Demographic characteristics of IDRS participants
Sample characteristics for the 2012 Illicit Drug Reporting System (IDRS) in South Australia (SA) were generally similar to previous years. Fifty-nine percent of the sample were male, three-fifths (61%) were unemployed and half (50%) had a history of previous imprisonment. The median number of years spent at school was 11, with over half (60%) reporting some kind of post-secondary qualification (primarily a trade or technical qualification). Thirty-two percent of the sample were currently undertaking some form of treatment for drug use, most commonly pharmacotherapy. These characteristics were largely unchanged from 2011.
In fact, the only significant difference in 2012 was that a greater proportion of the sample reported ‘home duties’ as their current employment status (15% in 2012 versus 5% in 2011).
Patterns of drug use
The median age of first injection among the IDRS sample was 18 years, which was stable from 2011. The first drug ever injected by participants was primarily methamphetamine (65%), followed by heroin (28%). However, in relation to drug of choice (favourite or preferred drug), heroin was the most popular drug nominated by participants (46%), closely followed by methamphetamine (39%). Interestingly, in 2012 methamphetamine overtook heroin as the drug injected most often in the last month (47% and 36% respectively).
Polydrug use was common among participants in 2012, and has remained consistently so across all years of the IDRS.
In 2012, the proportion of SA participants who reported recent use of heroin was slightly lower than reported in 2011. In addition, the frequency of use decreased to a median of 48 days in a six month period. Daily heroin use remained relatively stable at 29% (of recent heroin users), compared to 25% in 2011. White powder or rock continued to be the most common form of heroin used by participants. Heroin users continued to supplement or substitute their heroin use with other opioid substances such as morphine and methadone, and also with methamphetamine and benzodiazepines.
The median price paid for heroin at last purchase remained stable in 2012, at $400 for a gram and $100 for a cap. Fifty percent of participants able to comment reported that heroin purity was low, a non-significant increase from 2011 (37%). Perceptions regarding changes in purity over the past six months were mixed, with a third reporting that it had decreased and a third reported that it had remained stable. Availability, however, remained easy (44%) and very easy (48%), and this had reportedly remained stable over the preceding six months.
Experience of lifetime and past 12 month heroin overdose remained stable in 2012, with 11% of recent heroin users reporting that they had overdosed in the preceding year. Data from the SA Alcohol & Drug Information Service revealed that telephone calls relating to any opioid substance increased slightly in the 2011/12 financial year, whilst data from Drug & Alcohol Services SA (DASSA) showed that the proportion of clients nominating heroin as their primary drug of concern decreased in 2011/12.
In 2012, over three-quarters of participants (79%) had used some form of methamphetamine in the six months preceding interview, a non-significant increase from 2011 (66%). More specifically, there was a non-significant increase in the recent use of crystal methamphetamine, whilst the use of powder, base and liquid methamphetamine remained stable from 2011. Frequency of use declined across all forms of methamphetamine, and injecting remained the main route of administration.
In 2012, the median price paid for all three forms of methamphetamine (speed, base and ice) was $100 for a point. Few participants were able to comment on the current price for a gram of methamphetamine. The majority of participants able to answer reported that the price of methamphetamine had remained stable over the preceding six months; however, across all three forms of methamphetamine, there was an increase in the proportion of participants who reported that the price had increased.
Reports regarding the current purity of the three forms of methamphetamine were extremely mixed. The purity of base methamphetamine, as perceived by participants, was largely reported as high (42%), although a third reported it as medium (31%). In regards to methamphetamine powder almost equal proportions of the sample reported that purity was high (33%), fluctuating (31%) or medium (28%). Similarly, the purity of crystal methamphetamine was perceived as high (35%), medium (33%) or fluctuating (26%). All forms of methamphetamine were considered easy or very easy to obtain in 2012, and availability had reportedly remained stable over the preceding six months.
A higher number of calls were received by the Alcohol and Drug Information Service (ADIS) in SA regarding methamphetamine, whilst the proportion of DASSA clients nominating amphetamines as their primary drug of concern also increased. Moreover, the number of clients admitted to DASSA inpatient (detox) services with amphetamine as the primary drug of concern also increased.
Cannabis, though generally not the drug of choice among participants, was used by almost two-thirds of the sample – stable from 2011. Frequency of use decreased to a median of 90 days in a six month period; however, daily use remained stable at 44% of recent cannabis users. Whilst the majority of cannabis users reported that hydro was the form they had used most in the preceding months, bush cannabis was also commonly used.
In 2012, the price last paid for a bag of both hydro and bush remained stable at $25, as it has done for many years. Most of those who were able to comment perceived the potency of bush cannabis as ‘medium’ and hydro cannabis as ‘high’. Both hydro and bush cannabis were considered very easy or easy to obtain, and availability was stable.
The number of calls to ADIS concerning cannabis remained relatively stable, although there was an increase in the proportion of DASSA clients who nominated cannabis as their primary drug of concern.
In 2012, 58% of PWID reported recent use of some type of illicit opioid substance, excluding heroin; this was stable from 2011. Twenty-three percent of participants reported they had used illicit morphine in the six months prior to interview on a median of twelve days (range: 1-180) which was similar to 2011 reports. The price of illicit morphine appeared to increase slightly in 2012; however, due to small numbers no real comparison can be made with 2011 data. The majority of participants reported that the availability of illicit morphine was easy to very easy, and that this had remained stable over the preceding six months. As in previous years, the majority of morphine users reported use by injecting and they had mainly used illicit supplies of MS Contin® and Kapanol®.
Similarly, the recent use of illicit methadone syrup remained stable in 2012 (13% in 2012 vs. 11% in 2011) as did the frequency of use. Only three participants reported the recent use of illicit Physeptone® tablets, and frequency was low at a median of three days in the last six months (range: 2-3).
Compared to 2011, the number of participants reporting recent use of illicit buprenorphine remained stable, although the frequency of use did increase slightly to 12 days. Ten participants reported recent use of illicit Suboxone® tablets on a median of two days (range: 1-96), and ten participants reported recent use of Suboxone® film on a median of four days (range: 1-72 days) in the six months prior to interview.
The recent use of illicit oxycodone also remained stable in 2012. More specifically, 24 participants reported recent use of illicit oxycodone on a median of 5 days (range: 1-96) in the six months prior to interview. The main brands of illicit oxycodone used in the six months preceding interview were Oxycontin® (79%), followed by Endone® (16%).
Eleven percent of IDRS participants had used ecstasy and 7% had used some type of hallucinogen in the six months prior to interview, with both recent use and frequency of use remaining stable compared to 2011.
In 2012, approximately one-third of PWID (29%) reported recent use of any illicit benzodiazepines, which is similar to participant reports in 2011. Prevalence and frequency of recent cocaine use remained stable in 2012, with seven participants reporting that they had used cocaine on a median of four days within the preceding six months.
The recent use of illicit pharmaceutical stimulants was relatively stable in 2012, with 8% of the sample reporting use over the preceding six months. The frequency of use remained low at two days within a six month period (range: 1-10). Twenty-two percent of participants reported recently using OTC codeine for non-medicinal purposes, and they had done so on a median of 10 days within the six months preceding interview (range: 1-180).
Tobacco use remains highly prevalent among PWID, with 96% of the sample reporting that they had consumed tobacco on a median of 180 days in the six months preceding interview (i.e. daily use). Alcohol use was less common, with 66% of the sample reporting use on a median of 12 days in the past six months. Both alcohol and tobacco use remained stable from 2011.
In 2012, there was a non-significant increase in the self-reported mental health problems (other than drug dependence) among PWID in the six months preceding interview. However, among those who had experienced a mental health disorder, depression and anxiety continued to be the most commonly reported problems. Of particular concern was the significant decrease in the proportion of these participants who had sought professional help for such problems (34% versus 77% in 2011).
Using the Kessler Psychological Distress Scale (K10) (Kessler & Mroczek, 1994), it was found that almost two-thirds of the SA sample (62%) were at a high or very high risk of psychological distress. Similarly, using the SF-12, IDRS participants scored lower than the Australian population, indicating that IDRS participants had poorer mental and physical health than the population average.
For the third year running, participants of the IDRS have been asked the AUDIT-C as a valid measure of identifying heavy drinking. In 2012, among those who drank alcohol recently the mean score on the AUDIT-C was 5.1. More specifically, 62% of males and 37% of females scored 5 or more on the AUDIT-C, indicating the need for further assessment.
The number of participants who reported ‘borrowing’ needles remained low and stable in 2012 (n=5), as did the number of participants who had lent a used needle to someone else (n=9). The proportion of participants who had shared injecting equipment (other than needles) decreased in 2012 (17%), continuing a downward trend that has been observed since 2010. Re-use of one’s own needles (40%) and equipment (55%) was much more common.
In 2012, 73% of the participants reported experiencing at least one type of injecting-related health problem in the month prior to interview. By far the most commonly experienced problem was prominent scarring/bruising around the injection site (49%), followed by difficulty injecting (47%). About a third of participants reported that they had experienced a dirty hit, stable from 2011.
The prevalence of self-reported criminal activity in the month preceding interview remained stable in 2012, whilst the prevalence of past year arrest declined slightly. Drug dealing and property crime remained the most commonly committed crimes. Furthermore, the proportion of participants who reported a prison history also remained stable in 2012.
Driving a car while under the influence of alcohol was reported by 19% of participants who had driven in the preceding six months. Eighty-one percent reported driving under the influence of an illicit drug during that time, mainly methamphetamines, heroin and cannabis.
In 2012, the median expenditure on illicit drugs remained stable at $100.
Special topics of interest
Fagerstrom test for Nicotine Dependence
Among those who smoked daily, half had had their first cigarette within five minutes of waking up and 55% reported smoking between 11-20 cigarettes a day. Nearly half of daily smokers scored 6 or above indicating high nicotine dependence, with the mean HSI score being 5.0.
In 2012, participants were asked questions about the use of pharmaceutical opioids and pain. Sixty percent of the sample reported that they had recently used pharmaceutical opioids, and of these 55% reported using them for pain relief and 43% reported using them to treat self-dependence. Twenty-seven percent of those who commented reported being refused pharmaceutical medications due to their injecting history.
Brief Pain Inventory
In 2012, the Brief Pain Inventory (BPI) was asked to examine the association between injecting drug use and the legitimate therapeutic goals of pharmaceutical opioids (e.g. pain management). Forty-two percent of PWID reported that they had experienced pain (other than everyday pain) on the day of interview; this was most commonly non-cancer pain (80%), followed by acute pain (21%). The mean ‘pain severity score’ was 4.7, and the mean ‘pain interference score’ was 4.6. Of those who had experienced pain, 44% reported trouble obtaining pain relief medication in the preceding six months.
Opioid and stimulant dependence
Participants in the IDRS were also asked questions from the Severity of Dependence Scale (SDS) for the use of stimulants and opioids. Of those who recently used a stimulant drug (mainly methamphetamine) and commented, the median SDS score was 3.0, with 45% scoring four or above. Of those who recently used an opioid drug and commented, the median SDS score was 8.0, with 74% scoring 5 or above.
Forty-three percent of the IDRS sample reported a lifetime history of a traumatic brain injury on a median of 1.5 occasions. The median age of most severe traumatic brain injury was 25 years.
One-quarter of the group reported being under the influence of alcohol at the time of injury, and 16% were under the influence of drugs (excluding alcohol).
Due to the introduction of buprenorphine-naloxone film in 2011, questions were included in the 2012 IDRS survey asking about the recent injection of opioid substitution treatment medications. Thirteen percent of PWID reported recently injecting methadone, 10% buprenorphine-naloxone ‘film’, 7% buprenorphine and 7% buprenorphine-naloxone ‘tablet’.
Fifty-eight percent of those who injected methadone reported using their own medication the last time they injected; this compares to 17% for buprenorphine, and 50% and 43% for buprenorphine-naloxone ‘tablet’ and ‘film’ respectively.
Injection-related injuries and diseases
In 2012, the IDRS gathered more in-depth information on injection-related injuries and diseases, which was then compared to the Injection-Related Injuries and Diseases (IRID) project. The most common lifetime injection-related injury reported ever by the IDRS sample and in the IRID project was a dirty hit (74% and 68% respectively). In comparison, the most common injection-related problem experienced by the IDRS sample within the preceding six months was redness near the injection site (39%).
Participants in the IDRS were asked a number of questions regarding their knowledge of drug trafficking thresholds/possession laws. The majority of PWID (87%) believed the quantity of drugs caught with would affect the type of charge they received; however, there were a considerable number of participants who didn’t know what the drug trafficking thresholds were. Among those participants who were able to comment, the perceived trafficking threshold for heroin and methamphetamine was a median 2 grams, which is consistent with the actual threshold.
The findings from the 2012 SA IDRS have policy and research implications, and a number of recommendations are outlined below. However, it is worth noting that there were very few changes from 2011 and, as such, the number of recommendations have been kept to a minimum. In addition, several of these issues may have already received attention and/or may be in the process of further investigation. In 2012, methamphetamine was the most commonly used illicit drug among PWID, as well as the drug injected most often in the past month (overtaking cannabis and heroin respectively). In addition, there was an increase in the proportion of DASSA clients who nominated amphetamines as their primary drug of concern. Given the negative health effects that are associated with prolonged methamphetamine use, it is essential that education and harm reduction strategies continue to be disseminated among this population; and that existing treatment services are accessible, and appropriate for those who are dependent on methamphetamine. The proportion of participants who had ‘borrowed’ or ‘lent’ needles and syringes in the past month remained low and stable in 2012, and there was a decrease in the proportion of participants who had shared other injecting equipment (such as mixing containers and filters). However, re-use of one’s own needles and equipment remained common practice (40% and 55% respectively), as did past month experience of injection-related problems (73%). As such, it is imperative that information regarding safe injection practices and vein care continue to be disseminated. Tobacco use remains alarmingly high among PWID, with 90% of the sample reporting that they were smoking daily and 96% reporting any use in the six months preceding interview. This is in stark contrast to the general community, where the prevalence of smoking has been steadily decreasing. As such, it is a continuing recommendation that health campaigns be targeted specifically towards this group. Participants of the SA IDRS continue to have poorer mental and physical health than the population average. Of additional concern was the significant decrease in the proportion of participants who sought professional help for their mental health problems. It is therefore of paramount importance that services and strategies that cater for those with substance use and mental health problems continue to be developed and implemented.