NDARC Technical Report No. 212 (2005)
EXECUTIVE SUMMARY
Background
In 1998 the Australian Government Department of Health and Ageing commissioned the National Drug and Alcohol Research Centre (NDARC) to implement a national Illicit Drug Reporting System (IDRS), following a successful pilot study in Sydney during 1996 and a multi-state trial in 1997 (Hando, O'Brien, Darke, Maher, & Hall, 1997; Hando & Darke, 1998; Hando, Darke, Degenhardt, Cormack, & Rumbold, 1998). The 1998 IDRS study was conducted in New South Wales, Victoria and South Australia (McKetin, Darke, Hayes, & Rumbold, 1999), with each state undertaking an IDU survey, key expert survey, and analysis of available secondary indicator data.
In 1999, the IDRS study was replicated in New South Wales, Victoria and South Australia, with all other remaining states and territories participating through collection of secondary indicator data and conducting key expert interviews. In 2000, the IDRS became a truly national drug trend monitoring system when all states and territories conducted the complete IDRS study.
The aim of the IDRS is to monitor emerging trends related to the use of heroin, methamphetamines, cocaine and cannabis. The IDRS study provides nationally comparable data with respect to emerging trends in illicit drug use and related harms, and provides a basis for better informing future policy and research initiatives.
The value of Victorian IDRS findings
Available Victorian health and law enforcement indicator data sources provide important information in relation to illicit drug use prevalence and related morbidity and mortality within this jurisdiction. However, the majority of these data sources are by nature lag indicators (where the most recent data available may be up to 12 months old in some cases), and therefore insufficient on their own for strategic early warning purposes.
Since 1997 in Victoria, the IDRS has been a strategic early warning mechanism concerning illicit drug trends because it has strived to supplement available secondary indicator data sources with lead indicators (such as that provided by direct surveys with sentinel IDU groups and key experts) of drug prices, purity, availability and current patterns of use. Findings from successive IDRS studies conducted in metropolitan Melbourne have informed health, law enforcement and community sector responses to illicit drugs in Victoria since 1997.1 Some notable recent examples include:
- Expansion of IDRS-style illicit drug trend monitoring methods to focus on patterns and characteristics of psychostimulant use in Melbourne (Johnston, et al. in press).
- Informed the development of research into cocaine markets in Victoria and New South Wales (currently being undertaken).
- Informed the development of research into benzodiazepine and pharmaceutical opiate misuse and links to crime in Victoria, Tasmania and NT (results pending).
- Informed research into the course and consequences of the heroin shortage in Victoria (Dietze, et al. 2003).
- Victorian IDRS data was utilised in the recent review of the Victorian Drug Treatment Service System (Ritter, et al. 2003).
- Victorian IDRS data have routinely been used in policy development and review activities conducted by the Victorian Government (Di Natale & Ritter, 2003; Drug policy Expert Committee, 2000), and are routinely provided for inclusion in the Victorian Drug Statistics Handbook (Victorian Department of Human Services, 2004a).
- Victorian IDRS data has been disseminated widely via conferences, peer-reviewed publications and community reports.
A key advantage of the IDRS study is that it has replicated core methods across each state and territory over a number of years (this is the eighth year in Melbourne). At a national level, this has permitted the identification of emerging jurisdictional differences with respect to illicit drug markets, and in turn has enhanced the capacity of health and law enforcement sectors to develop proactive responses to illicit drug issues.
Summary of 2004 Victorian drug trends
Turning Point Alcohol and Drug Centre conducted the Melbourne arm of the 2004 IDRS study between June and September 2004. The project consisted of:
- A structured survey of 150 current injecting drug users recruited from a number of sites across the Melbourne metropolitan area.
- Semi-structured interviews with 52 key experts from a variety of professional settings, selected according to their knowledge about illicit drug use, and level of contact with illicit drug users during the six months preceding the survey.
- Analysis of secondary illicit drug use indicators.
Data collected via these three methods were analysed in order to identify illicit drug related trends in Melbourne for the 2003/04 year. Where appropriate, these data were also compared to findings from the 1997 to 2003 applications of the IDRS in Melbourne.
Heroin
Findings from the 2004 study suggest that the heroin market in Melbourne has stabilised since the reported shortage observed in 2001 (Fry & Miller, 2002).
In 2004, heroin was reportedly easy to very easy to access (91%) and availability had been stable. The reported prices of heroin decreased to $40 per ‘cap’ and $300 per gram in 2004, with a ‘cap’ being the most popular purchase amount. Respondent’s reports about their primary location for heroin scoring have remained relatively stable since 2003, with mobile dealers being accessed most often, followed by dealers’ homes.
As in 2003, a higher proportion of the IDU sample reported that they had mostly used heroin rock (87%) in the previous six months, and intravenous injection still constituted the most common route of administration (86%). Purity of heroin was reported as medium (40%) to low (26%), and most believed it had been stable (25%) or increased (24%) recently.
In general, the 2004 findings suggest that heroin is very easy to access and availability is stable, purity levels are stable to increasing, and the price has decreased, however supply is clearly not at the levels it was at prior to 2001 (the peak of the street heroin market in Melbourne). The trend in heroin use will continue to be monitored.
Methamphetamine
A distinction was made for the first time in 2002 between the different forms of methamphetamine (speed, base and ice) to improve the precision of data collection on the use, purity and availability of each of these forms. This data was collected again in 2003 and 2004, along with information on the use of amphetamine liquid and pharmaceutical stimulants.
Findings from the 2004 study suggest that the use of methamphetamine is widespread amongst the IDU surveyed, with 71% of participants reporting using some form (either speed, base or ice) in the preceding six months. However, prevalence of use and injection of the various forms of methamphetamine, particularly ice and base, decreased slightly in 2004. Reported use of ice by Melbourne IDRS participants almost doubled between 2002 (26%) and 2003 (50%), but has since decreased to 41%. Reported use of base decreased from 18% in 2003, to 11% this year. Reported use of speed powder remains quite high (65%), but has also decreased slightly from past years (70% in both 2002 and 2003).
The median number of days on which speed had been used in the preceding six months was 10, while for ice it was 4, and base 3 days. Frequency of methamphetamine use has decreased since the 2002 and 2003 IDRS studies.
The most common quantity of all forms of methamphetamine purchased (speed, base and ice) was a ‘point’, and respondents paid $30-50 for this amount. The reported price per gram of speed or ice was $180-200, while for base respondents (n=2) reported paying $100-150. Prices reported in 2004 were similar to those reported last year, and the majority of 2004 IDU respondents also reported that prices had been stable (speed 61%, base 50%, ice 53%).
The majority reported that all three forms (speed, base and ice) were easy to very easy to obtain at present and that the availability had been stable in the six months prior to interview. These drugs were predominantly sourced through social networks (speed 39%; base 50%; and ice 42%) or mobile dealers (speed 25%; base 25%; and ice 23%).
Cocaine
In 2004 the proportion of IDU reporting cocaine use in the preceding six months was 10%, with 2% reporting recent injection. Frequency of cocaine use was very low with a median of two days use in the preceding six months. These findings are low overall compared to other illicit drugs being reported on in the IDRS study, and lower than that reported in previous years.
The decreasing prevalence and frequency of cocaine use by the IDU interviewed as part of the IDRS study may be due to the lack of availability of this drug type, the cost, or possibly the widespread availability and use of other drug types in Melbourne.
In 2004 only two IDU respondents could confidently comment on trends in cocaine price, purity and availability. Both respondents reported that cocaine cost $200 per gram and that the purity of this drug was high at present. However, it is difficult to identify clear trends due to the consistently small number of IDU and key experts who are able to comment on this drug type. The expansion of drug trend monitoring research to other sentinel groups (e.g. non-injecting groups) will provide a clearer picture of cocaine trends in Melbourne.
Cannabis
Cannabis use in Melbourne has remained relatively stable. Eighty percent of IDU had used cannabis in the preceding six months (compared to 88% in both 2002 and 2003) and the median number of days used in the last six months was 180 (daily use). In terms of the number of users, cannabis was the second the most widely used illicit drug by participating Melbourne IDU, and the most frequently used in terms of number of days.
As in previous years, the overwhelming majority of IDU commenting on cannabis thought it easy to very easy to obtain, and that availability had remained stable in the preceding six months. The price of a gram of cannabis has remained stable since 1998 ($20 hydro, $20 bush), while the price per ounce has been relatively stable for the past four years ($240 hydro, $180 bush). A gram was the most popular purchase amount.
Other drugs
The 2004 Melbourne IDRS study has again provided evidence of widespread prescription drug use by injecting drug users (e.g. benzodiazepines, buprenorphine, morphine and anti-depressants).
The majority of IDU (82%) reported having used benzodiazepines in the six months prior to interview and most of these people (61%) mainly obtained their benzodiazepines licitly. The proportion of Melbourne IDRS participants who reported benzodiazepine injection steadily rose from 1999 (19%) to 2001 (40%), however there was a considerable reduction in the number reporting injection during 2002 (21%) and 2003 (15%). In 2004 reported rates of injection remained stable (16%). The reduction in benzodiazepine injection observed since 2001 is probably due to the combined effects of the changes in legislation regarding the availability of temazepam gel capsules, as well as a concerted education campaign aimed at prescribing doctors by the Victorian state government (Breen et al., 2003).
IDU and key experts also reported use and injection of prescription drugs such as morphine and buprenorphine. Of the IDU who reported using morphine in the past six months, the majority reported obtaining the drug illicitly, and most reported paying $50 for 100mg. Frequency of morphine use amongst this group was seen to be opportunistic rather than habitual. As in 2003, approximately one-third of participants reported using buprenorphine (licit or illicit) in the past six months. In 2004, over half (56%) of the respondents reported having injected buprenorphine in their lifetime, and 43% reported having injected the drug in the past six months.
Prevalence of anti-depressant use in 2004 appears to be stable, with 31% of users saying they used these drugs in the past six months. Frequency of use during that time was 108 days (or at least every two days). Almost one-quarter (23%) of respondents also reported ecstasy use within the last six months in 2004. The primary route of administration of ecstasy during that time was swallowing (19%), followed by injection (8%).
Associated harms/ Drug related issues
Self-reported recent experience of overdose and receipt of Narcan® has remained relatively stable since 2001. Other significant harms associated with injecting drug use (such as injection related health problems, hepatitis C virus transmission and other unsafe injecting behaviour) continue to be of major concern. Eleven percent of IDU reported that they had borrowed another person’s used needle/syringe, 21% had passed on their own used needle/syringe and 46% had used other already used injection equipment in the last month.
Overall, it was seen that the level of self-reported criminal activity amongst IDU decreased slightly in 2004. Key experts reported that in general, crime levels had remained stable. Both IDU and key experts reported that there had been an increase in police activity in the past six months. The majority of IDU participants (71%) reported that police activity had had no effect on the difficulty in acquiring drugs recently.
Conclusions
The 2004 Victorian IDRS study has provided evidence of both and changes, and stability within the illicit drug market places of metropolitan Melbourne. As in previous Melbourne IDRS studies, the demographic characteristics of the 2004 IDU sample were strikingly similar to those reported in past years. Also consistent with previous surveys, the majority of the sample reported that heroin was the drug they injected most often (69%), the last drug they injected (63%) and their drug of choice (63%).
Findings from the 2004 IDRS study suggest that the heroin market in Melbourne has stabilised since the reported shortage observed in 2001 (Fry & Miller, 2002). In particular, it has been reported in the current study that heroin is very easy to access and availability is stable, purity levels are stable to increasing, and the price has decreased. Nevertheless, heroin supply in Melbourne is clearly not at the levels it was at prior to 2001 and the trend in heroin use will continue to be monitored.
Findings from the 2004 study suggest that methamphetamine use was widespread among injecting drug users in Melbourne, however frequency of use remains lower than the levels reported in 2001-2002. As in 2003, these drugs were reportedly easy to obtain and were predominantly sourced through social networks and mobile dealers. Given the potential harms associated with the use of this drug type, the trend in methamphetamine use will continue to be monitored.
Amongst the IDU surveyed in Melbourne, prevalence and frequency of cocaine use remains low. This may be due to the lack of availability, the cost, and possibly the widespread availability and use of other drug types in this city. In contrast, the Melbourne cannabis market and patterns of use continue to be relatively stable. In terms of the number of users, cannabis was the second the most widely used illicit drug by participating Melbourne IDU, and the most frequently used in terms of number of days.
The 2004 study has again provided evidence of significant prescription drug use by injecting drug users (e.g. morphine, buprenorphine, benzodiazepines and anti-depressants). There is also evidence of misuse of these drug types by the IDU surveyed. Given the potential health harms associated with the injection of these drug types, further research is planned to investigate these issues in greater detail.
Continuing trends in the level of injection equipment sharing and associated health problems experienced by IDU (such as vein damage, poor general health and hepatitis C) have again been reported. Further research is needed to investigate the reasons for the continued levels of unsafe injecting.
The experience in Victoria has shown that the IDRS is an effective drug trend monitoring system and is valuable for informing policy and research.
Implications of 2004 findings
While the aim of the IDRS study is to monitor emerging trends in illicit drug use and related problems, it is not intended as a comprehensive and detailed investigation of illicit drug trends. The role of the Melbourne arm of the IDRS study is to identify yearly illicit drug use trends, and provide recommendations regarding key issues that warrant further monitoring and/or in-depth investigation.
The findings of the 2004 Melbourne IDRS study suggest the following priority areas:
- Continued monitoring of illicit drug markets for changes in price, purity and availability trends, and evidence of increasing harms.
- Further research to monitor the characteristics and impact of psychostimulant/ party drug use in Melbourne is required, along with consideration of the impact of these drug types upon both health and law enforcement sectors.
- Expansion of Victoria’s routine drug trend monitoring, through new methods and new sentinel groups, to improve the understanding of intersecting drug markets and related harms.
- Research to explore the nature of prescription drug use among injecting drug users in Melbourne, the extent of prescription drug diversion, and the health harms associated with prescription drug misuse.
- Further research to gain a better understanding of the determinants of unsafe injecting, particularly for those injecting practices that increase the risk of blood-borne virus transmission (e.g. HIV, HCV and HBV).
Since 1997, the Melbourne arm of the national IDRS study has proven to be a reliable, cost-effective and informative mechanism for the monitoring of illicit drug trends in Victoria. It yields data that are comparable from year-to-year and across jurisdictions, and it is a study that has much to offer health and law enforcement sectors in their efforts to respond more effectively to illicit drug trends.
Citation: Jenkinson, R. and O'Keefe, B. (2005) VIC Drug Trends 2004: Findings from the Illicit Drug Reporting System (IDRS), Sydney: National Drug and Alcohol Research Centre.