half of the participants were not worried about their ecstasy use and 20% percent wished that sometimes they could stop using ecstasy.
Of those that had used methamphetamines the median SDS score was zero (range 0-13), with 21% scoring four or above, the level of dependence. Of those that scored above four on the SDS, 30% reported specifically using crystal methamphetamine, 46% speed, 10% base and 23% reported no specific methamphetamine. Twenty percent of those that had used methamphetamines believed that their methamphetamine use was 'sometimes' out of control, 15% reported that missing a dose 'sometimes' made them feel anxious, 28% were 'sometimes' worried about their methamphetamine use, 16% 'sometimes' wished that they could stop and 14% found it quite difficult to stop using methamphetamine.
Participants in 2004 reported a range of other problems associated with their drug use. Participants were asked if they had experienced any occupation, social, financial or legal problems in the six months preceding interview that they would attribute to their drug use. Proportions reporting these harms predominantly attributed them to their use of ecstasy rather than other drugs.
Approximately two fifth of the sample had experienced financial problems (39%), occupational/study problems (38%) and relationship/social problems (31%) in the preceding six months attributable to the use of ecstasy and related drugs. Only a small number of participants reported legal problems; of the nine people who did, three attributed these problems at least in part to ecstasy and two reported having been cautioned by the police and one arrested.
Criminal activity, policing and market changes
Relatively few of the ecstasy users interviewed were involved in criminal activity apart from dealing drugs. Less than a fifth (12%) reported dealing drugs in the month preceding interview and most of them reported dealing less than once a week. Reports of criminal activity to fund the purchase of ecstasy have decreased over time. Small numbers were arrested and very few report a history of incarceration.
There was a marked decrease in the proportion of ecstasy users sampled who perceive recent increases in police activity. However, of those who did report an increase, the majority reported increase police presence in nightclubs, dance parties and raves (including 'doofs' and dance parties). KE reports were consistent with this.
The majority of all four samples of ecstasy users reported that police activity had not made it more difficult for them to obtain drugs.
Conclusion
There is increasing evidence that the use of ecstasy is widespread and that the market has increased or stabilised in recent years. The results of general population surveys (showing an increased prevalence of use over time), increases in arrests for possession or dealing ecstasy, increases in calls to telephone help lines about ecstasy, and reports from regular users, suggest that over time, this group is increasing in size and that ecstasy is being used more heavily. The PDI survey data show that regular ecstasy users score from a range of people and use in a wide variety of locations. All this information suggests that despite Australia’s continued effort to reduce both the importation and local manufacture of ecstasy, it has remained readily available in Sydney since 2000. Continued monitoring of the market for ecstasy will ensure policymakers are well placed to respond to changes in the market or to the nature and extent of ecstasy-related harms in a timely fashion.
Implications
There is evidence to suggest that ecstasy (MDMA) may be neurotoxic to serotonergic neurons in the brain, which are involved in mood regulation and memory function (Hegadoren, Baker et al. 1999; Boot, McGregor et al. 2000). The long term consequences of ecstasy use are not well understood. Results from the PDI suggest that there is the potential to reduce the harm associated with ecstasy and related drug use is this population. The challenge of harm reduction strategies is to incorporate messages that are credible and acceptable to the population.
The majority of ecstasy users reported a range psychological, neurological and physical harms related to their use of the drug yet they continue to use in ways that may be considered harmful. Substantial proportions reported recently bingeing on ecstasy and using large amounts of alcohol in conjunction with ecstasy. Both these patterns of behaviours are likely to increase the risks associated with ecstasy use and should perhaps be considered by health educators as harmful behaviour worth targeting.
Although many users were able to identify harms related to the use of ecstasy and other ecstasy and related drugs, there were users that did not know the risks associated with use. As regular ecstasy users are also polydrug users, it is important to provide accurate information to users regarding combinations of specific ecstasy and related drugs and their effects. The provision of evidence-based information to reduce the harm associated with the use (and poly use) of these drugs may help to avoid some of these harms. Further research may be required to provide a better understanding of harms associated with specific drug combinations. In addition it is important to acknowledge that users
may be using specific combinations of drugs to enhance effects or decrease the side effects of others. Some users of speed, ketamine, GHB and amyl reported the benefit of these drugs was the ability to enhance effects or decrease the side effects of other drugs. Some KEs also made comments consistent with this. It is a challenge to provide effective harm reduction strategies to this group, acknowledging their knowledge of the drugs while also attempting to limit harm.
The content of 'ecstasy' tablets is variable, and this is an issue of concern that could be potentially addressed by the consistent analysis of seizures by law enforcement agencies. Since 1997, the Victoria Police Forensic Services Department, Chemical Drugs Intelligence Team, has maintained a database on drug seizures. Over the last seven years this database has developed into a comprehensive record of drug seizures and trends within Victoria. This database will contain a greater number of seizures from other jurisdictions in the future, but at time of publication data for NSW was not available.
The use of other ecstasy and related drugs such as ketamine, GHB, MDA and LSD appears to be more sporadic. Consistent with a relatively low level of use of these drugs, only small numbers felt confident about commenting on the price, purity and availability of them. Consequently, many people who report the recent use of such drugs may not deliberately seek them out. This use may be more opportunistic and hence, they are unfamiliar with market indicators such as changes in their price, purity and availability. The relatively low rate of exposure to the regular use of these drugs is in itself an indicator of the smaller size of the markets for them. However the use of these drugs, however infrequent, is of interest as it may be that the most important factor related to REUs' use of these other drugs is the risks associated with the combinations of drugs used, i.e. the polydrug use itself. In addition, although use of ketamine, GHB and MDA stabilised in 2003, there have been increases since 2000 and continued monitoring is required to ascertain if the markets will continue to grow.
The 2004 NSW PDI results highlight the use of crystal methamphetamine among regular ecstasy users has remained at levels similar to 2003, but anecdotal evidence from KEs suggested an increase among this group of users and some considered that much of the harm experienced by REU was related to the use of crystal specifically. The increases documented in 2004 in recent use, use of crystal in a 'binge' session of use, other indicators of crystal use and an increase in the proportion that report crystal as 'very easy' to obtain, indicate an expanding market for this drug. This highlights issues for research, health and law enforcement. The market for crystal methamphetamine needs to be monitored, the routes of administration considered, and has been examined in separate research conducted at NDARC in 2004. In particular the harms associated with smoking need to be addressed.
For the first time in 2004 the PDI sample examined various risk behaviours such as injecting, sexual and driving risk behaviours, levels of overdose, health seeking behaviour, drug dependence and other problems. The findings of this assessment will be considered in greater detail in the coming months.
The health effects of ecstasy and related drug use were often considered relatively benign by users in the study. However the harms associated with injecting drug use, drug taking during sex and driving under the influence is substantial. It is important to investigate risk-taking behaviour in this population and monitor blood borne virus infection vaccination and testing as an outcome. This will allow to examine whether harm reduction messages are reaching this group and promote safe practices.
The regular ecstasy users interviewed generally report low levels of criminal activity, the most common of which was drug dealing. We found in 2004 that the majority of regular ecstasy users who deal drugs do so to pay for their ecstasy use (ecstasy profit) and a small minority tend to deal drugs for money (cash profit).
Continued monitoring of the ecstasy and other ecstasy and related drug markets will enable the collection and dissemination of information that will allow the implementation of timely policy responses to market developments. Continued monitoring will also enable the regular collection of indicative data relating to the size of the markets for other ecstasy and related drugs, such as GHB and ketamine, and will point to the need for research specific to such drugs. The replication of Party Drugs Initiative (PDI) in 2005 in all jurisdictions across Australia will be a useful addition to current knowledge about ecstasy and related drug markets across the country.
Citation: Degenhardt, L., Agaliotis, M., White, B. and Stafford, J. (2005) NSW Trends in Ecstasy and Drug Related Markets 2004: Findings from the Party Drugs Initiative (PDI), Sydney: National Drug and Alcohol Research Centre.