NDARC Technical Report No. 281 (2007)
EXECUTIVE SUMMARY
Demographic characteristics of REU
The sample of 100 regular ecstasy users (REU) interviewed in 2006 were typically young, with ages ranging from 18 to 61 years and the majority in their early- to mid-twenties. Participants were generally well educated and either employed on a full- or part-time/casual basis or currently engaged in full-time study. Few participants had come into contact with the criminal justice system or drug treatment agencies. These demographic characteristics are generally consistent with those reported among REU in the previous three years of the study. However, there was less recent injecting drug use, involvement in current drug treatment, and recent use of methadone and heroin among the most recent three cohorts relative to 2003, possibly reflecting less overlap between the IDU and REU populations in the latter three years of the study.
Patterns of polydrug use
While the participants were selected on the basis of regular use of ecstasy, and over half nominated ecstasy as their drug of choice, polydrug use was the norm among the REU interviewed. Recent use of alcohol, cannabis, tobacco, and methamphetamine (powder, base and crystal) was common, and over half had recently used psychedelic mushrooms. Between one-third and one-quarter had recently used nitrous oxide, cocaine, benzodiazepines, LSD, or 2CI. Around one-tenth had recently used opiates other than heroin or methadone, pharmaceutical stimulants, amyl nitrite, or antidepressants and the recent use of ketamine, methadone, MDA, GHB, buprenorphine, and heroin was uncommon. There was no recent use of 1,4B or GBL among the current sample.
Over the four years of the study there have been trends in the use of some drug types. Between 2003 and 2006 there has been a steady decrease in the recent use of ketamine, MDA, and amyl nitrite, and an increase in the use of cocaine. Relative to the 2005 sample, there was a slight decrease in the recent use of methamphetamine powder (62% vs. 77%) and a slight increase in the use of methamphetamine base (23% vs. 40%) and crystal methamphetamine (10% vs. 27%) in 2006. However, the highest recent use of crystal methamphetamine was observed among the 2003 sample (52%). One-quarter of the 2006 sample (23%) had recently used the hallucinogen 2CI among the 2006 cohort compared to less than one-twentieth of previous cohorts. Stable trends were observed in the use of most other drug types.
Ecstasy
Data from the National Drug Strategy Household Survey (NDSHS) suggest a steady increase in the national prevalence of ecstasy use in Australia between 1995 and 2004, where 7.5% of the population are estimated as ever trying the drug, and 3.4% were estimated as using the drug in the preceding 12 month period. The prevalence of recent ecstasy use among the Tasmanian sample has remained at least half that of the national estimate during this time, and it is unclear whether there has been any substantial change in the prevalence of ecstasy use in Tasmania over this time.
The participants interviewed in the present study had first started to use ecstasy on a regular basis at 20 years on average and a large majority of the sample had been using ecstasy for two years or more. The entire sample had recently used ecstasy in tablet form while a minority had recently used ecstasy capsules or powder. There was a wide variation in the frequency of ecstasy use among the sample, ranging from monthly to several times a week. On average, ecstasy had been used fortnightly with a median of two tablets taken in a typical session. Although ecstasy was typically swallowed, snorting of ecstasy was also common, with three-quarters of the sample recently snorting the drug. This may be an issue of concern due to potential damage to mucous membranes, a steeper dose-response curve, and the increased risk of blood-borne viral infections. A minority of the sample had also recently shelved/shafted (anal/vaginal administration), smoked, or injected ecstasy.
There were some concerning patterns of use among the sample. One-fifth (22%) had used ecstasy on a weekly basis or more frequently, three-quarters (79%) usually used more than one tablet in a typical session of use, and one-third (37%) had recently used ecstasy in a ‘binge session’ (a continuous 48 hour period of drug use without sleep). Relative to 2005, slightly greater proportions of the sample had usually used more than one tablet in a typical session, or had recently ‘binged’ on ecstasy, but the median frequency of ecstasy use overall was slightly lower. Whereas the long-term effects and risks of extended ecstasy use are largely unknown, evidence from toxicology studies in rats and neuropsychological studies in humans indicate that the safest pattern of use is to use the drug infrequently and in small amounts. Thus, those using the drug frequently or in large amounts for extended periods of time may be at a greater risk for neurological and neuropsychological harm.
Ecstasy was typically consumed in combination with other drugs. Alcohol, cannabis, and tobacco were commonly used in a typical session of ecstasy use. Just over one-tenth (15%) typically used methamphetamine when under the influence of ecstasy, similar to the proportion in 2005 (17%), marking a sustained reduction from the rates in the 2003 (25%) and 2004 cohorts (25%). The use of cannabis both under the influence and when ‘coming down’ from ecstasy and the use of benzodiazepines when coming down from ecstasy has also decreased slightly over the past four years.
The majority of participants (79%) reported drinking alcohol when under the influence of ecstasy and two-thirds (66%) typically consumed more than five standard drinks. Although the proportion reporting ‘binge drinking’ when under the influence and coming down from ecstasy had slightly declined from the high rates amongst the 2004 and 2005 cohorts, the high level of coincident binge alcohol and ecstasy use is still an issue of concern. There is an increased risk of dehydration when alcohol is combined with ecstasy and larger quantities of alcohol can be consumed when under the influence of psycho-stimulants without experiencing immediate effects of intoxication; however, the harms associated with this use still occur. Additionally, most of the overdose episodes reported by the REU in the current study involved alcohol and/or polydrug use.
Close to half (49%) of the REU sample had recently experienced no or few psychological symptoms of dependence in relation to their ecstasy use as measured by the Severity of Dependence Scale (SDS) for ecstasy. However, almost one-fifth (19%) reported experiencing significant symptoms of dependence in relation to ecstasy. High ecstasy SDS scores were associated with greater frequency and quantity of ecstasy use, binge drug use, and high levels of methamphetamine dependence and psychological distress scores.
Ecstasy was typically used at music-related venues including dance parties, nightclubs and live music events but was also used at a range of other locations including private parties and private residences. REU reports and anecdotal comments of KE suggest an increase in the use of ecstasy at locations other than dance/events and nightclubs, in particular at private residences and public bars. Qualitative comments of both KE and REU suggest that the use of ecstasy has become more ‘mainstream’ and less restricted to dance-related events and nightclubs. There were anecdotal reports of a broadening demographic of people consuming the drug locally, including the use of ecstasy by younger and older people as well as an increase in the social acceptability of the drug. Ecstasy appears to have become enmeshed in drinking culture and is likely to be used in combination with binge alcohol drinking.
The majority of participants perceived both benefits and risks to be associated with their ecstasy use. Perceived benefits were generally associated with having a fun and enjoyable time, social benefits such as enhanced closeness and enhanced communication with others, the enhanced appreciation of music/dance as well as acute drug effects such as enhanced mood and increased energy. The greatest risks perceived were the unknown contaminants/cutting agents in pills, legal/police problems, damage to brain function, and depression, among other psychological, neuropsychological, and physical risks. A minority considered acute physical problems such as vomiting, headaches, dehydration, overdose, and body temperature regulation, or the acute effects of intoxication, such as risk-taking behaviours, to be major risks of ecstasy use.
Price, purity and availability of ecstasy
Whereas there was evidence for an expanding ecstasy market in 2004, marked by decreased price, increased purity, and increased availability relative to 2003, in 2005 the market appeared to have tightened slightly, with a slight increase in price and decreased purity and availability relative to 2004. In 2006, a slight decrease in price and purity was observed, while availability remained relatively stable.
The median price reported by REU for one tablet of ecstasy was $40, which is slightly lower then the price of $45 reported in 2005. Over one-half indicated that this price had remained stable during the preceding six months, but one-quarter indicated that there had been a recent decrease in price. The median price reported by KE was also $40 and over half of those that commented (n=7) indicated that the price of ecstasy had recently decreased.
REU typically reported that ecstasy was ‘medium’ or ‘fluctuating’ in purity, with a smaller proportion reporting that ecstasy was ‘high’ in purity relative to previous years. REU typically indicated that this purity had remained stable or had fluctuated during the six months preceding the interview. KE indicated that the purity of ecstasy typically fluctuated or was ‘low’ to ‘medium’, with four out of eight KE reporting a recent decrease in the purity of ecstasy. There have been limited forensic analyses of the purity of ecstasy tablets seized by Tasmania Police. The median purity of the 33 seizures analysed during the 2003/04 reporting period was 26.0% and ranged from 10.4% to 44.5%. There were no analyses of ecstasy purity reported by Tasmania Police in the 2004/05 reporting period and the 2005/06 data was unavailable at the time of publication.
Both KE and REU indicated that ecstasy is ‘easy’ or ‘very easy’ to obtain and that recent availability had remained stable.
There was a substantial increase in the number of ecstasy tablets seized by Tasmania Police in the 2003/04 financial year, and the number of tablets seized has remained relatively stable since this time. Whereas this has had minimal impact on the number of arrests made in relation to ecstasy, there were a greater number of consumer (5) and provider (7) arrests reported in the 2004/05 reporting period relative to previous years (although these numbers remain low). Data for the 2005/06 financial year were unavailable at the time of publication.
Ecstasy markets and patterns of purchasing
Consistent with previous years, ecstasy was typically purchased from friends and obtained from friends’ homes. Over one-half (54%) indicated that when they purchased ecstasy, they typically purchased the drug both for themselves and others, while the remainder (44%) typically purchased ecstasy only for themselves. Although the ecstasy market is predominantly based on individuals sourcing the drug for other friends while making no cash profit, those that purchase ecstasy in larger quantities may be putting themselves at greater risk of being arrested as a provider rather than a consumer of the drug. While two-fifths (43%) of the sample perceived that getting tablets for friends carried a heavier penalty than getting tablets for themselves, the remainder of the sample did not perceive that there was a distinction. Almost half of the cohort (46%) were aware of some possible consequences of being charged with supplying ecstasy (although the suggested consequences were not necessarily technically correct in terms of the legislated legal sanctions), and the remainder were not able to confidently comment.
Under Tasmanian legislation, the offences of possession, supply, and trafficking of a controlled substance are based on various factors including ‘intent’ and are not necessarily determined by the quantity of the seized substance. However, the offence of trafficking, which carries the largest penalty, may be determined by possession of a trafficable amount of a controlled substance. For ecstasy (MDMA), this trafficable amount is 10g.
Methamphetamine
Consistent with previous years, use of methamphetamine was common among REU in 2006. Over three-quarters (78%) had used some form of methamphetamine in the preceding six months. Methamphetamine was typically swallowed or snorted and was used on a median of six times during this period (approximately monthly) in small quantities (0.1g). The proportion reporting recent use of any form of methamphetamine and the frequency of methamphetamine use has remained relatively stable since 2003.
Recent use of methamphetamine powder was most common (62%) followed by methamphetamine base (40%), and crystal methamphetamine (27%). Relative to 2005, the proportion that had recently used powder was lower (62% vs. 77%) and the proportion that had recently used base (40% vs. 23%) and crystal (27% vs. 10%) was higher in the 2006 cohort. The frequency of methamphetamine powder use has decreased slightly over the past three years of the study. In 2006, the quantity of methamphetamine base used in a typical session was greater (~0.2g) relative to previous years (0.1g), and relative to the other methamphetamine forms. The increase in the recent use of crystal methamphetamine was largely attributable to an increase in those who reported smoking the drug.
Over half of recent methamphetamine users (52%) had experienced no symptoms of psychological dependence as measured by the methamphetamine SDS. However, almost one-fifth (19%) had experienced significant symptoms of dependence. High SDS scores were associated with greater frequency of methamphetamine use, use of methamphetamine in combination with ecstasy, recent binge drug use, recent injecting drug use, and elevated levels of psychological distress.
The median price for one ‘point’ (0.1g) of methamphetamine powder and methamphetamine base was $40, and the median price for one ‘point’ of crystal was higher at $50. The price of methamphetamine base was $10 less in comparison to 2005.
Methamphetamine powder and base were reported to be ‘medium’ to ‘high’ purity, whereas crystal methamphetamine was reported to be ‘high’ in purity. Subjective reports of REU suggest decreased purity of methamphetamine base relative to 2005.
Methamphetamine powder and base were considered to be ‘easy’ or ‘very easy’ to obtain, and crystal methamphetamine was typically considered to be ‘difficult’ or ‘very difficult’ to obtain. The availability of methamphetamine base appears to have increased relative to 2005. Those that commented on crystal methamphetamine indicated that it had become more difficult to obtain in the last six months.
The overall use of methamphetamine among REU in Tasmania has remained stable, but there have been some recent shifts in the use and market characteristics of each form. The recent use of powder is slightly lower than 2005 and there has been a gradual decrease in frequency of use since 2003. The recent use, frequency of use, and availability of base has increased relative to 2005, and the price has decreased. While the recent use of crystal has also increased relative to 2005, it is still half of that reported in 2003, and prices have remained stable, and availability low.
Cocaine
The lifetime and recent use of cocaine has steadily increased among the REU interviewed in Tasmania since 2003. One-third (33%) had recently used cocaine in 2006, compared to one-fifth (20%) in 2005, and one-tenth among the 2004 (10%) and 2003 (7%) samples.
Cocaine was typically snorted and was used on a median frequency of two days (range 1-6 days) in the six months preceding the interview, with an average of 0.2 to 0.5 grams used in a typical session.
The median price for one gram of cocaine was $350 (range $250-500) and the price for one point (0.1g) of cocaine was $50 (range $35-50). These prices were typically reported to have remained stable during the six months preceding the interview, though one-quarter of those who commented indicated a recent decrease in the price of cocaine.
Cocaine was typically considered to be ‘medium’, ‘low’, or ‘fluctuating’ in purity, and to have recently remained ‘stable’ or ‘fluctuated’ in purity during the six months preceding the interview.
REU reports on the availability of cocaine were mixed, with half indicating that it was ‘easy’ or ‘very easy’ to obtain and half indicating that it was ‘difficult’ or ‘very difficult’ to obtain. Although a majority indicated that the availability of cocaine had remained stable during the six months preceding the interview, one-third indicated a recent increase in the availability of cocaine. KE comments also indicated a recent increase in the use and availability of cocaine among REU in Hobart.
Ketamine
The lifetime and recent use of ketamine has decreased among the Tasmanian EDRS sample since 2003. Less than one-tenth (6%) of REU interviewed had used ketamine during the six months preceding the interview. Ketamine had been used on an average of two occasions in the preceding six months in relatively small amounts. This, along with anecdotal reports of key experts, suggests predominately experimental use by a small number of people amongst this regular ecstasy-consuming cohort. Ketamine was typically swallowed or snorted and had been purchased in powder form.
Consistent with the relatively low use of ketamine among the 2006 REU sample, few participants were able to comment on the price, purity and availability of the drug and these estimates should therefore be interpreted with caution. One participant indicated that the price for one gram of ketamine was $180 and another indicated that they had purchased one point of ketamine for $40 during the six months preceding the interview. The purity of ketamine was considered to be high or medium and to have remained stable in recent months. The comments of KE and the patterns of use among REU both indicate relatively low availability of ketamine in Tasmania.
GHB
Consistent with the low levels of use reported among the Tasmanian REU sample in previous years, less than one-tenth (9%) of the REU sample had ever used GHB, and only three participants (3%) had used GHB during the six months preceding the interview. GHB was taken orally in liquid form on a median of 2 days (range 1-3 days) during this time. There was no lifetime or recent use of GHB-like substances such as 1,4B or GBL among the 2006 REU cohort.
Only two participants commented on the price, purity, and availability of GHB in Tasmania, making it difficult to delineate clear trends. Patterns of use among REU and anecdotal comments of key experts indicate low availability of GHB in Tasmania and predominantly experimental use by few people. However, considering the potentially harmful nature of GHB, future monitoring of GHB markets in Tasmania is important.
LSD and other psychedelics
Over half of the 2005 REU sample had used LSD at some stage of their lives and almost one-third had used LSD in the six months preceding the interview. A significantly greater proportion of males had ever and recently used LSD in comparison to the proportion of females. One tab or drop of liquid LSD was taken orally in a typical session of use, and LSD had been used on a median of 2 days in the preceding six months. Whereas LSD was most typically used at private residences, the use of LSD at dance-related events, nightclubs, and private parties was slightly higher in 2006 relative to previous years.
The median price for one tab of LSD was $20 (range $10-40) and this price was considered to have remained stable in the last six months. The purity of LSD was perceived by REU to be ‘medium’ or ‘high’ and stable during the six months preceding the interview. Two-thirds of the sample reported that LSD was ‘easy’ or ‘very easy’ to obtain, and the remainder reported that it was currently ‘difficult’ or ‘very difficult’ to obtain. Subjective reports of REU indicate a gradual increase in the availability of LSD since 2003, but levels of use have remained stable in successive EDRS cohorts during this time.
Almost three-quarters of respondents had ever used psychedelic mushrooms and over half had used mushrooms during the six months preceding the interview, which is an increase relative to previous years. A greater proportion of males had ever and recently used mushrooms in comparison to females. Mushrooms had been used on a median of three days in the preceding six months, approximately every two months. Both REU and KE noted a recent increase in the use of mushrooms at the time of the interview that was attributed to the seasonal increase in their availability. Almost two-thirds of the sample, and a greater proportion of males than females, had used some form of psychedelic (either LSD or mushrooms) in the last six months.
In 2006, almost one-quarter of the REU sample (23%) had recently used the experimental research chemical 2CI, which is a substantial increase relative to the small proportions that had recently used the drug in 2004 (5%) and 2005 (1%). Whereas this indicates an increase in the availability of 2CI locally, the frequency of use was relatively low, indicative of predominantly experimental use.
MDA
The lifetime and recent use of MDA among the Tasmania REU sample has decreased gradually from 32% and 21% respectively in 2003, to 14% and 3% respectively in 2006. MDA had been purchased in capsule form and had been swallowed or snorted on single occasions during the six months preceding the interview. Few respondents were able to confidently comment on the price, purity or availability of MDA and thus it is difficult to delineate clear trends. However, based on the decline in the use of MDA since 2003, and the comments of several KE, the local availability of MDA in Tasmania appears to be low.
Cannabis
The entire REU sample had used cannabis at some stage of their life, and a majority (82%) had used cannabis during the six months preceding the interview. Cannabis had been used approximately weekly on average during the six months preceding the interview, and this frequency of use tended to be greater for males relative to females (30 vs. 12 days), and for older relative to younger participants (72 vs. 12 days).
Participants were asked about the price, purity, and availability of hydroponically-grown (‘hydro’) and bush-grown (‘bush’) cannabis for the first time in 2006. Bush was typically cheaper than hydro, particularly when bought in larger amounts. The median last purchase price for one gram of cannabis was $15 for both bush and hydro (range $10-$25). The median last purchase price for one-quarter of an ounce was $85 ($70-$100) and $65 ($40-$80) for hydro and bush respectively, and the median price for one ounce of hydro was $250 (range $200-300) compared to $200 ($50-350) for bush. The purity of hydro was reported to be high and stable, and the purity of bush was reported to be medium and stable. Both bush and hydro were reported to be ‘easy’ or ‘very easy’ to obtain and availability was reported to have remained stable during the six months preceding the interview.
Patterns of other drug use
The majority of REU had recently consumed alcohol on an average of two days per week in the six months preceding the interview. A large majority (78%) of the 2006 EDRS REU sample had used alcohol at least weekly during the six months preceding the interview, which is substantially higher than both the Tasmanian (39.4%) and national (41.2%) estimates of prevalence for the general population, and among those aged 20-29 nationally (56.7%), from the 2004 National Drug Strategy Household Survey. A large majority of REU (85%) scored 8 or more on the alcohol use disorders identification test (AUDIT), suggestive of hazardous and harmful alcohol use and the possibility of alcohol dependence.
Tobacco had recently been used by four-fifths of the sample and over half the sample had smoked tobacco on a daily basis in the last six months, with others smoking tobacco less frequently. The proportion of daily smokers among REU interviewed in the present study (63%) is greater in comparison to both national (23.5%) and Tasmanian (27.7%) estimates of prevalence among those aged 20-29 from the 2004 National Drug Strategy Household Survey.
There has been a reduction among REU in the recent use of amyl nitrite from two-fifths (43%) in 2003 to less than one-tenth (16%) in 2006. The majority (90%) of those that had inhaled amyl nitrite had done so less than once a month during the last 6 months. The proportion of the sample reporting recent use of nitrous oxide has increased from one-quarter (25%) to two-fifths in 2005 (43%), and 2006 (39%). On average, nitrous oxide had been used less than monthly.
One-third of the sample had recently used benzodiazepines, on a median of five days in the last six months. One-tenth of the sample had recently used antidepressants, with one-third of these using them on a daily basis during the six months preceding the interview.
The use of other pharmaceuticals and opioid drugs was relatively rare among the regular ecstasy users interviewed in the current study, and those that had recently used these drugs had generally done so infrequently. Twelve percent had recently used pharmaceutical stimulants (such as dexamphetamine or methylphenidate), with a median frequency of approximately once every three months. Only small proportions of the sample had recently used methadone (5%), heroin (2%), and buprenorphine (1%). The recent use of other opiates (pharmaceuticals and alkaloid poppy derivatives) was slightly more common (14%) but relatively infrequent at once every two months.
Drug information-seeking behaviour
Two-thirds (66%) of the REU sample indicated that they had ‘sometimes’ bought a drug and it turned out to have different effects than they expected in the last six months, and two-thirds (63%) indicated that they did not know what was in the pills that they took. Whereas one-third (34%) of the REU interviewed in 2006 actively sought information about the content/purity of ‘batches’ of ecstasy pills, the remainder did so half the time or less (37%) or ‘never’ (27%). Participants typically obtained this information from friends, dealers, and other people as well as websites, personal experience, and pill testing kits. Ten participants reported recent use of pill testing kits, and one-half of these were aware of some limitations of testing kits.
The majority of REU were receptive to harm-reduction information. Three-quarters (72%) indicated that they would find pill testing kits personally useful if available locally. Other information resources that were considered useful by REU were information pamphlets, a local website, health outreach workers at events, and posters. Participants generally indicated that the result of pill testing would influence their decision to take a pill. For example, many would not take a pill if testing indicated that it contained potentially harmful substances such as PMA and DXM.
Several REU commented on the lack of information available to them on the effects of drugs and ways in which to consume them more safely. In 2005, REU indicated that they were particularly interested in finding out more information about the long-term effects of drug use (physical, psychological, neuropsychological, and neurological) and also considered it to be important that new consumers were aware of the acute effects of drug use and ways in which to use drugs more safely.
Risk behaviour
Less than one in ten regular ecstasy users (9%) had recently used substances intravenously, consistent with the proportion of recent injectors amongst the preceding two EDRS cohorts. Methamphetamine was typically the first drug ever injected and the most common drug ever and recently injected. The sharing of needles was relatively rare; however, two out of five had recently shared other injecting equipment such as spoons, tourniquets, and water. One-tenth of these recent injectors had always required others to inject them in the last six months. The majority of recent injectors had obtained injecting equipment from NSP outlets in the preceding six months and none reported difficulty in obtaining needles during this time.
A large majority (94%) of REU had been sexually active during the six months preceding the interview and most of these (87%) reported recent penetrative sex under the influence of ecstasy and related drugs. Participants were generally more likely to report some use of protective barriers with a casual partner than with a regular partner. Participants were slightly less likely to use protective barriers with a regular partner when under the influence of party drugs (60% vs. 49%). When having sex with a casual partner, participants were more likely to use protective barriers (82% vs. 91%) when under the influence of party drugs, but the proportion that ‘always’ used barriers declined when under the influence of drugs (47% vs. 34%). Whereas two-fifths of participants (40%) had been for a sexual health check up in the last year, one-third (37%) had never had a sexual health check up. Three-fifths of the sample had never been tested for hepatitis C or HIV. Three participants reported testing positive for hepatitis C.
Of those that had driven a car, one-half (48%) reported driving at a time when they perceived themselves to be over the legal alcohol limit during the last six months, compared to three-fifths (58%) in 2005. Three-quarters (78%) reported driving within an hour of taking ERDs in the last 6 months, compared to one-half (55%) in 2005. Most commonly, participants reported driving under the influence of ecstasy, cannabis or methamphetamine. Those that had recently driven under the influence of drugs were older, less likely to be students, and more likely to be full-time workers than those that had not. They were also more likely to have recently binged on ERDs and had recently used ecstasy more frequently and in larger amounts.
Almost one-half (46%) had recently ‘binged’ on ecstasy and related drugs (a continuous period of use for more than 48 hours without sleep). Substances most commonly used in a binge session of use were ecstasy, cannabis, alcohol, and methamphetamine. Those who had recently ‘binged’ had first started using ecstasy at an earlier age, had experimented with a greater number of drugs, and had recently used ecstasy more frequently and in larger amounts. They were also more likely to report recent injecting drug use, recent methamphetamine use, and to have typically used methamphetamine in combination with ecstasy during this time. They also reported higher psychological dependence scores for ecstasy and methamphetamine as measured by the SDS.
Health-related issues
Less than one-tenth of the sample (8%) reported that they had overdosed (passed out or fallen into a coma) on any drug in the six months preceding the interview. The main drugs involved in recent overdoses were ecstasy (43%), ketamine (14%), GHB (14%), methadone (14%), and Phenergan (14%). The majority of overdose episodes (86%) were associated with the use of more than one drug, most typically alcohol (43%), and cannabis (43%).
One-fifth (22%) of the 2006 REU sample had accessed health services in relation to drug use in the preceding six months. The most commonly accessed service was a GP (n=10), followed by ambulance (n=6), first aid (n=5), emergency (n=4), counsellor (n=3), hospitalisation (n=3), drug and alcohol worker (n=3), psychologist (n=3), and psychiatrist (n=2). Participants were most likely to access services in relation to the use of alcohol (n=10), ecstasy (n=9), methamphetamine (n=9), or cannabis (n=7) use, the drugs most commonly used among this cohort. A greater proportion of younger participants had accessed health services in comparison to older participants.
Mean scores on the Kessler psychological distress scale (K10) and the proportion with ‘high’ scores (25 or more) were higher among the current sample of REU relative to estimates among the general Australian population. One in ten REU (13%) had ‘high’ K10 scores indicative of high levels of psychological distress and a possible diagnosis of a mood disorder. Those with this high level of psychological distress were more likely to be unemployed, to be GLBT, to have recently injected, to have recently ‘binged’ on stimulants, to have ‘high’ methamphetamine dependence scores, and to have recently accessed health services. However, more than two-fifths of those with ‘high’ K10 scores had not accessed any health services in relation to their psychological distress in the preceding six months.
One half of the sample (55%) had recently experienced work/study problems in relation to drug use, two-fifths had recently experienced financial (45%) and social/relationship (44%) problems, and less than one-tenth (5%) had recently experienced legal/police problems in relation to drug use. Problems were most commonly attributed to ecstasy, methamphetamine, or cannabis. Whereas the majority of these problems were relatively minor, small proportions experienced more serious problems such as ending a relationship, being kicked out of home, leaving school, being sacked/quitting work, or having no money to pay for food or rent.
Criminal activity, policing and market changes
Consistent with previous years, the self-reported criminal activity among the 2006 REU sample was relatively low. With the exception of dealing drugs, only 8% of the REU interviewed had committed criminal offences during the one month preceding the interview, and 8% had been arrested during the preceding 12 months. Key experts generally indicated that there was no or little crime among the group of REU that they were familiar with.
Almost one-third of the REU sample (30%) and several key experts perceived that there had been an increase in police activity towards ecstasy users in the last six months; however, the majority of regular ecstasy users indicated that police activity had not recently made it more difficult for them to obtain drugs.
Conclusion
The REU interviewed for the current study were generally young, employed or studying, and not currently in drug treatment or legal trouble. While ecstasy was the preferred drug of most, polydrug use was the norm and the use of alcohol, cannabis, tobacco and methamphetamine common. The current harm-reduction messages in regard to ecstasy suggest that use of the drug infrequently and in small amounts may assist in minimising the risk of neurological and neuropsychological harm. This is concerning as a notable proportion of those interviewed were using ecstasy more than weekly, using multiple tablets on an occasion of use, and using for extended periods (more than 48 hours) without sleep. Moreover, the rate of binge alcohol consumption in combination with ecstasy is concerning and may also exacerbate health harms.
There was a subset of this cohort that experienced notable symptoms of dependence to both ecstasy and methamphetamine and were more likely to be involved in multiple risky health behaviours (injection, more frequent use, binge use) and to experience clinically significant levels of psychological distress. However, the level of harm experienced by the majority of participants was relatively low, with few recent overdose episodes, few people accessing health services in relation to drug use, only relatively minor work/study, financial, and social problems experienced by most users, and most not experiencing significant symptoms of dependence in relation to either ecstasy or methamphetamine, or high levels of psychological distress.
Only a minority of the cohort had accessed health services in relation to drug use, and this point of contact was most likely to be a general medical practitioner. While many consumers actively sought harm-reduction information about the risks and effects of the drugs that they chose to use, these messages were not necessarily reaching other consumers, and more proactive health programs to this demographic are clearly warranted.
Implications
It is important to remember that the aim of the EDRS is to investigate the patterns of drug use, drug markets and associated risks and harms among a sentinel group of participants that use ecstasy on a regular basis; as such, this population is not necessarily representative of all consumers of ecstasy and related drugs and the prevalence of ecstasy and other drug use can not be directly inferred. However, the study is designed to identify emerging trends and important issues, and the findings of the 2006 EDRS suggest five key areas for future policy:
1. Funding of specific health programs to meet the needs of local consumers:
There are currently no services that specifically cater to users of ecstasy and related drugs in Hobart, and aside from volunteer organisations at predominantly large-scale events there is currently very little dissemination of harm-reduction information to these populations. This indicates a clear need for funding and a proactive response in terms of the implementation of harm-reduction strategies. Although approximately half of the REU interviewed in the current study were actively seeking harm-reduction information in relation to the substances that they chose to use, these messages were not necessarily reaching other consumers. Despite this, the majority of REU were receptive to such information. Considering that drug information was typically sought from peers or peer-run organisations, and the fact that REU do not typically come into contact with traditional health services, it is likely that harm-reduction programs will attain maximum impact if delivered through peer-based organisations and mediums appropriate to the target group such as internet sites and outreach workers or information at events. Such a peer-led service would be extremely well-placed to target the following specific risk behaviours identified in the current study: polydrug and binge drug use, binge drinking, unsafe sex, and sharing of injecting equipment. By contrast, illicit-drug education campaigns based around 'fear arousal' have been shown to be ineffective or to even have contradictory effects (Ashton, 1999; Skiba, Monroe & Wodarski, 2004; West & O'Neal, 2004), and these programs, and associated sensationalised reporting of drug use in the media, run the real risk of undermining the potential for successfully reducing health harms amongst this population.
Consistent with this recommendation, a recent parliamentary inquiry into the manufacture, importation and use of amphetamines and other synthetic drugs (AOSD) in Australia recommended that harm-reduction strategies and programs receive more attention and resources in the execution of the National Drug Strategy (Commonwealth of Australia, 2007). The committee also recommended that that public education and demand-reduction campaigns for illicit drugs be factual, informative and appropriately targeted, seek input from young people and take account of user’s experiences. (Secretariat of the Parliamentary Joint Committee on the Australian Crime Commission, 2007)
2. Focused interventions to reduce the harm associated with binge drinking in combination with ecstasy:
The majority of participants (79%) reported drinking alcohol when under the influence of ecstasy and two-thirds of these (66%) typically consumed more than five standard drinks. Although the proportion reporting ‘binge drinking’ when under the influence and coming down from ecstasy had slightly declined from the high rates amongst the 2004 and 2005 cohorts, the high level of coincident binge alcohol and ecstasy use is still an issue of concern. There is an increased risk of dehydration when alcohol is combined with ecstasy. Additionally, larger quantities of alcohol can be consumed when under the influence of psychostimulants without experiencing the immediate effects of intoxication; however, the harms associated with this use still occur. A large majority (78%) of the 2006 EDRS REU sample had used alcohol at least weekly during the six months preceding the interview, which is substantially higher than both the Tasmanian (39.4%) and national (41.2%) estimates of prevalence for the general population, and among those aged 20-29 nationally (56.7%). A large majority of REU (85%) scored 8 or more on the alcohol use disorders identification test (AUDIT), suggestive of hazardous and harmful alcohol use and the possibility of alcohol dependence. Additionally, most of the overdose episodes reported by REU in the current study involved alcohol and/or polydrug use.
3. The provision of pill testing kits:
While there are some limitations to the use of commercially available ecstasy ‘testing kits’, currently there is often very little information available to consumers in regard to the substances contained within the tablets that are sold on the local market, and two-thirds of the participants in the current study indicated that they had sometimes bought a drug and it turned out to have different effects than expected. Limitations aside, use of these kits may allow consumers to be more informed about the tablets that they choose to use, and it was apparent that the consumers interviewed would act on information from testing kits – not taking a pill if it appeared to have an unexpected content such as potentially harmful substances such as PMA or DXM (see also Johnston et al., 2006). Testing kits can be purchased via the internet but are currently not available from any local source. There may be some benefit in making these available locally on a not-for-profit or cost-recovery basis, or facilitating provision of testing at dance and related events. The use and/or supply of testing kits under these circumstances would also allow for the limitations of these kits to be conveyed more effectively to consumers.
While noting some concerns about the potential limitations of pill testing kits, the recent parliamentary inquiry into the manufacture, importation and use of amphetamines and other synthetic drugs (AOSD) in Australia noted that a feasibility study an illicit tablet monitoring service is underway in Victoria, and that the results of the evaluation of this study will be informative for future policy decisions in relation to pill testing (Secretariat of the Parliamentary Joint Committee on the Australian Crime Commission, 2007).. The authors of this report concur with this view and would encourage Tasmanian services and consumers to support this feasibility study wherever possible.
4. Increased awareness among local consumers of legislation with regard to possession, supply, and trafficking of controlled substances:
Although the ecstasy market is predominantly based on individuals sourcing the drug for other friends while making no cash profit, those that purchase ecstasy in larger quantities may be putting themselves at greater risk of being arrested as a provider rather than a consumer of the drug. Over one-half (54%) indicated that when they purchased ecstasy, they typically purchased the drug both for themselves and others, while the minority (44%) typically purchased ecstasy only for themselves. Over half of the 2006 REU sample was not aware of the distinction between purchasing for themselves and others in terms of the law. Further, over half were not explicitly aware of the consequences with being charged with the supply of ecstasy. This indicates a need for increased awareness among REU in Tasmania of the risks associated with supplying ecstasy to friends, so that they are able to make informed choices with regard to this.
5. Consideration of the potential consequences of legislation surrounding smoking devices such as ice/crystal pipes:
Although the use of crystal methamphetamine had increased slightly among the REU interviewed in Tasmania relative to 2005, the overall use of methamphetamine (all forms) has remained stable among the cohort, and the recent use of crystal remains half that of the recent use observed among the 2003 cohort. Among the 2005 sample, the small number of people that had recently used crystal methamphetamine had typically injected the drug. In 2006, the increase seen in the recent use of crystal was among those smoking the drug. There has been some recent suggestion nationally that legislation should be enacted to ban the sale of smoking devices such as ice/crystal pipes. The possible dangers of such legislation are that consumers will turn to other potentially harmful routes of administration such as injection, or the use of ‘home made’ devices that are potentially less safe (e.g. broken light globes). These issues should be considered with regard to the introduction of such legislation, and the EDRS aims to examine the possible impact of such legislation in 2007. While the behavioural responses to such a policy change are not yet known, and risks to the health of consumers and the population more broadly are high (given the potential harm should a substantial proportion of smokers make the transition to injecting use), any such policy changes should be limited to discrete regions and their consequences carefully evaluated before wider enactment.
6. Monitoring and dissemination of party drug trend information:
Over the last four years, the findings of the EDRS have revealed some important trends in drug use among regular ecstasy-consuming cohorts in Tasmania. The use and availability of substances such as ketamine and MDA has decreased among the REU cohort since 2003, and the use of potentially harmful substances such as GHB is currently relatively low in Tasmania. There has been a gradual increase in the use and availability of cocaine and psychedelic mushrooms and a more recent increase in the use of the research chemical 2CI, though the frequency of use for these drugs remain relatively low. Although the overall use of methamphetamine has remained stable among the REU interviewed in Tasmania, there have been some shifts in the use of particular methamphetamine forms, notably a recent increase in the use of methamphetamine base and crystal methamphetamine among the sample in 2006. While there has been some recent concern nationally about the use of crystal methamphetamine, the use of the drug among REU interviewed in Tasmania in 2006 was still substantially lower than the level of use first reported in 2003. It is imperative that emerging trends in illicit drug markets are continually monitored so policy responses, emergency service workers, service providers and consumers are well informed to ensure the best outcome for the health of our community.