NDARC Technical Report No. 250 (2006)
EXECUTIVE SUMMARY
Demographic characteristics of injecting drug users (IDU)
Sample characteristics in 2005 were similar to previous years, with 101 IDU participating in the 2005 IDRS. The median age of the sample was 35 years and 64% of participants were male. Almost two-thirds (62%) of the sample was unemployed and almost half (46%) had a history of previous imprisonment. The median number of years spent at school was 10, but over half the sample (55%) reported having some kind of postsecondary school qualification (primarily a trade or technical qualification). Over half (53%) were currently undertaking some form of treatment for drug use, most commonly pharmacotherapy.
Patterns of drug use among IDU
The median age of first injection by the IDU sample was 18 years, and the drug most commonly first injected was amphetamine (60%), followed by heroin (33%). Heroin was nominated by over half of the sample (57%) as the drug of choice, followed by methamphetamine (27%). However, methamphetamine remained the drug most commonly injected by IDU in the last month (by 47%), followed by heroin (by 34%) and morphine (by 10%). Therefore, in 2005 there is still a discrepancy between what people want to use and what they are using most, suggesting the current price, availability and quality of heroin, in particular, is impacting on frequency of use (see heroin section below).
Polydrug use was common among the IDU in 2005 and has remained consistently so across the years of the IDRS. Similar to 2004, in 2005 there was substantial crossover between heroin users and methamphetamine users in the IDU sample. Forty-three IDU (43%) had used both heroin and some form of methamphetamine in the last six months. Frequency of injecting in the last month was greater than weekly for three-quarters of the sample, with 34% reporting injecting at least once a day.
Heroin
An increase in the price of heroin was noted in 2005, with the median price reported as $400 per gram by IDU. Heroin was still considered easy or very easy to obtain, while perception of heroin purity remained low to medium among IDU. The median purity of SAPOL heroin seizures appears to have remained relatively stable across the last four financial years, with median purity of 24% in 2004/05. Purity of SAPOL heroin seizures remains well below pre-shortage levels. There was an increase in the proportion of IDU obtaining heroin from a mobile dealer.
The proportion of IDU who reported recent use of heroin remained stable compared to 2004 (at 61%). There was, however, a decrease in the frequency of use of heroin for the second year in a row (following the substantial rise in frequency seen in 2003) to a median 28 days. Heroin users continue to supplement or substitute their heroin use with other opioid substances such as morphine and methadone.
Experience of recent heroin overdose among IDU in the sample remained low, though information from KE as well as the Royal Adelaide Hospital suggested a spike in nonfatal overdoses occurred in July/August of 2005. Other available treatment services & hospital data indicate that, over the last few years, heroin-related numbers have been stable to decreasing, while other opioid numbers have been stable to increasing.
In general, it seems that despite the ease of availability of heroin for most IDU, the increased price and continuing relatively poor quality of heroin was reflected in decreased frequency of use among IDU in 2005, despite the predominance of heroin as the drug of choice among this year's sample. In addition, over the long-term, indicators (such as treatment services and hospital data, police offences and seizure data) suggest stability or decline in the heroin market, which has not returned to pre-shortage conditions in Adelaide.
Methamphetamine
There were increases in the price, particularly of 'points' and gram amounts, of all three forms of methamphetamine from 2004 to 2005. Subsequently, in 2005, there was little difference in the median price paid for any amount of all three forms of methamphetamine, though crystal still tended toward being more expensive. All forms of methamphetamine were considered 'easy' or 'very easy' to obtain, though slightly larger proportions of IDU reported difficulty obtaining base and crystal forms in 2005. There was an increase in the proportion of IDU reporting that they usually obtained any form of methamphetamine from mobile dealers. The purity of base and crystal forms of methamphetamine, as perceived by IDU, had increased slightly, and remained as high or medium. Overall, the median purity of methamphetamine seized by SAPOL in SA for 2004/2005 was decreased (to 11.6%) compared to the previous year, and was the lowest seen in the past four years. SAPOL data on clandestine laboratory detections suggest that local manufacture of methamphetamine was still a contributor to the SA methamphetamine market.
The proportion of IDU reporting recent use of any methamphetamine remained stable (78%), and the frequency of use of any methamphetamine increased in 2005 (median 30 days), stabilising the dramatic decrease seen in 2004. Increased frequency of use was noted across all main forms of methamphetamine, particularly base, and this form remains the most used type of methamphetamine among IDU. There was no increase in the recent use of crystal methamphetamine (or 'ice') by smoking (10% of IDU in 2005).
Calls to ADIS in SA regarding methamphetamine remained stable, as have the number of clients (with amphetamines as the primary drug of concern) to all DASSA services. However, the number of clients to DASSA inpatient (detox) services with amphetamine as the primary drug of concern continued to decline, and in 2005 was at the lowest since 2001/2002. In contrast, state (SA) hospital admissions data showed the number of amphetamine-related admissions was continuing to increase (as at 2003/04), though this data lags behind other indicators.
In general, an increase in the price of all forms of methamphetamine was noted in 2005, though availability and perceived purity remained relatively stable. Use of all forms among IDU returned to 2003 levels, following what seems to have been an anomalous decrease in 2004 (possibly due to sampling method). These parameters, along with other indicator and key expert data, suggest that the methamphetamine market remains strong and generally stable in Adelaide. However, over the longer-term, problems with use seem to have declined somewhat compared to earlier years.
Cocaine
Similar to 2004, only a very small number of IDU were able to supply information regarding the price, purity or availability of cocaine, which was reflective of the relatively low numbers of IDU that had used cocaine in the last six months (a total of 16). In addition, although several KE were able to provide some information on cocaine, this was limited and none could nominate cocaine as their main area of expertise. Consequently, the data for price, purity and availability of cocaine in 2005 are again of limited value.
In 2005, an increase was seen in the number of IDU that reported recent use of cocaine (16 compared to 6 in 2004), but frequency of use remained low (at a median of 3.5 days in the last six months), and use of cocaine in general remained well below other illicit drug use among this sample.
The small number of KE and IDU either using cocaine or able to provide information in itself indicates the lack of a sizeable and visible cocaine market in Adelaide, particularly amongst the IDU sampled by the IDRS. Indicator data, such as the number of cocaine possession and provision offences, calls to ADIS, DASSA treatment services data for cocaine, and SA hospital admissions data, also support this presumption. However, data from the ACC show an increase in the number of cocaine seizures by SAPOL in 2004/2005. The possibility that a cocaine market exists beyond the scope of this survey should not be excluded, and readers are directed to the Party Drugs Initiative findings (Weekley et al., 2005), which show a higher level of use and availability of cocaine among a sample of regular ecstasy users in Adelaide.
Cannabis
In 2005, the median price reported for cannabis was $200 an ounce and $25 a 'bag' for either hydro or bush. With the exception of an increase in price of an ounce of bush (up from $180 in 2004), the price of these quantities has remained stable for years. Both hydro and bush cannabis were considered 'very easy' or 'easy' to obtain, and most cannabis-using IDU reported scoring the cannabis from a friend. Most also perceived the potency of either hydro or bush as high or medium.
Cannabis, though generally not the drug of choice among the IDU sample, was used commonly (by 80%), and the percent of IDU that had recently used cannabis has been stable across all the years the IDRS has been conducted. However, frequency of use of cannabis decreased markedly in 2005 (to a median 120 days), following four years of stability (at a median 180 days). Almost all cannabis users reported they had used hydroponically grown cannabis in the last six months, with a large majority reporting they mostly used hydro. KE generally reported no changes in any parameter of the cannabis market, or use of cannabis among IDU.
The number of calls to ADIS concerning cannabis remained stable, as did the total number of clients to DASSA treatment services; however, the number of clients attending inpatient detox services of DASSA continues to increase gradually. Cannabisrelated hospital admissions in SA have increased for three years to 2003/2004.
Overall, the cannabis market remains generally stable in Adelaide, and use among IDU remains common, despite a decrease in reported frequency of use among the 2005 sample.
Other opioids
As in recent years, in 2005 the use of other opioid substances by IDU was common, with 83% reporting recent use of some type of opioid substance, excluding heroin. There were some changes, however, in the use of other opioids by IDU in the 2005 sample, as follows.
Morphine
Although the proportion of IDU reporting recent use of morphine remained relatively stable (at 37%), there was a continued decrease in the frequency of use of morphine (to a median 8 days), for the second year in a row. The price and availability of morphine was unchanged compared to 2004. As in previous years, the majority of morphine users reported use by injecting, and mainly used illicit supplies of Kapanol® and MS Contin®.
Methadone and buprenorphine
In 2005 there was an increase in the proportion of IDU that reported recent use of illicit methadone syrup (to 24%), while the proportion reporting use of illicit buprenorphine remained stable (at 14%). Frequency of illicit use of both pharmacotherapy medications remained stable and low in 2005 (a median of 3 days for each). The percentage of IDU reporting injecting of either licit or illicit methadone or buprenorphine remained stable compared to 2004, at approximately a quarter of recent users of these substances. While there was no change in the proportion of IDU reporting mainly using an illicit supply of buprenorphine (25%), there was a small increase in the proportion of IDU reporting mainly using an illicit supply of methadone (38%). It is worth noting, however, that the majority still report mainly licit (prescribed) use of these substances.
Oxycodone
For the first time, in 2005, IDU were asked about use of oxycodone specifically, and 11% of the SA sample reported illicit use of oxycodone at very low frequency (median one day in six months).
Other drugs
The proportion of IDU reporting recent use of ecstasy (25%) or hallucinogens (8%) was stable and frequency of use remained low in 2005.
Although there was a small increase overall in the percentage of IDU reporting recent use of benzodiazepines (63%) in 2005, there was a decrease in the percentage reporting recent illicit use, and a decrease in the frequency of use. Sixty-five percent of benzodiazepine users reported mainly licit use, primarily of Diazepam.
Anti-depressant use was also stable, both in terms of percent reporting recent use (22%) and frequency of use. Almost exclusively licit use was reported, primarily of a SSRI.
Associated harms
The high prevalence of sharing of injecting equipment (other than needles) first noted in 2004 was maintained in 2005, with 39% reporting having shared equipment such as tourniquets, water and spoons.
While the prevalence of injecting of morphine, methadone and buprenorphine remained stable compared to 2004, there were some decreases seen with regard to injecting-related problems associated with these substances in 2005, particularly morphine and buprenorphine. However, a third or more of injectors of morphine, methadone and buprenorphine still reported experiencing injecting-related problems in the month prior to interview, such as substance dependence, scarring and bruising, difficulty finding veins, and abscesses or infections. Several KE commented that these problems were exacerbated by lack of IDU access and/or proper (single) use of filters and other injecting equipment, primarily due to financial constraints.
There was an increase in IDU-reported experience of anxiety and attendance to a GP for a mental health problem, in 2005. Depression and/or anxiety again predominated as the most commonly experienced mental health problem reported by IDU. KE reported mental health issues as generally stable in 2005.
While median expenditure on illicit drugs increased overall compared to 2004, IDU that used primarily heroin still spent a greater amount on average than primarily methamphetamine using IDU, though this difference was decreased in 2005.
There was an increase in the prevalence of criminal involvement reported by IDU, and of experience of arrest in the preceding 12 months, with drug dealing and property crime remaining the most common. Most IDU perceived that police activity was either stable or increasing and the majority reported that police activity had not made it more difficult to obtain drugs recently.
Implications
The findings from the 2005 SA IDRS have policy and research implications, and recommendations are outlined below. It is worth noting that several of these issues have already received attention and/or may be in the process of further investigation.
- Development of improved treatment protocols for methamphetamine use and dependence (underway at DASSA).
- Continued close monitoring of indicators of use of the crystal methamphetamine ('ice'), which is known to have very high purity and subsequently increased risk of harm associated with its use.
- Monitoring and characterisation of changes in purity and chemical structure of amphetamine and methamphetamine seizures, through forensic analysis.
- Continued focus on reducing supply of amphetamines and methamphetamine from local clandestine laboratory manufacture.
- Development and implementation of strategies to reduce diversion of prescribed pharmaceuticals (morphine, methadone, buprenorphine, and other opioid analgesics).
- Development and implementation of strategies to reduce behaviour and harms associated with injecting of formulations not intended for injection, such as morphine, methadone and buprenorphine.
- Given the recent overdose deaths in Adelaide in which buprenorphine was implicated, along with indications that diversion and injection of buprenorphine is occurring: closer monitoring of the presence of buprenorphine in overdose is warranted, both in fatal and non-fatal cases (as per the Designer Drug Early Warning System), and development and dissemination of education resources is needed regarding the risks and harms of injecting buprenorphine.
- Development and implementation of strategies to address issues associated with drug misuse and dependence and mental health comorbidity (particularly effective concurrent treatment).
Citation: Weekley, J., Simmonds, L. and Ali, R. (2006) South Australian Drug Trends 2005: Findings from the Illicit Drug Reporting System (IDRS), Sydney: National Drug and Alcohol Research Centre.