In 1998, the Australian Government Department of Health and Ageing (AGDHA) commissioned the National Drug and Alcohol Research Centre (NDARC) to implement a national Illicit Drug Reporting System (IDRS) aimed at monitoring emerging trends related to the use of heroin, methamphetamine, cocaine and cannabis in the Australian community. 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 majority of available data related to patterns of illicit drug use and associated morbidity and mortality are lag indicators, meaning the most recent data available may be up to 12 months old and therefore insufficient for strategic early warning purposes on their own. The IDRS serves as a strategic early warning mechanism because it supplements available secondary indicator data sources with lead indicators, such as direct surveys with groups of people who inject drugs (PWID) and key experts (KE) from each capital city in Australia. Findings from successive IDRS studies conducted in metropolitan Melbourne have informed health, law enforcement and community sector responses to illicit drugs in Victoria since 19971. Some recent examples of use of the IDRS methodology and/or Victorian data are:
- The development of research into cocaine markets in Victoria and New South Wales (Shearer, Johnston, Kaye, Dillon, & Collins, 2005);
- Stage One of Australia’s Drug Policy Modelling Project (DPMP) (Moore, Caulkins, & Dietze, 2005);
- Policy development and review activities and inquiries conducted by the Victorian Government (DCPC, 2004, 2006; DHS, 2006; Di Natale & Ritter, 2003; Victorian Department of Health, 2007);
- The annual Victorian Drug Statistics Handbook (Victorian Department of Health, 2009, 2011);
- A national survey examining attitudes, understanding and experiences of drug-driving (Mallick, Johnston, Goren, & Kennedy, 2007);
- Research into the use of amphetamine-type stimulants (ATS) and early intervention of methamphetamine-related harms (Jenkinson & Quinn, 2008); and
- Research into the self-reported wellbeing of PWID (Dietze et al., 2010).
Victorian IDRS data have also been disseminated widely at conferences and community forums, as well as through posters, quarterly bulletins, magazine articles and peer-reviewed publications.
Summary of 2012 Victorian IDRS methodology
The Centre for Population Health (CPH) at the Macfarlane Burnet Institute for Medical Research and Public Health conducted the Victorian arm of the 2012 IDRS study between June and September 2012. The project consisted of:
- A structured survey of 150 PWID recruited from six sites across metropolitan Melbourne;
- Semi-structured interviews with 15 KE from various professional settings, selected according to their knowledge about illicit drug use and level of contact with PWID during the six months preceding the survey; and
- Analyses of Victorian and national secondary indicator data related to illicit drug use.
Data collected via these three methods were analysed in order to identify illicit drug-related trends in Melbourne for the 2011/12 financial year. Where appropriate, these data were also compared to IDRS findings from 2000 to 2011.
Demographics of the sample
In 2012, 150 PWID were interviewed for the Victorian IDRS. The mean age of the sample was 38 years; 70% were male. Eighty-five per cent of participants were Australian-born and 11% identified as Indigenous. At the time of interview, 92% were unemployed and 95% received a government pension, allowance or benefit. Almost one-third reported residing in a boarding house, hostel or shelter, while 15% reported that they were homeless or had no fixed address.
Current drug use
The mean age of participants’ first injection was 18 years, with the first drug injected reported as heroin (47%) or methamphetamine (45%). Three-quarters reported that heroin was their drug of choice. Heroin (72%) was injected most often during the past month; 73% reported that heroin was the last drug they injected. Approximately two-fifths of the sample reported injecting drugs at least once per day.
Heroin is the most widely used injectable illicit drug among Victorian IDRS participants: 84% of the sample reported heroin use in the preceding six months, while 83% reported heroin injection. The proportion of participants who reported heroin as their main drug of choice increased significantly from 60% in 2011 to 74% in 2012 (p < 0.01). In 2012, the average frequency of heroin use increased from 63 days in 2011 to 72 days in 2012. Among recent heroin injectors, white/off-white rock (82%) was the form of heroin used most frequently in the six months prior to interview.
As in previous IDRS, KE described an ageing cohort of heroin users in Melbourne, many of whom were living with disability and other chronic health conditions. High levels of involvement in the criminal justice system were noted, with a large minority described as chronically institutionalised due to their frequency of incarceration. The majority of KE recommended expanding heroin users’ access to OST programs and recruiting more prescribers to the field with a holistic approach to drug treatment.
The IDRS collects information on the use and market characteristics of three main forms of methamphetamine available in Australia: speed, crystal methamphetamine (or ice), and base. In 2012, 67% of IDRS participants reported recent use of methamphetamine, while 63% reported recent methamphetamine injection. The prevalence of recent crystal methamphetamine use did not change significantly from 2011 (53%) to 2012 (59%), while the prevalence of recent speed use declined somewhat (from 49% to 39%, p = 0.081). Between 2011 and 2012 there was a significant increase in the prevalence of recent ice smoking (24% vs. 13%, p < 0.05). Overall, participants reported using methamphetamine on a fortnightly basis in the preceding six months.
Several KE reported an increase in the prevalence of crystal methamphetamine use in 2012, particularly among primary heroin users and people on OST treatment. It was reported that PWID had low levels of general knowledge about crystal methamphetamine and that many often referred to and perceived the drug as speed. KE reported that speed use remained common and that people generally expressed a preference for this type of methamphetamine over ice.
The prevalence of lifetime cocaine use was 64%. By contrast, 9% of participants reported recent use, a significant decrease compared with 2011 (17%). Seven per cent reported recently injecting cocaine. Most recent users reported use of powder cocaine (79%) in the six months prior to interview. In 2012, no KE commented on the prevalence and patterns of cocaine use among PWID in Melbourne.
Cannabis use was ubiquitous among the 2012 IDRS sample, with 85% reporting recent use. Hydroponically grown cannabis was used by most recent cannabis users (93%) during the preceding six months. Participants reported using cannabis daily (median=178 days), and smoking an average of six cannabis cones or one cannabis joint on the last occasion of use. KE reported a high and stable prevalence of cannabis use in the community.
In 2012, 87% reported lifetime use of methadone (prescribed or non-prescribed oral liquid or Physeptone®) and 55% reported recent use. Specifically, 45% of participants reported using prescribed (oral liquid) methadone daily in the preceding six months. By contrast, 20% of participants reported recent non-prescribed use on an average of three days in the past six months. Similar to 2011, 8% reported injecting non-prescribed methadone on a median of four days in the preceding six months. The prevalence of recent prescribed and non-prescribed Physeptone® use was very low (2% and 1%, respectively).
Three per cent reported use of prescribed buprenorphine in the preceding six months, while 19% reported non-prescribed use. Median days of non-prescribed use fell from an average of 30 in 2011 to 10 in 2012. Nineteen per cent reported injecting non-prescribed buprenorphine in the preceding six months (median=8 days), while 1% reported injecting prescribed buprenorphine (median=180 days). Most participants who commented reported recently using non-prescribed buprenorphine to relieve their withdrawal symptoms (60%) or to ‘self-treat’ their opioid dependence (20%).
Seventeen per cent reported recent use of prescribed buprenorphine-naloxone tablets; recent non-prescribed use was reported by 19%. In the six months prior to interview, prescribed users reported use on approximately three days per week (median=72 days), while non-prescribed users reported less than monthly use (median=5 days). Recent buprenorphine-naloxone tablet injection declined slightly in 2012, from 25% to 18%. Half of participants who commented reported recently using non-prescribed buprenorphine-naloxone tablets to alleviate their withdrawal symptoms.
In 2012, for the first time, IDRS participants were asked to respond to separate questions regarding the use of buprenorphine-naloxone film. Ten per cent reported recent use of prescribed buprenorphine-naloxone film; recent non-prescribed use was reported by 12%. In the preceding six months, prescribed users reported use on approximately three days per week (median=72 days), while non-prescribed users reported a median of two days use. Lifetime injection was reported by 8%; 7% reported recent injection on three days (median) in the six months prior to interview.
Twenty-nine per cent reported recent morphine use; 3% reported recent prescribed use on a median of two days in the preceding six months. By contrast, 27% reported recent use of non-prescribed morphine on a median of four days during the same period. Injection was the most commonly reported route of administration: 25% reported injecting morphine less than monthly in the past six months. Recent injection of non-prescribed morphine was significantly more common than injection of prescribed morphine (27% vs. 3%). The majority of participants who commented reported recently using non-prescribed morphine for the purposes of intoxication (56%) and as a substitute for heroin (38%).
The prevalence of recent (prescribed and non-prescribed) oxycodone use decreased significantly from 41% in 2011 to 29% in 2012. In the preceding six months, 6% reported prescribed use on a median of 20 days, while 26% reported non-prescribed use on a median of five days. Recent oxycodone injection decreased significantly from 36% in 2011 to 24% in 2012. Similar to morphine, recent injection of non-prescribed oxycodone was significantly more common than injection of prescribed oxycodone (23% vs. 4%). Sixty-three per cent of participants who commented reported using non-prescribed oxycodone to ‘self-treat’ their opioid dependence.
Over-the-counter (OTC) codeine
Compared with 2011, in 2012 the prevalence of recent OTC codeine use decreased significantly (22% vs. 39%), with participants reporting less than monthly use (median=5). The majority of participants who commented reported that Nurofen Plus® was the main brand used (80%).
Other opioids (not elsewhere classified)
Twenty-one per cent reported recent use of other opioids (meaning other than those listed above) on a median of seven days in the preceding six months. In 2012 the prevalence of recent use of (other) opioids decreased significantly compared with 2011 (21% vs. 37%). Prescribed use was more common than non-prescribed use (84% vs. 16%). The majority of participants who commented reported that Panadeine Forte® was the main brand used (86%).
Thirteen per cent of IDRS participants reported ecstasy use on one day (median) in the preceding six months. Three per cent reported recent ecstasy injection.
Four per cent reported recent use of hallucinogens on two days (median) in the preceding six months. No reports of recent injection were received. LSD was the most commonly used hallucinogen.
Benzodiazepines (other than alprazolam)
From 2000 to 2012 the proportions of Victorian IDRS participants reporting recent benzodiazepine use remained reasonably stable. In 2012, 70% reported recent use on a median of 90 days in the preceding six months. Only 1% reported recent injection. The proportions reporting recent use of prescribed and non-prescribed benzodiazepines were not significantly different (47% vs. 48%); however, 62% reported primarily using prescribed forms of these drugs. On average, users of prescribed benzodiazepines reported daily use (median=180) in the preceding six months, while users of non-prescribed forms reported use on a median of seven days.
A few KE reported that diazepam, oxazepam and temazepam use was challenging to manage in the service system context, particularly when large quantities were consumed (e.g., 25-50 mg).
In 2012, the prevalence of recent alprazolam use was not significantly different from that in 2011 (65% vs. 69%). The prevalence of recent prescribed alprazolam use was significantly lower than the prevalence of non-prescribed use (14% vs. 58%). Prescribed users reported daily use of the drug (median=180 days) in the preceding six months, whereas users of non-prescribed forms reported use on a median of 10 days.
In 2012, nine KE reported that they considered alprazolam to be the ‘most problematic drug’; concerns were primarily related to the drug’s dependence liability and negative behavioural effects. KE reported that alprazolam consumers were primarily injectors who used large quantities in a session when availability of drugs such as heroin was limited. The prevalence of use was described as stable, with prescribed and non-prescribed use reported as equally common. Only small proportions of PWID reportedly injected the drug. KE suggested rescheduling alprazolam and reducing the package size to offset the harms associated with use.
In 2012, the prevalence of recent quetiapine use was 37%, not significantly different from the prevalence in 2011 (30%). Recent users reported use on a median of 10 days in the preceding six months. Recent non-prescribed use was significantly more common than recent prescribed use (10% vs. 29%). However, while prescribed users reported using the drug daily (median=180), non-prescribed use was relatively infrequent (median=6 days). All recent users reported administering the drug orally; only 1% reported quetiapine injection in the past six months.
Thirteen per cent reported recent use of pharmaceutical stimulants on a median of four days in the preceding six months. Recent non-prescribed use was significantly more common than prescribed use (11% vs. 1%). Eight per cent of the sample reported injecting non-prescribed pharmaceutical stimulants; the median number of days of use was two in the past six months; no reports were received regarding the recent injection of prescribed forms of these drugs.
The prevalence of lifetime inhalant use significantly declined between 2011 and 2012 (32% vs. 19%). No participants reported recent inhalant use in 2012.
One per cent of the sample reported injecting steroids, doing so on a median of 13 days in the six months preceding interview. However, KE reported an increase in new NSP clients reporting the use and injection of steroids, peptides and melanotan.
Alcohol and tobacco
In 2012 the prevalence of recent alcohol use was 69%; on average, participants reported consuming the drug on a weekly basis (median=24 days). No reports were received regarding recent alcohol injection. By contrast, recent tobacco smoking was ubiquitous, with 95% reporting a median of daily use in the preceding six months.
Drug market: Price, purity, availability and purchasing patterns
In 2012 the median price paid for a ‘cap’ of heroin was $50, the same as in 2011, while the reported price of a gram increased to $300. However, participants most commonly reported purchasing 1.7 grams of heroin and paying $350. At the time of interview, most reported that heroin was very easy or easy to obtain and purity was low to medium. Participants reported primarily sourcing the drug from a known dealer at an agreed public location. The average purity of seizures by Victoria Police was 18% during 2011/12.
KE reported increased heroin availability in the preceding 12 months, with the price reported as stable, and purity reported as medium to low. It was also reported that PWID were purchasing the drug in larger quantities than they had previously. Based on observations of rising overdose and ambulance attendance numbers, some KE perceived that heroin purity had increased.
Between 2011 and 2012 the median price of a point of speed increased from $50 to $100. The price of a gram remained stable at $200. The median price of a point of crystal methamphetamine remained stable at $100, while the median price of a gram decreased from $800 to $500. The majority of participants reported that both speed and crystal methamphetamine were very easy or easy to obtain, and that availability remained stable during the past six months. Reports of speed purity varied widely, while reports of crystal methamphetamine purity suggested it was high to medium at the time of interview. The average purity of methamphetamine seizures by Victoria Police was 56% in 2011/12, significantly higher than the purity of seizures in 2010/11 (39%). By contrast, the purity of amphetamine seizures was 14% during the same period.
KE from both the LE and health sectors reported that methamphetamine availability increased during the preceding year.
Only four participants reported on the price of cocaine in 2012; reports were inconsistent so median prices are not reported. Three of four participants reported that cocaine purity was medium, with three of four reporting that the drug was easy to obtain. The average purity of cocaine seizures by Victoria Police increased to 49% in 2011/12 from 26% in 2010/11.
Law enforcement KE reported increased cocaine importation in Australia and a consequent increase in the number of seizures by LE agencies.
The median reported prices for grams of hydroponic and bush-grown cannabis remained stable at $20; the median prices of an ounce were reported as $250 for hydroponic cannabis and $240 for bush-grown cannabis. Most participants reported that both forms of cannabis were very easy or easy to obtain, and that the market was stable in the preceding six months. Hydroponic cannabis potency was reported as high or medium, while bush-grown cannabis potency was reported as medium.
Very few participants reported on the price of illicit methadone in 2012 so median prices are not reported. However, participant reports suggested that non-prescribed methadone was easy to obtain. The most common source of non-prescribed methadone was friends, from a friend’s home.
Participants most commonly reported purchasing an 8 mg buprenorphine tablet in 2012, for a median price of $20. Most participants reported that illicit buprenorphine was very easy or easy to obtain. The most common source of non-prescribed buprenorphine was friends, from a friend’s home or an agreed public location.
Buprenorphine-naloxone (tablets and film)
Participants most commonly reported purchasing an 8 mg tablet of buprenorphine-naloxone in 2012; median price was $15. Only two participants reported on the price of buprenorphine-naloxone film, so median prices are not reported. The tablets were generally reported as very easy or easy to obtain, as was the film. The most common sources for both the tablet and the film were participants’ friends.
In 2012 participants most commonly reported purchasing a 100 mg MS Contin® tablet; median price was $50, unchanged from 2011. Reports regarding the availability of illicit morphine at the time of interview were very inconsistent. The most common source of non-prescribed morphine was friends, followed by street dealers, via a street market or a friend’s home.
In 2012 participants most commonly reported purchasing an 80 mg tablet of OxyContin®; for a median price of $45, and a 40 mg tablet for a median price of $23. Reports regarding availability varied. The majority (56%) reported that illicit oxycodone was very easy or easy to obtain, while 44% reported that obtaining the drug was difficult or very difficult. While most reported that availability remained stable, 27% reported it had become more difficult to obtain the drug in the preceding six months. Similar to morphine, the most common source of non-prescribed oxycodone was friends, followed by street dealers, via a street market, friend’s home and an agreed public location.
Health-related trends associated with drug use
Overdose and drug-related fatalities
In 2012, 55% reported a lifetime accidental heroin overdose; the median number of overdoses was two. Among participants with an overdose history, 16% reported overdosing on heroin in the year preceding interview, not significantly different from 2011 (28%). During 2011, 1,241 non-fatal heroin overdoses were attended by Ambulance Victoria, and 97 deaths were officially defined as heroin-related. In 2012, six participants reported overdosing on drugs other than heroin in the preceding six months.
Specialist AOD treatment services
During 2011/12, 51,742 courses of treatment were delivered to 30,428 clients2 in Victorian specialist alcohol and drug treatment services3. Heroin was the most commonly cited drug of concern after alcohol and cannabis, comprising 11% of all clients and 11% of all courses of treatment. Amphetamine was cited as a drug of concern in 10% of courses of treatment and 11% of clients, while cocaine was cited in less than 1% of courses of treatment and clients.
In 2011 DirectLine responded to 42,896 alcohol and drug-related calls, with a drug of concern4 identified in almost half of all calls. Heroin was identified as a drug of concern in 12% of all drug-identified calls, whereas calls in which pharmaceutical opioids were identified comprised 31% of calls. In 2011, amphetamine was identified in 12% of drug-identified calls, an increase from 8% in 2010, while cannabis accounted for 11% of all drug-identified calls.
As at July 2012, 14,035 people were dispensed pharmacotherapy treatment in Victoria. Almost two-thirds (66%) were dispensed methadone, while almost one-third (29%) were dispensed buprenorphine-naloxone. Only 4% of pharmacotherapy consumers were dispensed buprenorphine.
In 2009/10 there were 1,357 opioid-related hospital admissions in Victoria, comprising 24% of all opioid-related hospital admissions in Australia. By contrast, in Victoria 357 amphetamine-related hospital admissions were recorded; these accounted for 21% of all Australian hospital admissions for the drug. Cocaine-related hospital admissions are relatively rare in Victoria: only 35 cocaine-related admissions were recorded, comprising 14% of admissions in Australia. In 2009/10, there were 451 cannabis-related hospital admissions in the state, accounting for 22% of all Australian cannabis-related admissions.
Injecting risk behaviours and health problems
Consistent with 2011, in 2012 11% of Victorian IDRS participants reported borrowing a used needle in the month prior to interview, most commonly from their regular sex partner. Twenty-five per cent reported lending a used needle to someone else in the preceding month, similar to 2011. While over half (60%) reported reusing their own needle in the previous month, only 15% reported having had trouble obtaining sterile injecting equipment when they needed it. Few participants reported injecting into their hand or wrist (9%), neck (5%), or groin (2%). Almost one-third reported injecting in public locations.
Although several KE reported observing a steady decline in the frequency with which PWID attended NSP, larger quantities of sterile equipment were dispensed at each visit. Other NSP KE recommended extending NSP hours into the night and during the weekend to counter equipment reuse, on-selling, and break-ins to public sharps bins. Implementation of a supervised injecting facility to improve the overall health of PWID was recommended.
In 2011, three new HIV diagnoses were recorded in which IDU was the likely exposure, comprising just over 1% of all new infections for the year. However, hepatitis C continues to be a major public health concern: according to the 2011 ANSPS, the estimated prevalence of hepatitis C was 66% among PWID in Victoria. In 2012, the self-reported prevalence of hepatitis C infection was 53% among the Victorian IDRS sample. The majority (88%) of participants who reported hepatitis B vaccination (n=90) reported completing the three-dose schedule. Almost half each reported testing for HIV, hepatitis B and hepatitis C in the three months preceding interview.
Alcohol Use Disorders Identification Test—Consumption (AUDIT-C)
The AUDIT-C uses a cut-off score of five or more to indicate the presence of risky to dependent drinking and whether further assessment is required. In 2012 the mean AUDIT-C score was 6.1, the same as in 2011. Sixty-three per cent of participants who reported drinking alcohol in the past year scored five or more on the AUDIT-C. Although men had higher mean scores than women (6.3 vs. 5.7), this difference was not significant.
Mental health problems and psychological distress
Self-reported mental health problems
Fifty-one per cent of 2012 Victorian IDRS participants reported experiencing a mental health problem in the preceding six months, similar to 2011. Among these, depression (76%) and anxiety (43%) were widespread; 12% reported having schizophrenia. Two-thirds of participants with a mental health problem reported attending a health professional, most commonly a GP. The majority of those who attended a health professional were prescribed psychotropic medication in the past six months, most commonly benzodiazepines and antipsychotic medications.
The Kessler Psychological Distress Scale (K10)
According to the K10, the prevalence of psychological distress was extremely high among 2012 Victorian IDRS participants; 74% of the sample was classified as having high or very high psychological distress in the four weeks prior to interview. Although the distributions of participants’ K10 scores remained similar to previous years, the prevalence of psychological distress was higher in 2012. By contrast, only 10% of the 2007/08 NHS sample was classified as having high or very high psychological distress in the preceding four weeks.
Short Form 12 (SF-12)
According to the SF-12, the self-rated physical and mental health of 2012 Victorian IDRS participants was much poorer than that of the Australian general population. On the SF-12, higher mean scores indicate better self-rated physical and mental health. Participants’ mean physical component score (PCS) was 45.4, while their mean mental component score (MCS) was 31.5, both significantly lower than the respective general population norms of 50.1 (PCS) and 49.8 (MCS).
Health service access
In 2012, 86% of participants reported visiting a health service in the four weeks prior to interview, most commonly a GP (n=102) or an OST prescriber (n=80). Participants reported that the majority of these visits were related to substance use (GP, 73%; OST, 99%). By contrast, fewer participants (n=14) reported accessing an emergency department (ED) in the preceding four weeks, with the majority (71%) of these visits reported as not substance-related.
Driving risk behaviour
Forty-six participants reported driving a vehicle at least once during the preceding six months. Of these, 28% reported driving under the influence of alcohol and 76% reported driving after using illicit drugs. Participants were asked to comment on their driving ability after illicit drug use; while 56% reported that illicit drugs had no impact on their driving ability, 18% each reported that their driving was slightly impaired and quite impaired.
Law enforcement-related trends associated with drug use
In 2012 almost half of Victorian IDRS participants reported a history of arrest in the preceding 12 months, most commonly in relation to property crime (60%) and use or possession of drugs (19%). In the month prior to interview, 41% of the sample reported that they were involved in crime; 27% reported involvement in property crime and 20% reported selling drugs for cash profit.
In 2010/11, heroin-related consumer (i.e., use/possession) and provider (i.e., manufacture/trafficking) arrests in Victoria changed little from 2009/10. However, between 2009/10 and 2010/11 the number of provider arrests relating to amphetamine-type stimulants declined, and cocaine-related consumer and provider arrests also declined. In Victoria, 78% of all cannabis-related arrests were consumer arrests.
Expenditure on illicit drugs
Over half of the Victorian IDRS sample reported purchasing illicit drugs on the day prior to interview, with a median spend of $100.
Special topics of interest
Fagerstrom test for nicotine dependence (FTND)
In 2012, 127 Victorian IDRS participants who reported they were daily smokers responded to the FTND. According to the FTND 23% of daily smokers were classified as having high nicotine dependence, while 22% were classified as having very high nicotine dependence.
In 2012, 79% of participants reported use of prescribed and non-prescribed pharmaceutical opioids (including morphine, oxycodone, OST medications such as methadone and buprenorphine-naloxone, and other opioids such as fentanyl, pethidine and tramadol) in the preceding six months. The most commonly reported brands were Methadone Syrup®/Biodone Forte® (35%), Suboxone® (17%) and OxyContin® (15%). The majority (70%) of these participants reported primarily using pharmaceutical opioids to ‘self-treat’ their opioid dependence. Approximately 13% reported that they were refused pharmaceutical opioids by a prescriber because of their IDU history, while 16% reported that they had given or sold their prescribed drugs to others. Approximately half of participants who had injected pharmaceutical drugs (n=64) in the past six months reported obtaining no information on filtering.
Brief Pain Inventory (BPI)
In 2012 the BPI was administered to Victorian IDRS participants. Almost one-third reported experiencing pain other than minor headaches, sprains or toothaches at the time of interview. Among these participants (n=47), the mean pain severity score was 4.4 out of 10, while the mean pain interference score was 5.2. The mean pain relief score was also 5.2; 36% reported that they had trouble obtaining pain relief from a doctor or specialist in the past six months.
Opioid and stimulant dependence
The Severity of Dependence Scale (SDS) is designed to measure the degree of psychological dependence on a range of substances. A cut-off score of four indicates methamphetamine dependence, while a cut-off score of five indicates dependence on heroin. In 2012 the SDS was administered to 144 recent heroin and other opioid users; for heroin, the mean SDS score was 8.2, with 88% of participants scoring five or more on the scale, indicating opioid dependence. The SDS was also administered to 95 recent methamphetamine and other stimulant users, yielding a mean SDS score of 3.4; 41% scored four or more, indicating methamphetamine dependence. Mean SDS scores did not differ significantly between men and women for either drug.
OST medication injection
In 2012, 18% of Victorian IDRS participants reported recent injection of buprenorphine, 16% reported recent injection of buprenorphine-naloxone tablets, 6% injection of buprenorphine-naloxone film and 5% injection of methadone.
Injection-related injury and disease (IRID)
In 2012, Victorian IDRS participants were asked an expanded set of questions about IRID to explore the extent and nature of these harms. In the six months preceding interview, participants most commonly reported experiencing non-serious IRID such as redness near the injection site (31%) and collapsed or blocked veins (24%). Of potentially serious IRID, the most commonly reported were thrombophlebitis (11%), pitting oedema (10%) and cellulitis (10%). Three per cent each reported experiencing serious IRID such as deep vein thrombosis, gangrene and venous ulcers in the preceding six months.
The 2012 IDRS assessed the prevalence of self-reported neurological conditions. Five per cent reported a history of epilepsy, while 3% each reported a history of stroke and hypoxia. The prevalence of traumatic brain injury (TBI) was determined by asking participants about a history of lost consciousness. Using this measure, the lifetime prevalence of TBI was 47%. Participants reported a median of two TBI in their lifetime, typically occurring at 25 years of age (median), at which the most severe loss of consciousness was 10 minutes (median). One-third reported losing consciousness for at least 30 minutes. At participants’ most severe TBI, 33% reported being under the influence of alcohol, while 44% reported being substance-affected.
Fifty-nine per cent reported experiencing sequelae of TBI. Of these (n=41), the most commonly reported complaints were memory loss (76%), poor concentration (63%), problems with finding the right words when speaking (61%) and mood changes (51%).
In 2012, Victorian IDRS participants were asked to respond to a hypothetical scenario about trafficking threshold quantities. Seventy per cent of participants reported believing that the quantity of drugs in their possession would affect the charge type.
The results of the 2012 Victorian IDRS indicate that the majority of illicit drug markets in Melbourne have remained stable during the preceding 12 months.
Key findings from the 2012 IDRS included:
- A significant increase in the proportion of participants reporting heroin as their drug of choice, from 60% in 2011 to 74% in 2012 and an increase in the median days of heroin use (from 63 to 72 days).
- 1.7 grams of heroin was the most commonly purchased quantity of heroin. KE reported that participants were purchasing heroin in larger quantities than they had previously.
- A slight decline in the prevalence of recent speed use (39% vs. 49%) and a significant increase in the prevalence of recent crystal methamphetamine smoking (from 13% in 2011 to 24%). KE reported an increase in crystal methamphetamine use among PWID, particularly primary heroin users, low levels of general knowledge about methamphetamine, and an increase in related harm.
- An increase in amphetamine-related events attended by Ambulance Victoria in 2011 compared with previous years.
- The proportions of recent (prescribed) OST pharmacotherapy users in the 2012 Victorian IDRS sample generally reflected the distributions of OST medication types dispensed to Victorian pharmacotherapy consumers as at July 2012.
- Modest proportions of participants reported recent OST medication injection, at relatively low frequencies (e.g., less than once per month). Overall, buprenorphine-naloxone tablet injection declined. The film was only injected by 7% on three days (median) in the preceding six months.
- A significant decrease in the prevalence of recent oxycodone use (from 41% in 2011 to 29%). The prevalence of prescribed morphine and oxycodone use was low and very few reported injection. However, prevalence of the recent injection of non-prescribed pharmaceutical opioids was comparatively high. Only a minority reported seeking information on filtering practices in relation to the injection of pharmaceutical opioids in the preceding six months.
- Recent non-prescribed alprazolam use was reported by the majority (58%) of the sample, although frequency of use was modest (median=10 days). On the other hand, 62% of the sample reported daily use of prescribed benzodiazepines (other than alprazolam). Non-prescribed quetiapine use was reported by 29% on six days in the previous six months. Recent injection of these drugs was very uncommon.
- A declining trend in the frequency with which PWID were attending NSP, with a concurrent increase in the ‘number of needles out’. This may be partially related to increased policy activity around some NSP in Melbourne. Despite this, other KE reported a need to extend NSP hours into the night and over the weekend. On average, participants reported attending NSP once per week in the preceding month and collecting a median of four sterile needle and syringes. Participants commonly reported reuse of their own syringes, although most reported no trouble obtaining sterile equipment in the past month.
- An extremely high prevalence of psychological distress (74%) among the 2012 Victorian IDRS sample.
- A continuing high prevalence of high-risk to dependent alcohol consumption (63%) among participants who drank alcohol in the past year.
- A higher prevalence of hepatitis C among PWID in Victoria than in Australia according to the 2011 ANSPS.
- A low prevalence of ED attendance related to drug use in the past four weeks.
- A high prevalence of self-reported TBI (47%) among 2012 Victorian IDRS participants.
On the basis of these findings, we recommend:
- Continued monitoring of illicit drug markets for trends in the prevalence and patterns of drug use, and price, purity and availability, and continued monitoring of related poor health and social outcomes.
- Further research on the impact of ageing among PWID, with particular attention paid to disability and chronic disease and the types of health and welfare services required to effectively service this population now and into the future.
- Expanding OST programs across Victoria and recruiting more prescribers to the field with a holistic approach to drug treatment. Increasing access to OST programs for dependent heroin users. Recognition that diversion of OST is a complex phenomenon that tends to operate as part of a ‘gift economy’ between friends that is related to the alleviation of withdrawal symptoms.
- Continued monitoring of the prevalence and patterns of non-prescribed alprazolam use, given the reported harms associated with use. Further research to tease out the temporal predictors and social determinants of use.
- Renewal of and reinvestment in safer injecting education programs and consumables targeted to PWID to reduce injecting-related disease and harm, particularly in relation to best practice sterile injecting techniques, correct filtering of pharmaceutical opioids such as morphine and oxycodone, and high-potency crystal methamphetamine. Broader harm reduction campaigns targeting the use of specific drug types (such as alprazolam, pharmaceutical opioids and crystal methamphetamine) that provide PWID with practical and relevant information related to reducing concurrent health and social harms.
- Increasing education about new hepatitis C treatment options and increasing access to hepatitis C treatment for PWID, including widespread promotion of hepatitis C RNA testing among PWID across Victoria.
- Increasing mental health resources for PWID given their very high prevalence of psychological distress, which is indicative of a high prevalence of serious mental illness.