NDARC Technical Report No. 246 (2006)
This report presents the results from the third year of a study monitoring ecstasy and related drug (ERD) trends in Victoria. A feasibility trial of this research was conducted in 2000 and 2001 in NSW, QLD and SA, and in 2002 the study was continued in those jurisdictions. 2003 marked the first year of a two-year national trial of the study, with the addition of capital cities in Western Australia, the Northern Territory, the Australian Capital Territory, Tasmania and Victoria.
The demographic characteristics, patterns of drug use, and perceptions of the price, purity and availability of ERDs among a sample of regular ecstasy users (REU) are described in this report. Their severity of dependence on ecstasy and methamphetamines, perceptions of the effects of drug use (e.g. benefits and risks), health risk behaviours and criminal behaviour are also reported. These findings are triangulated with information from key expert (KE) and secondary indicator data sources in an attempt to minimise biases and weaknesses inherent to each source of data. These methods are employed to gain an understanding of the current ERD markets in Melbourne, Victoria. Where appropriate, 2005 findings are compared to findings from the previous two years and implications of the results and the nature and characteristics of ERD markets are discussed.
Demographic characteristics of regular ecstasy users
The 2005 Victorian REU sample was typically aged in their mid-twenties and lived either in rental accommodation or in their family home. Most had completed high school, a substantial proportion had completed post-secondary qualifications, and participants were typically employed and/or studying full-time.
Patterns of drug use among REU
Polydrug use was the norm among the 2005 PDI participants, a pattern of use confirmed among ERD users more generally by the KE reports. The REU sample reported lifetime use of a median of 11.5 drug types and recent use of eight levels comparable to those reported by the 2003 and 2004 REU samples. The drugs used by the 2005 sample were also generally comparable to previous years, with both lifetime and recent use of alcohol, cannabis, tobacco and methamphetamine powder commonly reported. There have been some changes over the three years of the Victorian PDI, however, with reductions in reported levels of recent use of crystal methamphetamine and GHB, and lower levels of lifetime and recent methamphetamine base, ketamine and nitrous oxide reported in 2005 than in the previous years. In addition, the levels of recent cocaine use have increased from 2003 to 2005. Just over half (52%) the sample reported bingeing on drugs (defined as continuous use of drugs for more than 48 hours) in the six months prior to interview, most often on ecstasy, methamphetamine powder, cannabis and alcohol. Consistent with the 2004 findings, a small proportion (16%) of the 2005 REU sample reported having ever injected a drug.
The 2005 REU sample reported first use of ecstasy, on average, in their late teens. Although there was a wide range of frequencies and amounts of ecstasy used by the 2005 REU sample, over half (53%) reported using ecstasy pills fortnightly or less frequently. The median number of ecstasy pills used in a session was reported as two, with a median of three used in a heavy session. Most of the 2005 REU sample reported the use of other drugs in combination with ecstasy (97%) and during the comedown from ecstasy (88%). Ecstasy pills are most commonly used orally. Regular ecstasy users take ecstasy in a wide range of locations, most commonly nightclubs, dance parties/raves/doofs, private homes/parties and at live music events. The perceived (userdefined) benefits of ecstasy use include having fun, enhanced bonding with others, and enhanced mood and communication. The user-defined risks of ecstasy use include psychological/mental
health concerns, physical harms and neuropsychological harms.
Price, purity and availability of ecstasy
The price of ecstasy appears to have remained stable over the previous three years, with ecstasy typically costing $30 per pill (although lower prices tend to be paid for bulk purchases). The purity of ecstasy tends to be rated as medium to high, although many users perceived purity to fluctuate. Ecstasy remains readily available according to user reports, and is predominantly sourced from friends or known dealers in private residences and nightclubs.
Ecstasy markets and patterns of purchasing
Ecstasy is obtained via a range of methods, most commonly by paid employment and being given ecstasy by friends or partner (being shouted). Regular ecstasy users tend to have a number of people they can purchase ecstasy from, typically purchase for themselves and others, and purchase a median of five pills per transaction. In addition to ecstasy, most regular ecstasy users can obtain a range of other drugs from the dealers, most commonly methamphetamine powder and cannabis.
Of the three forms of methamphetamine, speed is most widely used by regular ecstasy users (in terms of both lifetime and recent use), followed by crystal meth and then base. Regular ecstasy users commonly use speed in conjunction with ecstasy and during binges. Methamphetamines are used in a variety of locations, predominantly nightclubs, and dance parties and in private homes. The three forms of methamphetamine are used in a range of ways: speed is mostly commonly snorted, whereas base is predominantly swallowed and crystal meth smoked.
The price of the three forms of methamphetamine has remained stable, with crystal meth (median of $385 per gram) more expensive than speed (median of $180 per gram) and base (median of $200 per gram). The purity of base and crystal meth is high and stable, whereas the purity of speed is less consistent. All forms of methamphetamines, however, appear to be readily available (although access to crystal meth has declined), and are most commonly acquired through friends and known dealers.
Methamphetamine use, particularly crystal methamphetamine use, has the potential to be associated with considerable harms (i.e. violence and mental and physical health problems).
A relatively high proportion of regular ecstasy users report lifetime use of cocaine. Levels of recent use reported by the 2005 REU sample (63%) were higher than those reported by both the 2003 (35%) and 2004 (48%) samples. Regular ecstasy users, however, tend to use cocaine infrequently, typically snorting it and using it in nightclubs and private homes.
Perhaps contributing to the relatively low frequency of recent use, cocaine is an expensive drug (median $300 per gram), with its purity typically rated as medium or low. Although there is little consistency in reports of the availability of cocaine, availability was most commonly reported as stable over the past six months. Cocaine is commonly purchased from friends in friends homes.
Smaller proportions of the 2005 REU sample reported lifetime (56%) and recent (35%) use of ketamine than in 2003 and 2004. Those from the 2005 sample reporting recent ketamine use typically use it infrequently, most commonly in private homes. The purity of ketamine is generally reported high, with price (median $180 per gram) and purity reported as stable. Reports of ketamine availability are inconsistent, with a recent trend of easy and stable availability. Ketamine is most commonly purchased from friends and known dealers in private homes and dance parties/raves/doofs.
Reports from the 2005 Victorian PDI suggest moderate prevalence of lifetime and low prevalence of recent GHB use among regular ecstasy users. Indeed, fewer of the 2005 REU sample reported recent GHB use (16%) than the 2004 sample (27%), although those from the 2005 sample reporting recent use reported more GHB frequent use.
GHB is used across a wide range of locations, predominantly private homes, dance parties and nightclubs. GHB is inexpensive (median $2.50 per ml) and the price has remained stable. Current GHB purity is regarded as medium to high, but there is little consensus about recent changes in purity. GHB is readily available and availability has remained stable. GHB appears to be increasingly being purchased from known dealers in their homes.
There remains a considerable level of concern regarding GHB, specifically GHB-related overdose, among professionals working in a range of capacities with regular ecstasy users.
Evidence suggests a high prevalence of lifetime use of LSD with moderate levels of recent use among regular ecstasy users. Recent users report infrequent use of LSD across a wide range of locations, predominantly outdoors, private homes, and at dance parties.
LSD is relatively cheap (median $15 per tab) and the price has remained stable. Current LSD purity is regarded as high, with purity described as stable. There is little consistency in the reported current availability of LSD, although availability tends to be reported as stable over the previous six months. Regular ecstasy users most commonly purchase LSD from friends in private homes.
Reports suggest low prevalence of lifetime and recent use of MDA among regular ecstasy users. Recent users report infrequent use of MDA across a wide range of locations, predominantly nightclubs and private homes. It is difficult to comment on trends in the price, purity and availability of MDA given the small number of respondents able to comment in 2005.
Patterns of other drug use
Reports from the 2005 Victorian REU sample and KE suggest almost universal lifetime and recent use of alcohol, and high prevalence of alcohol use in conjunction with (73%), and during comedown from ecstasy (35%). Indeed, a larger proportion of the 2005 REU sample reported drinking during the comedown period, drinking larger quantities, and drinking during binges, than of the 2004 REU sample.
High lifetime and recent use was also reported for cannabis, which was also commonly used in conjunction with ecstasy (50%) and during the comedown period (56%). Nearly one-quarter (23%) of recent cannabis smokers reported using it daily during the six months prior to interview. Very high lifetime and recent use was reported for tobacco, with many REU being daily tobacco smokers. Over half the REU sample reported having ever used psilocybin mushrooms, with nearly one in five reporting recent use. Over half of the REU sample report lifetime use of benzodiazepines, with more than one-third reporting recent use. The 2005 Victorian REU reported relatively low levels of lifetime and recent use of anti-depressants, inhalants and heroin and other opiates.
Drug information-seeking behaviour
The majority (91%) of the 2005 REU Victorian sample reported attempting to find out the content and purity of pills sold as ecstasy at least some of the time, most commonly asking friends who had taken it (79%) or asking dealers (63%). Slightly more than one-third (38%) of the sample reported personal use of testing kits. There was a moderate level of awareness of the limitations of testing kits among those who reported having used them, with over half (56%) able to comment on the limitations. The findings also suggest that the results of pill testing may influence the drug use behaviour of regular ecstasy users: nearly two-thirds (62%) of those participants reporting personal use of testing kits indicated that they would not take a pill if test results suggested that it contained ketamine, and over three-quarters (79%) reported that they would not take a pill which produced no reagent test reaction. Participants were also asked what information sources they would find most useful if they were made locally available, with websites (61%) and testing kits (60%) receiving the most support.
Evidence from the current study suggests that there are low levels of injecting drug use by regular ecstasy users, with the sharing of needles rare among those regular ecstasy users reporting injecting. The sharing of other injecting equipment (i.e. spoons or other mixing equipment, water and/or filters) is, however, more common. This population appear not to experience difficulties in accessing injecting equipment, most commonly accessing equipment through Needle and Syringe Programs (NSPs) and chemists. Among regular ecstasy users reporting recent injection, there appears to be low levels of HBV vaccination and low levels of HCV and HIV infection. These findings, however, need to be interpreted with caution, given the small numbers of participants reporting recent injecting behaviour.
Regular ecstasy users appear to be a relatively sexually active group, among whom condom use with regular sex partners is infrequent, but with casual partners relatively frequent. Unsurprisingly, this group tend to report having sex while under the influence of drugs, most commonly ecstasy, cannabis, alcohol and speed. A small proportion of those who had had casual sex under the influence in the past six months reported that they never used condoms when doing so.
The current study also suggests that risky driving practises are relatively common among regular ecstasy users: over half (58%) of the REU sample who reported having driven in the six months prior to interview reported having driven soon after (i.e. within one hour) of taking any illicit drug/s and slightly more than one-third (35%) reported having driven under the influence of alcohol (i.e. over the legal limit). Those reporting driving after using illicit drugs most commonly did so following ecstasy or speed use. It will be of interest to determine the influence of the recently introduced random drug driving tests on the levels of drug driving among this population.
Although not a commonly reported experience among regular ecstasy users, overdose is a significant harm associated with ERD, and particularly GHB use.
The evidence suggests that small proportions of regular ecstasy users are dependent on ecstasy and/or methamphetamines, as indicated by scores on the Severity of Dependence Scale (SDS).
The participants in the current study reported low rates of health and treatment services utilisation for their ERD use. This appears to be a result of a number of factors including service utilisation not being necessary due to generally infrequent patterns of use and low levels of harms, and, among those experiencing harms, a lack of recognition that such harms are associated with ERD use. From the reports of both the REU sample and KE, GPs and counsellors appear to be the treatment types most commonly accessed by regular ecstasy users.
The findings suggest that considerable proportions of regular ecstasy users experience occupational/study, financial and relationship/social problems due to their use of ERDs. It is important to note, however, that users may consider the majority of these problems as relatively minor in nature and that few experience legal/police problems associated with their ERD use.
Criminal activity, policing and market changes
The reports of the 2005 REU sample and KE suggest that the majority of regular ecstasy users do not undertake criminal activities and/or experience legal problems. A considerable proportion, however, appear to be involved in dealing drugs, either for ecstasy or cash profit.
Although there was a widespread perception among the 2005 REU sample that police activity had recently increased as indicated by an increased presence of sniffer dogs, increased police presence at specific events and venues in general and the introduction of drug-driving buses the majority reported that police activity had not made it more difficult to obtain ERDs.
The results reported here describe trends in the market for ecstasy and related drugs in Victoria, and provide comparisons with the findings of the 2003 and 2004 studies. Many characteristics of ERD use reported in the previous Victorian and national reports (e.g. Breen et al., 2003) are confirmed in the current study, perhaps suggesting a level of stability in this illicit market. Regular ecstasy users are typically aged in their mid-twenties, are well educated and tend to be employed and/or students.
Polydrug use appears to be the norm among regular ecstasy users, with a range of drugs used in conjunction with and during the comedown from ecstasy. Binging on drugs also appears to be common by this population, although few engage in intravenous drug use.
Many of the drugs investigated in this research (e.g. ecstasy, methamphetamine powder) were identified as readily available, although some classes of drug (e.g. cocaine and crystal meth) appear more difficult to access or are highly variable in their availability. Similarly, there was a degree of variability in the frequency with which some drugs were used. Ecstasy, speed and cannabis were used regularly, whereas cocaine was used infrequently and opportunistically. In general, risk behaviours, health-related problems and criminal activity among REU were relatively uncommon. However, considerable proportions of REU reported driving soon after taking drugs (both ERDs and alcohol) and participating in dealing. Problems associated with ERD use tend to involve work, study and social relationships, and were reported by a substantial proportion of participants.
This third consecutive year of the Victorian PDI study has provided further indication of the patterns and characteristics of ERD use and related consequences in Melbourne. Patterns of polydrug use, binge drug use, the frequency and locations where some drugs are used, and the availability of many drugs have shown a degree of consistency across the three years of data collection. Other characteristics, such as the prevalence of recent GHB and cocaine use, were inconsistent across time and warrant further exploration.
With increasing community interest in the patterns and characteristics of ERD use, the Victorian PDI represents a key knowledge base from which to further explore these local markets. The primary aim of the national PDI was to provide a snapshot of the characteristics of regular ecstasy use in Australia. Although the data collection methods described in this report have several limitations, the findings provide information that can be used to inform other research with the capacity to target emergent questions relating to regular ecstasy use (see below).
The findings of the 2005 Victorian PDI study suggest the following recommendations:
- Polydrug use by REU, associated harms and explorations of harm reduction strategies warrant further investigation.
- The wide range of settings in which ERDs are used necessitates a broadening of the settings and target audiences of harm reduction messages.
- Targeted research examining the extent and nature of injecting drug use in ecstasy-using populations is required. Interventions addressing issues including the risks of sharing any injecting equipment and increasing awareness of HBV vaccination may usefully be developed.
- GHB use continues to be associated with increased risk of harm, especially overdose. The influence of the recent anti-GHB campaigns influence on drug use behaviour and attitudes towards GHB users could usefully be examined.
- Problems experienced by regular ecstasy users and the perceived risks of ecstasy use, warrant further exploration. Increased understanding of such issues may have implications for the development of both prevention and harm reduction strategies.
- A notable proportion of regular ecstasy users appear to experience dependence on ecstasy and/or methamphetamines. Levels of dependence on a range of drugs in this polydrug using population need to be explored further.
- There is evidence of low levels of treatment utilisation among regular ecstasy users. Reasons for this (beyond low levels of use and harms) should be explored. Such research may usefully inform the development of a tool designed to increase recognition of problematic use and encourage treatment utilisation among those experiencing harms.
- Regular ecstasy users report relatively high levels of driving under the influence of both alcohol and ERDs. Targeted research is needed in this area, particularly in the context of Victorias new drug-driving testing initiatives and the impact such initiatives may have on behaviour. Attitudes towards these initiatives and drug driving more generally need to be assessed to allow for education and awareness campaigns to be developed.
- Although experienced by a minority of regular ecstasy users, overdose events are a significant concern. Little is known about the circumstances around overdose, hampering efforts to both prevent and treat such events. Further research examining such factors is a priority.
- There is a lack of suitable resources for users following adverse events (i.e. overdose) outlining harm reduction strategies, and the signs and symptoms of overdose, to allow early identification. The development of such resources is a priority.
- Despite relatively high levels of reported dealing, there appears to be a general lack of awareness of the criminality of on-selling and dealing/supplying to friends among regular ecstasy users. These issues need to be examined in greater detail, potentially informing the development of resources designed to raise awareness of such issues and the potential penalties of such behaviour.
- There is evidence that the majority of regular ecstasy users attempt to determine the content and purity of ecstasy pills prior to taking them, and that, although only a small proportion have used testing kits, many would do so if they were more widely available.
Citation: Johnston, J. and Jenkinson, R. (2006) Victorian Trends in Ecstasy and Related Drug Markets 2005: Findings from the Party Drugs Initiative (PDI), Sydney: National Drug and Alcohol Research Centre.