Executive Summary

Demographic characteristics of injecting drug users (IDU)

One hundred IDU were interviewed for the 2003 IDRS in the ACT. The sample was very similar to that interviewed in 2002. Sixty four percent were male and the mean age of the sample was 34 years. The majority (83%) of the IDU were unemployed, and 38% had a previous prison history. The mean age of formal school years completed was 11, and 37% reported they had trade or technical qualifications, while only 7% reported that they had university or other tertiary qualifications.

Patterns of drug use among IDU
Over half the sample (53%) reported injecting once or more times a day (regardless of the drug injected). Younger IDU were more likely to inject on a daily or more basis (64%) than older users (51%). The 2003 IDU sample injected more frequently than did the 2002 sample.

Similar to 2002, heroin was the drug of choice for the majority of respondents (73%), followed by methamphetamine (14%) and cannabis (7%). Sixty three percent of the sample reported heroin to be the drug they injected most often in the month prior to interview. Compared with 2002 (17%), there was a significant increase in the proportion of IDU reporting methamphetamine to be the drug they injected most often in the month prior to interview in 2003 (30%), as well as methamphetamine being the last drug they injected prior to interview (27% in 2003 compared with 15% in 2002.)

Polydrug use was universal amongst IDU, with respondents reporting an average of 11 drug classes used in their lives and 7 drug classes used in the six months preceding interview. Eighty five percent of IDU interviewed in 2003 had used more than one drug in the day prior to interview (excluding tobacco) with the most common being cannabis (60%), heroin (57%) and/or alcohol (28%).

Heroin
The price of heroin remained stable in 2003 at $50 a cap and $350 a gram, as did availability, with heroin being reported as ‘easy’ or ‘very easy’ to obtain in the ACT. When compared to the previous year, a greater proportion of IDU in 2003 reported that the purity of heroin was increasing. This is supported, albeit weakly, by ACTGAL analysis of AFP heroin seizures, where an increase in purity was seen from 24% to 26% from 2001-2002 to 2002-2003. However, KIS data was equivocal with equal proportions stating that heroin purity had either increased or decreased. There appears to be a decrease in the availability of heroin powder, with a concomitant increase in the availability of rock heroin, although powder remains the most common form available.

However, while the price of heroin appears to be stable and unequivocal conclusions cannot be drawn concerning changes in heroin purity, there is a clear indication that the frequency of heroin use has increased in 2003, with increases in the median days of use and the proportion of IDU reporting daily use of this substance. There has also been an increase in the number of non-fatal overdoses attended by the ACT Ambulance Service.

Methamphetamine
Seventy four percent of the IDU interviewed for the ACT IDRS in 2003 reported the use of methamphetamine in the past six months. While this is approximately the same proportion that reported methamphetamine use in 2002, there are a number of notable changes in the ACT methamphetamine market. In 2003, methamphetamine was easier to obtain, and was purer and cheaper to buy. Much of this shift in the market is attributable to the increasing availability of crystal methamphetamine. There is a clear trend in the ACT methamphetamine market toward the use of crystal methamphetamine or ‘ice’ in 2003 and a corresponding reduction in the use of base methamphetamine and, to a lesser extent, methamphetamine powder (‘speed’). The increase in the use of crystal methamphetamine has resulted in an increase in the purity of methamphetamine being used by IDU. Among recent methamphetamine users, 71% reported that crystal methamphetamine was the form most used in the six months prior to interview. The fact that the rise in methamphetamine use in the ACT appeared in the context of a stable heroin market (rather than parallel to a decrease in heroin availability and use) is of great concern. A considerable proportion of IDU commented on the widespread use of methamphetamine, even in the traditional heroin- or opiate-using market.

Cocaine
As has been the case in the IDRS in previous years, cocaine does not appear to be a drug of choice for IDU in the ACT. Only 13% of IDU in 2003 had used cocaine in the six months prior to interview, and amongst those who had, patterns of use were infrequent. A small number of IDU commented on the price, purity and availability of cocaine, reporting that it was ‘difficult’ to ‘very difficult’ to obtain in the ACT, and that this had remained stable. The median price for cocaine was reported at $50 for a cap ($65 in 2002) and $200 for a gram ($250 in 2002), representing a decrease in price from the previous year. In 2002-2003 the AFP made two cocaine seizures, though neither were suitable for purity analysis. In addition to this, the IDU data regarding cocaine purity relied on limited numbers and the results at best, were mixed.

Cannabis
Cannabis use was widespread and frequent amongst the IDU sample in 2003. Cannabis had been used by 86% of the IDU sample in the six months prior to interview, with just over half the sample (51%) reporting daily use. This year, for the first time in the IDRS, a differentiation was made between outdoor-cultivated cannabis (‘bush) and indoor-cultivated cannabis (‘hydro’). As predicted, differences in price existed between the two forms of cannabis. The median price for an ounce of bush and hydroponic cannabis was $200 and $323 respectively. Consistent with key informant reports, ninety percent of IDU commenting on cannabis reported that it was ‘easy’ to ‘very easy’ to obtain, and that this had remained stable (70%) over the past six months. As has been the case in previous years, hydroponic cannabis remains the dominant form of cannabis on the market. The average weight of cannabis seized by the AFP has been increasing over the past three years and key informants attribute this to the increasing prevalence of large scale, hydroponic set-ups being discovered by the AFP in private residences.

Illicit use of methadone
In 2003, the level of use of diverted methadone among the ACT IDU sample was similar to that reported in 2002. Sixty-two percent of the sample used methadone in the six months prior to interview and, of these, 39% were not enrolled in methadone treatment at that time. Thirty-four percent of the sample had injected methadone in the preceding six months, a slight increase from the 29% reporting this in 2002. Of those IDU who had recently used methadone, 42% had used diverted methadone syrup, and 8% had used diverted physeptone.

Illicit use of buprenorphine
As was the case in 2002, in the six months prior to interview, only ten percent of the 2003 IDU sample reported the use of buprenorphine. Only one respondent reported both the use of illicitly obtained buprenorphine and the injection of buprenorphine during this period.

Morphine
Compared with 2002 (37%), in 2003, there was an increase in the proportion of IDU reporting the recent use of morphine in the ACT (50%). Similarly, of concern was the fact that there was a significant increase among IDU in the reported injection of morphine in the six months preceding interview (34% in 2002 to 49% in 2003). Of the IDU who had used morphine in the six months prior to interview, 76% had used illicitly obtained morphine at least once during this period, and a similar proportion (74%) reported that illicitly obtained morphine was the predominant form they had used. As in past years, MS Contin® was the preferred brand of morphine for almost all (97%) recent morphine users.

Other opioids
The use of ‘other opioids’ remained relatively stable across 2003 and the preceding year. In the six months prior to interview, almost one in five IDU (17%) reported the use of ‘other opiates’, with Panadeine Forte® being the most popular preparation used. Eighty-eight percent of recent opioid users had used illicitly obtained opiates in the six months preceding interview, with three quarters (76%) of users reporting they mainly used illicitly obtained opiates during that period. A similar proportion (16%) of the sample reported the use of homebake heroin during the six months prior to interview. While only 8% of the sample reported the injection of other opioids in the six months preceding interview, all of those who had recently used homebake had injected it (16%).

Benzodiazepines
Benzodiazepine use remained high among the IDU sample in 2003. Over half (64%) the 2003 IDU sample reported using benzodiazepines in the six months preceding interview, though only a small proportion (9%) had injected benzodiazepines during this period. Fifty-six percent of the sample had used illicitly obtained benzodiazepines at least once during this period, while one third (34%) reported that they mainly used benzodiazepines that were illicitly obtained. Valium® (64%) and Serepax® (19%) were the favoured forms of benzodiazepines among IDU in 2003.

Associated harms
The reported rate of ‘borrowing’ used needles among IDU remained stable across 2002 (11%) and 2003 (12%). Of concern was the fact that the proportion of IDU reporting that they had lent needles (24%) or shared injecting equipment (35%) had slightly increased from the previous year (16% lent needles, 28% shared equipment). There was no change in the preferred locations of injection reported by IDU, with ‘private home’ again cited as the most common location of injection.

Almost two thirds (65%) of the sample reported that they had experienced at least one injection-related problem in the month prior to interview (this figure is identical to that reported in 2002), with one third (36%) of the sample reporting having experienced two or more problems during this period. As in 2002, the most commonly reported difficulties were scarring/bruising and difficulty injecting.

Implications
The most important trend observable from the 2003 ACT IDRS is the change in the methamphetamine market. The shift to the easier availability and increasing use of crystal methamphetamine, along with a decrease in price, suggests that there is likely to be a concomitant increase in amphetamine-related problems in the future. The shift to the use of crystal methamphetamine means an increase in the purity of methamphetamine, as supported by the increase in the purity of seizures of methamphetamine over the past year. This increase in the use of purer methamphetamine is likely to result in an increase in methamphetamine-related problems. This is supported by increasing calls to the ACT Alcohol and Drug Program’s 24-hour telephone help line and the comments of key informants in both law enforcement and health-related contexts, who remarked that they were seeing an increase in agitation and aggression in drug users in their routine work. However, the number of clients in methamphetamine-related case management at the ACT Alcohol and Drug Program continues to remains low compared with the high rates seen in 2001.

The decrease in price and increase in purity and availability of crystal methamphetamine has happened in the context of a stable heroin market. There is no evidence to suggest that the recent rise in crystal methamphetamine use is the result of a shift in the ACT illicit drug market from heroin to methamphetamine. On contrary, the results of the 2003 IDU survey indicate that this has occurred in the presence of an increasing frequency in heroin use.

Evidence from the IDU survey and from one key informant suggests that there is an increase in the injection of prescribed morphine in the ACT in 2003. Almost half of the IDU interviewed in 2003 reported that they had injected morphine in the six months prior to interview.

Citation: Ward, J. and Proudfoot, H. (2004) ACT Drug Trends 2003: Findings from the Illicit Drug Reporting System (IDRS), Sydney: National Drug and Alcohol Research Centre.