NDARC Technical Report No. 179 (2004)
EXECUTIVE SUMMARY
In 2003 the Australian Government Department of Health and Aging commissioned the National Drug and Alcohol Research Centre (NDARC) to conduct the fourth national Illicit Drug Reporting System (IDRS). All states and territories completed all three components of the full IDRS. Additional funding was again secured through the National Drug Law Enforcement Research Fund (NDLERF) to complement core funding from the Department. This additional funding enabled the non-core jurisdictions to undertake the IDU component of the study. NDLERF funding was also provided to allow the Party Drugs Initiative to be expanded to all Australian jurisdictions for the first time.
The 2003 IDRS aims to provide a means by which to identify any emerging drug-related trends and potential harms associated with such trends. It can also be used as a means to identify areas requiring further investigation. As in previous years a specific emphasis was placed on the use of heroin, methamphetamine, cocaine and cannabis. Additional data was also collected to enable the exploration of drug markets dealing in illicit methadone and morphine.
The National Drug Research Institute has conducted the WA component of the IDRS since 1999. This report represents the fifth year of involvement in the IDRS for WA and the fourth year in which all three IDRS data sources were used. These were:
- Quantitative interviews with 100 injecting drug users (IDU)
- Qualitative interviews with 29 key informants (KIs) who have regular contact with IDU and are employed in health, outreach, law enforcement and other professions.
- Analysis of a range of indicator data from survey, health and law enforcement sources.
Demographic characteristics of injecting drug users (IDU)
Males made up 68% of the IDU sample who had an age range from 18 up to 48 with a mean of 34 years. While all IDU indicated that English was their main language, eight identified themselves as having ATSI heritage. Nearly three quarters of the sample lived in their own home or flat. The average number of years of schooling was 10 with one third indicating that they had not gone on to any further study. With regards to drug treatment, 40% indicated that they were currently receiving treatment for their drug use, the most common modality being methadone maintenance therapy. A history of incarceration in prison was noted amongst 30% of the sample.
Patterns of drug use among IDU
As in 2002, heroin remained the most popular drug of choice amongst the IDU interviewed in 2003 (40%) with methamphetamine being second (38%). Amphetamine remained the drug most commonly injected in the month before the survey followed by heroin and then by morphine. This same pattern was also seen with regards to the drug most recently injected, with amphetamine again being the most commonly mentioned substance (56%). The most frequent reasons given for disparities between drug of choice and drug most commonly injected were availability (n=9) and health effects (n=8). The average age of first injection was 19 and, on average, IDU in the sample had been injecting for 15 years. Frequency of injection in the month prior to the survey ranged from no instances, up to multiple times a day. However, the largest group were those IDU who reported injecting more than weekly, but less than daily (40%). Injection on at least a daily basis was reported by 41% if IDU interviewed.
Heroin
Although heroin remained the most popular drug of choice amongst the IDU sample, available evidence suggests that the use of heroin in Perth remains relatively low compared to its predominance prior to 2001 with 63% IDU reporting its use in the last six months. The frequency of use and reported availability amongst IDU heroin appears to be relatively unchanged in the last twelve months. Similarly, the price per gram appears to have stabilised at $550. Purity, as reported by IDU is generally seen as being “low”, a view supported by the continuing low rates of reported opiate overdose. There is some evidence that homebake heroin continues to be used as a heroin substitute however, its rates of use (n=27) and average number of days of use amongst IDU in the last six months (39) remain significantly unchanged from those reported in the previous year.
Methamphetamine
As noted above, methamphetamine remained the second most popular drug of choice amongst IDU in the survey. Methamphetamine also remained the most commonly injected drug among IDU, it’s rates of recent use in WA (89%) in 2003 exceeding that of any other Australian jurisdiction (Breen et al 2004). Certain changes appeared to have taken place with regards to the forms of the drug currently in circulation, with the use of crystal methamphetamine or “ice” being seen for the first time to exceed the traditional powder form of the drug as the most commonly used. In addition, there was some evidence that crystal methamphetamine has become cheaper and more readily available. These price changes have seen the price of crystal per gram fall from $400 to $350. Despite suggestions by some key informants that there may be developing trends towards manufacturers “cutting” crystal methamphetamine with difficult to detect adulterants, the prevailing view amongst IDU was that this form of the drug was generally of a high purity relative to the powder or paste forms. That this high level of purity in an increasingly available form of methamphetamine may be causing problems can be seen reflected in the frequent references by key informants of impulsive and aggressive behaviour witnessed amongst IDU with whom they had contact. Several key informants reported trends by users towards the smoking of methamphetamine as a means of harm reduction, however this is not well reflected in the IDU data which may suggest that this trend may involve newer users taking up smoking as opposed to a transition from injecting by established IDU.
Cocaine
There were only 10 IDU reporting use of cocaine in the last six months. Very few IDU (n=2) and no key informants were able to provide detailed information concerning the price, purity or availability of cocaine in Perth. Where information was provided, it was often seen to be conflicting. Whilst it could be argued that injecting drug users in Perth may be a poor sentinel population for monitoring trends associated with this drug, it appears that cocaine remains scarce in Perth and its regular use amongst injecting drug users continues to be rare.
Cannabis
Cannabis was once again in extremely wide and regular use throughout the IDU sample (81% in the last six months) and generally seen as being very easy to obtain and of high strength. Prices appeared to have remained relatively stable at around $260 per ounce, although this was slightly higher ($270) for an ounce of hydroponically grown cannabis and somewhat less ($220) for an ounce of naturally cultivated or “bush” cannabis. Ounces were the most commonly purchased quantity although the $25 “stick”, “bag” or “foil” also remained commonplace. Use of both hydroponic and “bush” cannabis was extremely common, whilst forms of hashish remained unusual. Small time growers were believed to be the most common origin of purchased cannabis although the existence of large scale cultivation by organised crime was acknowledged. Where cannabis was believed to have come from large scale operations, this was invariably seen to involve hydroponically cultivated plants.
Illicit use of methadone
Relatively small numbers of IDU were found to have recently used either illicit methadone syrup (14%) or Physeptone® tablets (eight percent). The great majority of this use was found to be by injection. While price was generally agreed to have been stable, it is difficult to gauge actual price of methadone on the black market due to the very small number of highly diverse purchases. Ease of availability similarly appeared to differ greatly between individual IDU.
Illicit use of buprenorphine
Recent illicit use of buprenorphine amongst the IDU sample was not significantly more common than it was in 2002, although the number of IDU admitting to illicit use exceed that reporting licit use. The drug was most commonly administered by injection. Use of illicit buprenorphine was not commonplace (n=18), and its consumption appeared to occur on an infrequent basis relative to those IDU who consumed the drug legitimately. As days of use of illicit buprenorphine were not specifically asked about in 2002, comparisons with previous years were not feasible.
Morphine
Morphine continued to be the most commonly used opiate other than heroin. Recent illicit use of morphine was reported by 41% of IDU who had consumed the drug in the last six months which while significantly less than in the previous year, was offset by a significant increase in the average number of days of use (n=60). With the exception of one individual, all IDU who had recently used morphine had injected it. MS Contin® was by far the most common variety although occasional use of Kapanol® was reported. Availability of morphine was generally seen as being either “very easy” or “easy” with a 100mg tablet carrying a median price of $50.
Other opioids
Use of other opiates usually involved codeine based pharmaceutical medications (eg: Panadeine Forte®) or, less commonly, Oxycontin®, indicating a narrower range of brands than in the previous year. Significantly less IDU (26%) reported recent use of these drugs than in 2002 and they appeared to be used for a lower average number of days (n=17). Although the majority of use of other opiates was illicit, the most common route of administration was oral. However, recent injection of these drugs was also very common.
Benzodiazepines
Benzodiazepines continued to have been used on a recent basis by a majority (67%) of the IDU sample, albeit a significantly smaller number than was observed in 2002. Similarly, rates of injection also had fallen significantly. A third of the IDU sample reported that their use of these drugs was illicit. One key informant commented that the “pharmacological repertoire appeared to have narrowed”. Certainly the range of types of pills observed in the 2003 sample was much less than in 2002 although diazepam, and temazepam preparations remained the most commonly employed.
Associated harms
The prevalence of HIV among WA IDU appeared to remain relatively low and data from the Australian NSP survey suggests that there may be a decrease in the rates of HCV (43% of IDU tested) transmissions. Infections of HBV were self reported by 21% of IDU in that survey. Also evident is a decline in the sharing of injecting equipment, particularly equipment other than needles and syringes (by 34% of IDU) Recent experience of opiate overdose also remained uncommon with just five reported incidences amongst the IDU sample. The less serious injection related health problems were more frequently seen, most notably scarring and bruising and difficulty injecting. “Dirty hits” were not unusual (21%) although at rates very similar to those seen in 2002. While most of these “dirty hits” involved methamphetamine or heroin, a not insubstantial number involved the injection of pharmaceutical drugs. Significantly less IDU in 2003 (25%) had recently sought the services of a mental health professional in the previous year, the most common reason being for treatment of depression, and anxiety followed by drug induced psychosis. With regards to harms associated with legal issues it was noted that less IDU (50%) in the sample admitted to participation in criminal activity than in 2002, and further that significantly less (36%) had been arrested in the 12 months preceding the survey. Law enforcement data similarly recorded a reduced number (n=7858) of drug related arrests.
Implications
While relatively little change has been observed in trends associated with heroin, cannabis or cocaine, implications may arise with regards to methamphetamine and pharmaceutical drugs. Continued high rates of amphetamine use accompanied by reportedly much more pure forms of the drug are likely to present challenges to both law enforcement and health bodies due to the likelihood of increased rates of amphetamine-related psychosis which can result in impulsive or aggressive behaviour.
The use of pharmaceutical drugs, notably benzodiazepines and opioids appears to have become less popular. However, it appears that use may have intensified among those who continue to use providing some cause for concern from a health perspective. This is particularly so with reference to the hazards implicit in actively and regularly injecting substances intended for oral administration. The ongoing use of homebake heroin is similarly an issue for WA in particular. This is particularly so with reference to the hazards implicit in actively and regularly injecting substances intended for oral administration or, in the case of homebake, corrosive chemicals remaining in the solution from the manufacturing process (Reynolds, et al., 1997).
Citation: Fetherston, J. and Lenton, S. (2004) Western Australian Drug Trends 2003: Findings from the Illicit Drug Reporting System (IDRS), Sydney: National Drug and Alcohol Research Centre.