NDARC Technical Report No. 256 (2006)
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, methamphetamine, 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. 2004).
- Informed the development of research into cocaine markets in Victoria and New South Wales (Shearer, et al. 2005).
- Informed the development of research into the use of drugs amongst populations of at-risk youth in Melbourne (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 were utilised in the review of the Victorian Drug Treatment Service System (Ritter, et al. 2003).
- Victorian IDRS data has informed Stage One of Australia's Drug Policy Modelling Project (DPMP) (Moore, Caulkins, & Dietze, 2005).
- Victorian IDRS data have routinely been used in policy development, review activities, and inquiries conducted by the Victorian Government (Drug and Crime Prevention Committee, 2004; 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, 2005a).
- Victorian IDRS data has been disseminated widely via conferences, 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 ninth 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 2005 Victorian drug trends
Turning Point Alcohol and Drug Centre conducted the Melbourne arm of the 2005 IDRS study between June and October 2005. 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 50 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 2004/05 year. Where appropriate, these data were also compared to findings from the 1997 to 2004 applications of the IDRS in Melbourne.
The 2005 IDRS detected a number of trends of relevance during the preceding six to twelve months. Table A provides a summary of identified trends in price, availability, purity and prevalence of use for the four main illicit drug types explored in this study — heroin, methamphetamine, cocaine and cannabis. These are discussed in turn, along with summary details on other drug trends and associated harms/drug-related issues.
Over two-thirds (68%) of the IDU survey respondents reported that heroin was their main drug of choice, and 89% of the sample reported having used and injected the drug in the preceding six months. As in previous years, a higher proportion of the VIC IDU sample reported that they had most commonly used heroin rock (85%), compared to powder (15%) in the past six months.
Respondents reported using heroin on a median of 81 days in the past six months, with almost one-quarter (22%, n=29) reporting using heroin on a daily basis during that time. Frequency of heroin use appears to have been relatively stable during the past three years, and remains much lower than that reported prior to 2001.
In 2005, respondents reported that the current median price of a cap of heroin was $45; a quarter gram $100; a half gram $175; and a gram $310. The reported price of heroin increased slightly in 2005. Caps of heroin remained the most popular purchase amount (n=80), followed by half grams (n=71).
Current heroin purity was reported as low (49%) to medium (30%) by the majority of IDU respondents who commented (n=136), and most reported that purity had been stable or decreasing in the past six months. Most key experts reported that purity was generally medium, and that this had been stable for the past six months.
The majority of IDU respondents who could comment on the availability of heroin (n=136) reported it as either very easy (62%) or easy (30%) to obtain at the time of interview, and that availability had been stable (70%) over the past six months. Most participants reported that they usually scored/purchased heroin from mobile dealers or a dealer's home, and this has remained relatively stable since 2003. Key experts confirmed that heroin availability was easy to very easy, and that mobile dealing had become entrenched and is far more common than street dealing in most areas.
Eleven percent (n=16) reported having experienced a heroin overdose at least once within the previous six months, and 7% (n=10) had received Narcan® in that time. Most key experts noted that overall the level of non-fatal heroin overdose is reportedly low, and has been stable in the past six months.
In general, the 2005 findings suggest that heroin is very easy to access and availability is stable, purity levels are low and relatively stable, and the price is stable to increasing. These trends in heroin use will continue to be monitored.
Different forms of methamphetamine are currently available in Australia. Since 2002 the IDRS study has collected information on the use, price, purity and availability of the three main forms of methamphetamine: speed, ice and base. This data has been collected every year since, 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 some form of methamphetamine (speed, base or ice) in their lifetime, and 79% had used methamphetamine in the past six months (speed 75%, ice 29%, base 13%). Prevalence of use of speed and base increased slightly in 2005, whilst the use of ice reportedly decreased. As in the 2004 IDRS, key experts commented that methamphetamine use is still very prevalent amongst the IDU in Melbourne, with the majority of key experts reporting that from one-third to 'most' heroin users were also using methamphetamines.
Injecting was reported to be the most commonly used route of administration of methamphetamine in the last six months (94%, n=112). Smaller numbers reported swallowing (25%, n=30), smoking (24%, n=28), and snorting (13%, n=15) methamphetamine in that time. Those who had used methamphetamine in the preceding six months reported a median of 10 days, with 13 participants reporting using between every second day and daily. Of the key experts who were able to report on methamphetamine use, several reported that clients were using an average of three to five times per week, whilst others reported that their clients were daily users, often using 1-2 points of speed once to twice per day.
In 2005, the reported median prices for a point of each of the three forms of methamphetamine were: speed $40; base $45; and ice $50 (the purer forms were slightly more expensive). Most reported that prices had been stable, although only small numbers were able to comment on the price of the purer forms (base and ice).
The majority reported that speed was easy to very easy to obtain at present (80%) and that availability had been stable in the six months preceding interview (69%). The purer forms (in particular ice) were reported to be more difficult to obtain at present, and availability had been stable, or had become more difficult in the past six months. In terms of source of methamphetamine, most people reported scoring from a friend (including gift from friend), dealer's home or mobile dealer.
Reports of methamphetamine purity were variable, particularly in the case of speed and base. Most reported that speed was of low to medium purity, although one-fifth also reported it was high. Base was generally perceived to be of medium to high purity, and most reported that the purity of ice was high.
Some key experts noted that there had been an increase in mental health issues associated with methamphetamine use. In particular, the use of ice and the availability of inexpensive, but poor quality methamphetamine, were seen to be related to the increase in mental health issues.
While close to two-thirds of respondents to the 2005 IDU survey reported lifetime use of cocaine (62%, n=93), only three participants (2%) identified cocaine as their main drug of choice.
Fifteen percent of the IDU surveyed reported having used cocaine in the previous six months, with the reported principal routes of administration being injecting (11%, n=16), and snorting (8%, n=12). Among those who reported using cocaine in the past six months, frequency of use was very low (median 3 days), suggesting irregular, opportunistic use patterns.
In 2005, seven participants commented on the current price of a gram of cocaine, reporting that this quantity currently costs $300 (range $300-400), and four participants reported that a cap of cocaine currently costs $50 (range $50-60). The majority of respondents who commented on cocaine purity reported that it was low (42%, n=5), to medium (33%, n=4) at present.
Twelve participants in the Melbourne study commented on the availability of cocaine, with over half (67%, n=8) reporting that cocaine was currently difficult or very difficult to access. Most (64%, n=7) reported that cocaine availability had been stable during the previous six months, or had become more difficult to access (27%, n=3). Respondents most commonly reported obtaining cocaine from a dealer's home, or mobile dealer.
Whilst the prevalence of recent cocaine use increased slightly in 2005 (15% compared to 10% in 2004), and nine key experts reported occasional use of cocaine by 'a few' of their client base, the use of cocaine among the IDU sample in Melbourne still remains low and infrequent. As indicated in previous years of the IDRS study in Melbourne, cocaine may be seen as desirable, but too expensive or difficult to access, for the majority of primary heroin users who were interviewed. 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 use in Melbourne remained relatively stable in 2005. Eighty-seven percent of IDU had used cannabis in the preceding six months (compared to 80% in 2004, and 88% in both 2003 and 2002) and the median number of days used in the last six months was 130. 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 who commented 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 increased slightly (hydro $250; bush $200). A gram was the most popular purchase amount, and cannabis was most commonly accessed through social networks.
The 2005 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 (73%) reported having used benzodiazepines in the six months prior to interview, and most of these people (60%) 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%), but decreased again in 2005 to 6% (the lowest proportion reported since the IDRS study commenced in Melbourne in 1997). The reduction in benzodiazepine injection observed in Melbourne since 2001 is most likely due to the combined effects of the changes in legislation regarding the availability of temazepam gel capsules, as well as a concerted education campaign by the Victorian state government (Breen et al., 2003). More recently (in March 2004) all gel-cap temazepam formulations were withdrawn from the market.
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. In 2005, approximately two-thirds of participants (63%) reported using buprenorphine in the past six months, and 76% of those had mostly obtained it licitly (i.e. with a prescription in their own name). In 2005, 63% of the respondents reported having injected buprenorphine in their lifetime, and 39% reported having injected the drug in the past six months.
Prevalence of anti-depressant use in 2005 appears to be stable, with 30% of IDU reporting that they used these drugs in the past six months. Median frequency of use during that time was 130 days. Almost one-third (30%) of respondents also reported ecstasy use within the last six months in 2005. The primary route of administration of ecstasy during that time was swallowing (25%), followed by injection (12%).
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 concern. Fifteen percent of IDU reported that they had borrowed another person's used needle/syringe, 23% had passed on their own used needle/syringe, and 50% had used other already used injecting equipment (such as spoon/mixing container or filter) in the last month.
Overall, it was seen that the level of self-reported criminal activity amongst IDU was relatively stable (to decreasing) in 2004. Key experts also reported that, in general, crime levels had remained stable. Both IDU and key experts reported that police activity had been stable to increasing (in some areas) in the past six months. The majority of IDU participants (68%) reported that police activity had had no effect on the difficulty in acquiring drugs recently.
The 2005 Victorian IDRS study has provided evidence of both and changes and stability within the illicit drug marketplaces of metropolitan Melbourne. As in previous Melbourne IDRS studies, the demographic characteristics of the 2005 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 (68%), and their drug of choice (68%).
Findings from the 2005 IDRS study suggest that the heroin market in Melbourne has been relatively stable over the past 12 months. In particular, it has been reported in the current study that heroin is very easy to access and availability is stable, purity levels are low and relatively stable, and the price is stable to increasing. Heroin supply in Melbourne is clearly not at the levels it was at prior to 2001, however, and trends in heroin use and associated outcomes will continue to be monitored.
Findings from the 2005 study suggest that methamphetamine use was widespread among the injecting drug users interviewed in Melbourne; however, frequency of use remains lower than the levels reported in 2001-2002. As in 2004, these drugs (in particular speed) were reportedly easy to obtain and were predominantly sourced through social networks, dealers' homes, and mobile dealers. 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 methamphetamines, trends in 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, 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 Melbourne cannabis market and patterns of use continue to be relatively stable.
The 2005 study has again provided evidence of significant prescription drug use by injecting drug users (e.g. benzodiazepines, morphine, buprenorphine, and antidepressants). There is also evidence of misuse of these drug types by some of the IDU surveyed. In 2005 some IDU also reported experiencing injection-related harms specific to these drug types.
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 Melbourne has shown that the IDRS is an effective drug trend monitoring system and is valuable for informing policy and research.
Implications of 2005 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 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 2005 Melbourne IDRS study suggest the following priority areas:
- Continued monitoring of illicit drug markets for trends in price, purity and availability, patterns of drug use, and related outcomes.
- 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 outcomes.
- 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 bloodborne 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.
Citation: Jenkinson, R. & O'Keefe, B. (2006) Victorian Drug Trends 2005: Findings from the Illicit Drug Reporting System (IDRS), Sydney: National Drug and Alcohol Research Centre.