Demographic characteristics of injecting drug user participants
In 2012, 100 participants were recruited for the 2012 WA IDRS participant survey, which was the standard amount. Demographic characteristics of the sample were broadly comparable to those of the previous year. The mean age was 41 years, with 68% male. Almost the entire sample (98%) reported that English was the main language spoken at home and only one respondent identified as Aboriginal or Torres Strait Islander (ATSI). Most (79%) were unemployed and, on average, had 11 years of schooling compared with a mean of 10 in 2011, and 72% reported having some form of post-high school education. Currently being in drug treatment was reported by 41% compared with 59% in 2011 and a history of prison by 54% compared with 36% the previous year. Methadone remained the most common form of drug treatment. The majority of respondents in 2012 were recruited via a Needle and Syringe Program.
Patterns of drug use among the PWID sample
Mean age of first injection was 19 years. Amphetamines remained the drug most commonly reported as first injected by 52%, up from 47% the previous year. Heroin remained the prime drug of choice in the sample reported by 74%. This figure represents the highest number of PWID nominating heroin as their drug of choice since the IDRS commenced in Western Australia. Injecting was most commonly reported on a ‘more than weekly but not daily’ basis by 37%. Heroin was both the drug most injected in the past month (53%, compared with 32% the previous year) and the principle drug most recently injected (46%).
The greatest proportion of respondents nominated heroin (46%) as the drug most recently injected for the fourth year running. This figure was significantly higher than the 32% of PWID who reported this in 2008. As in 2011, methamphetamines remained the class of drugs least likely to have been the most recently injected, nominated by just 18% of respondents. Other opiates were nominated by 35%.
Injecting ‘more than weekly but less than daily’ remained the most common frequency of injection, reported by 37% of PWID in 2012. Numbers reporting injecting weekly or less fell from 24% in 2011 to 12% in 2012.
In 2011, over half the sample reported use of tobacco, alcohol, cannabis, any form of methamphetamine, any form of benzodiazepines and heroin in the last six months.
Lifetime use of heroin was reported by 96% of PWID and recent use by 80%. Of these recent users, 98% had injected the drug. Average days of use in the last six months was 94 compared to 72 days in 2011. Daily use of heroin was reported by 20% of the sample. Recent use of homebake was reported by 42% with a mean of 39 days of use compared to 20 days in 2011. Powder remained the most commonly reported form of heroin used, reported by 41%.
The median price of recent purchases of one gram of heroin was $600. The greatest proportion of participants reported on the price of a one-quarter gram which had a median price of $200; consistent with prices reported the previous year. Availability was reported as either ‘easy’ or ‘very easy’ by 92% of PWID in 2012, and was generally reported as having been stable. Current heroin purity was generally described as ‘medium’ by 35% of those responding, and 44% reported that this level of purity had remained stable over the previous six months.
The IDRS distinguishes between methamphetamine powder (‘speed’), methamphetamine base, and crystal methamphetamine (‘ice’ or ‘crystal’).
Lifetime use of any form of methamphetamine was reported by 96% of the sample and recent use by 72%. Lifetime use of speed powder was reported by 92% and recent use by 45%. Lifetime use of base or paste methamphetamine was reported by 27% and recent use by six percent. Lifetime use of crystal methamphetamine was reported by 87% and recent use by 64%. Use of liquid amphetamine remained uncommon. Mean days of use of any form was 26.
The median price of a point of speed remained $100, and a gram as $700 although this data was provided by very small numbers of respondents. Only one respondent spoke about the price of base, citing a cost of $100 for a point. The median price of a point of crystal was $100 and a gram was $750. Prices for methamphetamine were generally agreed to have remained stable. Availability of speed and crystal were both rated as ‘very easy’ by 59% of those responding. Only one respondent talked about availability of base, describing it as ‘easy’. The availability of all forms was reported as being stable. Purity of both speed and crystal were generally reported as being ‘high’. Purity of both forms was reportedly stable over the previous six months. Just one respondent talked about purity of base, indicating that it had tended to fluctuate.
Lifetime history of coke use was reported by 80% of the sample and recent use by 15%. Mean days of use in the last six months remained low at four. The most commonly used form as reported by 80% of those responding was powder. Only one PWID reported on the price of cocaine, citing $150 for a quarter of a gram. Availability was only reported by two PWID with irreconcilable responses. Similarly, just two PWID commented on purity, one describing it as ‘medium’ and the other as ‘low’. These extremely small numbers of respondents both in the current sample and in previous years make it impossible to draw firm conclusions as to the state of the cocaine market in Western Australia.
A lifetime history of cannabis use was reported by 97% and recent use by 79%. Mean days of use in the past six months was 107 with use on a daily basis reported by 31%. Hydroponic cannabis remained the most commonly used form, reported by 96% of those responding.
The median price of an ounce of hydro remained stable at $350 for an ounce and $25 for a gram. The price of bush was reportedly $300 an ounce, up from $250 the previous year, but the small number of PWID providing this information makes it difficult to determine if this is a significant change. Prices of both forms were generally regarded as having been stable. Both forms were generally regarded as ‘very easy’ to obtain by those who responded, with 74% reporting this for hydro compared to 46% the previous year. This level of availability was largely agreed to have remained stable over the previous six months. Potency of hydro was described by 69% of those commenting as ‘high’ while potency of bush was described as ‘medium’ by 79% of those commenting compared with 50% in 2011. Potency of both forms was widely held to be stable.
Illicit use of pharmaceuticals
Lifetime illicit use of methadone was reported by 57% and recent use by 22%. Average days of use was 14 compared with 25 days in 2011. Use of illicit Physeptone was less common with lifetime use reported by 44% and recent use by 15%. The average days of use during the last six months was six. The reported price remained one dollar per one millilitre, which has been comparable to previous years. Of those responding, 40% described obtaining illicit methadone as ‘easy’.
Buprenorphine and buprenorphine-naloxone
Lifetime use of illicit buprenorphine (Subutex) was reported by 44% and recent use by 15% with a mean of 34 days of use. Lifetime use of illicit buprenorphine/naloxone (Suboxone) was reported by 33% and recent use by 16% with a mean of 47 days of use. Lifetime use of Suboxone film was reported by 20% and recent use by 18% with a mean of 28 days of use. Median price for an 8mg pill of Subutex was reported as $35 with its availability generally described as ‘very easy’. The median price for an illicit pill of Suboxone was $45 with availability reportedly ‘easy’. The median price of Suboxone film was reportedly $38 and its availability generally described as ‘easy’.
Lifetime use of illicit morphine was reported by 82% and recent use by 43% with a mean of 40 days of use compared to 22 days in 2011. As in previous years, MS Contin remained the most common form of morphine with a 100mg tablet carrying a median price of $70. Of those responding, 56% reported that illicit morphine was currently ‘very easy’ to obtain. It was generally agreed that this availability had remained stable over the last six months.
Lifetime use of illicit oxycodone was reported by 76% and recent use by 48% with a mean of 35 days of use. The proportion reporting use in the last six months was 48% in 2012, which was a significant increase from 30% in 2011. As in previous years, the most commonly reported brand was Oxycontin. The median price of an 80mg tablet was $80. Availability of illicit oxycodone was reported as ‘very easy’ by 49% of those responding. Availability was widely perceived as having remained stable.
Over the counter codeine
Lifetime use of OTC codeine was reported by 27% and 13% reported consuming them in the last six months compared to 34% in 2011. Given the popularity of preparations such as Panadeine, Neurofen and Mersyndol in Australia, these figures seem implausibly low and it would seem advisable to interpret this data with caution.
Other opioids (not elsewhere specified)
Lifetime history of using of other miscellaneous opioids was reported by 43% and recent use by 25% with a mean of 39 days. The most commonly reported form was Panadeine Forte with very small numbers also mentioning fentanyl, tramadol, minor analgesics and opium.
A lifetime use of any benzodiazepine was reported by 90% of the sample and recent use by 82% which was significantly higher than the 61% reported in 2011 and was the highest level of use recorded since the IDRS commenced data collection in Western Australia. Mean days of use was 117 compared to 99 days in 2011, with 31% reporting consumption on a daily basis. Mean days of use of illicit benzodiazepines was 34 compared to 12 in 2011. Diazepam remained the most commonly reported form of benzodiazepine. Illicit alprazolam (Xanax) was specifically asked about and had been recently used by 46% for a mean of 34 days. While most alprazolam use in the sample appeared to be illict, most use of other benzodiazepines appeared to be prescribed.
Lifetime prevalence of pharmaceutical stimulants (licit or illicit) by the WA PWID sample was 65% compared to 50% the previous year, and recent use by 23% with an average of 13 days of use. Only one of these respondents had a valid prescription, with all other use being illicit.
Hallucinogens and ecstasy
Lifetime use of hallucinogens was reported by 84% and recent use by 11% for a mean of four days. The most commonly reported hallucinogen was LSD (n=7) followed by DMT (n=2).
A lifetime history of having consumed ecstasy was reported by 77% and recent use by 12% compared to one respondent the previous year. Ecstasy was taken on a mean of eight days of use. Almost all of this ecstasy was in pill form, with just one respondent reporting consuming the drug in capsule form.
Lifetime use of inhalants was reported by 31% of the WA PWID and recent use by 4% on a mean of five days of use in the past six months. In 2011, the average number of days inhalants were used was one day and no respondents reported using inhalants daily. Inhalants used included amyl nitrate, nitrous oxide and ether.
Alcohol and tobacco
Lifetime use of alcohol was reported by 100% of the WA PWID sample and recent use was reported by 67%. The average number of days used in the last six months was 47. There were nine respondents who reported drinking on a daily basis. Use of the AUDIT-C screen revealed 45% of male drinkers and 53% of females were either hazardous drinkers or have an active alcohol use disorder.
A lifetime history of having smoked tobacco was reported by 97% and recent use by 91%. Virtually all of these respondents smoked on a daily basis with 177 average days of use.
A lifetime history of illicit Seroqual was reported by 42% and recent use by 19%. Mean days of use was 13. There was also 14% of the sample who reported having a valid prescription for Seroqual who consumed the drug much more regularly on a mean of 98 days. There were no reports of injecting Seroqual.
A lifetime history of heroin overdose was reported by 47% compared to 64% in 2011. The median number of overdoses was three times. A heroin overdose in the past year was reported by 16% and there were no reports of overdose in the month proceeding the survey. There were 359 narcotic overdoses attended by ambulance in the 2011/12 period compared with 323 the previous year.
Overdose on drugs other than heroin was reported by 24% of the 2012 sample with seven non-heroin related overdoses in the past twelve months. Drugs involved included crystal methamphetamine, ecstasy, alcohol, oxycodone and other opioids.
Calls to ADIS
Data from the Alcohol and Drug Information Service revealed a decline in the 2011/12 financial year in calls with heroin as the primary drug of concern, but a substantial increase in those relating to amphetamines. Numbers of calls dealing with cocaine remained stable and uncommon. Although calls with cannabis as the primary drug of concern appear to have increased, this is actually a reflection of the ADIS cannabis data now including calls to the Cannabis Intervention Requirement Scheme (CIRS).
Numbers of opioid hospital admissions have continued to increase over the 2009/10 financial year with WA having an admission rate of 627.51 per million compared to the national rate of 465.45. Amphetamine-related hospital admissions have remained relatively stable with WA continuing to exhibit much higher rates than nationally (252.06 per million vs. 136.41). Hospital admissions for cocaine remained uncommon with just 11 admissions in 2009/10 and a WA rate of 8.33 per million compared with the national rate of 19.63. Cannabis related admissions climbed steeply for reasons that are not clear. In 2009/10 WA rates for the first time narrowly exceeded national rates (168.04 per million vs 163.71).
Injecting risk behaviours
In 2012, the vast majority (91%) reported that they had not used a needle after someone else in the last month. Of the remainder that did report using a needle after someone else, common frequencies were using a needle once (n=5), twice (n=2), three to five times (n=1) and more than 10 times (n=1) in the last month. Of these respondents, 88% (n=8) reported that only one person had used the needle before them and one individual reported two other people having used the needle before them. Reporting the use of other equipment after someone else was reported by 17% of respondents. There were 14 respondents who reported that someone else had used a needle after them in the last month. That this had happened once was reported by four respondents, twice by two, three to five times by four, six to ten times by two and two respondents said it had happened on more than ten occasions. There were 14 respondents who reported that someone else had used a needle after them in the last month. Sharing of other equipment was reported by 17%, unchanged from 2011.
In WA, the hepatitis C virus (HCV) continues to be more commonly notified than the hepatitis B virus (HBV). The prevalence of human immunodefiency virus (HIV) among those people who inject drugs in Australia has also remained stable at relatively low rates over the past decade, with HCV more commonly reported. Data on notifiable diseases shows a slight increase in numbers of unspecified cases of both HBV and HCV while numbers of incident cases remain low and stable.
With regards to blood-borne viruses, 52% of the sample reported being positive for HCV and 11% for HBV. Just one individual was positive for HIV/AIDS. Virtually all of the PWID sample had been tested for blood-borne viruses at some stage, and around one third had been tested in the past three months.
Among the PWID sample interviewed as part of the IDRS, the most commonly reported injection-related problems were scarring/bruising and difficulty injecting, both reported by 38% The proportion reporting a dirty hit did not change significantly, being 16% in 2012 compared to 15% in 2011 with the most commonly implicated drug being oxycodone. A wide range of other injecting-related complications were also reported among the sample.
Mental health problems and psychological distress
Mental health problems were reported by 42% of PWID in 2012. As in previous years, the most commonly reported problems were depression and anxiety. Of those that self-reported a mental health problem, 62% reported attending a professional in relation to the problem.
According to the Kessler Scale of Psychological Distress, 47% of PWID in 2012 were at high or very high risk of psychological distress.
PWID also completed the Short Form 12 Item Health Survey measuring physical functioning and psychological distress. PWID scored more poorly in terms of both domains than the mainstream Australian population with 43.4 vs 50.1 on the physical domain (PCS) and 35.8 vs 42.4 on the mental health domain (MCS).
Driving risk behaviours
Of those PWID who had driven a vehicle in the last six months, 22% reported driving without a license and 12% driving while under the influence of alcohol. In contrast, 86% of PWID reported driving after consuming illicit drugs. Of these PWID, 49% believed that consuming illicit drugs had no impact on their driving ability.
Law enforcement trends
In 2012, 25% of respondents reported that they had been arrested in the past 12 months. Involvement in any criminal activity in the past month was reported by 47% compared with 30% in 2011. As in previous years, the most common form of criminal activity was dealing drugs.
In 2009/10, law enforcement data for WA as a whole indicated that the number of drug arrests for heroin, amphetamine-type stimulants, cocaine and cannabis have all declined.
Special topics of interest
Fagerstrom test for nicotine dependence
Use of the Fagerstrom nicotine test showed that more than half (52%) of those daily smokers responding were heavily nicotine dependent.
The consumption of any pharmaceutical opioid in the six months prior to the survey was reported by 80% of the WA user sample. The most common reasons given for using pharmaceutical opioids were ‘to treat self-dependence’, ‘seeking an opiate effect’, ‘pain relief’, ‘can’t score heroin’, ‘cheaper than heroin’, and ‘knowing what dose to expect’.
Asked if they had ever been prescribed pharmaceutical opioids for pain relief revealed that 40% of these respondents had been. There were also 23% who indicated that they had been refused a script for pain relief. Having ever sold, traded or given away their pharmaceutical opiate script was reported by 21%. Asked if they had ever sought information regarding the filtering of these preparations for injection, 55% (n=39) indicated that they had not.
Brief Pain Inventory
PWID also completed the Brief Pain Inventory used for the assessment of pain. Pain other than ‘everyday pain’ (e.g. headaches) was reported by 30% on the day of the interview, primarily ‘chronic non-cancer pain’. The pain severity score ranged from 1.3 to 8.5 with a mean of 5.3, indicating typically mid-range pain. Of those receiving medication for this pain, 26% reported receiving no relief and 33% of those reporting pain were not receiving any medication. Experience of trouble accessing pain relief from a doctor was reported by 69% of PWID experiencing pain. Asked about the degree to which this pain interfered with daily activities revealed a mean score of 5.5 indicating moderate levels of interference.
Opioid and stimulant dependence
Participants in user interviews completed the Severity of Dependence Scale (SDS) to screen for dependence upon opioids and stimulants. There were 85% of the 2012 sample found to be dependent on opioids and 28% found to be dependent on stimulants.
Opioid substitution medication injection
Of the WA PWID sample, 17% of participants reported recently injecting methadone, 11% reported recently injecting buprenorphine, 13% buprenorphine-naloxone ‘tablet’ and 11% buprenorphine-naloxone ‘film’. For the most part, these medications were either the respondents’ own script or obtained from a friend or partner.
Injection related injuries and diseases
In 2012, IDRS participants were asked if they had ever and recently (last six months) experienced any injection-related injuries or diseases (IRID) from the list used in the IRID project. The most common recent problems were redness near the injection site and swelling near the injection site, both reported by 28% of respondents. A dirty hit in the last six months was reported by 16% of all respondents, but had ever been experienced by 57%. Other common events or symptoms recently experienced included thrombosed veins by 22%, thrombophlebitis by 21%, nerve damage by 20%, hives by 19%, pitting oedema by 18%, accidental injection in an artery by 12%, and lymphoedema by 10%.
There were six respondents who had ever been diagnosed with epilepsy and two respondents had ever been diagnosed with diabetes. There were no respondents who reported having ever been diagnosed with stroke or hypoxic brain damage.
A history of having ever been knocked unconscious was reported by 47% of PWID a median of two times. The median duration of being unconscious was five minutes and 81% of instances were less than half an hour. Being under the influence of alcohol or drugs at the time of the most recent incident were each reported by 34% of those responding. Asked if they had experienced symptoms following the incident, 72% of these PWID reported that they had, most commonly poor concentration, memory loss, and problems with coordination or balance.
PWID were asked about the quantities of drugs they could be in possession of to avoid a sell or supply offence if caught by the police. Although 90% correctly believed that the quantity of drugs could affect the type of charge received, knowledge of what these actual threshold quantities were was often poor.