NDARC Technical Report No. 274
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 the collection of secondary indicator data and completion of key expert interviews. In 2000, the IDRS became a truly national drug trend monitoring system when all states and territories conducted the complete study.
The aim of the IDRS study is to monitor emerging trends related to the use of heroin, methamphetamine, cocaine and cannabis. The IDRS study provides nationally comparable data with respect to patterns of 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 recent examples of where the IDRS methodology or Victorian data have been used include:
- in the development of research into cocaine markets in Victoria and New South Wales (Shearer, et al. 2005);
- in the development of research into the use of drugs among populations of at-risk youth in Melbourne (the YDRS study, currently being undertaken);
- in the development of research into benzodiazepine and pharmaceutical opiate misuse and links to crime in Victoria, Tasmania and NT (results pending);
- in research into the course and consequences of the heroin shortage in Victoria (Dietze, et al. 2003);
- in drug trend monitoring research on patterns and characteristics of psychostimulant use in Melbourne (Johnston, et al. 2004);
- in the review of the Victorian Drug Treatment Service System (Ritter, et al. 2003);
- in Stage One of Australia’s Drug Policy Modelling Project (DPMP) (Moore, Caulkins, & Dietze, 2005);
- in policy development and review activities and inquiries conducted by the Victorian Government (Drugs and Crime Prevention Committee, 2004 & 2006; Di Natale & Ritter, 2003);
- in the annual Victorian Drug Statistics Handbook (Victorian Department of Human Services, 2006a).
Victorian IDRS data has also been disseminated widely via conferences, community forums, posters, magazine articles, and peer-reviewed publications.
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 tenth year the study has been conducted 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 2006 Victorian drug trends
Turning Point Alcohol and Drug Centre conducted the Melbourne arm of the 2006 IDRS study between June and October 2006. 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 58 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 2005/06 year. Where appropriate, these data were also compared to findings from the 1997 to 2005 applications of the IDRS in Melbourne.
Heroin
Over half (59%, n=88) of the IDU survey respondents reported that heroin was their main drug of choice, and 76% (n=114) reported having used and injected heroin during the preceding six months. Prevalence of recent heroin use by Melbourne IDU respondents decreased in 2006 (76% compared to 89% in 2005, 86% in 2004 and 90% in 2003).
Respondents reported using heroin on a median of 56 days during the past six months, with one-fifth (21%, n=24) reporting using heroin on a daily basis during that time. As with prevalence of recent heroin use, frequency of use also decreased in 2006, reaching the lowest level reported since the IDRS study commenced in Melbourne in 1997.
In 2006, respondents reported paying (median price): $40 for a cap, $110 for a quarter-gram, $200 for a half-gram, and $350 for a gram (on the last occasion of purchase). The reported price of heroin remained relatively stable in 2006, although the median price for a gram increased slightly. The most popular purchase amount of heroin was a half-gram (n=43), followed by a cap (n=33).
Current heroin purity was reported as medium (44%, n=42) to low (34%, n=33) by the majority of IDU respondents who commented (n=96). The majority of key experts (KE) commenting on heroin purity also reported that it was low (n=10) or medium (n=8). As in previous years, a higher proportion of the Melbourne IDU sample reported that they had most commonly used heroin rock (94%), compared to powder (6%) during the previous six months.
The majority of IDU respondents who commented on the availability of heroin (n=97) reported it as either very easy (57%, n=55) or easy (30%, n=29) to obtain at the time of interview, and that availability had been stable over the past six months (52%, n=50). Most participants who commented on where they usually source their heroin (n=93) reported that they usually purchased from known dealers (65%), street dealers (28%), or friends (27%). Participants were also asked about the venues (locations) where they normally scored heroin, with most reporting an agreed public location (54%), dealer’s home (30%), or street market (29%). Key experts confirmed that heroin availability was easy to very easy to obtain, and that mobile dealing had become entrenched and is far more common than street dealing in many areas.
Two percent of IDU (n=3) reported having experienced a heroin overdose within the previous six months, and 1% (n=2) had received Narcan during that time, a reduction since 2005. Most key experts noted that overall the level of non-fatal heroin overdose was low, and five indicated that overdose rates had recently decreased.
While heroin reportedly remained very easy to access in Melbourne in 2006, and over half of the IDU sample reported that heroin was their main drug of choice, both the reported prevalence and frequency of heroin use by IDU decreased this year, as did reports of recent heroin overdose. Heroin purity levels remained low and the price was stable to increasing. These trends in heroin use will continue to be monitored.
Methamphetamine
Different forms of methamphetamine are currently available in Australia. For the past five years the IDRS study has collected information on the use, price, purity and availability of three main forms of methamphetamine: speed, base and crystal meth/ice, along with information on the use of amphetamine liquid and pharmaceutical stimulants (e.g. dexamphetamine, Ritalin).
As in previous years, almost the entire sample (97%) of IDU survey respondents reported having used at least one of the three main forms of methamphetamine (speed, base or crystal meth/ice) during their lifetime, and 81% (n=121) reported use during the previous six months (speed 71%, crystal meth/ice 53%, and base 15%). Nine percent of the sample also reported recently using pharmaceutical stimulants (prescribed or not prescribed), and three percent reported using amphetamine liquid. Reported prevalence of use of both speed and base remained relatively stable in 2006, while the use of crystal meth/ice increased (although frequency of use remained low).
As in 2005, key experts commented that methamphetamine use is still very prevalent amongst IDU in Melbourne, and the majority reported increases in methamphetamine use during the past six months.
Injecting was reported to be the most commonly used route of administration of methamphetamine by IDU during the past six months (78%, n=117). Smaller numbers reported smoking (24%, n=36), snorting (13%, n=19), and swallowing (7%, n=11) methamphetamine during that time.
Those who had used methamphetamine during the past six months reported a median of 16 days of use (speed 13 days, crystal meth/ice 5 days, base 3 days, and liquid 3 days), while fifteen respondents reported using methamphetamine between every second day and daily during that time. All key experts commenting on frequency of use reported that infrequent, recreational and/or binge use was more common amongst methamphetamine users, and that injecting and smoking were the preferred routes of administration.
In 2006, the reported median price for a point of each of the three forms of methamphetamine was: speed $35, base $50, and crystal meth/ice $50 (the purer forms were slightly more expensive). Most reported that prices had been stable over the past six months.
The majority of IDU survey participants reported that methamphetamine (particularly speed and crystal meth/ice) was currently easy to very easy to access, and availability had been stable over the past six months. In terms of sourcing methamphetamine, most reported scoring from known dealers or friends.
Reports of methamphetamine purity were variable, particularly in the case of speed powder, where similar proportions of IDU reported that the purity was either low (23%), medium (34%), or high (25%). Most reported that crystal meth/ice was of medium to high purity, while there were too few reports on the purity of base to identify trends.
A number of key experts reported an increase in mental health issues among methamphetamine users (particularly crystal meth/ice users). In addition, some IDU reported that they had experienced substance-related aggression following the use of these drugs.
Findings from the 2006 IDRS study suggest that the prevalence of methamphetamine use (in particular speed) among injecting drug users in Melbourne is quite high. Whilst frequency of methamphetamine use remains lower than for other drug types, patterns of use will continue to be monitored given the potential harms associated with the use of this drug.
Cocaine
Although over half (59%, n=88) of the respondents to the 2006 IDU survey reported lifetime use of cocaine, only two participants (1%) identified cocaine as their main drug of choice. Nineteen percent (n=28) of the IDU surveyed reported having used cocaine during the previous six months, with the reported principal routes of administration being injecting (13%, n=20), and snorting (11%, n=16). Among those who reported using cocaine during the past six months, frequency of use was very low (median 2 days), suggesting irregular, opportunistic use patterns.
In 2006, four participants commented on the current price of a gram of cocaine, reporting that this quantity currently costs $350 (range $300-500), and two participants reported that a half-gram of cocaine currently costs $150-200. No participants were able to comment on current cap prices, but one participant reported that a point of cocaine currently costs $50.
Three of the five respondents (60%) who commented on current cocaine purity reported that it was high at present. Another respondent reported that the purity of cocaine was medium (20%, n=1), and the other that it fluctuated (20%, n=1). Most reported that cocaine purity had been stable (60%, n=3) during the previous six months.
Four of the six participants (67%) who commented on cocaine availability reported that it was currently easy to access, while the other two participants (33%) noted it was very easy. All six respondents reported that availability had been stable during the previous six months. Respondents most commonly reported buying cocaine from friends (33%, n=2) or known dealers (33%, n=2).
Whilst the prevalence of recent cocaine use by the IDU surveyed increased slightly in 2006 (19% compared to 15% in 2005 and 10% in 2004), and 21 key experts reported occasional use of cocaine by ‘a few’ of their clients, the use of cocaine amongst the IDU sample in Melbourne still remains low and infrequent and appears to be fairly opportunistic.
The expansion of drug trend monitoring research to other sentinel groups (e.g. psychostimulant users) will provide a clearer picture of cocaine trends in Melbourne.
Cannabis
Cannabis use in Melbourne continued to remain relatively stable. Almost all of the 2006 Melbourne IDU participants (97%, n=145) reported having used cannabis in their lifetime and 83% reported cannabis use in the preceding six months (compared to 86% in 2005, 80% in 2004, and 88% in both 2003 and 2002). Cannabis was reported to be the most widely used illicit drug by IDU respondents during the previous six months, and the most frequently used in terms of number of days (median 180 days, i.e. daily use).
As in previous years, the overwhelming majority of IDU who commented on cannabis thought it easy to very easy to obtain, and that availability had remained stable in the preceding six months. Cannabis was commonly accessed through social networks, and, as in previous years, the type most commonly used was hydroponic cannabis (95%).
In 2006, median prices reported for hydroponic cannabis (on the most recent occasion of purchase) were: a gram $20, three grams $50, a quarter-ounce $70, a half-ounce $140, and an ounce $200. Prices reported for these quantities remained relatively stable in 2006, although the median price of an ounce decreased slightly.
The potency of hydroponic cannabis was described as high (60%) to medium (34%), while the potency of bush/naturally-grown cannabis was generally rated at medium (43%). Eleven key experts reported that cannabis was the primary drug of choice amongst the drug users with whom they had the most contact. In addition, in 2006 many key experts (n=22) reported that cannabis was commonly used as a secondary drug in combination with heroin and/or methamphetamine.
Other drugs
The 2006 Melbourne IDRS study has again provided evidence of widespread prescription drug use by participating injecting drug users (e.g. benzodiazepines, morphine, methadone, buprenorphine and antidepressants). The majority of IDU (71%) reported having used benzodiazepines during the six months prior to interview, and most (69%) mainly obtained their benzodiazepines licitly. In 2006, reported rates of recent benzodiazepine injection remained relatively stable (9%, n=14, compared to 6%, n=9 in 2005), and frequency of benzodiazepine injection remained very low.
In 2006 participants were also asked about their use of both buprenorphine (Subutex) and buprenorphine/naloxone (Suboxone). Half (50%, n=75) of the IDU respondents reported buprenorphine use (prescribed or non-prescribed) during the past six months and 38% reported injecting the drug during that time. The median number of days of buprenorphine use during the past six months was 80 days (or close to every second day). Sixteen percent (n=24) reported both lifetime and recent use of the combination buprenorphine/naloxone drug, and 7% (n=10) reported recent (past six months) injection. Reported methadone use was relatively stable in Melbourne in 2006.
Around one-third (35%) reported using morphine during the past six months and the preferred method of use was injecting. The types of morphine most commonly used by IDU respondents who reported recent use were MS Contin and Kapanol. Close to one-third (27%) also reported recent use of oxycodone, although frequency of both morphine and oxycodone use was low.
Prevalence of antidepressant use in 2006 appears to be relatively stable, with 27% of IDU reporting that they used these drugs in the past six months. Median frequency of use during that time was 32 days.
Almost one-quarter (24%) of respondents also reported ecstasy use within the past six months, although frequency of use remained low. The primary route of administration of ecstasy for this group during the last six months was oral (19%). Recent inhalant and hallucinogen use was relatively uncommon among this group.
In 2006 key experts also reported steroid use and injection among some of their clients, stating that there was a need to promote harm reduction strategies among this population.
Associated harms/drug-related issues
Twelve percent of the 2006 IDU respondents reported that they had borrowed another person’s used needle/syringe during the past month and 17% reported having loaned their own used needle/syringe during that time. One-third (35%) reported using other injecting equipment (such as a spoon/mixing container or water) after someone else during the past month. Both IDU and key expert reports suggest that rates of injecting equipment sharing decreased in 2006. Self-reported recent experience of heroin overdose and receipt of Narcan also decreased in 2006; however, other significant harms associated with injecting drug use (including injection-related health problems and blood-borne viral infections such as hepatitis C) continue to be of concern.
In 2006 a significant proportion of the IDU sample also reported driving soon after taking an illicit drug(s), most commonly after using heroin, cannabis or speed.
Overall, it was seen that the level of self-reported criminal activity amongst IDU was relatively stable in 2006. Key experts also reported that, in general, crime levels had remained stable. Both IDU and key experts reported that police activity had also been stable during the past six months. The majority of IDU participants (75%) reported that police activity had had no effect on the difficulty of acquiring drugs recently.
Conclusions
The 2006 Victorian IDRS study has again provided evidence of both changes and stability within the illicit drug marketplaces of metropolitan Melbourne.
The demographic characteristics of the 2006 Melbourne IDU sample were strikingly similar to those reported in previous years (which is not unexpected given that the recruitment strategies remained the same). Also consistent with previous surveys, the majority of the sample reported that heroin was the drug they injected most often (48%), the last drug they injected (45%), and their drug of choice (59%), although these proportions were lower than those reported in previous years.
Reports from both IDU and KE suggest that there have been some recent changes in the heroin market in Melbourne. While heroin reportedly remained very easy to access in 2006, and over half of the IDU sample reported that heroin was their main drug of choice, both the reported prevalence and frequency of heroin use by IDU decreased this year (to some of the lowest levels reported since the IDRS study commenced in Melbourne in 1997). Heroin purity levels remained low and the price was stable to increasing. These trends in heroin use and associated outcomes will continue to be monitored.
Findings from the 2006 study suggest that methamphetamine use was widespread among the injecting drug users interviewed in Melbourne; however, frequency of use remains lower than for other drug types. As in 2005, these drugs (in particular speed and crystal meth/ice) were reportedly easy to obtain and were predominantly sourced through known dealers and friends (social networks). Some key experts noted that there had been an increase in mental health issues associated with methamphetamine use, and some IDU reported that they had experienced substance-related aggression following the use of these drugs. Given some of the potential harms associated with the use of methamphetamine, these trends will continue to be monitored.
Among 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, cannabis was the most widely used illicit drug by participating Melbourne IDU, and the most frequently used in terms of number of days. The Melbourne cannabis market and patterns of use continue to be relatively stable.
The 2006 study has again provided evidence of significant prescription drug use by injecting drug users (e.g. benzodiazepines, morphine, methadone, buprenorphine, and antidepressants). There is also evidence of misuse of these drug types by some of the IDU surveyed. In 2006 IDU also reported experiencing injection-related harms specific to these drug types.
Whilst some great improvement in health outcomes for IDRS participants were observed in 2006, including reductions in non-fatal heroin overdoses and rates of needle/syringe sharing, continuing trends in the level of injection-related 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 strategies that could potentially reduce some of these risks and harms.
The experience in Melbourne has shown that the IDRS is an effective drug trend monitoring system and is valuable for informing policy and research.
Implications of 2006 findings
While the aim of the IDRS study is to monitor emerging trends in illicit drug use and related outcomes, it is not intended as a comprehensive and detailed investigation of illicit drug markets. 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 2006 Melbourne IDRS study suggest the following priority areas:
- continued monitoring of illicit drug markets for trends in price, purity, availability, patterns of drug use, and related outcomes;
- 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 outcomes;
- further research to monitor the characteristics and impact of psychostimulant use in Melbourne, along with consideration of the impact of these drug types upon both health and law enforcement sectors;
- further research into the injection of steroids and the risks and harms associated with this practice;
- further research into drug-driving, particularly in regard to peoples’ understanding of impairment and the circumstances in which they drive soon after taking illicit drugs;
- further research to explore the nature and extent of prescription drug use among injecting drug users in Melbourne, and the health harms associated with prescription drug misuse;
- further research to gain a better understanding of the determinants of both unsafe injecting and sex practices, particularly for those practices that increase the risk of blood-borne viral infections (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 this city. 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.