NDARC Technical Report No. 254 (2006)
Demographic characteristics of injecting drug users (IDU)
In 2005, 106 IDU were interviewed in Queensland for the IDRS. About two-thirds of the sample was male, about two-thirds were unemployed, one in four had a grade 12 education or higher, 44% had a prison history and a significant minority (16%) identified as Indigenous. Almost a third were currently in some form of drug treatment, typically methadone or buprenorphine substitution therapy.
IDU in 2005 were on average 34 years old, with those identifying heroin as their drug of choice on average 5.7 years older (Mean = 36.6 years) than those nominating some form of methamphetamine (M = 30.9 years) as their drug of choice. The average age of the IDU sample interviewed for the IDRS has increased by an average of 1½ years each year since 2000, when IDU were on average 26.4 years old. This trend may reflect an ageing cohort of injecting drug users accessing NSPs in south-east Queensland.
Patterns of drug use among IDU
IDU in 2005 reported first injecting at 19.3 years of age on average - consistent with previous years. Also as in previous years, there was a positive correlation between age and age at first injection, indicating that more recent recruits into injecting may also be initiating into injecting at a younger age. This correlation was stronger for females than for males, suggesting that the trend towards earlier initiation to injection may be more marked for females.
As one would expect, older IDU reported having used more drug classes in their lifetime, and males reported using more drug classes than did females; however, despite the ageing sample in 2005, the trend towards increased polydrug use, observed in 2004, reversed in 2005. Nevertheless, IDU in 2005 still reported using an average of 6.1 drug classes in the last 6 months, and injecting 2.4 drug classes in the last 6 months.
In 2005 the IDRS documented a number of instances in which the prevalence of use of a particular drug decreased (i.e. fewer IDU reported recent use), while the average frequency of use, among those who had used recently, increased. These divergent trends underscore the importance of monitoring prevalence, frequency and quantity of use, in order to gain a full understanding of trends in illicit drug use.
The impact of the 2001 heroin shortage continues to be evident in the Queensland heroin market, with evidence of on-going suppression of supply, decreased and unstable purity, and increased price ($400/gram). Perhaps reflecting reduced and unstable availability, fewer IDU in 2005 reported recent heroin use (64%); however, among those who had used recently, the average frequency of use doubled from an average of once a week in 2004 to twice a week in 2005. Evidently, for regular heroin users, availability is stable or perhaps even increasing. Despite this, the number of arrests for heroin use/possession in the state continues to be markedly lower than prior to and during the heroin shortage, and telephone helpline calls suggest a reduction in the number of people seeking assistance with heroin-related problems. Hospitalisation rates for heroin are also well below those seen during and before the heroin shortage, and the small increase in opioid-related admissions in 2005 may reflect problems related to other opioids, including prescription opioids, as well as or instead of heroin. The number of opioid pharmacotherapy registrations in Queensland has continued to rise each year, with 852 registrations in 2004. In contrast to Australia as a whole, the vast majority of pharmacotherapy clients in Queensland (80% in 2004) are registered with a public prescriber. Despite high rates of injecting drug use and opiate dependence among new prison receptions, only 1% of client registrations in Queensland (vs. 6.4% nationally) were in correctional facilities.
The IDRS monitors trends in three forms of methamphetamine: powder, base and crystal ('ice'). While the former two are mostly locally produced, often in small 'box labs', crystal methamphetamine or ice is mostly imported. As in previous years, in 2005 patterns of use and trends associated with powder and base differed substantially from those for ice.
The price of powder and base did not change between 2004 and 2005 ($200/gram, $100/half gram); however, ice, which has traditionally been more expensive, fell to the same price as these less pure forms. While the majority of IDU once again rated all forms of methamphetamine as easy or very easy to get, ice was considered less readily available than the other forms, with availability less stable over time. The availability of all forms of methamphetamine fell in 2005. IDU consistently (and accurately) rate ice as higher in purity than powder and base; however, in 2005 the proportion of IDU rating ice as high in purity increased, while the proportion rating powder and base as high purity decreased. According to key experts, a growing proportion of IDU prefer powder and base to ice, which they perceive as too pure, and associate with a range of acute physical and mental health problems.
The proportion of IDU reporting recent methamphetamine use dropped in 2005 (78%), while the average frequency of use among those using recently increased. In order to interpret these trends, it is once again necessary to distinguish between ice and other forms of methamphetamine. The drop in recent methamphetamine use seems to have been driven largely by a fall in the proportion of IDU reporting recent ice use, which in 2005 fell to 36% - the lowest level recorded by the IDRS since 2000. Simultaneously, recent use of powder among IDU increased to 65% in 2005. These divergent trends in methamphetamine use provide support for key expert reports of a trend away from ice use to less pure forms of methamphetamine, among many IDU.
Indicator data suggest increasing health and legal problems associated with methamphetamine use in Queensland; however, these data must be interpreted cautiously. Telephone helpline statistics and hospital admission data show an increase in the number of amphetamine-related problems, but these increases may reflect increasing awareness and help-seeking among users, as well as or instead of an increase in the absolute number of problems. Similarly, while the number of arrests for use/possession of 'amphetamine-type stimulants' (ATS) in Queensland rose in 2005, key expert reports suggest that ATS are increasingly a priority for law enforcement, and thus that the observed increase in arrests may reflect increased law enforcement efforts in the ATS market, rather than increased market activity. Furthermore, the inclusive ATS category encompasses not only amphetamine and methamphetamine, but also ecstasy (MDMA). Until it is possible to disaggregate MDMA - and methamphetamine-related events in law enforcement data, arrest data will be of limited use in monitoring the methamphetamine market.
Cocaine use has traditionally been rare, sporadic and opportunistic among IDU in Queensland, and this continued to be the case in 2005. Among the small proportion (11%) who reported recent use, the frequency of use was very low (on average once a month) and most IDU reported using intranasally, rather than injecting. The small number of IDU reporting on cocaine renders reports of price, purity and availability less reliable; there was little evidence of change in the cocaine market in 2005, with the price continuing to vary between $200 and $300 per gram. IDU in 2005 rated the purity of cocaine as high; however, there was little agreement with respect to availability, illustrating that, in such a niche market, availability is both fickle and driven by the quality of one's connections.
Although there seems to be relatively little contact between cocaine users and either health or law enforcement agencies in Queensland, available indicator data provide some evidence of an increase in the size of the cocaine market. The number of arrests for cocaine use/possession in Queensland increased by a factor of four between 1999/00 and 2004/05, although in the most recent year there was a total of only 20 arrests. The number of hospital admissions related to cocaine has also increased over this time, although, again, the overall number of such events remains small. Anecdotal reports from users and key experts suggest that there may be a sizeable and growing niche market for cocaine among non-injectors in Queensland; however, at present there is little reason to suspect that use of this drug will increase substantially among IDU.
The cannabis market in Queensland has traditionally been distinguished by its relative stability over time; however, trends emerging over the last few years show that the market is not entirely static. In order to better understand the cannabis market it is important to distinguish between two forms of the drug - hydroponic cannabis (hydro) and bush cannabis although it remains unclear exactly what users mean when they refer to these two forms of the drug.
As in previous years, in 2005 IDU typically rated hydro as high potency and bush cannabis as medium or low(and perhaps declining) potency; however, it is not currently possible to compare these reports with objective purity data. IDU also reported that the price of hydro was about one-third higher ($300/oz., $90/¼oz.) than for bush ($230/oz., $70/¼oz.) , with little evidence of a change in the price of either form over time. Consistent with previous years, hydro was reported to be easy or very easy to obtain by 88% of IDU; however, the availability of bush is lower (39% reporting easy/very easy) and may be decreasing.
Most IDU reported obtaining their cannabis from a friend or a dealer's home, with fewer in 2005 reporting sourcing cannabis from a street dealer or a mobile dealer. The number of arrests for cannabis use/possession rose markedly between 2000/01 (2,092 arrests) and 2004/05 (2,847 arrests); however, this number includes both actual arrests and an increasing number of instances of diversion for first-time cannabis possession. The proportion of IDU reporting recent cannabis use in Queensland has dropped slightly, but consistently, since 2000, with 76% reporting recent use in 2005. Until 2004 the average frequency of use among users was increasing; however, this has dropped in 2005 to an average of 4 days out of 7.
Use of illicit pharmaceuticals
Trends in use of illicit pharmaceuticals among IDU, particularly other opioids, reflect those for heroin. In the context of a sustained suppression of the heroin market in Queensland, IDU appear to be increasingly sourcing and injecting a range of alternative opiates which, in contrast to heroin, are of consistent purity, and relatively consistent price and availability.
The proportion of IDU reporting recent use and injection of illicit methadone increased between 2003 (18%) and 2004 (23%), but decreased slightly in 2005 (21%). Nevertheless, in 2005 16% of IDU reported recent injection of illicit methadone. According to key experts, a proportion of IDU are becoming increasingly disenchanted with methadone maintenance therapy, and are deciding either not to seek treatment, to seek buprenorphine treatment instead, or to self medicate with illicit methadone, morphine or buprenorphine.
Use and injection of illicit buprenorphine increased markedly between 2003 (7%) and 2004 (19%), and increased further in 2005 to 20%, with 17% reporting recent injection. There is evidence of extensive diversion of buprenorphine among IDU, with 63% of those who reported recent use indicating that they had mostly used illicit buprenorphine in the last six months. At least one dispensing service in south-east Queensland has implemented a policy precluding any buprenorphine take-away doses, in an effort to reverse this trend.
Use and injection of illicit morphine increased rapidly among IDU from the time of the heroin shortage, with 50% of IDU in 2004 reporting recent use. In 2005 there was a significant drop in reports of morphine use and injection, with only 32% reporting recent use and 28% recent injection. MS Contin® 100mg tablets continue to be the favoured brand, however, the price for 100mg morphine tablets has risen from by 25% to $50 in 2005.
Prior to 2005, IDU interviewed for the IDRS were not asked specifically about oxycodone; however, in 2005 16% reported recent use, and 14% reported recent injection. Just as the majority of IDU report that they mainly use illicit (vs. licit) morphine, 84% of those reporting recent use of oxycodone in 2005 reported mainly using illicit oxycodone. The preferred brand for injection seems to be Oxycontin®.
Evidently, one undesirable consequence of the sustained heroin shortage in Queensland has been a marked increase in the use and injection of other, cheaper and more reliable opiates. These alternative opiates are not designed to be injected, and a proportion of IDU in 2005 reported a range of injection-related harms as a consequence of injecting these preparations.
Following increased restrictions on the availability of 10mg temazepam gel capsules in May 2002, rates of benzodiazepine injection among IDU dropped markedly, and this reduction has been sustained through 2005. The prevalence of benzodiazepine use by any route also fell in 2005, with 51% reporting recent use. By contrast, the proportion reporting daily benzodiazepine use increased from 3% in 2004 to 15% in 2005, perhaps reflecting shifting prescribing practices rather than diversionary activity. Among those reporting recent benzodiazepine use, the average number of days injected recently increased in 2005, although to a median of only 7 days in six months. In 2005, 43% of those reporting recent benzodiazepine use stated that they had mostly used illicit (vs. licit) benzodiazepines in the last six months, indicating that benzodiazepine diversion and injection is still a health concern for this population. As in previous years, in 2005 the vast majority of IDU reported mostly using Valium®.
The number of syringes being dispensed to IDU in Queensland has continued to climb, with 5,302,300 syringes dispensed throughout the state in the 2004/05 financial year. At the same time, the proportion of IDU reporting recent sharing of injecting equipment has declined from 51% in 2000 to 21% in 2005. The rate of hepatitis C notification in Queensland has also fallen, from 1,588 notifications in 1991 to 946 notifications in 2005 - a fall of 40% in 14 years. A notable exception to this encouraging trend is the rate of hepatitis C infection among prisoners in Queensland, which in 2004 was estimated at 30% of new prison receptions.
As in previous years, the majority of IDU in 2005 reported usually injecting in a private home; however, 20% reported usually injecting in riskier locations such as a car, the street or a public toilet. The number of injection-related problems reported by IDU fell noticeably between 2002 and 2003, driven largely by a reduction in reports of scarring or bruising at the injection site, difficulty injecting and thrombosis. There has been little change in reports of injection-related problems among IDU since 2003, with the most commonly reported problems in 2005 being scarring/bruising (37%) and difficulty injecting (31%).
Forty-six percent of IDU reported driving under the influence of drugs at least once in the last six months. The drugs mostly commonly used prior to driving were cannabis, heroin and powder methamphetamine. Twenty-five percent of IDU reported having become verbally aggressive after substance use recently, with 32% reporting becoming verbally aggressive during withdrawal. Fifteen percent reported becoming physically aggressive under the influence of a drug, with 11% reporting becoming physically aggressive during withdrawal. The drugs most commonly associated with aggression were alcohol, methamphetamine, heroin and cannabis.
The proportion of IDU reporting recent criminal activity (other than drug possession) dropped from 60% in 2000 to 44% in 2005. The majority of crimes were drug-related or acquisitive in nature. Forty-four percent of IDU in 2005 reported having a history of incarceration, and 37% reported having been arrested in the last year the lowest proportion ever recorded by the IDRS in Queensland. Despite this, the proportion of IDU reporting recent acquisitive crime increased from 2004 to 2005, with 34% reporting recent drug dealing (vs. 26% in 2004) and 23% reporting recent property crime (vs. 22% in 2004). Between 2004 and 2005 the average amount spent by IDU on drugs yesterday increased 14% from about $122 to $140.
Mental health problems - particularly anxiety and depression - continue to be common among IDU, with 26% reporting seeing a mental health professional recently in 2005. The proportion reporting experiencing mental health problems was considerably larger, indicating a degree of unmet healthcare need in this group.
Illicit drug markets in Queensland, as in other jurisdictions, continue to fluctuate and to interact. Accordingly, these markets should be monitored on a regular basis, and should not be interpreted in isolation from one another. The 2005 Queensland IDRS documented a number of new trends, and provided further evidence of inter-dependence among illicit drug markets in Queensland. In particular, it seems clear that changes in the availability of heroin have been associated with changes in the use of methamphetamine, and changes in the use of other opiates including morphine, methadone, buprenorphine and oxycodone. It is also clear that the cannabis market in Queensland is dynamic, and that further research is required to understand patterns of use and other market dynamics.
To the extent that illicit drug markets are interdependent, supply reduction, demand reduction and harm reduction policies should adopt a holistic view, recognising that targeting the use of one drug may impact on the availability and use of other drugs. In order to minimise drug-related harm, the realities of endemic polydrug use and interdependent illicit drug markets must be recognised. The data presented here further underscore the importance of this recognition.
Citation: Kinner, S., Fischer, J. & Ali, R. (2006) Queensland Drug Trends 2005: Findings from the Illicit Drug Reporting System (IDRS), Sydney: National Drug and Alcohol Research Centre.