NSW Trends in Ecstasy and Related Drug Markets 2011: Findings from the Ecstasy and Related Drugs Reporting System (EDRS)

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Author: Laura Scott, Lucy Burns

Resource Type: Drug Trends Jurisdictional Reports

EXECUTIVE SUMMARY

The 2011 NSW Trends in Ecstasy and Related Drug Markets report represents the twelfth year in which data has been collected in NSW on the markets for ecstasy and related drugs. The Ecstasy and Related Drugs Reporting System (EDRS; formerly the Party Drugs Initiative, or PDI) is the most comprehensive and detailed study of ecstasy and related drug markets in NSW. Using a similar methodology to the Illicit Drug Reporting System (IDRS), the EDRS monitors the price, purity and availability of ‘ecstasy’ (3,4-methylenedioxymethamphetamine - MDMA) and other related drugs such as methamphetamine, cocaine, gamma-hydroxybutyrate (GHB) 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); 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 ecstasy and other drugs. Regular ecstasy users are recruited as they are considered a sentinel group to detect illicit drug trends. The information from the REU is, therefore, not representative of ecstasy and other drug users in the general population, but is indicative of emerging trends that may warrant further monitoring.

The findings from each year not only provide a snapshot of the drug markets in NSW, but also help to provide an evidence base for policy decisions, inform harm reduction messages, and provide directions for further investigation when issues of concern are detected. Continued monitoring of the ecstasy and related drug markets in NSW 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.

Demographics

  • 100 REU were sampled in the 2011 EDRS (77 male and 23 female).
  • Participants were young (mean age=24 years), reasonably well educated and most commonly spoke English as their first language.
  • Very few participants reported being currently in drug treatment (3%).
  • These demographics have remained relatively stable over time aside from mild variations in employment status, the completion of tertiary education and income.


Patterns of drug use among REU

  • Participants had experience with a wide range of drugs; having used an average of 11 different drug types during their lifetimes and 7 different drug types over the past six months.
  • One-in-ten reported having ever injected a drug.
  • Increases were seen in recent use of tobacco, ketamine and magic mushrooms.
  • Reductions were seen in the recent use of heroin.
  • Ecstasy was the main drug of choice for one-third of the sample.
  • One-third of the group had recently binged on ecstasy and related drugs (ERD). The median number of binge episodes was 4 in the past six months.

 

Ecstasy
Consumption Patterns

  • Ecstasy was used on a median of 13 days over the past six months (i.e. approximately fortnightly).
  • Participants had used a median of 2 tablets during a ‘typical’ occasion of use (range 1-12).
  • Swallowing was the main route of administration (93%).
  • The vast majority of REU (91%) reported using other drugs in combination with ecstasy the last time they used it, most commonly alcohol, tobacco, cannabis and cocaine.
  • The majority (70%) of participants used other drugs to help them come down from ecstasy the last time they used it (most commonly cannabis, alcohol and tobacco).
  • Ecstasy was most commonly last used at a nightclub (55%) and other public venues.
  • The proportion of the NSW population who reported using ecstasy within the last twelve months fell significantly from 3.5% in 2007 to 3% in 2010.
  • Approximately one-third (30%) of men interviewed for the Sydney Gay Community Periodic Survey reported having recently used ecstasy. A significant decline from the previous survey.
  • Key experts noted that ecstasy use is common among young people and that older users are starting to regain interest in the drug as the purity reportedly has begun to increase.


Market Characteristics

  • Price: $25 per tablet.
  • Purity: Currently low and stable.
  • Availability: Currently easy to obtain and stable.
  • Several key experts had reason to believe that the purity of ecstasy was beginning to increase after a substantial period of low purity.


Methamphetamine
The 2011 EDRS distinguished between three different forms of methamphetamine: methamphetamine powder (‘speed’); methamphetamine base (‘base’); and crystal methamphetamine (‘crystal’).

Consumption Patterns

  • Speed:
    • Two-thirds of REU had ever used speed and one-third had done so recently.
    • Speed was used on a median of 3 days over the preceding six months and was primarily snorted (88%).
    • The frequency and quantity of use appeared to be stable from 2010 to 2011.
  • Base:
    • Two-fifths of the sample had ever used base and 16% had done so recently.
    • Base was used on a median of 2 days over the preceding six months and was primarily swallowed (100%).
    • The frequency and quantity of use appeared to be stable from 2010 to 2011.
  • Crystal
    • One-third of the sample had ever used crystal and one-fifth had done so recently.
    • Crystal was used on a median of 6 days over the preceding six months and was primarily smoked (84%).
    • While the frequency of use was stable, the average quantities used increased slightly from 2010 to 2011.
  • Speed was commonly used in public settings, crystal in private settings and base was a mix of both.
  • The use of methamphetamine among the NSW general population remained stable from 2007 (2.3%) to 2010 (2.1%).
  • The use of speed and crystal by respondents in the Sydney Gay Community Periodic Survey has been in decline since 2007.
  • KE generally agreed that speed and crystal were becoming less common and that base was quite uncommonly seen.


Market Characteristics:

  • Speed:
    • Price: $80 per gram and apparently increasing from 2009.
    • Purity: Reports were variable.
    • Availability: Currently easy to obtain and stable.
  • Base:
    • Price: $100 per gram and reportedly stable
    • Purity: Currently medium to high and appeared to be stable.
    • Availability: Currently difficult to obtain and stable.
  • Crystal:
    • Price: $60 per point and reportedly increasing.
    • Purity: Generally high although variable.
    • Availability: Currently easy to obtain and stable.
  • Key experts agreed that speed and crystal had become more difficult to access and that the purity of speed was low.


Cocaine
Consumption Patterns

  • The majority of the group (84%) had tried cocaine at least once, and 59% had used it recently.
  • Cocaine was used on a median of 4 days (i.e. less than monthly) over the preceding six months.
  • The proportions using cocaine, the frequency and quantities used had all remained stable from 2010 to 2011.
  • Recent use of cocaine among the NSW general population increased significantly from 1.6% in 2007 to 2.1% in 2010.
  • From 2007 to 2011 there was a significant increase in the use of cocaine among participants of the Sydney Gay Community Periodic Survey.
  • Key experts reported that cocaine use they saw was primarly localised among young professionals in nightclubs and was uncommon at festivals.


Market Characteristics

  • Price: $300 per gram, stable.
  • Purity: Variable although appears to have decreased.
  • Availability: Currently easy to obtain, stable.
  • Key experts had observed increases in cocaine importation from Mexico. Reduced presence of the adulterant Levamisole was also reported.


Ketamine
Consumption Patterns

  • Over half of the sample had tried ketamine at least once and 39% had used it recently.
  • Ketamine was used on a median of 2 days (i.e. less than monthly) over the preceding six months.
  • There was a significant increase in proportions reporting recent ketamine use and an apparent decrease in quantities used from 2010 to 2011.
  • Recent use of ketamine among the NSW general population remained low and stable.
  • There was a significant decline in the use of ketamine among participants of the Sydney Gay Community Periodic Survey from 2007-2011.
  • Key experts reported ketamine use was not widespread among Sydney party goers but localised to certain groups.


Market Characteristics

  • Price: $150 per gram, stable.
  • Purity: Currently high and stable.
  • Availability: Reports variable.
  • Key experts reported that the availability of ketamine was low and it was uncommonly seen.
     

GHB
Consumption Patterns

  • One-third of the sample had tried GHB at least once and 16% had used it recently.
  • GHB was used on a median of 2 days (i.e. less than monthly) over the preceding six months.
  • The frequency and quantity of use of GHB remained stable from 2010 to 2011.
  • Recent use of GHB among the NSW general population remained low and stable.
  • From 2007 to 2011 the use of GHB among participants of the Sydney Gay Community Periodic Survey was stable.
  • Key experts were concerned about the risks of alcohol pre-loading and GHB use among groups who were not well-acquainted with harm reduction strategies for central nervous system (CNS) depressants.


Market Characteristics

  • Price: $10 per mL, stable.
  • Purity: Reports variable.
  • Availability: Currently difficult to obtain, stable.
  • Key expert comments indicated that GHB purity was currently poor and that it was difficult to access.

 

LSD
Consumption Patterns

  • Three-quarters of the sample had tried d-lysergic acid diethylamide (LSD) at least once and almost half had used it recently.
  • LSD was used on a median of 2 days (i.e. less than monthly) over the preceding six months.
  • Unlike most other drugs, LSD was often used in outdoor settings.
  • The use of LSD among the sample appeared to be increasing over the past four years.
  • The use of hallucinogens among the NSW general population increased significantly from 0.6% in 2007 to 1.4% in 2010.
  • The use of LSD among participants of the Sydney Gay Community Periodic Survey remained relatively low and stable over time.
  • Key expert comments indicated that LSD use was increasing among certain subgroups of party goers.


Market Characteristics

  • Price: $20 per tab, stable.
  • Purity: Currently high, stable.
  • Availability: Currently easy to obtain, stable.
  • Key experts reported that the purity of LSD was variable and that it tended to be imported rather than manufactured in Australia.


Cannabis
Consumption Patterns

  • Almost every participant had tried cannabis at least once and the vast majority had used it recently.
  • Cannabis was used on a median of 48 days (i.e. twice per week) over the preceding six months.
  • The use of cannabis had remained relatively stable over time.
  • The use of cannabis among the NSW general population increased significantly from 9.1% in 2007 to 10.3% in 2010.
  • The use of cannabis among participants of the Sydney Gay Community Periodic Survey has declined since 2007.
  • Key experts were concerned about the use of cannabis among young people and among same sex attracted women.


Market Characteristics

  • Hydro
    • Price: $20 per gram; $300 per ounce, stable.
    • Potency: Currently high, stable.
    • Availability: Currently very easy to obtain, stable.
  • Bush
    • Price: $20 per gram; $290 per ounce, stable.
    • Potency: Currently medium, stable.
    • Availability: Reports variable.
  • Key experts agreed that cannabis use continues to be widespread.


Research chemicals

  • The two most common research chemicals recently used among Sydney REU were dimethyl tryptamine (DMT) (n=7) and mephedrone (n=4).
  • Key experts reported that they had not heard much about mephedrone lately and that there had been a substantial drop in the availability of piperazines (mainly 1-benzylpiperazine - BZP).


Other drug use

  • Every participant reported the lifetime use of alcohol and all but one had used it recently.
  • Key experts reported that alcohol continued to be one of the most problematic drugs among REU.
  • The majority of REU had used tobacco at least once and 92% had smoked within the past six months.
  • One-third of the group had recently used benzodiazepines. Illicit use was more common than licit use.
  • One-in-ten REU had recently used antidepressants. Licit use was more common than illicit use.
  • Amyl nitrite was used more commonly among this group (40%) than nitrous oxide (13%).
  • The use of heroin was uncommon with only 2% reporting recent use; however, one-tenth reported having recently used other opiates.
  • One-quarter of the sample had recently used mushrooms, significantly higher than in 2010 (10%).
  • One-fifth of the group had recently used pharmaceutical stimulants. Illicit use was more common than licit use.
  • The use of over the counter codeine-containing and stimulant products was common among REU (39% codeine and 27% stimulants); however, this included both licit and recreational use.
  • The use of performance and image enhancing drugs (PIED) was uncommon in this group.


Health-related harms associated with ecstasy and related drug use

  • One-third of participants reported having overdosed on a stimulant drug throughout their lifetime.
  • One-quarter reported having ever overdosed on a depressant drug.
  • Deaths associated with ecstasy, ketamine and GHB have remained stable in the past year. Increases were observed in deaths associated with methamphetamines in 2010/11.
  • One-quarter of the group reported that they had recently accessed a medical or health service in relation to their drug use.
  • Calls to ADIS and FDS regarding ecstasy and amphetamines appear to have declined from early 2007 onward. Calls regarding cocaine, ketamine, GHB and LSD have remained relatively stable from 2010 to 2011.
  • Participants commonly reported that their drug use caused repeated social problems (36%); resulted in exposure to risk of injury (40%); and/or interfered with responsibilities (43%). Recurrent drug-related legal problems were uncommon (5%).
  • Hosptial admissions in which amphetamine was the principal diagnosis appear to have declined in NSW; those for cocaine have remained low and stable nationally while those where cannabis was the principal diagnosis appear to be increasing gradually.
  • One-quarter of the group had recently experienced a mental health problem. Mood and anxiety disorders were those most commonly reported.
  • Participants completed the Kessler 10-item Psychological Distress Scale (K10). One-quarter of the group fell into the ‘high’ or ‘very high’ distress categories.


Risk behaviour

  • One-tenth of the sample had ever injected a drug and 8% had done so recently.
  • One-third of the group had completed a Hepatitis B vaccination schedule.
  • Rates of testing for blood-borne viral infections (BBVI) were low with 33% having recently tested for Hepatitis C, 32% for human immunodeficiency virus (HIV) and 42% having recently had a sexual health check-up.
  • Three-quarters of the sample had recently had penetrative sex with a casual partner. Approximately two-fifths did not use a sexual barrier on the last occasion (regardless of whether or not they were intoxicated). The main reasons were that it was not mentioned, the partner was using contraception or the participant did not wish to use it.
  • Over half the sample had recently driven a vehicle. Of these, two-fifths had done so while over the legal blood alcohol limit and more than half after having taken an illicit drug.
  • Participants completed the AUDIT. The majority (80%) of the group fell in the ‘harmful drinking’ range.


Criminal activity

  • Fourteen percent of REU had reportedly been arrested over the past year.
  • More than two-fifths of REU had committed a crime within the past month. Most commonly drug dealing and property crimes.
  • The number of arrests for ecstasy use/possession seemed to have decreased from mid-to-late 2009 onward and those for ecstasy deal/trafficking likewise from early 2010. Increases were noted in the numbers of arrests for use/possession of amphetamines. The numbers of police-recorded incidents for the use or possession of cocaine and of cannabis have been increasing since mid-2007.
  • The majority of participants (79%) reported that half or more of their friends had used ecstasy during the previous six months.


Special topics of interest

  • More than half of the total NSW sample smoked cigarettes daily. One fifth of daily smokers in NSW were classified as highly dependent on nicotine.
  • Eleven percent of REU’s responses on the SDS scale indicated ecstasy dependence.
  • More than half of the group had recently gone online for a drug related activity; most commonly involving sharing information about drugs.
  • Almost half the group reported that their drug use had impacted negatively on their sleep.
  • The average quality of life was 7.7 out of 10 and was fairly comparable for men and women.


Implications
The NSW branch of the EDRS aims ultimately to monitor trends in the Sydney ecstasy and related drug (ERD) markets and to investigate harms associated with ERD use. The 2011 NSW EDRS revealed ongoing fluctuations in drug markets and signs of drug related harms which are discussed below.

Ongoing fluctuation in ERD markets
Over the past two years, there has been growing evidence of increasing experimentation among REU with other existing and emerging substances. Data from 2010 revealed growing interest in drugs such as LSD and GHB in particular subcultures around the city. This interest appears ongoing with 2011 data revealing increasing use of hallucinogens (including mushrooms and LSD) among REU and also among the general Australian population.

Emerging psychoactive substances
As in 2010, the use of emerging psychoactive substances (EPS) was low among Sydney REU. While reasonable proportions of REU had experience with different EPS (mainly 4-bromo-2,5-dimethoxyphenethylamine (2CB), DMT, mephedrone and salvia) the proportions who had recently used these drugs was low. This suggests that these drugs are not yet entrenched in the Sydney market. This may reflect low user demand (due to the availability of so many other drugs in Sydney), or perhaps low availability of EPS. An alternative explanation is that use of these drugs may be more common in scattered subcultures which may not be well sampled using the EDRS methodology. It is at this stage, unclear why reports of EPS use are so low in Sydney compared to some smaller jurisdictions.

Much of the media surrounding these emerging drugs has associated their use with online purchasing practices. Data from the ‘online’ module included this year suggests that online purchasing of drugs may not be as common as once thought. In 2011, less than one-in-ten REU had recently bought drugs online. Furthermore, participants often commented that their online purchases usually consisted of transactions with friends or dealers in their own city as opposed to international purchases and importation. This may explain the relatively low rates of EPS use in Sydney and may suggest that the availability of these drugs is also low. Ongoing monitoring of the use of these drugs is needed, as well as further investigation of online purchasing patterns as drug markets continue to expand on a national scale.

Problematic use of ‘party drugs’
There is growing evidence that some people experience problematic use of ecstasy. Data from the Ecstasy Severity of Dependence Scale (SDS) suggests that, as a conservative estimate, approximately one-in-ten REU in the Sydney sample are ecstasy dependent. In addition, more than half of the group reported that they recently worried about their use of ecstasy. Each year the EDRS also reports high rates of self-reported drug related problems (such as problems maintaining responsibility, exposure to risk, interpersonal relationships and legal issues). Moderate rates of mental health concerns are also commonly observed. EDRS data also shows that substantial minorities of REU seek assistance from health professionals for drug related concerns.

Taken together, these data suggest that a small group of people who use ecstasy and other party drugs do experience an ecstasy dependence-like syndrome which may include mental health problems and negative impacts on every day activities. This group is likely to benefit from the provision of treatment or other harm reduction services. However, traditional drug rehabilitation services tend to focus on people with histories of chronic alcohol use and people who inject drugs. Strategies and interventions developed with these groups in mind may not translate well to REU whose treatment needs may differ from these groups. More work is needed to identify the treatment needs of this group and to investigate models of service provision which will be most effective.

Alcohol and tobacco use
High levels of harmful alcohol use have been recorded in the EDRS data for several years. In 2011, eighty percent of the sample was classified as drinking alcohol at harmful levels based on their patterns of alcohol use. This year the EDRS was able to provide data on harmful tobacco use as well. Ten percent of the sample was classified as highly dependent on tobacco. Further, more than half of the group identified themselves as daily smokers. This figure is substantially higher than that of 15.1% recorded for the general Australian population in 2010 (Australian Institute of Health and Welfare, 2011).

The pharmacokinetics of ecstasy co-administration with alcohol and tobacco are not well understood. Given that extensive polydrug use is common among REU, it becomes even more difficult to determine interactions occurring with different combinations of drugs. Nevertheless, the potential for synergistic interactions is present and could increase the risk of an acute adverse drug-related event.

The long term impacts of high levels of alcohol and tobacco consumption among regular polydrug users is also poorly understood. However, given that each of these factors provides additional stress to the cardiac system, there is reasonable cause for concern. Preventative measures such as education campaigns and interventions to reduce alcohol and tobacco intake among this group are warranted. Furthermore, ongoing monitoring will be important for early identification and treatment of any medical issues which may emerge.

Sexual health
REU are at high risk of contracting BBVI and sexually transmitted infections (STI). High risk sexual practices that REU undertake include having multiple sexual partners, infrequent use of barriers during sexual intercourse and injecting drug use which can expose REU to transmission of BBVI and STI. Rates of testing for STI were low in 2010 and continued to be low in 2011. It is generally accepted that as rates of testing for infections increase, so can rates of treatment and of the adoption of safe and appropriate sexual practices. The data presented herein are concerning and relevant in the context of recent government initiatives to improve rates of testing for STI among young people in NSW. Young, male REU are an at risk group and would likely benefit from targeted interventions to improve their engagement with health service providers regarding testing for BBVI and STI.

Conclusions and future directions
In a climate of changing ERD markets, the EDRS has continued to fulfill its role by providing data on market trends and acting as a responsive tool which has allowed the investigation of specific areas of interest in a timely fashion. These data are used by health providers and law enforcement agencies to assist in risk assessment and planning; they provide an evidence base for policy makers; and guide researchers in the field as they attempt to unravel increasingly complex interactions between drugs, drug users and their environment. A key priority for the EDRS has been to provide feedback to these different stakeholders in an ongoing and timely fashion through the use of regular publications, stakeholder meetings; media liason and submissions to government. These interactions in turn, help to shape future directions for the project.
In 2012, the EDRS will aim to continue to monitor changes in the ERD markets both in terms of use and market characteristics (such as price, purity and availability of different drugs). Special modules will further examine the issue of ecstasy dependence as well as gathering data on the prevalence of neurological insult; investigating concepts of body image; and examining attitudes to different areas of drug policy among this group.