NDARC Technical Report No. 268
EXECUTIVE SUMMARY
Demographic characteristics of injecting drug user (IDU) participants
The mean age of 37 years was significantly older than that of the 2005 sample (35 years). The gender ratio remained static at 66% male. Virtually all were from an English speaking background. Aboriginal and Torres Strait Islanders made up 15% of the sample which was somewhat higher than the previous year (6%). Mean years of education was 10 with 54% having completed a post-school qualification. Students accounted for six percent of the sample and 72% were unemployed. The sample was predominantly heterosexual with 45% currently in treatment for their drug use. A history of incarceration in prison was reported by 48%, which was significantly higher than the 33% in the 2005 sample.
Patterns of drug use among the IDU sample
The mean age for commencing injection was 19 years with injecting careers spaning from one to 41 years. Amphetamines remained the most common substance with which to have commenced injecting. Heroin remained the dominant drug of choice amongst the sample despite smaller numbers nominating it in this role than in previous years. Opiates other than heroin, when viewed collectively were being used much more frequently and had displaced methamphetamine as the most injected drugs. These other opiates were also the drugs most recently injected with 50% of the IDU sample indicating this to be the case. The most common rate of injection was ‘more than weekly but less than daily’ accounting for 41% of the sample. Polydrug use was highly normalised with no IDU identified who had exclusively used just one drug class out of heroin, methamphetamine, other opiates, cannabis or benzodiazepines.
Heroin
Although the price of a gram of heroin remained unchanged at $550, in many other respects the market for illicit heroin had experienced a downturn with user perceptions of both availability and purity substantially less than in 2005. Despite this, availability was generally viewed as ‘easy’but purity was viewed as ‘low’. Recent use was reported by 53% of the sample down from 69% and mean days of use had fallen from 81 to 47. Powder heroin remained noticeably more common than rock. Overdoses remained uncommon with just six IDU reporting an overdose due to heroin in the last twelve months.
Methamphetamine
The price of a gram of methamphetamine had remained static since 2005 regardless of form. Thus, a gram of powder cost $300, a gram of base cost $325 and a gram of crystal methamphetamine cost $400. User perceptions of the purity of base and crystal also remained unchanged with purity of both forms continuing to be described as ‘high’ however, perceptions of the purity of powder had fallen and it was generally rated as ‘low’. By user report, the availability of crystal had improved following a decline in availability in 2005 and was seen as ‘easy’ to obtain. Powder methamphetamine however was perceived to be less available, but nevertheless was still rated as ‘easy’ to obtain. Base methamphetamine had clearly declined in availability but there was little consensus among IDU as to what current availability was like. Users of any form of methamphetamine had increased with 86% of IDU having used in the last six months, but mean days of use remained unchanged at 51. There were 66% of IDU who had recently used methamphetamine powder which was unchanged from the previous year but mean days of use had fallen to 19. Numbers using base had fallen to 40%, but days of use remained relatively unchanged at 20. Use of crystal methamphetamine remained stable at 76% and mean days of use constant at 35.
Cocaine
As in previous years only small numbers of IDU were able to comment about cocaine, a fact that in itself may be considered informative as to the continuing scarcity of cocaine amongst Perth IDU. This fact also necessitates caution in the interpretation of all data pertaining to cocaine. Based on one purchase, a gram of cocaine reportedly cost $350. Very small numbers of reports provided no consensus as to availability although this appeared to have fallen since 2005. What reports there were suggested that purity remained ‘high’. Numbers of IDU reporting recent use had fallen to just 10% with mean days of use remaining stable at six.
Cannabis
Prices of an ounce of cannabis remained relatively unchanged at $280 for an ounce of hydroponic cannabis and $200 for an ounce of bush cannabis. User reports suggested that the availability of hydroponic cannabis had fallen, but nevertheless was still rated as ‘easy’. Bush cannabis was also viewed as having ‘easy’ availability, a situation unchanged from 2005. Potency of both forms was viewed by users as unchanged with hydroponic cannabis rated as ‘high’ and bush as ‘medium’. Numbers of recent users in the IDU sample remained relatively unchanged at 80%. Mean days of use had also remained stable at 105. As in previous years hydroponic cannabis was found to be the dominant form.
Use of illicit pharmaceuticals
Illicit Methadone
Recent use of illicit methadone syrup had remained stable with 21% of IDU having consumed it in the last six months with a mean of 26 days of use which was not dissimilar to the 2005 mean. The majority of this use was by injection. There had been an increase in the use of illicit Physeptone with 35% of IDU reporting recent use. Mean days of use had remained stable at eight. As with syrup, injection remained the main route of administration. Price appeared to have remained stable at one dollar per ml or mg. Availability remained unchanged with most users describing it as ‘very easy’.
Illicit Buprenorphine
Numbers using illicit buprenorphine in the last six months remained stable at 31% of IDU and mean days of use was likewise stable at 43. The mean price for a tablet was $43. Recent illicit use of Suboxone was reported by nine IDU despite the fact that more than half of these had experienced withdrawal symptoms as a result. Mean days of use was 28. Almost all IDU providing information were aware that illicit Suboxone was being sold for a mean price of $30.
Morphine
Recent use of illicit morphine was reported by 51% of the IDU sample with mean days of use standing at 48. Price of MS Contin 100mg, the most common form, remained unchanged at $50. There was no real consensus concerning the current availability of illicit morphine although it appeared to have become more difficult to obtain than in the previous year, possibly due to considerable amounts of the drug being converted into homebake heroin rather than sold directly.
Oxycodone
Illicit oxycodone use in the last six months was reported by 42% of IDU, a figure relatively unchanged from the previous year. Mean days of use was 17 which was also similar to mean days reported in 2005. The most common purchase was 80mg tablets of Oxycontin for a mean price of $51. Prevailing opinion held availability to be ‘easy’.
Other opioids
Recent use of homebake heroin had increased with 54% of IDU having consumed it in the last six months, compared to 34% the previous year. Mean days of use was 49 which was also a significant increase on the 30 days in 2005. Other miscellaneous opiates (primarily codeine based preparations) had not changed significantly with 31% of IDU having recently used them for a mean of 39 days.
Benzodiazepines
Benzodiazepines had recently been used by 75% of IDU with mean days of use standing at 85. Licit use of these drugs continued to exceed illicit use and as in previous years the main form used was diazepam.
Associated harms
While there was no reported change in incident cases of Hepatitis C Virus (HCV), there was a slight increase in incident cases of Hepatitis B Virus (HBV). Rates of sharing equipment showed little change however, rates of repeated sharing had declined with virtually all involving sharing with only one person, generally a regular sex partner. There was a substantial increase in injection related problems largely driven by more people reporting difficulty in injecting. Numbers reporting driving a vehicle whilst under the influence of illicit drugs remained very high with more than half the entire sample having done so in the six months prior to interview. Average expenditure on drugs the previous day was $100 which was a significant increase on the previous year. Mental health issues had recently been experienced by 44% of the sample which was not significantly removed from 2005. Depression and anxiety remained the predominant mental health issues. Acts of aggression whilst in withdrawal exceeded those caused whilst intoxicated. Crystal methamphetamine was the drug most commonly implicated in such acts overall. Numbers reporting involvement in criminal activity remained unchanged from the previous year.
Implications
There were a number of implications arising from the 2006 findings, many of these stemming from the continued rise in the use of pharmaceutical drugs the point where non-heroin opiates had become the most injected class of drugs. As most of these are intended for oral consumption rather than injection it seems likely that this trend will ensure that a variety of injection related problems will continue to be seen amongst this population. Further, experiences of this type of drug use in the United States have demonstrated that their widespread use generates a pre-existing market for heroin to return to and also has the potential to generate new forms of crime such as assaults on chronic pain patients and robberies of pharmacists with a view to obtaining medications. As there is little evidence of a rise in such crime at present, it may be inferred that substantial levels of onselling medication and ‘doctor shopping’ are occurring. The massive rise in the use of homebake heroin and decline in the availability of morphine suggests that a considerable amount of diverted morphine is not being sold directly, but first processed or “baked” to manufacture homebake heroin. The ongoing popularity of opiates in an environment of low purity heroin also raises the possibility that recent trends in North America, which saw dealers lacing low grade heroin with pharmaceuticals such as fentanyl resulting in a number of overdoses, could be replicated here. Recent events documented in local media of an armed robbery on a pharmacy with a view to obtaining pseudoephedrine (Eliot, 2007) may be an illustration of how attempts to restrict precursor chemicals used in the manufacture of methamphetamine might have the unintended consequence of generating previously unseen types of criminal activity.
Citation: Fetherston, J. & Lenton, S. (2007) WA Drug Trends 2006: Findings from the Illicit Drug Reporting System (IDRS). Sydney: National Drug and Alcohol Research Centre.