NDARC Technical Report No. 236 (2005)
EXECUTIVE SUMMARY
The PDI is a national monitoring system for ecstasy and related drugs that is intended to serve as a strategic early warning system, identifying emerging trends of local and national interest in ecstasy and related drug (ERD) markets. The PDI was conducted across Australia for the first time in 2003; monitoring of these markets has been undertaken since 2000 in NSW, SA and Qld.
The PDI is based on the IDRS methodology and consists of three components:
- interviews with regular ecstasy users (REUs), considered a sentinel group of drug users who could comment on these drug markets;
- interviews with key experts (KEs), professionals who have regular contact with REUs through their work; and
- indicator data sources related to ERDs.
The PDI monitors the price, purity, availability and patterns of use of ecstasy, methamphetamine, cocaine, ketamine, GHB and other related drugs. It also monitors harms related to these drug types. It is designed to be sensitive to trends, providing data in a timely manner, rather than describing issues in extensive detail.
The results of the two-year national pilot PDI indicate that regular ecstasy users tend to be young, relatively well-educated, and likely to be employed or engaged in studies. Small proportions of participants in all years were currently in drug treatment or had previously been incarcerated. This is in strong contrast to the demographic profile of the regular injecting drug users (IDUs) accessed for the IDRS, who are typically older, unemployed, and with both drug treatment and incarceration histories.
Aims of this report
This report is an evaluation of the national pilot PDI study. The data from the jurisdictions that undertook the PDI prior to the national pilot is, however, included in the present report. This additional data provides a good illustration of the trends in use over time and the value of monitoring these markets over time. The questions asked in this report are as follows:
- Was the PDI successfully conducted in all Australian jurisdictions?
- What were the strengths and weaknesses of the method?
- Did the data from the PDI provide a unique source of information about illicit drug markets in this country?
- Did the PDI provide a data source of use for policymakers, health, law enforcement and researchers in their understanding of trends in ERD markets?
1. Conduct of the PDI around the country
The PDI was successfully conducted around the country. Due to the relatively hidden nature of these markets, considerable work was required in those jurisdictions that had not conducted the PDI previously.
This points to the fact that good links with appropriate groups related to these markets is important. Researchers need to maintain a flexible and innovative approach to accessing and maintaining links with users, key experts and relevant agencies involved in events or groups who have contact with such users.
2. Evaluation of the method
Although the prevalence of ecstasy use in most Australian jurisdictions is substantial and increasing, reliable and valid information about the patterns and context of use, related harms and, in particular, about the nature of the drug market is difficult to gather. The PDI attempts to overcome these limitations using the well-established triangulation approach, combining user surveys, interviews with key experts and collation of existing indicator data.
The PDI was successfully implemented in all jurisdictions and the information provided by the PDI received positive feedback with regard to its validity and usefulness (see below). The trial demonstrated that the methodology employed herein allows the successful monitoring of the market for ecstasy. It was possible to collect data related to ecstasy that was as comprehensive as the data collected in the IDRS to monitor trends in the ecstasy and related drug markets. Ecstasy is the most widely preferred and widely used of all the drugs that could be classed as ‘party drugs’, and can rightfully be considered one of Australia's main illicit drugs, along with cannabis, methamphetamine, cocaine and heroin. Given the demonstrations of the capacity of the IDRS to successfully monitor trends in the markets for these drugs (Darke, Kaye, & Topp, 2002; Darke, Topp, Kaye, & Hall, 2002; Darke, Topp, & Ross, 2002; Topp, Degenhardt, Kaye, & Darke, 2002), and its relatively limited capacity to monitor the market for ecstasy, it is consistent that the methodology can be adapted to allow the effective monitoring of trends in a fifth major illicit drug market.
The trial also suggested, however, that the methodology is unlikely to enable the rigorous monitoring of trends in the markets for other related drugs, such as ketamine, LSD or GHB. Even among those that do use the less common other drugs, patterns of use tend to be less frequent than ecstasy use. Much of the use of these drugs is opportunistic in nature, and there are much fewer dedicated users of these drugs than there are dedicated users of ecstasy. As a result, even among those who report the recent use of other drugs, the extent of knowledge relating to their price, purity and availability tends to be relatively limited.
There is considerable variation in the extent to which markets for different illegal drugs are hidden. One factor, likely to influence how ‘hidden’ a drug market is, is the perceived stigma or risk associated with use of the drug. In this respect, one might expect the ecstasy market to be relatively accessible to researchers, given growing evidence of decreasing stigma associated with recreational drug use in general, and ecstasy use in particular (Duff, 2003). Indeed, recruitment of REUs for the PDI project is reasonably straightforward in most capital cities, and samples recruited in this way are reasonably representative of REUs in Australia, at least in terms of demographics and patterns of drug use (2004).
Another factor likely to impact on the effectiveness of ongoing monitoring is the degree to which the market is open or closed to entry by consumers and to public view. Particularly from a law enforcement perspective, it is easier to gather information about drug use and supply when this occurs in open, accessible locations (e.g. the street, nightclubs), when it is relatively easy for naïve users to enter the market (i.e. purchase and consume the drug), and/or when users of the drug are easily identified because their behaviour makes them conspicuous. REUs typically have not had contact with either law enforcement or health professionals for their drug use, so they may be considered a more “hidden” group of illicit drug users. This means that routine data sources may not be as useful as self-reported data to inform us about changes in drug use and the harms that users are experiencing.
The collation of extant indicator data sources relating to ecstasy and related drugs was the most difficult element. There were difficulties in identifying and accessing extant data sources relevant to ecstasy and related drugs. Fewer relevant data sources exist for ecstasy and related drugs than for the other illicit drugs such as heroin (Kinner, Fowler, Fischer, Stafford, & Degenhardt, 2005). Ecstasy is a relatively new drug in Australia's illicit drug markets. Moreover, as we have argued above, users of ecstasy and related drugs are a less 'visible' population than users of other illicit drugs, and are less likely to come into contact with various government and non-government agencies. As a result, compared to the data sources that exist for the other illicit drugs (e.g. heroin), fewer data sources exist which could provide information about trends in ecstasy and related drug markets.
It would be of considerable use to examine ways in which routine data collection systems might be able to collect specific data on ecstasy and related drugs. One first step in this direction would be the separation of ecstasy from other amphetamine-type stimulants (ATS) in health and law enforcement operational information systems.
In the meantime, the difficulties with the availability and accuracy of appropriate indicator data ensure that both KE and REU reports are even more important for the unique information they are able to provide about trends in ERD markets.
3. Uniqueness of the PDI
There is currently no other system in place in Australia to monitor trends in ecstasy and related drug markets. Due to previous NDLERF funded research, data on these markets exists in NSW, SA and Qld from 2000, and since 2003 in the remaining jurisdictions. We have repeatedly been informed that this is a unique data source on a relatively hidden population both within Australia and internationally.
Available indicator data are currently very limited in scope and detail. Key expert data are valuable, but the low level of users’ contact with health and law enforcement agencies also limits the detail KEs can provide. Even more than with the IDRS, the user survey forms the backbone of the PDI. In order to provide a more balanced ‘triangulation’ of data for the PDI in future, better use needs to be made of existing data collected routinely across Australia.
As well as providing the only data from ecstasy and other drug users on these drug markets in a timely manner, the project identified existing data sources to integrate available information. As the target population has limited contact with health and law enforcement agencies, the indicator data that are currently collected have not been well examined or integrated to date, and are at present of limited value in monitoring these markets.
4. Usefulness of the data
One of the most consistent messages we have received about the PDI is that the unique nature of the information collected in the PDI has proved useful to agencies, researchers, treatment centres and law enforcement around the country. Reports were received from a variety of agencies about the uses to which the PDI data were put.
Implications
The IDRS methodology was successfully adapted and implemented across the country to monitor ecstasy and related drug markets. This enabled the collection of information that is not obtained through the IDRS.
Both users and KEs in both years of the national trial reported that the number of people using ecstasy had recently increased and that, in recent years, ecstasy has become a mainstream drug firmly established in the illicit drug landscape in Australia. These reports by users and KEs are validated by the results of the 2004 NDSHS, which indicated that the prevalence of both lifetime and recent use of ecstasy in Australia continues to increase especially among young adults. Prevalence of use increased again in 2004, with ecstasy now established as the second most commonly used illicit drug in Australia among young adults. Indeed, a youth culture that revolves around the use of drugs like ecstasy and associated trends in music and fashion is evident not only in Australia but throughout the Western world (Griffiths et al., 1997).
To confidently determine trends in the market according to jurisdiction, data would need to be collected on an ongoing basis. In states where data has been collected for longer periods, there are some indications that suggest the quantity and frequency of ecstasy use among these samples of regular users may have increased. These quantitative self-report data obtained from users are supported by the impressions of some KEs across all jurisdictions, who reported increased use of ecstasy and other drug use among users with whom they had recent contact.
Continued monitoring of the market for this drug will ensure policymakers are able to respond to changes in the market or in the nature and extent of ecstasy-related harms in a timely fashion, as has been enabled through the routine conduct of the IDRS since 1996. It will also enable the regular collection of indicative data relating to the size of the markets for other drugs, such as GHB and ketamine, and will point to the need for research specific to such drugs as and when it arises.
Citation: Degenhardt, L., Stafford, J., Kinner, S., Johnston, J. Fry, C., Bruno, R. and Agaliotis, M. (2005) Reflections on a two-year national pilot study of the Party Drugs Initiative (PDI), Sydney: National Drug and Alcohol Research Centre.