NDARC Technical Report No. 280 (2007)
This report presents the results of the EDRS (formerly known as the Party Drugs Initiative: PDI), a study undertaken to monitor ecstasy and related drug markets in South Australia. 2006 was the seventh 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. They were also generally either employed or full-time students with less than a fifth of the sample unemployed. Most REU were well educated and half had completed some kind of post-school qualification. Very few had a history of imprisonment or were currently undergoing treatment for drug use. Key expert (KE) reports of the demographics of ecstasy users were generally consistent with the 2006 REU sample.
Patterns of drug use among REU
Regular ecstasy users have been consistently described as polydrug users and the EDRS samples continue to verify this. In 2006, as in previous years, most of the sample reported recent use of some form of methamphetamine (at levels equivalent to ecstasy use), as well as cannabis, alcohol and tobacco. Other substances reported as recently used by substantial proportions of REU were nitrous oxide, Lysergic Acid Diethylamide (LSD) and cocaine, though use of these and other drugs was at a much lower frequency. Compared to 2005, there was an increase in the proportion of REU reporting recent use of ice/methamphetamine and benzodiazepines, and a decrease in the proportions of REU reporting recent use of powder and base methamphetamines, cocaine, ketamine, amyl nitrate, Gamma-hydroxy butyrate (GHB) and tobacco.
The trend in binge behaviour stabilised in 2006 with 57% reporting having binged at least once in the preceding six months. There was an increase in binge use of ice/crystal methamphetamine and methamphetamine powder, compared to 2005, with a decrease in binge use of base methamphetamine.
The majority of REU reported use of any drug primarily by swallowing or snorting in 2006. However, 13% of REU reported recent injecting, most commonly some form of methamphetamine. No clear long-term trend in prevalence of injecting among REU was discernible, but it must be noted that there was an increase in REU injecting of ecstasy in 2006. In reference to route of ecstasy administration, KE comments indicated that injecting was uncommon, but increasing, among this group of drug users.
Over the last seven years there has been little change in parameters of ecstasy use, with the reported mean age of first use, median days of use, ‘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 2006 this was reported by the majority of the sample (80%) compared to less than half the sample in 2000 (44%). In addition, a large proportion of the sample has consistently reported binge use of ecstasy across this time, with over half the sample having done so in 2006. REU mainly use ecstasy by swallowing, with substantial proportions also reporting recent use by snorting. Ecstasy continued to be used most commonly at nightclubs, friends’ homes, raves/doofs/dance parties, private parties or at their own 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 most common. There was an increase in the proportion of REU reporting typically using crystal methamphetamine with ecstasy, and increases in the proportion of REU reporting use of benzodiazepines, and anti-depressants during the comedown period.
KE information confirms that REU commonly combine other licit and illicit drug use with ecstasy use, with methamphetamine and alcohol particularly common, and that there was a wide range of frequency of ecstasy and related drug use, from every weekend (particularly among younger users) to less frequent or ‘special occasion’ use.
The reported price of ecstasy was stable (at $30/tablet) compared to 2005, and considered to be stable in the last six months. Availability continued to be considered ‘easy’ or ‘very easy’ by REU, and most reported usually obtaining their ecstasy from a friend. Almost two-thirds (64%) of REU were able to obtain drugs other than ecstasy from their main ecstasy dealer, the most common being some form of methamphetamine, cannabis, LSD and cocaine. The majority of REU believed that the purity of ecstasy was either medium or fluctuating in 2006, similar to previous years. The Australian Crime Commission (ACC) reports that the median purity of SAPOL seizures of phenethylamines in 2004/05 was 29%, the same as that reported in 2003/04.
Ecstasy was generally purchased for both self and others, and purchased from a median of four people in the last six months. The majority of REU purchased ecstasy one to six times in the previous six months, with three percent purchasing ecstasy over twenty-five times in that period.
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 risk associated with the unknown content of ecstasy pills.
In 2006, more REU reported recent use of ice/crystal methamphetamine (62% from 41% in 2005), but recent use of powder (51% from 66% in 2005) and base (63% from 82% in 2005) forms of methamphetamine decreased, compared to 2005. The frequency of recent methamphetamine use was somewhat different for the three forms of methamphetamine (a median of 12 days for powder, six days for base and four days for crystal). This level of use decreased for base and ice/crystal, but frequency of powder use increased compared to 2005. Despite a decrease in the frequency of recent crystal/ice use, an increase in the percentage of REU reporting recent use of crystal by smoking continued in 2006 (from 14% in 2004, 27% in 2005 and 47% in 2006). Of note was a decrease in the proportion reporting recent use of crystal by swallowing, from 71% in 2005 to 55% in 2006. This was the first time that smoking as a route of administration of crystal methamphetamine has been used as the preferred method of administration by REU, with larger proportions of REU usually swallowing in previous years. There was some support of increased smoking of ice/crystal among REU from KE reports, including reports that glass pipes (for smoking) were more frequently seen by police.
Overall, the locations at which REU reportedly scored all three forms of methamphetamine were from their friends’ homes, with substantial proportions also reporting scoring at a dealer’s home, their own home or at an agreed public place and to a lesser extent, private parties.
There has been some changes in price, with a slight decrease in the price of a point of base methamphetamine (from $25 to $22.50), and for a gram of methamphetamine powder (from $65 to $50). Increases were seen for both points (from $25 to $50) and grams (from $200 to $400) of crystal. There was little change in the purity (medium to high for powder, high for base and crystal), and availability (easy to very easy) of methamphetamines. However, ACC data indicate that the median purity of methamphetamine seized by SAPOL in SA for 2004/05 had decreased (to 11.6%) compared to the previous year, and the lowest seen in the past four years. South Australian Police (SAPOL) data on clandestine laboratory detections suggest that local manufacture of methamphetamine was still a contributor to the SA methamphetamine market.
There was a decrease in the proportion of REU reporting recent use of cocaine in 2006 (31% in 2006 from 49% in 2005), though no change in the frequency of cocaine use, which remains low among those that had used recently. The most commonly reported locations of both ‘usual’ and ‘last’ use were a friend’s home and nightclubs.
Though the number of REU able to comment on these parameters was small, reports indicated that the ‘current’ price of cocaine was stable (at $300/gram), and the perception was that purity was stable (high), and availability had decreased, compared to 2005. Data from the ACC show an increase in the number of cocaine seizures by SAPOL in 2004/05, while the median purity was relatively stable at 31%. As in previous years, KE suggested that the cocaine market in Adelaide was mostly restricted to a small subset of users.
Eleven percent of REU reported recent use of ketamine in 2006, though frequency of use remained low. The prevalence of recent use of ketamine among REU had decreased for the second year, following a steady increase in use from 2001 to 2004. The most commonly reported locations of both ‘usual’ and ‘last’ use of ketamine was a friend’s home. KE comments suggest use of ketamine is either ‘accidental’ (in ecstasy pills) or restricted to a subset of users, and supports REU reports of use at private venues.
Though the number of REU able to comment on these parameters was very small, reports indicated that the current estimated price of ketamine had increased to $300/gram (from $200 in 2005), and it was considered to be of good quality, though difficult to obtain.
Less than ten percent of REU (7%) reported recent use of GHB, a decrease compared to 2005 (18%). The frequency of recent use was low, consistent with previous years.
Price, purity and availability data for GHB in 2005 were based on a very small sample of REU and are therefore of limited value. Data suggest that the price of GHB had decreased slightly and that it remained more difficult to obtain GHB in general compared to earlier years (2001 and 2002)
KE information suggested that GHB use was not common among REU generally, but evidence of harm associated with its use was evident in emergency department attendances.
Approximately one-third (34%) of the REU sample reported recent use of LSD, and prevalence of recent use decreased in 2006. Frequency of use of LSD remains consistently low. KE reports suggest that LSD use was not common among REU, and used only occasionally among those that did use.
The price of LSD was stable (at $10 per tab) and low, perceived purity had increased, and availability remained stable and generally easy, compared to 2005.
Nine percent of REU reported recent use of 3,4 – Methylenedioxyamphetamine (MDA) in 2006. The proportion of REU reporting recent use of MDA was stable compared to 2005, with the frequency of use increased but has remained consistently low across the seven years of the EDRS survey. KE information suggested that MDA was not commonly used by REU, except as a (suspected) constituent of pills sold as ecstasy.
Price, purity and availability data for MDA in 2006 were based on a very small sample of REU and are, therefore, of limited value. Data suggest that the price and purity of MDA was stable, and that it had become easier to obtain.
Eighty-three percent of REU reported recent use of cannabis in 2006. The proportion of REU reporting both lifetime and recent use of cannabis remained stable compared to 2005, but the frequency of recent cannabis decreased (70 days in 2006 from 85 days in 2005). The proportion reporting binge use of cannabis decreased to 24% in 2006 from 32% in 2005. The price, purity and availability of both hydro and bush cannabis remained stable in 2006 compared to 2005.
The number of cannabis possession (from 316 in 2005 to 351 in 2006) and provision offences (from 1,576 in 2005 to 1,612 in 2006) recorded by SAPOL increased in 2006. However, contribution of cannabis to the total number of illicit drug possession and provision offences in 2005/06 decreased (60%), compared to 68% in 2004/05. Telephone calls to the SA Alcohol and Drug Information Service (ADIS) regarding cannabis remained stable. The SA rate of admissions to hospital for cannabis (primary diagnosis) remained stable, however the national rate increased in 2005/06 compared to 2004/05.
As in previous years, the majority of the REU sample reported recent use of alcohol and tobacco and, although the frequency of use of both these drugs has fluctuated somewhat across the years, it has remained relatively high. KE information also suggests that use of these substances was common, but that frequency of use varied widely. In 2006, 17% of the REU sample were found to be in need of an evaluation for alcohol dependence, according to the Alcohol Use Disorders Identification test (AUDIT).
Substantial proportions of the samples have also consistently reported recent use of benzodiazepines, though frequency of use was generally low. However, the use of benzodiazepines is steadily increasing with one-third of REU reporting recent use in 2006 compared to only 26% in 2005. The majority of KE reports suggest that use of benzodiazepines was increasing among REU, although commenting that such use is generally low level and is associated with getting sleep after being up for long periods, or to help with ‘comedown’ from drug use.
Anti-depressants were recently used by a small proportion of REU, and KE reports suggest use was primarily as prescribed among this group. Use of inhalants has also remained fairly stable across the years, with one-third of the REU sample in 2006 reporting recent use of nitrous oxide, and approximately one-tenth reporting use of amyl nitrate, with frequency of use of both substances remaining consistently low. One-fifth of REU reported recent use of some type of pharmaceutical stimulant (e.g. dexamphetamine), and 18% reported recent use of ‘magic mushrooms’, both at low frequency.
Drug information-seeking behaviour
Twenty percent of the REU sample reported that they ‘always’ found out about the content of ecstasy, but only 11% always found out about the content of other drugs before taking them, the majority relying on information from friends that had experience with use of the drug concerned. Over a third (35%) reported that they used reagent-based testing kits to find out the content of ecstasy pills, with a third of these unaware of any limitations regarding use of such kits, and 22% stating they would still take the pill if no reaction occurred on testing (meaning the content was not fully elucidated).
Thirteen REU reported recently injecting any drug in 2006, most commonly some form of methamphetamine (particularly base and crystal) or ecstasy. With regard to longer-term trends, there was no evidence of an increase in the prevalence of recent injecting among REU across the years. Injecting drug use was considered generally rare, and still taboo, among this illicit drug-using group, and more likely to occur among primarily methamphetamine users, rather than primarily ecstasy users.
As was seen last year, in 2006 there was little reported sharing of needles, or sharing of other injecting equipment, among recent injectors, and most reported usually injecting themselves, in the company of close friends, in private homes.
Blood-borne viral infections
At the time of interview, 44 REU stated that they had completed a hepatitis B virus (HBV) vaccination schedule, mostly unrelated to susceptibility due to any risk factor. Approximately a quarter of the REU sample reported that they had been tested for either hepatitis C virus (HCV) infection or for human immunodeficiency virus (HIV) infection, with almost all, in both cases, reporting that their status was negative.
Sexual risk behaviour
Evidence of risky sexual behaviour was again apparent among the REU sample in 2006. Of the REU that reported having had penetrative sex with a casual partner in the last six months, 68% reported that they had not always used a condom. In addition, 78% 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 – and, of those, 42% reported that they had not always used a condom with a casual partner. In this context, almost half the REU sample reported they had never undergone a sexual health check-up.
Driving risk behaviour
Almost half of the REU that had driven a vehicle recently reported that they had driven over the limit for alcohol, a median five times, in the last six months. Further, 79% of recent drivers reported having driven within an hour of use of ‘any’ illicit drug, most commonly ecstasy, methamphetamine and cannabis.
Ecstasy and related drug harms
In 2006, seventeen percent of recent methamphetamine users were found to fit the criteria of clinically significant dependence, according to the Severity of Dependence Scale (Kessler, Price & Wortman, 1985; Kessler & Mrozek, 1994). Four percent of REU were found to be at high risk of psychological distress, 61% at medium risk and 35% at low risk of psychological distress, according to the Kessler Psychological Distress Scale (K10).
Twenty-two REU reported that they had ‘ever’ overdosed on ecstasy or a related drug, most commonly involving alcohol and ice/crystal methamphetamine. Only three REU reported recent experience of overdose; the ‘main drugs’ believed responsible were ecstasy, alcohol and crystal methamphetamine, respectively, though multiple drugs were involved in each case.
The proportion of clients attending Drug and Alcohol Services South Australia (DASSA) treatment services with ecstasy as the primary drug of concern has been stable for the last two years, and relatively low compared to other illicit drugs (one percent of total clients). The proportion of clients nominating amphetamines as the primary drug of concern has remained relatively stable over the last four years, and was 19% in 2005/06. As such, amphetamines were the second most commonly nominated primary drug of concern by clients of DASSA, after alcohol (52%), and dominated as the most common illicit drug of concern. As in previous years, two-thirds of the REU sample reported having experienced one or more problems related to their drug use in 2006; the majority of which related to some aspect of their social life or relationships, followed by financial, work or study problems. Use of ecstasy or some form of methamphetamine was most commonly held responsible, at least in part, for these problems.
Criminal activity and perception of police activity
In 2006, thirty percent of REU reported involvement in some type of crime, and 11 REU reported having been arrested in the last 12 months, similar to the previous year. Drug dealing was the most commonly reported crime across all years of the survey. KE agreed that criminal activity was uncommon among this group, with the exception of their illicit drug use, and an increase in dealing drugs to friends.
Three-quarters of the REU sample purchased ecstasy for themselves and others in the previous six months, and as such were engaged in ‘supply’ of an illicit drug to others. Over half of those who had ‘supplied’ ecstasy to others had purchased ecstasy monthly or less, with 4% purchasing at least three times per week. Nearly half of those who had purchased ecstasy for themselves and others usually obtained 10 or more pills when purchasing ecstasy. A third of the REU sample believed they knew how much ecstasy they needed to be in possession of to be charged with supply if caught by police. The consequences of being convicted of supplying ecstasy were unknown by the majority of the REU sample, with over half of the REU sample believing there is no difference between getting tablets for personal use or for their friends in the eyes of the law.
As has been consistent across the last five years, the majority of REU reported that their ability to obtain drugs had not become more difficult due to police activity in 2006. The majority of REU believed that police activity had been stable recently.
In 2006, REU were asked if they had seen sniffer dogs at an event in the previous six months, with 27% reporting that they had. Twelve of those who had seen sniffer dogs reported that they had drugs on them when they saw the sniffer dogs, with two reporting that they took the drugs to avoid detection, three did nothing and the remainder made no comment.
The findings from the 2006 SA EDRS have policy and research implications, and several recommendations are outlined below. It is worth noting that several of these issues may have already received attention and/or may be in the process of further investigation.
- Continued use of multiple drugs in combination, and binge use of drugs, by REU warrants continued education regarding the harms associated with such behaviour, and continued promotion of harm reduction strategies.
- Given the high level of use of methamphetamine, a drug of dependence among REU, development and dissemination of education and harm reduction strategies, regarding the harms associated with use of methamphetamine, need to be directed at young people.
- Continued close monitoring is required of indicators of use, especially use by smoking, of ice/crystal methamphetamine, which is known to have very high purity and subsequently increased risk of harm associated with its use.
- Continued focus is required on reducing supply of ecstasy and amphetamines, including from local clandestine laboratory manufacture.
- Continued close monitoring is required of the prevalence of injecting among REU, and development and implementation of strategies to reduce harms associated with injecting among this group of illicit drug users.
- Increased promotion of ‘safe sex’ practices is needed within this population of illicit drug users.
- Given the prevalence of drink and drug driving among REU, and the introduction of roadside drug testing in SA, development and implementation of education and harm-reduction programs directed at young people, regarding the harms associated with such behaviour and the effects of different drug types upon driving ability, is needed.
- Considering the prevalence of alcohol related harm among REU and daily alcohol consumption by some REU specific harm reduction information is needed targeting this group.
- Given the lack of knowledge among the REU sample in relation to South Australian legislation regarding the sale/supply/possession of ecstasy, development and implementation of education campaigns directed at young people is needed.
- Development and implementation of strategies to address issues associated with drug misuse and dependence and mental health co-morbidity (particularly effective concurrent treatment).