NDARC Technical Report No. 224 (2005)
This report presents the results of the Party Drugs Initiative, a study undertaken to monitor ecstasy and related drugs markets in South Australia. 2004 was the fifth year in which regular ecstasy users in Adelaide have been surveyed and comparisons with previous years have been drawn where possible. Trends in the demographic characteristics and patterns of drug use among regular ecstasy users, the prevalence of risk-taking and harms related to drug use, as well as the level of criminal involvement among this group, are presented. Also presented are details on current price, purity and availability of ecstasy and related drugs in Adelaide, and the trends in these drug markets.
Demographic characteristics of regular ecstasy users (REU)
Similar to previous years, the majority of REU were male, and on average, aged in their early 20s. The majority of the sample was either employed or full-time students with less than 20% reporting being unemployed. Most REU were well educated and almost half had completed either a trade/technical qualification (26%) or a tertiary qualification through university or college (20%). Very few had a history of imprisonment or were currently undergoing treatment for drug use. Key expert (KES) information supported this demographic profile of REU generally.
Patterns of drug use among REU
Regular ecstasy users were identified as polydrug users with the median number of drugs used reported to be 11 across lifetime and 7 in the last six months. Large proportions of the sample reported recent use of some form of methamphetamine (90%) and cannabis (81%), as well as alcohol (96%) and tobacco (65%). Other substances reported as recently used by substantial proportions of REU were nitrous oxide, ketamine, LSD, cocaine and benzodiazepines. Compared to 2003, the proportion of REU reporting recent use of cocaine had decreased, but remained stable for most other substances. Though a small increase in the percentage of REU that reported binge behaviour (to 53%) was noted this year, the percentages per substance were relatively stable. In 2004, 12% of REU reported recent injecting, most commonly some form of methamphetamine. No clear long-term trend in prevalence of injecting among REU was discernible.
Over the last five years there has been little change in parameters of ecstasy use, with the reported mean age of first use, median days of use, and average or most amount used in a typical session all remaining relatively stable across this period. There has, however, been a gradual increase in the proportion using more than one tablet in a typical session, to the point that in 2004 this was reported by the majority of the sample (84%) compared to less than half the sample in 2000 (44%). In addition, a large proportion of the samples have consistently reported binge use of ecstasy across this time, with almost half the sample having done so in 2004. REU mainly report use of ecstasy by swallowing, with substantial proportions also reporting recent use by snorting. Ecstasy continued to be used most commonly at nightclubs, raves/dance parties, private parties or at people's homes.
Most REU report typically using at least one other drug either with ecstasy or at comedown, with tobacco, alcohol, cannabis and some form of methamphetamine reported as most commonly used with ecstasy, and tobacco, alcohol, cannabis, and to a lesser extent, benzodiazepines, being most commonly used at comedown. There were reductions in the proportions of REU reporting recent use of alcohol, either with ecstasy or at comedown, in 2004, compared to 2003.
KES information confirms that REU are polydrug users, that binge use of ecstasy and other drugs was not uncommon and that there was a wide range in frequency of use of ecstasy, from regular weekend use (particularly among younger users) to less regular special occasion use.
The price of ecstasy was stable (at $30/pill) and availability continued to be considered easy or very easy by REU, and most reported usually obtaining their ecstasy from a friend. The majority of REU believed that the purity of ecstasy was either medium or fluctuating in 2004, similar to previous years. The ACC reports that the median purity of SAPOL seizures of phenethylamines (including MDMA) in 2004 was 29%, a slight decrease compared to 2003. SAPOL data indicates an increase in detection of MDMAproducing clandestine laboratories in 2004 that suggests local manufacture of MDMA has taken a foothold in SA.
No increase in the number of ecstasy-related calls to ADIS were recorded in 2004, and although a doubling of the number of presentations to DASC treatment services was noted, the total number of ecstasy-related presentations remains a very small proportion of total presentations (0.6%).
The most commonly perceived benefits of ecstasy use among REU were enhanced communication and sociability, enhanced closeness and empathy toward others, that it added more fun or enjoyment to an occasion, and enhanced mood. The most commonly perceived risks associated with taking ecstasy were some kind of physical, psychological or neuropsychological harm, or unknown pill content.
In 2004, more REU reported lifetime use of base methamphetamine, but recent use of all forms of methamphetamine remained stable, compared to 2003. The largest proportion of the REU sample reported recent use of base (72%), followed by powder (62%) and crystal (47%), in 2004. The frequency of recent use of all three forms of methamphetamine was the same (a median of 6 days), and similar to levels reported in 2003. There were no significant differences between males and females with regard to average frequency of use of all forms. There were no other substantial changes in the parameters of use of any form of methamphetamine, in particular there was no indication of increased use of crystal methamphetamine, compared to 2003. KES information supports the findings that methamphetamine use in general was common among REU, but that use of crystal methamphetamine was still relatively rare.
Overall, the most common locations REU reported usually using methamphetamine were nightclubs, friend's homes, their own home, private parties or raves/dance parties. A larger proportion of REU reported usually using crystal at home than anywhere else, but powder or base was most commonly reported as usually being used at a friend's home or nightclub.
In comparison to 2003, there appears to have been little change in price or purity of all forms of methamphetamine. ACC data indicates that median purity of SAPOL seizures have been stable for the past two years (at ~20%). Availability of all forms of methamphetamine remained generally easy, but a decline in the perceived availability of both powder and crystal methamphetamine were noted, compared to previous years. REU most commonly obtained all three forms of methamphetamine from their friend's homes, with substantial proportions also reporting scoring at a dealer's home, their own home or at an agreed public place (particularly with regard to base). SAPOL data indicates that clandestine production of methamphetamine continues in SA, with evidence emerging in 2004 of local production of the purer crystalline form ('ice'). In addition, SAPOL data indicates an increase in the number of methamphetaminerelated provision offences in SA in 2003/04.
The number of amphetamine-related calls to ADIS remained stable, but the proportion of presentations to DASC treatment services for amphetamines declined.
There was a further decline in the proportion of REU reporting recent use of cocaine in 2004 (to 26%), though no change in the frequency of cocaine use, which remains low among those that had used recently. The most common locations of use of cocaine differed from those of ecstasy and methamphetamine: use of cocaine was most likely to occur in a friend's home, a private party or a nightclub.
Cocaine continued to be relatively expensive (at an average $250/gram) and perceived as difficult to obtain, with medium or low purity, by the majority of REU able to comment. ACC data indicates that median purity of SAPOL seizures in 2003/04 was 38.5%, an increase compared to 2002/03 (20.6%). However, the small number of seizures and the lack of comparable data from previous years makes meaningful trend analysis impossible. As in previous years, KES suggested that the cocaine market in Adelaide was mostly restricted to a small subset of REU.
Both cocaine-related calls to ADIS and cocaine-related presentations to DASC remained consistently low and stable compared to previous years.
Over a third of REU reported recent use of ketamine in 2004, though frequency of use remained low. The prevalence of use of ketamine among REU seems to have stabilised in 2004 following a steady increase from 2001 to 2003. A small number of KES associated with the scene reported ketamine use was increasingly common among REU. Ketamine was more likely to be used at a friend's home or a private party than at other public venues.
The current price of ketamine was stable at $180 to $200 per gram, purity was considered high by the majority (an increase compared to 2003), and availability was reported as easy or very easy and becoming easier recently. Ketamine was most commonly purchased from friends or known dealers by those able to comment.
Just over 10% of REU reported recent use of GHB, and there has been a stabilisation of prevalence of use of GHB among REU in the last two years, following the spike in 2002. The frequency of use, already low, declined further in 2004 compared to previous years. Price, purity and availability data for GHB in 2004 was based on a very small sample of
REU and therefore of limited value. Data suggests that the price of GHB was stable and that it remained more difficult to obtain GHB in general compared to earlier years (2001 and 2002). Limited KES information suggested that GHB use was still common among a sub-group of users, despite its reputation as a risky drug.
Approximately a third of the REU sample reported recent use of LSD, and prevalence of recent use was relatively stable compared to 2003, following a decrease from previous years. Frequency of use of LSD remains low. KES reports suggest that LSD use was not common among REU, though likely to be more common among younger users or within a different 'tribal dance' scene.
The price of LSD in 2004 was unchanged and low (at $10 per tab). Perceived purity was slightly increased and availability was decreased, compared to 2003.
Fourteen percent of REU reported recent use of MDA in 2004. The proportion of REU reporting recent use of MDA was decreased compared to 2003, but the frequency of use was relatively stable and remains consistently low across the five years of the PDI survey. Limited KES information suggested that MDA was not commonly used by REU or available in Adelaide, but was sought by a small percentage of users.
Price, purity and availability data for MDA in 2004 was based on a very small sample of REU and therefore of limited value. Data suggests that the purity of MDA was stable and considered high or medium, and that it remained more difficult to obtain MDA compared to earlier years (2001 and 2002).
As in previous years, the majority of the REU sample reported recent use of alcohol, tobacco and cannabis, and although the frequency of use of these drugs has fluctuated somewhat across the years, it has remained relatively high. KES information also suggests that use of these substances was common, but that frequency of use varied widely. Substantial proportions of the samples have also consistently reported recent use of benzodiazepines (40% in 2004), though frequency of use was generally low. Also, KES reports do not, in the main, support common use of benzodiazepines among REU. Antidepressants were recently used by a small proportion of REU, with the majority reporting use as prescribed.
Use of inhalants has also remained fairly stable across the years, with almost half the REU sample in 2004 reporting use of nitrous oxide a median 4 days, and 16% reporting use of amyl nitrate a median 3 days, in the last six months. KES suggest that nitrous oxide use was particularly common among younger users.
Twenty-one percent of REU reported recent use of some type of pharmaceutical stimulant (eg. dexamphetamine) a median 2 days in the last six months.
Several aspects of risk-taking among REU were assessed as part of the REU survey, for the first time in 2004.
Twelve REU reported recently injecting any drug, most commonly some form of methamphetamine (particularly base) or ecstasy. Four REU also reported injecting
ketamine, and of particular note, five REU reported injecting buprenorphine (a prescribed medication for opioid dependence), at a frequency equivalent to once a
fortnight, on average, in the last six months. Three REU also reported injecting heroin a median 10 days in the last six months. No injecting of either ketamine or buprenorphine was reported in 2003, though two REU reported injection of heroin and three REU reported injection of other opiates (eg. codeine) in that year.
The frequency of injecting among injectors was high (in terms of the number of times any drug was injected), at a median 91 times. There was little reported sharing of needles, though five people reported recent sharing of injecting equipment other than needles, such as spoons (or the drug mix) and water. Most injectors reported usually injecting themselves, in the company of close friends, in private homes.
Self-reported BBV vaccination, testing and status
At the time of interview, 41 REU stated that they had completed a Hepatitis B virus (HBV) vaccination schedule, most reported they had done so because they were going overseas or they were vaccinated as a child. Twenty-five REU reported that they had been tested for Hepatitis C virus (HCV) infection and twenty-nine REU reported that they had been tested for human immunodeficiency virus (HIV) infection, with the majority in both cases reporting that their status was negative.
Sexual risk behaviour
Of the REU that reported having had penetrative sex with a casual partner in the last six months, more than half of them (52%) reported that they had not always use a condom. In addition, 76% of those who reported having had penetrative sex recently, reported having done so whilst under the influence of a drug or drugs - most commonly ecstasy, followed by alcohol, cannabis or some form of methamphetamine. Of those who reported having had penetrative sex with a casual partner whilst under the influence of a drug or drugs, 42% reported that they had not always used a condom. In this context, half the REU sample reported they had never undergone a sexual health check-up. Of the remaining half, 33 REU reported having had a sexual health check-up in the last year, 15 more than a year ago and two were unsure.
Driving risk behaviour
Sixty-one percent of the REU sample reported having driven within an hour of use of any drug. The drug most commonly reported as having been used within an hour prior to driving were ecstasy (43%), methamphetamine base (35%), cannabis (31%), alcohol (24%), methamphetamine powder (21%), and crystal methamphetamine (17%).
Ecstasy and related drug harms
In 2004, 9% of ecstasy users and 17% of recent methamphetamine users were found to fit the criteria for clinically significant dependence on each drug, respectively, according to the Severity of Dependence Scale.
A small number of REU (n=10) reported recent experience of overdose, the main drug responsible most commonly reported as alcohol (n=4), followed by ecstasy (n=2), GHB (n=2) and nitrous oxide (n=2). Indicator data from the RAH Emergency Department suggests GHB admissions has remained stable compared to 2003, and an ambulance services KES reports GHB overdose callouts to be stable, but still a major component of total overdose attendances among this group of 'recreational' drug users.
Treatment services data (ADIS and DASC) indicates that the only change in help-seeking behaviour was in relation to methamphetamine-related presentations to DASC treatment services, which saw a decline in 2004 compared to 2003. AIHW data regarding SA hospital admissions for 2002/03 shows that the rate of amphetamine-related admissions continues to rise, but this data was not as up-to-date as other sources and therefore may not fully reflect emerging trends.
The survey also asked users about their experience of other problems related to their ecstasy or other drug use during the last six months, in the categories of work/study, financial, legal/police and social/relationship. As was the case in 2003, three-quarters of the REU sample reported having experienced one or more problems related to their drug use in 2004. The majority of problems experienced by REU related to some aspect of their work or study, followed by social and financial problems, and use of ecstasy, or some form of methamphetamine, was most commonly held responsible, at least in part, for these problems.
Criminal activity and perceptions of policing
In 2004, 25% of REU reported involvement in some type of crime, which was lower than reported criminal involvement in the previous three years. A decline in the percentage of REU reporting having been arrested in the last 12 months was also noted. Drug dealing was the most commonly reported crime across the five years of the survey. Nearly twice as many REU reported that they 'paid' for ecstasy by dealing drugs for an 'ecstasy profit' (n=23), than reported that they dealt drugs for a 'cash profit' (n=12). In 2004, no REU reported using any other illegal method of paying for ecstasy in the six months prior to interview.
In 2004, equal proportions reported that police activity had been either stable (27%), or increasing (27%), with a large proportion (41%) reporting that they didn't know whether police activity had changed in that time. As has been consistent across the three years depicted, the majority of REU (86%) reported that their ability to obtain drugs had not become more difficult due to police activity in 2004.
As in 2003, the users themselves, in additional comments on police activity, reported an increase in the presence of both undercover and uniformed police officers at nightclubs and raves, and a larger number of police patrols, in general, in and around the scene in 2004. In contrast, law enforcement KES indicated a continuing focus on dealers and source of supply.
The demographics of regular ecstasy users and the patterns of ecstasy use remained stable in most respects in 2004, as did the prevalence and frequency of use of other drugs among this group, such as methamphetamine, alcohol, cannabis and tobacco. There continued to be a substantial proportion of REU reporting recent use of both ketamine and benzodiazepines in 2004, but frequency of use was low. Prevalence of recent cocaine use decreased, while prevalence of recent GHB use remained low. Of note, given concerns of increased use in other jurisdictions, was that there was little indication of increased use of crystal methamphetamine ('ice') among REU in the sample.
There were few changes in the ecstasy or methamphetamine markets in Adelaide, with both being stable in terms of price and readily available to the majority of REU in our sample in 2004. There was emerging evidence of local manufacture of the purer form of crystal methamphetamine ('ice'), as well as MDMA ('ecstasy'). For the first time in 2004, reporting of various risk behaviours among the REU sample was possible, with evidence of risky sexual practices (eg. % not always using condoms when engaging in casual sex), substantial levels of driving under the influence of drugs, and unsafe injecting practices (eg. sharing of equipment, injecting of non-injectable substances).
Also for the first time in 2004, a measure of dependence on ecstasy and methamphetamine was obtained, with 9% and 17% of recent users showing symptoms of clinically significant dependence on each drug, respectively. A small percentage of REU also reported experience of overdose, primarily related to use of alcohol, but also ecstasy and GHB. Indicator data and KES information also suggest that GHB overdose remains a stable but substantially prevalent harm associated with its use.
Both ecstasy user reports and KES information indicates that the level of criminal involvement among this group is generally low apart from drug dealing. Also, the majority of drug dealing reported by users involves 'ecstasy profit' rather than 'cash profit', which many users may not regard as a criminal offence.
The 2004 South Australian Party Drugs Initiative again expanded and allowed insight into additional aspects of ecstasy and related drug use. The following issues identified in the 2004 survey, will require ongoing attention from policy makers, researchers and health professionals;
- For the first time in 2004, REU were asked a series of questions designed to assess their dependence on ecstasy and methamphetamine. The Severity of Dependence Scale was employed for both ecstasy and methamphetamine despite the SDS not yet having been validated for ecstasy use. Whether or not users can become dependent on ecstasy has been under debate for some time, while the results presented here are not able to definitively answer that question they do indicate that a small percentage (9%) may qualify for a dependent diagnosis using the methamphetamine cut-off score. With over half of REU reporting some type of problematic use further work on validating the SDS for use in ecstasy users is warranted.
Ecstasy has been known in the past, and currently, as the "love drug" and reports from REU regarding sexual activity are consistent with this tag. Approximately three quarters of the sample had engaged in penetrative sex while under the influence of a drug or drugs, mostly ecstasy. Almost all the REU sampled in 2004 were sexually active in the 6 months prior to interview, half reported multiple partners and over half engaged in casual sex. Of particular concern is the finding that half of the REU engaged in casual sex in the prior 6 months had not used a condom. On a more positive note, a third of the sample reported obtaining a sexual health check-up in the previous year, however it is evident from the overall
results that increased promotion of safe-sex practices are required.
- Each year of the last 4 years a fifth of REU, on average, have reported ever injecting a drug. While fluctuations in the actual numbers of REU injecting drugs make discerning trends difficult, the consistent prevalence of the practice among REU suggests that this is an area that needs ongoing attention from health professionals and others. In particular, the REU sampled within this study evidence relatively high rates of equipment sharing. In 2004, 42% (5 out of 12) reported sharing various items of injecting equipment. Education campaigns need to be focussed not just on the dangers of injecting itself, but specifically on the risks taken when sharing equipment.
- The prevalence of drug driving is currently the focus of a number of organisations and State government agencies within Australia. In South Australia the situation is no different with the current government considering introducing legislation to police the practice of driving under the influence of drugs other than alcohol. The results of the 2004 survey reveal that driving within an hour of use of any drug was a common practice with approximately 60% of REU reporting having done so in the six months prior to interview. The largest proportion reported driving within an hour of using ecstasy (43%) followed by cannabis (31%), any methamphetamine (24%), and alcohol (24%). Additional research is needed to identify the reasons behind the high proportion of REU engaging in drug driving so that effective prevention and education campaigns can be designed and implemented as soon as possible.
Citation: Weekley, J. Pointer, S. and Ali, R. (2005) SA Trends in Ecstasy and Related Drug Markets 2004: Findings from the Party Drugs Initiative (PDI), Sydney: National Drug and Alcohol Research Centre.